Medicine is generally defined to be, The art of preserving health when present, and of restoring it when lost.

Men would never think of any particular regimen or mode of living in order to preserve health, before they felt the pains which accompany the want it. The first painful sensation must necessarily have produced a desire for relief. But in a period when physicians and medicines were equally unknown, how was that relief to be obtained? or what system of conduct would man in this situation naturally follow? Whoever can answer these questions, will unfold the genuine principles of the medical art, and give an infallible standard for judging what progress has been made in the improvement of it, what particular circumstances have contributed to obstruct or forward the knowledge and cure of diseases.

Medicine being thus founded on a powerful instinct in human nature, its existence in some form must have been coeval with the first disease that appeared among mankind. Most arts require the experience of ages before they can arrive at a high degree of perfection. Medicine is unquestionably one of the most ancient; and consequently, the improvement of it might be expected to bear some proportion to its antiquity. But, whilst philosophy, in all its branches, has been cultivated and improved to a great extent; medicinae, notwithstanding the collateral advantages it has of late derived from anatomy and other sciences; still continues to be buried in rubbish and obscurity.

Many causes have contributed to retard our progress in the knowledge of the causes and cure of diseases. In the early ages, prescriptions were either the result of tradition founded upon uncertain facts, or mere random trials without any rational view of success: Accordingly, when any uncommon case occurred, the patients were placed in cross-ways, and other public places, to receive the advice of passengers who might chance to know the disease or an efficacious remedy. In this way valuable medicines might be accidentally discovered. But memory, and, in remarkable cures, engravings on pillars or the walls of temples, were poor instruments for recording the symptoms of diseases, and the ingredients of prescriptions.

After the knowledge of medicine began to be studied and practised as a liberal profession, a jealousy of reputation, joined to a thirst for money and ignorance of philosophy, laid a solid foundation for medical disputation. One party of physicians, known by the name of Empirics, excluded all reasoning, and trusted solely to experience. Another party, called Dogmatists, maintained, that no man ought to prescribe, without being able to give a theory both of the disease and of the nature and action of the medicine. This dispute continued for ages, and, like other disputes of a similar nature, remains still in some measure undecided. The principles of both these parties are unquestionably good. But the physician who excludes either of them, will make but little progress in the knowledge of his profession. A judicious mixture of the two is indispensible necessary. Indeed it is difficult to determine whether too great an attachment to empiricism or dogmatism has contributed most to obstruct the improvement of physic.

But there is one cause which has operated more powerfully in preventing the improvement of medicine than even a combination of all the other causes. Most branches of philosophy are principally cultivated by people who expect their reward in reputation, not in money. The practice of physic is become as literally a trade as any branch of business whatever. Young men are taught physic with no other view than that of gaining their bread. Whenever a physician gets into extensive practice, he may bustle and make a noise; but, even supposing his abilities to be great, he can never find leisure to think, or digest his observations.

Another cause of the imperfect state of medicine arises from the varieties in constitutions, and the complex nature of diseases. It is even extremely difficult, after a disease has been cured, to determine with certainty, whether the cure was performed by the operation of nature, or by any particular virtue in the medicine. This difficulty is greatly increased by the variety of different medicines, and different ingredients in the same medicine, which are commonly administered during the course of a disease.

Of late several attempts have been made to reduce medicine into the form of a regular science, by distributing diseases into classes, orders, genera, and species. Sauvage was the first, and indeed the only person who ever attempted to complete this great work. Others, as Linnæus, Vogel, Dr Cullen, &c., have since endeavoured to improve Sauvage's method of classing; but they have contented themselves with an enumeration of the characters and arrangement of the different genera, without entering into their history or cure. Sauvage enumerates 315 genera, Linnæus 325, Vogel 560, and Dr Cullen has reduced them to 132. The bare inspection of these numbers shews, that physicians are far from being agreed with regard to what constitutes the generic or specific characters of a disease. Indeed, we may venture to affirm, that they never will agree upon this point: The diagnostic symptoms of diseases are not so easily discovered as the stamina or petals in a flower, or the number of teeth or toes in in a quadruped. However, before making any observations on the advantages or disadvantages that may probably result from the classification of diseases, we shall lay before our readers the last and shortest distribution, published last year by Dr Cullen, one of the professors of medicine in the university of Edinburgh, under the title of Synopsis Nosologiae Methodicae, or rather, Genera Morborum Præcipua.

The doctor divides diseases into the four following classes, viz.

Class I. Pyrexiae, or Feverish Disorders, II. Neuroses, or Nervous Diseases, III. Cachexiae; comprehending such disorders as proceed from a diseased state of the whole or any part of the body, without an original fever, or any nervous complaint. IV. Locales; comprehending diseases which affect a part only, not the whole body.

The first class (Pyrexiae) is subdivided into five orders, viz.

Order I. Fevers, or Fevers, is subdivided into two sections, viz. 1. Intermittent; and, 2. Continued fevers.—The first section contains three genera, viz. 1. The Tertian fever; 2. The Quartan; 3. The Quotidian.—The second section likewise contains three genera, viz. 1. The Synocha; 2. The Typhus; 3. The Synochus.

Order II. Phlegmasiae, or fevers accompanied with any local pain. This order contains 17 genera, viz. 1. Phlegmone; 2. Ophthalmia; 3. Phrenitis; 4. Cynanche; 5. Peripneumonia; 6. Pleuritis; 7. Carditis; 8. Peritonitis; 9. Gastritis; 10. Enteritis; 11. Hepatitis; 12. Splenitis; 13. Nephritis; 14. Cystitis; 15. Hysteritis; 16. Rheumatism; 17. Arthritis.

Order III. Exanthemata, or eruptive fevers; comprehending 10 genera, viz. 1. Erysipelas; 2. Pestis; 3. Variola; 4. Varicella; 5. Rubecula; 6. Miliaria; 7. Scarlatina; 8. Urticaria; 9. Pemphigus; 10. Aphtha.

Order IV. Hemorrhagie, or fevers accompanied with a flux of blood, not proceeding from any external cause. This order comprehends 4 genera, viz. Epitaxis; 2. Hemoptysis; 3. Hemorrhoids; 4. Menorrhagia.

Order V. Profluvia, or fevers attended with an increased secretion, not naturally of the bloody kind. This order contains 2 genera, viz. 1. Catarrhus; 2. Dysenteria.

The second class (Neuroses) is subdivided into four orders, viz.

Order I. Comata, or lethargic diseases; containing 3 genera, viz. 1. Apoplexia; 2. Paralysis; 3. Catalepsis.

Order II. Adynamiae, or diseases arising from a stoppage or diminution in any of the involuntary motions, whether vital or natural. This order contains 4 genera, viz. 1. Syncope; 2. Dyspepsia; 3. Hypochondriasis; 4. Chlorosis.

Order III. Spasmi, or irregular motions of the muscular fibres. This order contains 13 genera, viz. 1. Tetanus; 2. Convulsion; 3. Epilepsy; 4. Palpitatio; 5. Asthma; 6. Pertussis; 7. Pyrosis; 8. Colica; 9. Cholera; 10. Diarrhoea; 11. Diabetes; 12. Hysteria; 13. Hydrophobia.

Order IV. Vesaniae, or diseases of the mind, without a fever or coma. This order contains 4 genera, viz. 1. Amentia; 2. Melancholia; 3. Mania; 4. Somnium.

The third class (Cachexiae, or diseases arising from a depraved state of the whole or a great part of the body, without a fever or nervous complaint,) is subdivided into 3 orders, viz.

Order I. Marcories, or diseases attended with a wasting of the whole body; containing 2 genera, viz. 1. Tabes; 2. Atrophia.

Order II. Intumescentiae, or diseases accompanied with an external swelling of the whole or a great part of the body. This order contains 13 genera, viz. 1. Polysarcia; 2. Pneumatisis; 3. Tympanites; 4. Phytometra; 5. Anafarca; 6. Hydrocephalus; 7. Hydrorachitis; 8. Hydrothorax; 9. Acites; 10. Hydrodrometra; 11. Hydrocele; 12. Phycosoma; 13. Rachitis.

Order III. Impetiginae, or diseases attended with a cachexy which deforms the skin and external parts of the body. This order contains 8 genera, viz. 1. Scrophula; 2. Syphilis; 3. Scorbutus; 4. Elephantiasis; 5. Lepra; 6. Frambusia; 7. Trichoma; 8. Icterus.

The fourth class (Locales, or diseases affecting only a part of the body,) is subdivided into seven orders, viz.

Order I. Dysæsthesiae, or diseases arising from any of the senses being destroyed or impaired by a fault in the external organs of sensation. There are 8 genera in this order, viz. 1. Caligo; 2. Amblyopia; 3. Dysceea; 4. Paracusis; 5. Anosmia; 6. Agheulria; 7. Anaesthesia; 8. Anaphrodisia.

Order II. Dyscinesiae, or diseases attended with the destruction or defect of motion in any part through a fault of the organs. This order contains 6 genera, viz. 1. Aphonia; 2. Mutitas; 3. Paraphonia; 4. Pellilimus; 5. Strabifimus; 6. Contraction.

Order III. Apoceneses, or diseases attended with an increased flux of the blood or other humours, without a fever, or increased motion of the fluids. This order contains 5 genera, viz. 1. Profusio; 2. Epiphora; 3. Ptyalifimus; 4. Enuresis; 5. Gonorrhoea.

Order IV. Epischeses, or diseases arising from a suppression or obstruction of any usual excretions. This order contains 3 genera, viz. 1. Obilitatio; 2. Itchuria; 3. Amenorrhoea.

Order V. Tumores, or diseases attended with an increased size of the part, without a phlegmon. This order contains 14 genera, viz. 1. Aneurisma; 2. Varix; 3. Ecchymoma; 4. Schirrus; 5. Cancer; 6. Bubo; 7. Sarcoma; 8. Verruca; 9. Clavus; 10. Lupia; 11. Ganglion; 12. Hydatis; 13. Hydrarthrus; 14. Exofosis.

Order VI. Ectopiae, comprehending diseases aris- Having thus given a short account of the origin and present state of physic, we shall now proceed to the history and treatment of diseases.

Of Fevers in general.

Hoffman defines a fever to be, "A spasmodic affection of the whole nervous and vascular system, annoying all the functions of the body, arising from any cause which has power to irritate the nervous parts to a more intense contraction; and when it operates, it drives the vital fluids from the outward parts to the heart and great vessels; and afterwards, when the systole of the heart and arteries are increased, they are drove back with rapidity and heat, through the constricted vessels, to the outward parts again, till the spasms being relaxed, the secretions are performed, and the fever vanishes."

The formal or fundamental cause of a fever consists in the spasmodic affection of the whole nervous and fibrous genus. This plainly appears from the usual phenomena of a fever, viz., a pain in the back, more particularly about the loins; a coldness, especially of the extreme parts; a shivering, shaking, trembling; a livid colour of the nails; a subsidence of the vessels of the hands and feet; a shrunk, dry skin; a yawning; a stretching; a pale, livid countenance; a trembling and palpitating motion of the heart; an anxiety of the praecordia, difficult breathing, inquietude, restlessness; a sensation of an ebullition of the blood about the heart; a contracted, weak, small pulse; a nausea, and an inclination to vomit; a suppression of perspiration; coliciveness, with thin watery urine.

Hence it naturally follows, that whatever has a power to irritate and solicit the nervous and vascular system to spasms, is most likely to generate a fever. To this class belong violent passions of the mind, especially terror and anger; a poisonous, subtle, caustic matter, either bred within the body, or received by infection; a stoppage of perspiration; a suppression of critical sweats; eruptions driven back; an abundance of purulent ulcerous matter adhering to various parts; aliments too acid and sharp; corrupt and bilious crudities lodged in the prime via; excessive watching; a violent pain and tension of the nervous parts; inflammations, tumours, and abscesses; hurting the nervous parts by sharp instruments; acid and corrosive drugs; cold baths, and, on the contrary, those that are too hot or affringerent.

According to the different nature of these causes, and the various manner of affecting the nerves, arise fevers of divers kinds. Some are benign, others malignant; some are intermitting, others continual; some are simple, others compound; others regular or anomalous; eruptive, spotted, putrid, hectic, or slow. Some admit of an easy cure, others a difficult; some soon terminate, others are protracted a long time; and many hurry the patient suddenly out of the world.

Yet, every frequent systole of the heart and arteries discoverable by the pulse ought not to be called a fever. For these may often arise from violent bodily exercise; or, from a commotion in the blood caused by hot and spirituous liquors. That only which arises from internal causes, and is preceded by shivering, shaking, and cold- nefs of the extreme parts, is properly a fever: For there is always, as it were, a double motion in a fever; the one from the circumference to the centre, or from the external parts to the internal, the heart and lungs; the other from the centre to the circumference. The first motion is attended with a small, contracted, weak, pulse, with an anxiety of the praecordia and difficulty of breathing; the second with an increased motion of the arteries, a large pulse, and heat extended even to the extreme parts.

The cause of the febrile motion is an universal spasm; and that motion never ceases till the spasm is resolved. The signs of its being resolved are, a free perspiration, and a breathing sweat; the pulse, which before was hard, impetuous, and quick, becomes soft, moderate, and slow; the urine lets fall a sediment, and the strength gradually returns. When these appear all together, they declare the solution of the disease, and are called the crisis.

Of Intermittent Fevers, or Agues.

This fever is of the regular kind, and is attended with the following symptoms. At first, the head aches, the limbs seem weary; there is a pain in the loins about the first vertebra of the back, which ascends towards the epigastrium, with a painful sense of a tension in the hypochondria, and coliciveness: then comes on a coldness of the external parts, especially of the nose and ears; stretching, yawning; a shivering and shaking, sometimes even to make the bed tremble under the patient; the pulse is small, contracted, and weak: again the patient is troubled with thirst; then follows a nausea, with fruitless reaching to vomit; again, a pituitous, bilious, or green matter is brought up, commonly joined with a troublesome cough, and an expectoration of phlegm derived from the acid clammy crudities of the stomach; to these succeeds an anxious burning and dry heat, which pervades the whole body. The face, which was collapsed and pale, the contracted, rigid skin, and the empty vessels of the hands and feet, begin to rise, and grow red and turgid; the pulse becomes more great, full, and quick; the restlessness increases, the breathing is more difficult, and the patient, with his eyes almost closed, begins to talk a little wildly.

Afterwards, the symptoms begin to abate, the heat becomes mild, the skin relaxes and grows moist; the urine is of a flame colour, but without a sediment; the pulse is more moderate; and then a sweat breaking out, terminates the paroxysm. The duration of the fit is uncertain; sometimes it ends in ten or eleven hours, and sometimes not till twenty-four. On the intercalary day, the body is still feeble and coldish, with a disposition to shiver; the pulse is slow and weak; the urine is turbid, and deposits a sediment, or there is a nubecula which shows a disposition thereto.

In the Bastard or Spurious Tertian, the symptoms are milder, the heat is not so burning, the vomiting is not so frequent, and the urine is not so high-coloured; but then it is a more lingering complaint, and on the well day there is a latitude and want of appetite. This attacks men of an inactive disposition, and women whose bodies are of a loose texture, in the autumnal season.

The fit of the Irregular Tertian observes no particular time; for it sometimes comes on in the morning, sometimes in the afternoon, in the evening, or at midnight. The paroxysm is sometimes longer, sometimes shorter; the urine lets fall no sediment within the time of remission or intermission; the sweating is either too sparing or too profuse. When the fit is off, several unusual symptoms may appear; as, a looseness, a bleeding at the nose, sickness at the stomach, a violent heartburn, pains in the belly, or the gripes. These sort of agues are generally Epidemic, and most commonly appear in the summer and autumn.

Sometimes a tertian ague is Double, which may be distinguished from a quotidian, by the time of the fits, which is not the same every day, but every other day.

There is sometimes a Continual Tertian, which begins with shivering and shaking, an anxiety, vomiting, loss of strength, and then a violent heat. The fits do not intermit, but only remit. The pulse continues frequent with heat and debility, and all the symptoms return with fresh vigour every other day; but at length admit a perfect intermission.

An Endemic Tertian is proper to certain places; as a low situation, and full of marshes, producing a great number of gnats and other insects, like some parts of Kent, and the hundreds of Essex. In such places, the natives themselves have a little of it every year; and strangers seldom or never escape, without a preservative, which is only the bark infused in brandy, with a little snake root, of which two ounces night and morning are to be taken.

A Quartan Ague has two fits in four days, or two days quite free from a fit.

It begins about four or five in the afternoon, sometimes sooner and sometimes later, with a great latitude, stretching, a blunt pain in the head, back, loins and legs; the feet and hands are cold; the whole body is pale; the face and nails livid, to which shivering and shaking supervene. The tongue and the lips tremble, the breathing is difficult, with restlessness and tossing; the pulse is contracted and hard, and sometimes unequal; and there is an anxiety about the praecordia. These symptoms continue about two or three hours. In some the body is costive; in others there is a stimulus to stool, and to make water. In some there is a nausea or vomiting, with stools. Some advanced in years have their minds pretty much disturbed; the heat comes on gradually, not burning but dry; the pulse becomes equal, quick, and large; but the dull pain in the head remains, with a vertiginous affection; the skin becomes only a little moist; and in about four or six hours the symptoms vanish, except a dull pain in the bones, joints and feet. The urine in the fit is sometimes thin and watery, sometimes thick and with a sediment.

Sometimes a quartan ague is Double, that is, when the fits come on every other day at different hours; and it is Spurious when a paroxysm begins at any other time of the day but that above-mentioned. It is said to be Continual, when on the intercalary days there are shiverings and pandiculations, with a greater heat than usual, a quicker pulse, a want of appetite, a debility, a dryness of the mouth, a lightness of the head, a disturb- ed sleep, and a reddish urine, with a thick rose-coloured sediment.

A QUOTIDIAN AGUE or fever returns every day, and is not so common as the tertian or quartan.

The acception of this fever is about four or five in the morning, with cold and shivering; to which succeeds a cardialgic nausea, and inflation of the belly; in some, a pain in the head; in others, fainting fits; in most, vomiting or stools, or both. Then comes on a moderate heat, with thirst, but not very intense. The pulse, which was before irregular and weak, becomes more quick, but not very hard. The urine is not of a flame but rather of a citron colour, and turbid. Some are exceeding sleepy. At length a moderate sleep supervenes; and in about ten hours or longer, the fit goes off, leaving the body dull and heavy.

From these symptoms it appears, that the whole nervous system is agitated and suffers greatly by spasmodic contractions; which proceeding chiefly from the medulla spinalis, affect preternaturally not only the coats of the vessels, but all the fibres throughout the body, thereby greatly disturbing the motion both of the solids and fluids.

The material cause of this, and all other fevers, according to Hoffman, is a fluid of an active nature, endowed with a caustic acrimony, which solicits the internal and exquisitely sensible parts to spasmodic contractions. It is generated chiefly in the biliary ducts and flexures of the duodenum; where the vitiated, bilious salivary and pancreatic juices meeting with the crudities of a bad digestion, ferment together, and, not being timely expelled, become virulent. This matter passing through the lacteals, into the blood, and thence into the nervous parts of the head, medulla spinalis, intestines, and stomach, as also to the nervous coats of the excretory and secretory ducts, excite an universal spasm, which first forces the blood to the interior and greater vessels; and afterwards the systaltic motion of the heart and arteries being increased, the motion of the whole mass of blood and humours is accelerated, and the obstructions of the small vessels of the nervous parts are opened; upon which the spasm ceasing, the excretory ducts are relaxed, the febrile matter passes off through the pores of the skin by perspiration or sweat, and the fit ceases, till by the generation of fresh matter a new paroxysm is brought on.

As to the cure, when a load of vitiated humours in the stomach and duodenum require depletion, which is known from having indulged in too plentiful eating, from an anxiety of the praecordia, from eructations, and a bitter taste in the mouth, a vomit, after the first fit, in the time of intermission, is to be given. In tender constitutions, 10 grains of ipecacuanha may be given alone; but to the more robust, a grain or two of emetic tartar may be added. Or if it is necessary to purge at the same time,

1. Take half an ounce of Epsom salt, and two or three grains of emetic tartar. Mix them and make them into a powder; to be dissolved in a pound of pure lukewarm water, and taken two hours after the fit.

The evacuation ought to be facilitated with draughts of water-gruel made fat with fresh butter. Then take the following electuary, which will crush the disease in the bud.

2. Rob of elder, one ounce; 5 drams of Peruvian bark; 2 drams of chamomile flowers in powder; extract of the lesser centaury, and powder of jelliflowers, of each half a dram; add as much syrup of lemon as will make an electuary. Half a dram to be taken every two hours, after the fit has gone off.

But if anything forbids vomiting, and yet there is plenty of serous crude humours which require evacuation, we must begin the cure with detergent and aperient salts.

When the whole intestinal canal has been cleansed by these salts, duly repeated at proper intervals, and the ague still continues, add an equal weight of bark thereto, or give the electuary above prescribed.

When the patient is obnoxious to the hypochondriac passion, the stomach inflated, and the body coltive, neither vomits nor salts must be ventured upon, but carminative and emollient clysters.

But it must be remembered, that neither bleeding, nor emetics, nor cathartics, nor the bark, nor any strengthener nor astringent is to be administered or given in the fit, or near the time it usually comes on.

If a tertian is autumnal, obstinate, or changes to a quotidian, the antifebrile potion of Crollius will be proper.

3. Salt of wormwood, a dram; spirit of sulphur, a scruple; 4 ounces of fennel water. Mix them together for a drink.

Let the patient take it just as the fit comes on, and be well covered with bed-cloaths.

Bleeding is proper only in a hot season, when the heat of the patient is excessive, attended with a delirium, and in the prime of life, full of blood, and subject to passion.

Opiates will appease the symptoms; but they disturb the crisis, and protract the disease. Likewise alumious, chalybeate, and vitriolic remedies will stop the fits; and if they are given to patients of the lowest class, care must be taken that they sweat after them, by drinking hot decoctions, or by exercise.

Absorbents have often a happy effect in these diseases; but if given in too great a quantity, they will not dissolve in the stomach. Harris advises 2 scruples of the simple powder of crabs claws, two hours before the fit, and to be repeated in an hour, in mint-water; no small beer is to be drank for eight hours after. It may be repeated in the same manner against the next time the fit is expected; as likewise a third time.

Langrisl asserts, that in long continued agues or intermittent fevers, which have baffled the bark and many other medicines, he has met with more advantage from rhubarb and calomel exhibited in small doses, than from anything else he had tried.

To prevent the return of an ague, the bark must be repeated every week or ten days, for three several times, with the same intervals. Likewise bitters and chalybeates are very serviceable for the same purpose.

Of the CATARRHAL FEVER, or the Continual Quotidian of the ancients.

It generally begins in the evening, with a shivering and and a coldness of the extreme parts, especially of the feet, and soles of the feet; a costiveness; a frequent desire of making water, but the urine is small in quantity; a weakness of the head, an universal languor of the whole body, a false appetite, thirst, difficulty of swallowing, a stimulus in the larynx; a heat in the nostrils and fauces, attended with sneezing; a weight in the breast; towards night, heat, and a quicker, fuller pulse, with a defluxion of rheum, a heat in the fauces, unquiet sleep, a sweating in the morning, a heaviness and dulness of the whole body, and a loss of appetite.

The immediate cause of this disorder is a sharp acrid serum or lymph, subsisting in the glandulous tunic, and irritating them with pain, tumour, and redness. This happens in the whole region of the nostrils, palate, and fauces; as also in the alpera arteria, with the bronchial branches; and farther in the oesophagus, stomach, and intestines. Hence a hoarseness, a cough, a hawking up of viscid matter, a sneezing, a defluxion of the lungs; likewise a nausea, sometimes a vomiting; a heat about the precordia; a gripping of the guts, followed with a salutary flux.

It more frequently attacks women and children than men, and those that indulge themselves in strong liquors. It sometimes happens from the drying up of a scald head and other eruptions. Sometimes it is epidemical.

This disease is most frequent in the spring and autumn, in sudden changes of the weather from hot to cold, from dry to moist, and vice versa; as also from change of air, if of different qualities; from being exposed to the cold air of the night, and from throwing off winter-garments too soon.

This disease is not dangerous in itself, if rightly managed, and terminates in seven or fourteen days at farthest: for the latitude of the body then disappears; and the other complaints, especially the head-ach and hemi-crania are appeased, when the catarrh appears, and there is a plentiful discharge from the nostrils.

It often goes off, in some, in the beginning, with an increased perspiration or by sweat; in others after a few days, by hawking up a large quantity of viscid matter, or a plentiful discharge of a mucous serum by the nose; in others, by a looseness, when the urine at the same time, which before was thin and little, becomes copious and heavy, with twice the quantity of sediment as in a natural state.

The intentions of cure are three, 1. To sheath the acrimony of the lymph. 2. To increase perspiration. 3. To promote the expectoration of the viscid mucus.

The saline sharpness of the lymph may be taken off by the absorbent and diaphoretic powders, humecting and oleous remedies; such as, oil of sweet almonds, sperma ceti, milk, cream, almond emulsions, with the addition of white poppy seeds, barley broth, water gruel, chicken broth, with the yolk of an egg; as also liquorice-juice, liquorice-tea, dried figs and raisins. If the acrimony is very subtle and corroding, gentle anodynes should take place, such as saffron, diacodium, and floxax pills.

To promote a diaphorese,

1. Take a scruple of the powder of contrayerva; Virginia snake-root and saffron, of each 5 grains. Mix and make them into a powder. To be repeated in 4 or 6 hours, if necessary.

To appease the cough,

2. Take oil of olives, an ounce and a half; pure water, 6 ounces; spirit of hartshorn, 40 drops; pectoral syrup, one ounce. Mix them, and take a spoonful every four hours.

To promote perspiration, order tea, with leaves of veronica, hyssop, liquorice-root, elder flowers, wild poppies, and fennel seeds; as also the more fixed diaphoretic powders, with antispasmodic waters; but especially bodily motion and exercise.

To promote the excretion of the thick, viscid mucus, figs and raisins are proper, with brandy burnt, and reduced almost into a syrup. Likewise a pectoral elixir, made of gum ammoniac, myrrh, liquorice-root, elecampane-root, saffron, benjamin, and oil of annised, whose virtue may be heightened by the vinous spirit of sal ammoniac or tincture of tartar. The stagnating mucus of the nose may be dissolved by often holding to the nose the dry volatile sal ammoniac, mixed with a few drops of genuine oil of marjoram.

The regimen should be temperate; and cooling things, as well as acids, should be avoided.

The aliment should be sparing, the drink warm and wholesome; the best is a decoction of pearl-barley and shavings of hartshorn, as also water gruel.

If the body is coltive; besides water-gruel, manna, prunes, and raisins, nothing is better than an emollient clyster.

In the decline of the disease, when the cough is too moist, the defluxion great and obstinate, it will be proper to take a large dose of manna, to two or three ounces in fennel-water, to carry the humours downward.

When the cough is very violent, it must be appeased with a mixture of oil of sweet almonds fresh drawn, and French syrup of capillaire.

When women labour under a suppression of the menstres, the body must be kept open with clysters; bezoardic powders must be given, and a grain of saffron added to each dose, or a few grains of flowers of sulphur; but avoid sweet things and expectorants.

When the fever is vanquished, and the lungs continue in a flat state, which is known from too large a spitting, to the bezoardic powders must be added a few grains of cortex eleocharis.

In a violent obstinate cough, sweet pectorals, and incrusting remedies too plentifully given, bring on a cachexy, or phthisis, by spoiling the appetite, and hurting the tone of the lungs. Hoffman.

What we commonly call Catching Cold, may be cured by lying much in bed; by drinking plentifully of warm sack-whey, with a few drops of spirit of hartshorn, posset-drink, water-gruel, or any other warm small liquor; living upon spoon-meats, pudding, and chicken, and drinking everything warm: In a word, treat it at first as a small fever, with gentle diaphoretics; and afterwards, if any cough or spitting should remain, by softening the breast with a little sugar-candy and oil of sweet almonds, or a solution of gum ammoniac in an ounce of barberry. barley-water to make the expectoration easy, and afterwards going into the air well clothed.

Of the Semiterterian Fever.

This is an epidemic fever, compounded of an intermitting tertian and a continual quotidian.

It generally makes its onset before noon, with coldness, shaking, and a contracted pulse; to which succeeds a frequent pulse, with heat, which continues some hours, till a warm sweat appears, without a complete intermission. The heat, after a slight chillness, increases towards night, with a quick pulse; which is more moderate the next day, without thirst; till the evening, when a flight shivering comes on, and the symptoms return. On the third day, the shaking fit appears again with more intense heat, and proceeds in the same track as before; so that the fever is never quite off, but has an exacerbation in the evening: however, the shaking fit is most conspicuous every third day in the morning.

Besides the foregoing symptoms, the strength fails, the appetite is languid, sleep is wanting, the urine is thin and crude; but after the fit on the third day, it is thick and coloured, and a small quantity of crude matter is brought up with coughing. It is sometimes attended with a pain in the back and the abdomen, together with a swelling in the latter. Some at the access of the fit of the tertian, are affected with a nausea and cardialgia. Some vomit, others faint, and others again are delirious.

This fever is generated by all things that render the humours thick and impure, especially those that fill the prime vis, and the vessels of the mesentery, with impurities. Those are most liable to it who live upon sweet, acid, and fermentable aliment, that live an idle sedentary life, that drink less than they ought, or love sweet wines; as also those that give way to sadness and melancholy.

It generally terminates either on the ninth or thirteenth day, in health, or another disease, or death.

It is a good sign when a sweat breaks out at the decline of the paroxysm, and when, on the seventh day, being critical, or, after it, the belly is disturbed, and is followed with a flux of a bilious, putridous, or bloody matter, for it foretells the solution of the disease; as also when the pains in the belly are very sharp, and grow worse at certain hours, being followed with a fainous and purulent diarrhoea, or when plenty of black blood comes away.

It is a bad sign, when nothing of this happens: but, on the other hand, a heat about the praecordia, a tension and pain in the whole region of the stomach, a vomiting and hiccup, inquietude, tossing and trembling of the hands, are very ominous, and shew that the inflammation has reached the stomach.

The cure is to be performed, 1. By speedily discissing the inflammatory fluids in the coats of the intestines and mesentery, and preventing it from spreading farther. 2. By correcting and gently evacuating the matter of the intermitting fever.

The first end may be obtained by diaphoretic powders, mixt with a little nitre, in small doses, but taken often.

Take of scorzonera root, 2 ounces; shavings of hartshorn, and pastular minor, of each one ounce; of chicory root, half an ounce. Boil the ingredients for half an hour in 8 pounds of water.

To cleanse the first passages, and to carry off the morbid matter, use a solution of manna with cream of tartar, raisins, and a little sal polychrest.

Things of this kind cleanse the intestinal canal, without raising a commotion in the blood, without stimulating the nervous parts, and without sinking the spirits.

Purges in the beginning are unsafe, because the morbid matter is not prepared; but if the body is coltive, it may be opened with an emollient and saponaceous clyster.

All detergent salts are improper in this disease, except stibiated nitre and sal polychrest; for these have an aperient, diuretic and laxative virtue, and may be given to 15 grains in a proper vehicle. When this fever is on the decline, and nature seems intent in carrying off the disease by stool, then the above laxative will be proper.

Bleeding will be proper in the very beginning of the disease, if the patient is plethoric, the heat urgent, the strength not much impaired, and when some critical hemorrhage is suppressed. All heating medicines are to be avoided, as well as strict astringent earthy terebraceous powders; and also the bark, unless there is a perfect intermission; for this last, as Baglivi observes, has brought on fatal inflammations, or slow hectic fevers.

Of the Nervous Fever.

In a nervous fever, the patients at first are subject to slight transient chills often in a day, with uncertain flushings of heat; they have a little thirst, lassitude, and weariness; they are apt to sigh, and complain of a heaviness, dejection, and anxiety, with a load, pain, or giddiness of the head, with an inclination to yawn and doze; they want appetite, and disdine every thing; they have a dryness of the lips and tongue without any considerable thirst; they have frequent nausea's, with reaching to vomit: the breathing is difficult by intervals, and especially towards night there is an exacerbation of the symptoms, with a low, quick, unequal pulse; the urine is pale, and made often and suddenly; a torpor, or obstinate pain and coldness often affect the hind-part of the head, or a heavy pain is felt along the coronary future. These commonly precede some degree of a delirium.

The countenance is heavy, pale, and dejected: sometimes they are quite wakeful; and when they fall asleep, they are so insensible of it, that they disown it.

The pulse is very remarkable in this disease, and requires the most diligent attention; for it is generally low, quick, and unequal: the inequality consists in this, that a few pulsations shall be more swift, frequent, and large, sometimes fluttering; and then presently it returns to be low and quick.

The urine has generally no sediment; and when it has, it is like bran; it is sometimes of a whey-colour, or like dead small-beer. The dryness of the tongue seldom appears at the beginning, though it is then sometimes covered with a thin whitish mucus; but at the close of the disease, it often appears very dry, red, and chapped.

About the seventh or eighth day the giddiness, pain, or heaviness of the head, become much greater, with a constant flant noise in it, or tingling of the ears, which is frequently the forerunner of a delirium.

The load on the praecordia, the anxiety and faintness, grow much more urgent; and the patient often falls into an actual deliquium, especially if he attempts to sit up. Now, cold sweets appear suddenly on the forehead and back of the hands, while the cheeks and palms glow with heat, and as suddenly go off. If the urine grows more pale and limpid, a delirium is certainly at hand, with universal tremors and subfultus tendinum; the delirium is generally little more than a confusion of thought and action, a continual muttering and faltering of speech. Sometimes they awake in a hurry and confusion, and presently recollect themselves, but forthwith fall into a muttering, then doze again.

At the state, the tongue grows often dry, with a yellow list on each side; and when the patient attempts to put it out, it trembles greatly. If at this time a copious spitting comes on, it is a very good sign. When there is a difficulty of swallowing or continual gulping, it is a dangerous symptom, especially with a hiccup.

On the ninth, tenth, or twelfth day, the patient often falls into profuse sweats, which at the extremities are commonly cold and clammy; and frequently there are thin stools, which are generally both colliquative and very weakening. A warm moisture on the skin is reckoned salutary; and a gentle diarrhoea often carries off the delirium and sleepiness.

When the extremities grow cold, the nails livid, the pulse exceeding weak and quick, insomuch that it rather trembles and flutters than beats, or creeps surprisingly slow, with frequent intermissions; then nature sinks apace, and the patient becomes quite insensible and stupid; the delirium turns to a profound coma, which soon ends in death; or the stools, urine, and tears, run off involuntarily, as a prelude to a speedy dissolution; or there are vast tremblings and twitchings of the nerves and tendons, which terminate in a general convulsion, and this in a cessation of all motion. One or other of these ways closes the scene, after the patient has languished fourteen, eighteen, or twenty days, nay, sometimes much longer.

All persons grow deaf and stupid towards the end of the disease, and if the deafness ends in an impolthume of the ear, or when a parotis suppurates, or a large pustular eruption breaks out about the lips and nose, they are good symptoms.

The cure is to be performed with gentle medicines of the cordial and diaphoretic kind, in order to promote perspiration; by application of blisters, and by a proper regimen and method of diet. It will bear no other evacuation than moderate cordial diaphoretics, and blisters; unless a gentle emetic should be indicated in the beginning, or a small dose of rhubarb when it has continued long. Bleeding is very prejudicial, and much sweating hurtful. In giving diaphoretics, we should always have regard to the urine; for if that, from being pale, gradually heightens to an amber colour, we are right in our dose, especially if, when in bed, a gentle dew or moisture comes on without a restlessness; and we must always remember, that over-sweating will raise the fever, and endanger the patient.

If the patient is inclinable to deliquia or faintings on every little motion, or complains of greater latitude or faintness than ordinary, it will be necessary that he lie in bed and have blisters applied; if delirious, the blisters must be laid on high on the nape of the neck.

If rest is wanted, give a few grains of the flores martiales; and if a loofenefs is not feared, the flores martiales may be more freely given.

A vomit ruffles nature much less than a common purge, and is necessary where a nausea, load, and sickness of the stomach, are urgent. If the body is coltive, clysters of milk, sugar, and salt, may be injected with safety and advantage every second or third day. The temperate cordial and diaphoretic medicines are certainly most proper in these fevers; a supporting, well regulated, diluting diet is necessary, and will go a great way in the cure, especially if assisted by well timed blisters, and keeping the patient quiet in body and mind. Opiates are commonly very pernicious; mild diaphoretics, as pulvo contrayerv compof, with a little castor and saffron, and small quantities of theriac androm. or elixir paregoricum, will have much better effects. Where the confusion or dejection of spirits are considerable, galbanum or sylphium, with a little camphire, should be added; and blisters should be forthwith applied to the neck, occiput, and behind the ears: during all this, a free use of thin wine-whey, some pleasant pifan, with a little soft wine, must be indulged. A little chicken-broth also is of service, both as food and physic, especially towards the decline of the disorder; and for the same reason, thin jellies of hawthorn, sage, and panada, are useful, adding a little wine to them, with juice of Seville oranges or lemons.

It was said above, that profuse sweats should never be encouraged; yet the patient is never so easy as while he is in a gentle, easy sweat, for it soon removes the exacerbation of the heat, hurry, &c. when there are irregular partial heats, with great anxiety, restlessness, delirium, difficulty of breathing, and a vast load and oppression on the praecordia, so as to resemble a peri pneumonic case: yet beware of bleeding; for the small, low, quick, and unequal pulse utterly forbids it, as well as pale, watery, limpid urine.

Here then the nervous cordial medicines are indicated, and blisters to the thighs, legs, and arms.

Take of the compound powder of contrayerva, 15 grains; of English saffron, 3 grains; a scruple of the cardiac confection; and a sufficient quantity of syrup of saffron to make a bolus.

When great tremors and subfultus tendinum come on, instead of the pulvis contrayerva, a scruple of musk may be used.

This bolus should be taken every fifth, sixth, or eighth hour, and a temperate cordial julep may be given now and then out of thin wine or cyder-whey, or, which in many cases is better, out of thin mustard-whey.

But this difficulty of breathing, anxiety, and oppression of the praecordia, often precede a miliary eruption on the seventh, ninth, or eleventh day, which should be promoted by soft, easy cordials, proper diluents, sometimes with a little theriaca androm. or elixir asthma, as tending to calm the uneasiness, and to promote a diaphoresis.

In profuse, colliquative sweats, give a little generous red wine, perhaps a little diluted, which moderates the sweat, supports the patient, and keeps up the miliary pala-

Towards the decline of the fever, when the sweats are copious and weakening, give small doses of the tincture of the bark, with saffron and snake-root, interposing now and then a dose of rhubarb, to carry off the putrid col-

lusions, which makes the intermissions or remissions more distinct and manifest.

When there is an evident intermission, give preparations of the bark out of draughts made with salt of wormwood and juice of lemon. This method will shorten these fevers, even with miliary eruptions.

Under any evacuations, diluting nourishment is absolutely necessary to keep up the spirits and repair the loss of the juices, and the patient should be frequently prompted to take them. When any discharges are very immoderate, they may be prudently restrained, but not repelled.

Gilchrist affirms, that to all the warming, attenuating, stimulating, or antipasmodic remedies, cinnamon should be added, and that in no small quantity. And he highly recommends the use of the bark in the decline of long nervous fevers, or after a remission. And when there is occasion for blistering, he thinks the head most preferable whenever it is much affected, though he does not disapprove the laying blisters on the back and limbs.

When the low, depressing, nervous symptoms are stronger, the higher methods of stimulating are more necessary, and easily borne; in raving, with a low, intermitting pulse, subsultus, fainting, and coldness of the extremities, besides frequent blistering, we must give camphor and castor. The uses of Virginian snake-root, valerian, afa fatida, myrrh, and terrous absorbents, are well enough known, and the forms in which they are given. Refreshing juleps should not be taken by spoonfuls, but by draughts. Acrid cataplasms may be laid to the feet till they begin to stimulate or raise a just degree of heat; then apply poultices of bread, milk, and vinegar, especially during the exacerbation, to allay the heat and struggle; renewing them alternately, in order to keep up a gentle heat and stimulus. A quick, hard, and more contracted pulse, with smart heat, tossing and anxiety, shew it is over-done.

Of Epidemic, Catarrhal, Eruptive Fevers.

These fevers are continual, but not violent: they are attended with a prostration of strength, watching, loss of appetite, and are sometimes joined with an eruption of spots on the skin, arising from the plenty and intense diffusion of an excrementitious serum, not without contagion and danger of life.

These fevers were called by the ancients, continual, quotidian, feverous fevers; and by some of the moderns, malignant catarrhal fevers, because they are mild at first, and attended with a running at the nose, a catarrh, an infarction of the breast, and a cough on the first days, with exacerbations at night.

At the beginning of this disease, the face of the patient has a morbid aspect, and he is out of order three or four days before he takes to his bed. He complains of a spontaneous weariness, a grievous pain of his body and joints, as if his bones were bruised and broken; his strength is languid, his appetite is lost, he has a slight fainting fit, a cardialgic nausea, a pain in the head, an unquiet sleep, with cothlenea. In the evening there is a coldness and shivering followed by heat, the symptoms increase, and there is a greater loss of strength, insomuch that he can scarce stand upright. The pain in the head grows worse, with a giddiness and inquietude. Some have a violent pain in the back, others in the side: they have an anxiety about the precordia, the internal parts are hot, the fauces dry, the pulse contracted, quick and weak, the urine is pale without a sediment, and the breathing difficult.

On the fourth or eleventh day, spots appear in some, chiefly on the back, breast, and arms, with or without relief. Some have more, some less, of various colours, as purple, a brownish, livid, or a pale rose. These are sometimes broad, sometimes small; and in many like fleabites. These different spots serve to distinguish the fever by several names, such as miliary, puncticular, bastard petechial, and the like.

When this disease is at its state, or vigor, all the symptoms are worse; the inquietude runs very high, as well as the tossing of the body with unusual postures. The mind is disturbed, the speech incoherent, sleep wanting, the sweat is coldish, with a more intense difficulty of breathing, and a contracted, unequal, quick and frequent pulse, as in the nervous fever.

When a subsultus tendinum, want of thirst, rumbling in the belly, hiccup, an inflammation of the fauces from aphtha, convulsions, a syncope, with coldness of the extremities, and a most plentiful sweat, supervene to these symptoms, they are certain forerunners of death. On the other hand, when a sweat breaks out about or on the critical days, that is, the seventh, eleventh, or fourteenth day, and continues several days, though want of strength remains; or if there is a loofenes for some days, it is a sign of health; and this the more certain, if the contracted pulse enlarges, the hard grows soft and becomes more equal; if the patient is more cheerful, and his lying in bed more sedate, with a hardness of hearing, and a turbid urine depositing a sediment. If this happens about the critical days, it is a certain sign of a happy event. After this the sleep, appetite, and strength, gradually return; but this is seldom the case before the fourteenth day.

Patients of a strong constitution, the common people, and rustics, with a good regimen alone, generally succeed better than the weak, the unwholesome, the sad, the thoughtful, the luxurious, the slothful, and the studious. All excretions by urine, stool, or sweat, are bad in the beginning, and on other days except the critical. Those that die are carried off by a phreny, or an inflammation of the meninges, or of the oesophagus and fauces from aphtha of the stomach itself. If blood is taken away in these defeases, it is either of a bright red, very fluid and serous, or too thick and blackish.

In the cure of this disease, the physician should take care not to disturb the salutary excretions, but proceed cautiously, and abstain from strong medicines of every kind, watching and assailing the motions of nature as much as possible. The indications are, 1. To restrain and pre- vent the entire dissolution of the blood and humours. 2. To temperate and dilute the salino-sulphureous acrimony of the humours, and at the same time to keep the fluids fluxile. 3. To promote gently the excretions by stool, urine, the skin, and spittle. 4. To assist and restore the lost strength.

To prevent the putrid dissolution of the humours, direct vinegar, the juices of oranges and lemons, and syrups of the same; spirit of vitriol, spirit of salt, spirit of nitre, especially those that are dulcified.

To abate the acrimony, absorbent, teftaceous, and bezoardic powders will be proper. To dilute at the same time, you may order a decoction of barley with scorzonera and shavings of hartshorn; as also the syrup of orange juice, chicken broth, and the like.

To promote the cuticular excretions, give diaphoretic simple waters, alexiteal waters, with the tincture of valerian root, or snake root. To assist the excretions by stool, common domestic clysters will be useful; or those made of a decoction of barley, oil of sweet almonds, camomile flowers, elder flowers, syrup of violets, common salt, or nitre.

Or you may order the following laxative, which must be given with caution.

Take 2 ounces of manna, a dram of cream of tartar, 3 ounces of scorzonera water, half an ounce of syrup of violets, 3 drops of oil of juniper. Mix and make them into a draught.

To raise the spirits and restore the strength, a little wine will not be improper, with hartshorn jellies, China orange or Seville orange juice with sugar.

A congruous regimen in these diseases is of very great consequence; for if the patient is kept too hot, the dissolution of the blood will be promoted, a costiveness will be induced, the anxiety will be increased, the impure salt and acrid humours will be actuated, the strength will be exhausted, the sweating will be too speedy and profuse, and spots will appear on the skin. On the other hand, if cold is cautiously admitted, especially to the feet, perspiration will be checked, the eruptions and spots will be driven back: There will be griping pains, a loofeney, and the critical evacuations will be disturbed. All sudden changes from hot to cold, or cold to hot, are equally bad. A temperate regimen is best. However, care should be taken that the patient does not breathe his own atmosphere full of morbid exhalations, so very prejudicial to health; but the air should be drawn out of the room, and fresh admitted.

The perspiration should constantly be kept up, and the linen of any kind should not rashly be changed, nor should the patient be removed from one bed to another. He should be enjoined not to rise frequently. And if the bed-cloths are wet and must needs be changed, let them be well aired, and pretty much worn.

An erect posture of the head and body is to be shunned either in or out of bed, especially if the pulse is very weak and the strength little; as also when the disease is near the state.

The mind should be kept as cheerful as possible, and all occasions shunned of exciting anger, fear, terror, or pusillanimity in the patient. His hope of recovery should be kept up as much as possible, instead of being terrified with the prediction of death.

It is an undoubted axiom, that all strong medicines are hurtful in this disease; such as emetics, purgatives, and diuretics; as also sudorifics of too spirituous a nature; But temperate and moderate things are very useful.

It must be remembered likewise, that these fevers have certain types and periods, and exacerbations and remissions at certain times; which a physician should always carefully observe. In the frebile heat, and when the symptoms are most intense, humectants, diluents, and the absorbent nitrous powders above mentioned will be most proper, with a very moderate external regimen. When the pyroxyism is ended, the skin lax, more soft, and disposed for excretions; then analeptics, medicines that stimulate; and if there is occasion, bezoardics, and things that promote perspiration; as also the infusion of veronica, scordium, and liquorice, drank as tea, are likely to do the greatest service. And because a diarrhoea frequently carries off the disease, it is never to be kept, especially about the critical times, neither with astringents, sedatives or opiates: But if nature tends to this excretion, and is too sluggish, she is to be assisted by the laxative draught above described, with the addition of tamarinds.

There is no evacuation so dangerous as bleeding at the nose; for then there is a congestion of blood in the head from the spasms of the lower parts. However, if the flux of blood is moderate, and the body abounds with it, instead of being hurtful; it will relieve the head, though this seldom happens. When there are a few drops only without alleviation, they portend a delirium and an inflammation of the fauces: But when the flux is copious, the strength will diminish, and the eruptions return inwards not without danger. Therefore, to prevent a conflux of blood to the head, the feet must be always kept in a moderate heat and moisture; mild blisters should be laid to the calves of the legs, and the body should be opened with clysters or solutions of manna. These will also be serviceable when the haemorrhage is too large. But when it is too little, and the eyes look red and wild, with a strong pulsation of the temporal arteries, besides the former, it will be proper to apply cupping-glasses to the nape of the neck, or to thrust a straw up the nose to cause it to bleed, or to use a scarifying instrument.

Bleeding in these fevers must be used with great circumspection; for it is much more proper as a preservative than a cure. But when the disease has made its onset with great loss of strength, complicated with catarrhal disorders, and when putrid and malignant fevers are rife, it must be always omitted. If the stomach has lately been surfeited with incongruous aliment, a grain or two of tartar emetic in a solution of manna will be necessary. Blisters will be of great use when a retrocession of the eruptions is apprehended, when the excretions are slow, and when there is a sleepiness and torpor; in which cases, they may be laid to the arms and calves of the legs.

Of the Malignant, Goal, and Spotted Fevers.

The true spotted fevers are very malignant, contagious, and detrimental to the head and strength, attended with spots of various colours, arising from a corruption of the vital fluids, and a putrid dissolution consequent thereupon.

These petechial fevers are deservedly called malignant, or poisonous, as they generally proceed from a most subtile, active, virulent vapour, or miasma, which is infectious. At first they often seem mild and gentle, and have the appearance of catarrhal fevers; but they soon exert their violent effects in a most fatal manner.

At first the patient complains of great weakness and loss of strength, and is apt to faint away.

The head aches, and from the very beginning is hot, dull, attended with a dejection of mind. There is constant watchfulness; the appetite is lost; the pulse is languid, small, and unequal; there is an oppression of the breast, sometimes a dry cough, an undulatory and tremulous twitching of the muscular and tendinous fibres, with a subsultus tendinum. Many neither complain of heat, nor pain, nor anxiety, and assert that they feel nothing bad, but weakness and want of sleep. The urine is generally thin at first, and like that of sound people. On the fourth, fifth, or the seventh day, the spots appear principally on the back and loins, of various colours, generally without relief; wherefore they are rather symptomatical than critical.

Huxham says, these fevers attack with much more violence than the slow and nervous; the rigors, if any, are greater, the heats sharper and more lasting, yet at first sudden, transient, and remittent; the pulse more tense or hard, but commonly quick and small, though sometimes slow and seemingly regular for a time, and then fluttering and unequal. The head-ach, giddiness, nausea, and vomiting, are much more considerable, even from the very beginning. Sometimes a severe fixed pain is felt in one or both temples, or over one or both eye-brows, frequently in the bottom of the orbit of the eyes. The eyes always appear very full, heavy, yellowish, and often a little inflamed. The countenance seems bloated, and more dead-coloured than usual. Commonly the temporal arteries throb much, and a tinnitus aurium is very troublesome; a strong vibration also of the carotid arteries comes on frequently in the advance of the fever, though the pulse at the wrist may be small, nay, even low; This is a certain sign of an impending delirium.

The prostration of spirits, weakness, and faintness, are often surprisingly great and sudden; sometimes, when the pulse seems tolerably strong, the respiration is very laborious, and interrupted with a kind of sighing or sobbing, and the breath is hot and offensive.

There is generally a sort of lumbago, or pain in the back and loins, a weariness, soreness, and pain in the limbs. Sometimes a great heat, load, and pain at the pit of the stomach, with a perpetual vomiting of porraceous or black bile, of a nauseous smell, with a troublesome hiccup.

The tongue at the beginning is white, but grows daily more dark and dry, or of a shining, livid colour, with a kind of bubble at the top; sometimes exceeding black for many days: At the height, it is generally dry, stiff, and black, and the speech scarcely intelligible.

The thirst, in the increase of the fever, is commonly very great, sometimes unquenchable; and all the drinks seem bitter and nauseous; at other times there is no thirst, though the mouth and tongue are exceedingly foul and dry; this is a dangerous symptom, and ends in a phrenzy or coma. The lips and teeth, near the state, are furred with a very black tenacious froth.

At the onset of the fever, the urine is often crude, pale, and vapid; but grows to so high a colour as to resemble a strong lixivium, or citron urine, tinged with a very small quantity of blood: it has no sediment, or cloud, for many days together; but by degrees grows darker, like dead strong beer, and smells offensive.

The stools, especially near the state, or in the decline of the fever, are for the most part very offensive; green, livid, or black, frequently with severe gripes or blood. When they are more yellow or brown, the less is the danger; but the danger is greatest of all when they come away insensibly. If the belly be hard, swelled, and tense, it is a very bad symptom. A gentle diarrhoea is often very beneficial, by which nature carries off the morbid matter.

The more florid the spots are, the less is the danger; and it is a good sign, if the black or violet become of a brighter colour. The large, black, or livid spots, are almost always attended with profuse bleedings. The small dusky, brown spots, like freckles, are almost as bad as the livid and black. Sometimes they are attended with profuse, cold, clammy sweats; at which time the spots vanish without any advantage.

The eruption of the spots is uncertain; sometimes they appear on the fourth or fifth day; sometimes not till the eleventh, or later. The vibices, or large livid or dark greenish marks, seldom appear till very near the fatal period. Sometimes about the eleventh or fourteenth day, when the sweats are profuse, the spots disappear, and vast quantities of small, white, milky pustules break out. If there is an itching, smarting, red rash, it commonly greatly relieves the sick, as well as large, fretting, watery bladders on the back, breast, and shoulders. A scabby eruption about the lips and nose is a salutary symptom; the more hot and angry the better. Brown dark aphthae are more uncertain and dangerous, as well as those exceeding white and thick like lard. They are followed with difficulty of swallowing, pain and ulceration of the fauces and oesophagus, with incessant hiccup; the whole prime vie are at length affected, a bloody dysentery comes on, and a mortification of the intestines.

Pringle observes, that in hospital, goal, or camp fevers, the first complaints are gentle horrors, and little feverish heats, alternately succeeding each other, with loss of appetite; the disorder being greatest at night, the body is hot, the sleep interrupted and not refreshing. They have constantly some pain and confusion in the head, chiefly about their forehead; the pulse is at first but little quicker than the natural, and the drought, if any, is inconsiderable. They are too ill to mind business, and too well to be confined. In this state, a change of air, with a vomit and sweat, will perform a cure; yet a large bleeding at this time will sink the pulse, and bring on a delirium.

When the symptoms come on quick and violent, the fever seems to be inflammatory, and can only be distinguished by a knowledge of the circumstances; and bleeding yields no relief, but exasperates the complaints. The aforesaid symptoms are now more high, with great languor, nausea, and pains in the back, with pain and confusion in the head, and great dejection of spirits.

The pulse at this time is generally quick and full; now a moderate bleeding affects the pulse but little; if large, it will sink, and bring on a delirium. The worst kind of blood is when the crassamentum is dissolved, which is a sign of high putrefaction.

If the patients lie warm, the body is generally coltive; if cold, there is a diarrhoea. If they have bilious stools when they are warm, they are critical, and not to be checked unless immoderate. In the worst kind of these fevers, in the last stage, a diarrhoea commonly carries the patient off; but then the stools are involuntary, colligative, ichorous, or blackish, and of a cadaverous smell, which are the effects of a mortification in the bowels.

The heat of the body at first is not considerable; but if the pulse is felt for a while, there is an uncommon heat, which remains upon the fingers some minutes afterwards. A day or two before death, the extremities feel quite cold, and then the pulse is hardly to be distinguished.

The skin is generally dry and parched; yet in the beginning there are often imperfect sweats, without any relief. A continued and generous sweat is the surest cure.

The tongue is generally dry, hard and black, with deep chaps; but towards the last it is soft and moist, and the colour is a mixture of green and yellow. The drought is sometimes great, at other times very little.

Some prefer their senses through the course of the disease, except a confusion and stupor; but few keep them till death, if it prove fatal. They sleep seldom and seem to be pensive and in deep thought. The face is not ghastly nor morbid, till towards the last. The confusion of the head often rises to a delirium, especially at night, but seldom changes to rage. A tremor is more common than a subfusus tendinum. The pulse sinks all along, the stupor or delirium and tremor increase, and the spirits are relieved in proportion to its rising to the head. Frequently the patient is dull of hearing from the very beginning, and at last grows almost deaf.

When the delirium is at its height, the face is commonly flushed, and the eyes red, unless after large evacuations; then it appears meagre; the eyelids in slumber are only half shut; and the voice, which is constantly slow and low, sinks to a degree scarce to be heard.

When the fever is protracted with a low pulse, they have a particular craving for something cordial; and nothing is so acceptable as wine. They long for no food; but will take panada, if mixed with wine.

There are spots, but not always. In hospitals they are less usual at the first breaking out of the disease; but when the air is more corrupted, the spots are common. They are of the petechial kind, of an obscure red, paler than the measles, not raised above the skin, of no regular shape, but confluent. These spots are very irregular, sometimes appearing on the fourth or fifth day, and at others on the fourteenth. They are neither critical nor mortal signs, but dangerous; if purple, they are more ominous, but not absolutely mortal. In a few cases there have been purple streaks and blotches. These sometimes, as well as the spots, do not appear till after death. This fever, on account of its exacerbations at night, may be looked upon as the lowest degree of the remitting kind.

The duration is uncertain, and in proportion to the virulence. Their course is generally from fourteen to twenty days; some have died or recovered after four weeks. When the course is long, it commonly terminates in abscesses of the parotid or axillary glands, sometimes in an hectic: Some, after this fever is over, fall into an irregular intermittent; many complain of a pain in their limbs, and want of rest; and almost all of great weakness, confusion in their heads, and noise in their ears. When the air is highly malignant, the disease terminates, in five or six days, either in death or a critical sweat.

The most peculiar symptoms of this disease, are always a singular attack upon the head, as a stupor, or pain; and if it lingers, a slow low voice, and sinking of the spirits, without any large evacuation; pale urine, petechial spots, the bad effects of large bleeding, or too many clysters; lastly, the disagreement of cooling medicines, excepting in the beginning; and on the other hand, the agreement with wine, volatiles, and other cordials, during the greatest part of the disease.

As to the prognostics, the spots are so far from being salutary, that the more plentiful they are the greater is the degree of the corruption; when they are livid, lead-coloured, and of a greenish black, they shew a phacelous corruption. Those who escape are not freed by a cutaneous excretion, but by large sweats, breathing a stinking acor; or by critical fluxes of the belly; which happen by the benefit of nature, when the corruption of the fluids is not great. Many are apt to fall into a phacelous corruption of the stomach, intestines, and other viscera, or into a phrensy, or more frequently into an anginous inflammation of the fauces and oesophagus, as appears from the intolerable smell which happens after death. This unhappy event is prefigured, if there is no thirst, or one that is unquenchable; if the tongue is dry, chap, black; the fauces inflamed and beset with fordes, with difficult swallowing; if, after the eruption of the spots, a difficult breathing and straitness of the breast remains and gains ground; or if a delirium increases after sweating, and a flux of the belly, the urine being at the same time turbid, and depositing no sediments; lastly, if the eyes are dim, the patient catching at straws; if there is a subfusus tendinum, if the excrements come away infensibly, or if there is a cold sweat with convulsions.

Pringle observes, that those who are weakened by other distempers, or their cures, are more susceptible of the goal or hospital fevers than the strong and vigorous; and that one who is recovered is more subject to relapse, than he who is to be first attacked.

All the prognostics, says he, taken singly, are uncertain. The following signs are good: to have no delirium; to have the pulse neither very low nor quick, or, if sunk, to have it rise by wine or cordials, with an abatement of the delirium; and to have the tongue moist, and of a natural colour. It seems peculiar to this fever, that deafness is generally a good sign. The natural and best crisis is by sweat, when the pulse rises, and the symp-

Vol. III. No 72. toms abate; next to that is an insensible perspiration, which is known by the softness of the skin, moisture of the tongue, and a remission of the other symptoms. Bilious stools, with turbid urine, and a moist tongue, may be considered as signs of a favourable crisis. But the contrary of all these are bad; as also the subcutaneous tenderness, inflamed eyes, and great anxiety. It is observed to be among the worst signs, when the patient complains of blindness, or when he cannot lie but on his back, and pulls up his knees; or if, when inebriated, he endeavours to uncover his breast, or makes frequent attempts to get out of bed. If there are ichorous, cadaverous, and involuntary stools, it is a sign of certain death.

The formal ratio of these pernicious fevers, consists in the putrid dissolution or colliquation of the blood and vital fluids, especially of that highly elastic fine fluid which is contained in the blood, and separated in the brain and spinal marrow, by which it is distributed by the nerves to all the body, induced with sense and motion, for it greatly vitiates and defiles this liquid. However, such is the nature and power of that poisonous vapour, by which found bodies are infected, that it not only induces a putrid fermentation into the blood and other fluids, but acts immediately on the inward and nervous parts of the brain, which it corrupts, and produces a languor in the vital and animal powers, even while the state of the blood and humours remain free from corruption.

This virulent vapour enters the body by the nostrils, fauces, and bronchia; whence it immediately reaches the nerves in the brain, and renders the patient light-headed, with a dulness of the head, and a loss of strength, and a vertiginous affection. It likewise mixes with the saliva, descends into the stomach, which is a nervous part, and there takes up its principal residence; whence the bad symptoms generally appear first in the stomach and praecordia, with a nausea and an inclination to vomit, as also a diarrhoea with gripes, or a coliciveness, with loathing of food, anxiety of the praecordia, and watery eruptions from the stomach.

Hence the reason evidently appears, why nothing is more proper to guard against this disease than turning away one's face from the patient, frequent spitting, chewing angelica, zedoary, or pimpernel, and smoking tobacco; hence likewise appears, why the force of this poison is exerted in the stomach, which is beset with copious crudities, and pituitous and salival sores; and likewise why gentle emetics, joined to alexipharmics, commonly destroy the disease in the bud.

It may be induced by a bad state of the air: for a long moist, rainy, cloudy, and southerly state of the air, dulls and depresses the motions of the solids and fluids necessary for life: to this may be added a long and frequent inundation of water, which is apt to generate putrid diseases; as likewise the exhalations arising from putrid unburied bodies, or from the excrements of animals, especially if confined and shut up from the air.

In the regimen, it is necessary, if possible, to breathe a serene, temperately warm air. The room should not be heated too much, it being found to be hurtful. The patient should eat nothing solid in the decline of the disease, nor after it. A free use of food, of nourishing and comforting broths abounding with oleous particles is pernicious, especially about the critical days, in the state of the disease, or where there is any critical evacuation. Nothing is more hurtful than an erect situation.

Alexipharmics, volatile salts, hot and spirituous bezoardics, are hurtful, especially with a hot regimen: for they dissolve the blood, and increase the number of spots; or cause head-aches, inflammations, or copious sweats.

Bleeding has been good in plethoric bodies, and in those who have been accustomed to hemorrhages; on the contrary, if the patient is low or weak, bleeding is hurtful.

Gentle vomits are useful by way of prevention, and in the very beginning of the disease; but in the progress and state have had a bad effect.

Blisters have been greatly praised in the state of the disease, when there has been a delirium, a sopor and convulsions, being applied to the neck.

We reject all opiates and soporiferous medicines, on account of the pulse and want of strength; because they retard the excretions, increase the malignity, and so hasten death.

The medicines used are elder-flower water, that of limes, elms, roses, of the tops of scordium, scabious, and carduus benedictus; as also syrups of citrons, pomegranates, and the juice of roses; powders of mother of pearl, diaphoretic antimony, crabs-eyes, amber, terra sigillata, burnt hartshorn, pure nitre. Alexipharmics are, camphire, essence and extract of scordium, vincetoxicum, the bezoardic spirit and tincture, the essence or spirit of vitriol, and dulcified spirit of nitre: Moisteners, the decoction of scorzonera, shavings and jelly of hartshorn: Analptics, orange-flower water, fresh oil of citrons, with sugar, confection of alkanes, and balsam of life: Antispasmodics, essence of calcar, cinabbar, and succinated spirit of hartshorn.

In the beginning of the disease, use a bezoardic powder of nitre, and a little camphire, often repeated; in the progress and state of it, a mixture of temperate waters, diaphoretics, analptics, antispasmodics, and cordial bezoardic powders, with a little juice of citrons. In the drink put nitre, or philosophic spirit of vitriol, or sulphurated glyceris of antimony, to keep the body open. Also give drink of the filtrated decoction of hartshorn, and root of scorzonera, either hot or cold. About the critical day give gentle alexipharmics, with things to promote sweat when nature seems to tend that way.

This is the best and surest method of cure. But if the vomiting is too great, with an anxiety of the praecordia, and profuse diarrhoeas, accompanied with gripes, apply outwardly Venice treacle, expressed oil of nutmegs, camphire, oil of cloves, and balsam of Peru, mix together, to the region of the stomach. If a diarrhoea exhausts the patient too much, give a nitrous bezoardic powder, with a little camphire, and theriac coelitis. If the body is coltive, with gripes, prescribe lenient clysters, or such as are made entirely of oil. To raise the strength, allow spiritous things, such as comfort and are aromatic; but they must be externally applied to the pulses or pit of the stomach, or nostrils. To quench thirst, give an electuary of Muscovada sugar and dulcified spirit of nitre. Nature many times strives in vain to discharge the irritating matter, by vomit, without the assistance of art; and therefore something to promote it will render it much easier; which may be done by an infusion or decoction of ipacacuanha, or oxymel scillicicum, with a slight infusion of camomile flowers.

The prime vise should be unloaded by very gentle methods, such as clutters of milk, sugar and salt; laxatives of manna, cream of tartar; Glauber's purging salt, tarmarins, and rhubarb.

When there are signs of redundancy of the bile, it should be forthwith discharged by vomit or stool, as nature points out; which is often succeeded by an amazing change for the better, where an inexplicable anxiety, load on the precordia, perpetual sickness, eructation, and singultus, had preceded.

Between the seventh and fourteenth day, nature endeavours to relieve herself by vomit, or more frequently by loose stools; then given a gentle laxative the eighth and ninth day, unless some eruption appear, or a kindly sweat forbid it.

But the constant and grand effort of nature, is to throw off the putrid malignancy through the pores of the skin. If it be a breathing sweat at the state of the disease, and the pulse grows more open, soft, and calm, a little before and during its continuance, it is always salutary; but if it be profuse, cold, clammy, or partial, about the head and breast only, the sign is not good. Profuse sweats in the beginning are generally pernicious, especially if a rigor supervenes.

Sweats should never be forced by violent hot medicines, regimen, &c. Plentiful subacid diluents will be sufficient, and gentle cordial diaphoretics.

As acids and subastringents are given to preserve the crisis of the blood and tone of the vessels, and to prevent the farther putrefaction of the humours, diaphoretics, especially camphire, should be joined with them.

Dr Brookes used the following prescription of the bark for many years with success, not only in intermittent and slow nervous fevers, but also in the putrid, pestilential and petechial, in the decline, though the remissions have been very obscure; but if the patient is costive, or hath a tense or tumid abdomen, he premised a dose of rhubarb, manna, or the like.

Take two ounces of Peruvian bark in powder, an ounce and a half of orange-skin, 3 drams of Virginian snake-root, 4 scruples of English saffron, 2 scruples of cochineal, and 20 ounces of spirit of wine. Mix and infuse the ingredients in a close vessel for three or four days, and then filtrate the infusion.

Of this give from a dram to half an ounce every fourth, sixth, or eighth hour, with ten, fifteen, or twenty drops of elixir of vitriol, out of any appropriated draught, or diluted wine. The above composition tends to strengthen the solids, to prevent the farther dissolution and corruption of the blood, and in the event to restore its crisis.

With this view also give a generous red wine, as a most noble, natural, subastringent cordial, which is of high service in the state, but more especially in the decline of these fevers, acidulated with the juice of Seville oranges or lemons, as also with cinnamon, the rind of Seville oranges, and the like, to which a few drops of elixir of vitriol may be added. Rhenish and French white wines, when diluted, are also a most salutary drink, and generous cyder is little inferior to either.

Of the Pestilential Fever.

A pestilential fever is a most acute one, arising from a poisonous miasma, brought from eastern countries; and unless it is immediately expelled out of the body, by the strength of the vital motions, by buboes and carbuncles, it is fatal.

It differs from other contagious, malignant, and eruptive fevers, because it is the most acute; for it sometimes kills on the first, and sometimes on the second day. Besides, in our climate it is not epidemic or sporadic, from a bad way of living, or unhealthful air; but happens when it is most salutary, from contagion alone. There is something very singular in this infectious miasma; for though it is apt to spread at a strange rate, yet it will abate by intense cold, and be plainly extinguished: wherefore in a cold season, and very cold countries, it either does not appear at all, or in a very mild degree; whereas if the climate is hot, it is not only most vehement, but most common.

In this, as in all other contagious diseases, the venomous miasma is swallowed in with the air, and insinuates itself in the salivary juice, where its tragedy is first acted. Whence it assaults the head, brain, nerves, and animal spirits, producing a torpor in the head, a heaviness, a sleepiness, a violent pain, a stupor of the senses, a forgetfulness, inquietude, watching, and loss of strength. From the fauces it proceeds to the stomach, creating loathing of food, nausea, anxiety of the precordia, a cardialgia, attended with fainting, reaching to vomit, and vomiting itself. Hence it proceeds to the membranes of the spinal marrow, and the coats of the arteries, producing horrors, languid, small, contracted, quick pulse, and even fainting. All these are generally signs and symptoms of the plague; which are of a more violent and quick operation, in proportion to the virulence of the pestilential miasma.

All plagues are not of the same nature, but vary according to different constitutions and circumstances. Those who have written of the plague universally agree, that spungy and porous bodies of an obese habit, of sanguine and phlegmatico-sanguine constitutions; women, young persons, and children; persons of a timid disposition, that are poor, live hard, or are given to luxury, and sit up late at nights; are more apt to be afflicted with this disease, than the strong and intrepid, lean, nervous; those induced with large vessels; men, or old persons obnoxious to the hemorrhoidal flux, and who have ulcers and open ulcers. Nothing brings on this distemper more than fear, dread of death, and a consternation of the mind.

Pestilential fevers are so called, when the patient falls into sudden weakness; for it is a kind of malignant fever, attended with more grievous symptoms; the patients die in a short time, that is, in two, three, or four days, and sometimes sooner. If malignant fevers arise in war-time among among the soldiers, they are called camp-fevers; in Hungary, an Hungaric fever. But the plague, or pestilence, is known when buboes and carbuncles arise in various parts of the body. The sweating sickness had its rise in England, in which the patient fell into a violent sweat, of which many died in a day's time.

The pestilential poison disturbs all the functions of the body; for unless it be expelled to the external parts, it is certainly fatal. Nor is this to be done as in other fevers, by large sweats, by stools, by a flux of urine, by cutaneous evacuations of blood, or by bleeding at the nose, either natural or artificial, for they rather hasten destruction. The salutary and critical excretion which perfectly solves the pestilential disease, is by tumours in the surface of the body not otherwise than the erysipelas, between the third and fourth day; and the sooner the better, for then the symptoms are mitigated. The pestilential tumours are of two kinds; the first arises in glandulous places, most commonly in the groin and arm-pits, sometimes in the parotid and mammary glands, as also the lower maxillary, under the chin, and in those near the aspera arteria. It is a hard, painful, tenitive swelling of the glands, with great heat; and if they are salutary, being swollen, they grow soft, and suppurate. The other sort is the anthrax or carbuncle. Celsius describes it in this manner. It is a swelling on which there are pustules, which rise but little; they are black, sometimes sublivid or pale. In this there seems to be a fancies; it is black underneath. The body itself is more dry and harder than usual. There is as it were a crust about it, surrounded with an inflammation; nor can the skin be raised up in the part, but is joined to the flesh underneath. Mindererus, who was present at the plague, says, that a carbuncle is of the size of a grain of mustard-seed; and about its edge, there is a circle, or burning halo, of a large size. The flesh which it seizes is like an eschar or putrid flesh, and falls off as if torn out by a wolf. No part of the body is free from these carbuncles; but they generally lay hold of the membranes of the muscles, and the nervous and fibrous substance of the skin, especially in the back, arms, and thighs. At first there is an exquisite itching in the part; which when scratched, pustules arise; they are of a red, livid, or whitish purple colour, or sometimes black. When the pustules are pressed, they seem to be full of pus; under which there is an ash-coloured crust, which being taken away, the flesh appears corrupted and spungy, with intolerable pain and burning of the circumjacent flesh, which is followed by a mortification of the part.

When the plague is fatal, some die of a fainting the first or second day. But in many, when the poison is not expelled, or, if expelled, returns back, it brings on a mortification of the nervous coats of the noble parts, of the pleura, oesophagus, stomach and intestines, or the meninges of the brain; which creeps speedily to all the viscera, and the blood itself; whence the carcases swell, and have a most intolerable stench. Sometimes, when the pestilential tumours are too plentiful, they die of a symptomatic fever, from the inflammation, pain, and intolerable heat.

It has been before remarked, that the plague is not a native of our country, but is brought from remote places; whence the best preservative is to fly to a distant country; for the same reason, those princes best consult the welfare of their subjects, who in the time of the plague endeavour to prevent the spreading of the infection, and, when a family is afflicted, separate the well from the sick, and burn all their moveables. While this disease reigns, all persons should live temperately, avoid an excess in the use of the non-naturals, and abstain particularly from violent affections of the mind, and everything else that dejects the strength, disturbs perspiration, and generates crudities in the prime vice; the mind is especially to be supported, and fear, dread, and pusillanimity are to be banished; for more die of terror than of the plague itself.

As in the small-pox, the management consists in clearing the prime vice in the beginning, in regulating the fever, and in promoting the natural discharges; so in the plague, the same indications will take place. In the plague, indeed, the fever is often much more acute; the stomach and bowels are sometimes inflamed, and the eruptions require external applications, which to the pustules of the small pox are not necessary.

When the fever is very acute, a cool regimen is necessary; but when the pulse is languid, and the heat not excessive, moderate cordials must be used. The most gentle emetics may be given; the best is ipecacuanha, if the stomach or bowels are not inflamed, for then certain death must be expected.

As for the eruptions, they must be brought to a suppuration as soon as possible; and as soon as they appear, fix a cupping-glass thereon, without scarification; and when that is removed, apply a suppurating cataplasm, or plaster of warm gums.

If the tumors will not suppurate, as the carbuncle seldom or never does; yet if a thin ichor or matter exudes through the pores, or if the tumours feel soft to the touch, or, lately, if it has a black crust upon it, then it must be opened by incision, either according to the length of the tumor, or by a crucial section. If there is any part mortified, as is usual in the carbuncle, it must be scarified. Then it will be necessary to stop the bleeding, and dry up the moisture with an actual cautery, dressing the wound afterwards with dressings and pledgets, spread with a common digestive.

The next day the wound ought to be well bathed with a fomentation of warm aromatic plants, with spirit of wine in it, in order, if possible, to make it digest, by which the sloughs will separate. After this, the ulcer may be treated as one from a common abscess.

But the patient runs great hazard in this way, notwithstanding the utmost care; therefore artificial discharges for the corrupt humours should be attempted. To this purpose, large bleeding and profuse sweating are recommended to us upon some experience.

As for sweating, as Sydenham advises, it must be continued without intermission.

If there is a vomiting, the patient should be made to sweat with the weight of the bedcloths alone, drawing the sheet up to his face.

When the sweat is begun, it should be promoted with sage posset-drink, or small-beer, in which mace has been boiled, boiled, repeating them pretty often for twenty-four hours; in the mean while, the spirits of the patient are to be kept up with comforting broths. The bystanders should forbear to wipe off the sweat, nor should the patient change his linen all that time, which is a necessary caution; if it be stopped before that time, it will be to no manner of purpose; during the sweat, the diarrhea, if any, and the vomiting, will stop of their own accord.

Theriaca, and the like solid medicines, being offensive to the stomach, are not the most proper sudorifics. An infusion of Virginia snake-root, in boiling water, or, for want of this, of some other warm aromatic, with the addition of about a fourth part of aqua theriacalis, is safer.

Those who are obliged to be near the sick, must take care that the miasmata do not approach their vital juices, nor yet the salival. To this purpose, frequent spitting, and washing the mouth with vinegar, or wine, or sniffing them up the nose, are useful. The efficacy will be still greater, if they are imbued with rue or citron rind. For an acid is the genuine antidote of a putrid and sulphurous miasma. Wherefore it is much safer to hold acids in the mouth, than alexipharmic roots. It will likewise proper to get a few spoonfuls of Rhenish wine, or bezoardic vinegar, diluted with water or wine, and so take them. The Turks deal much in the juice of lemons.

When the plague is actually begun, and the body is coltive, a gentle clyster should be used. Then a sweat should be promoted (twenty-four hours at least) that the poison may exhale and pass through the skin; and epithems to the heart will not be without benefit, though they reach only to the right orifice of the stomach, and its nervous coats; they may be made of theriac, expressed oil of nutmegs, camphire, saffron, caltrop, and bal-sam of Peru. But above all, acids are highly praised; such as, juice of citrons, Seville oranges, lemons, vinegar, &c., which resist poison, putrefaction, and prevent the dissolution of the blood.

When the strength of the disease is vanquished, gentle laxatives will be proper to expel the fordes during the course of this disease.

It is worthy observation, that few medicines are best; for which reason people of the lower class generally come off better than persons of distinction; and there is nothing worse than to give alexipharmics abounding with a hot volatile oil; much less ought volatile spirits to be given, for they fix the poison upon the nervous parts. Yet herbs and roots of this kind are not altogether to be condemned, if mixed with acids and nitre. A mixture of carduus benedictus water, and wine vinegar, when given to four spoonfuls, with a dram of crabs-eyes and theriaca, and repeated, were very useful in the plague at Hall in 1682. In the plague likewise in Lombardy, 1526, many recovered with the juice of goats-rue, vinegar, water of carduus benedictus, and a little theriac given to make the patient sweat: and Thonner observes, that nothing was of any advantage in the plague except theriacal vinegar given in the beginning to promote a sweat. And in the year 1544, when a malignant fever raged among the soldiers, a whole regiment was saved, to whom this vinegar was given in due time, except a very few. And in the plague at Rome, vinegar with rue, pimpernel root, betony, garlick, and juniper-berries, with a little camphire added to the infusion, caused many to escape. Likewise the preservative water of Sylvius has been greatly esteemed, because of the vinegar. And Mindererus affirms, that unless alexiterials be given within twenty-four hours, all medicines are vain.

Of the Military Fever.

A military fever is not unlike a catarrhal, and is attended with a more intense motion of the vascular and nervous system, whereby a corrupt lymphatic matter of a peculiar nature is expelled from the inward, and more especially the nervous parts, to the surface of the skin, in the form of small, rough, milia pustules, sometimes red, and sometimes white.

These small pustules are exceeding numerous, causing a corrugation, roughness, and dryness of the skin, and have a fetid smell peculiar to themselves. There is no eruption so inconstant as this, for it will sometimes strike in suddenly, and as suddenly appear again, and is attended with an itching pricking sensation more than any other kind. Other eruptions are common to all countries, and are equally vexatious to men as well as women; but the military seems familiar and endemic to some places only, and more frequently attacks the female sex, especially in childbed. It is neither epidemic nor contagious, and seems rather owing to a fault in the viscera and fluids, than the intemperance of the air.

The military eruptions are either red or white, and are both more or less acute, benign or malignant. The red are less dangerous, are generally free from a fever, and then are chronic, appearing at stated seasons of the year; but sometimes they are accompanied with an acute fever. The white seldom or never appear without a fever, and therefore are more dangerous. In these the lymph is affected with a kind of acidity; for the patient discharges plenty of serum by sweat, urine, stool or salivation, which are the effects of an acid which coagulates the thicker part of the blood, and separates the serum from it. Besides, all kinds of acids and refrigerants, not excepting nitre, freely taken, are most hurtful in this disease. On the contrary, absorbents and anti-acids, and things which render the blood spirituous, are most salutary. Women who eat much fruit, and such like trash, of the aecent kind, and live idle sedentary lives, are most subject to this disease.

Sometimes the military eruptions are idiopathic, and sometimes symptomatic, and supervene to other fevers, especially the continual, when on the decline. They likewise appear very commonly with the measles, smallpox, putrid and spotted fevers, when drawing towards an end; and then they raise a new fever, whose attack the debilitated patient is not able to stand.

The idiopathic begins with a slight shivering, succeeded with heat and loss of strength, sometimes even to fainting. There is a straitness about the breast, attended with anxiety and deep sighs, reflexions and watching. There is a pricking kind of a heat perceived in the back, with an alternate succession of cold, shivering, and heat under the skin, but most sensible in the palms of the hands. hands. Women in child-bed have the flux of the lochia stopped, and the milk recedes from their breasts. To these succeeds a roughness of the skin like that of a goose; and a great number of pustules appear, sometimes white and sometimes red, or both together, of the size of millet (or mustard) seed. They first beset the neck, then the breast and back, and afterwards the arms and hands. When these begin to rise on the surface of the skin, the more grievous symptoms cease. The pulse, which before was hard, contracted and quick, grows more soft, free, and slow; the dejection of mind goes off; the skin becomes moist, and the belly, which was bound so much that the patient could not break wind, now spontaneously admits him to go to stool. Afterwards the pustules ripen, and are full of a stinking ichor. The urine appears more saturated, and a singular fetid sweat, proper to this disease, breaks forth; the flux of the lochia in females returns, and within the space of seven or eight days the pustules disappear, with great itching in the extreme parts, drying up and falling off in scales. Then the patient recovers strength, and regains health.

It is hard to determine the day of the eruption of the pustules; but it is generally the tenth or eleventh day from the beginning, if the fever makes a regular progress; sometimes on the eighteenth, and sometimes on the twenty-first, or twenty-second day.

Bad signs are, when the milky pustules appear and vanish by turns, and the symptoms continue violent; but it is worse if they quite disappear: Hence an oppression of the breast, with fits, a strangeness of the fauces, loss of strength, and great anxiety.

Fatal signs are, when the morbid matter not being thrown out again, there is an inward heat and the extreme parts are affected with cold and shivering, and there is a cold profuse sweat; or, on the contrary, when the extreme parts are hot, and a notable sense of coldness is perceived in the abdomen, then the patient dies in a fainting fit, arising from a mortification of the stomach, intestines, brain, or womb.

The cure of this fever depends on the following things:

1. To correct and temperate the acid morbid matter which disturbs the nervous parts. 2. To relax the spasmodic strictures of the nervous fibres proceeding from thence. 3. To evacuate the prepared morbid matter through the pores of the skin, and prevent its striking in.

To dilute the sharpness of the humours, and to appease the irritation of the nervous parts, the following decoction may serve for common drink.

Take shavings of hawthorn, scorzonera root, and sarsaparilla, each two ounces; and boil them in 6 pounds of water.

Let the patient be always kept in an equal moderate heat, and abstain from strong alexipharmics, and things actually hot, because they throw him into too profuse a sweat. But when there is an apprehension of the pustules striking in, then the decoction may be drank hot, with moderate excellent, as the exigence requires. Nor should the medicines be too cooling, because they increase the anxiety and faintness. In the red spot, when there is an internal heat, with thirst and a great pulse, diaphoretics with a little nitre will be proper; even though red and white pustules appear together. But nitre alone should be used with caution, especially when there are signs of malignity. No malt liquor should be drank, but the former decoction.

The belly should be neither too much bound nor too open; yet even the gentle laxatives are not to be given till the pustules begin to dry; and then there is nothing else required but an emollient clyster.

Bleeding should be cautiously used; for when the weakness is excessive, the sweats profuse, and the pulse quick, it must be omitted. On the contrary, it is necessary for childbed women, when the lochia is suppressed, and the symptoms of a military fever begin to appear; but then it must be done speedily, and the great anxiety, fainting, and difficulty of breathing will cease, and the pustules break out.

Blistering on the back are very proper for this disease; for they help to draw off the impure serous humours, and stimulate the fatigued nervous fibres to a contraction, so as to expel the morbid matter.

Of the Scarlet Fever.

The scarlet fever may happen at any season of the year, but it appears most commonly towards autumn. It reigns chiefly among children. It begins with coldness and shivering, as in other fevers, without any violent sickness. Afterwards the skin is covered with red spots, which are larger, more florid, and not so uniform as the measles. The redness remains two or three days, and then disappears; then the cuticle falls off, and leaves behind it a sort of mealy scales, scattered over the body, which appear and disappear two or three times.

Let the patient abstain from flesh, all hot cordials, and spirituous liquors; let him not go out of doors, nor be confined constantly to his bed; and then medicines will be of little use.

Apply a blistering plaster to the neck, and every night give a paregoric of diacodium; and after the fever ceases, let the patient be purged with a very gentle cathartic, agreeable to the age and constitution.

Of the Measles.

The measles are an eruptive catarrhal fever, generally epidemic, which by the increased vital motion of the heart and arteries throws on the skin an acrid, caustic, inflammatory matter, in the form of red spots. They begin with chilliness and shivering, and heat and cold succeed by turns. The next day the fever comes on with great sickness, thirst, and loss of appetite: the tongue is white, but not dry. There is a little cough, a heaviness of the head and eyes, and a continual sleepiness. There is a sneezing and a swelling of the eye-lids, a furred humour oft diffuses from the nose and eyes, which are certain signs the eruption is at hand. In the face the spots are small; but on the breast broad and red, not rising above the surface of the skin. The patient often has a looseness, with greenish stools.

These symptoms continue and increase till the fourth, sometimes the fifth day; at which time spots like fleabites appear, increasing in number and magnitude, and in some places run together, rendering the face variously spotted. These spots consist of very small red pimples, almost contiguous, and rising but little above the skin. They may be felt by a gentle touch of the finger, but the rising cannot easily be discerned by the naked eye.

From the face the spots gradually proceed to the breast, belly, thighs, and legs. The symptoms do not immediately vanish after the eruption, as in the small-pox, except the vomiting. The cough and fever increase, with difficulty of breathing. The weakness, and a fluxion on the eyes, sleepiness, and want of appetite, still continue.

On the sixth day, and sometimes sooner, the skin of the face and forehead begins to grow rough; and the cuticle breaking, the pustules die away; while on the rest of the body the spots are broad and red. On the eighth day the spots disappear in the face, and are scarce perceptible elsewhere. On the ninth they quite vanish; fine, thin, light scales, like flour, falling off from the skin at that time.

The measles in general are not dangerous, unless from an insalubrious epidemical constitution of the year, which sometimes renders them malignant. This may be known by a sudden loss of strength, coldness of the extreme parts, great rashes, vomiting, difficulty of swallowing, and a delirium. If petechial spots or miliary eruptions supervene, there is great danger. A continual cough, a looseness, and great uneasiness, are bad. Profuse sweats are no good sign. When the disease is ended, if the cough and hoarseness remain, a consumption and hectic will follow, without speedy assistance.

Those who die of the measles are generally suffocated on the ninth day. Some, when the disease is ended, have a looseness, which continues several weeks, and brings on a mortal fever: Some have a slow fever, with an atrophy and a swelling of the abdomen, which are fatal.

If children are suspected to abound with crudities in primis viis, it will be proper to evacuate with half a grain of tartar emetic, and syrup of succory with rhubarb. When there are worms, anthelmintics should be given. In adults abounding with blood, phlebotomy is necessary on the first days. Medicines too hot, and cold nitrous things, are equally hurtful. As soon as the eruption is ended a gentle cathartic is proper.

In a cough nothing is better than oil of almonds fresh drawn, mixt with syrup of capillaire; half a spoonful of which should be given often in water-gruel.

To absorbent and diaphoretic powders, half a grain of saffron may be added.

When this disease attacks women who are subject to hypochondriac or hysterical spasms, or when the menstrual flux is at hand, it is often attended with fainting fits, difficulty of breathing, with constrictions of the throat, and great anxiety of the precordia. Therefore the eruptions are not to be driven out with hot remedies, but rather with such things as allay spasms, paregoric and carminative clysters, sometimes bleeding, as also a little castor and nitre mixt with bezoardic powders. By these means the spots will appear in a short time.

When a diarrhoea happens, it must be cautiously treated, and not hastily stopt; because it carries off a great deal of filth, and often puts an end to the disease. Then it will be best to wash the acrimony out of the intestines by demulcent clysters. But if, when the disease is over, the diarrhoea continues obstinate, it will be proper to add a few grains of the bark of eleutheria with bezoardic powders.

When there are haemorrhages, which are generally signs of malignity, nothing must be used that is directly astringent, much less opiates and anodynes.

If the patient falls into too profuse a sweat, so that the linen is quite wet, it must be changed very cautiously for such as is well aired and warm, otherwise the spots will strike in. Many have been killed in a few hours, by a sudden change from hot to cold.

When the spots are gone, the patients should not expose themselves to the air; but be careful of their diet; otherwise they may fall into an asthma, suffocating catarrh, or consumption.

Sydenham, for the cough, orders the following.

Take an ounce and an half of the pectoral decoction; syrup of violets, and true maiden-hair, of each an ounce and a half; make them into an apozem, and take three or four ounces four times a-day.

Let the patient keep his bed for two days after the first eruption.

If, after the measles disappear, a difficulty of breathing, fever, and other symptoms, should supervene, resembling an inflammation of the lungs, let blood be taken away freely from the arm, once, twice, or three times, as occasion shall require; leaving a due space between each bleeding; and let the pectoral apozem above described be given, or oil of sweet almonds alone. About twelve days from the invasion, let the patient be purged.

Of the Small-Pox.

The small-pox is commonly divided into two kinds; the distinct and confluent.

The distinct fort begins with chills and shivering, intense heat, a violent pain of the head and back, an inclination to vomit: in adults, a great propensity to sweat; a pain at the pit of the stomach, if it be pressed with the hand; a dulness and drowsiness, and sometimes epileptic fits, especially in children; and if the breeding of teeth is over, it is a sign the small-pox is at hand; for if the fit happens over night, the small pox will appear in the morning, and are, generally speaking, of the favourable fort.

On the fourth day from the beginning they break out, sometimes later, seldom before, at which time the symptoms either abate or wholly disappear.

The spots at first are reddish, and spread themselves over the face, neck, breast, and the whole body. Then there is a pain in the fauces, which increases as the pustules grow turgid.

On the eighth day the spaces between the pustules, which hitherto were white, begin to grow red and swell, and to be affected with a tenise pain. The eye lids are puffed up, and close the eyes; next to the face, the hands begin to swell, and the fingers are distended; the pustules of the face, before smooth and red, begin to be rough, (the first sign of maturation,) and whitish, and throw out a yellowish matter, in colour like a honey-comb. The inflammation of the face and hands being now at the height, the interstices between the pustules are of the colour of damask roses; and the more mild the disease is, the greater is the likeness.

The pustules about the face, as they ripen, grow more rough and yellow. But on the hands and the other parts of the body, they grow whiter and less rough.

On the eleventh day the swelling of the face and inflammation disappear; and the pustules being ripe, and of the size of a large pea, grow dry, and fall off.

On the fourteenth or fifteenth day they vanish entirely; except some obstinate pustules on the hands, which continue a day or two longer, and then break. The rest come off in branny scales, and in the face leave pits behind them.

Through the whole course of this disease the patient's body is either wholly bound, or he goes to stool but very seldom. Generally those who die of the small-pox, die on the eighth day in the distinct, and on the eleventh in the confluent sort. Then the face, which ought to be turgid, and the interstices florid, on the contrary is flaccid and whitish, at the same time that the pustules are red and elevated, even after the death of the patient. The sweat, which was injudiciously promoted by cordials and a hot regimen, suddenly ceases; in the mean while the patient is seized with a phrensy, a violent anxiety, a tossing and sickness; he makes water often and little, and a few hours close the tragic scene.

In the confluent sort there are the same symptoms, but much more violent. The fever, anxiety, sickness, vomiting, &c., more cruelly torment the patient; yet he does not so soon fall into a sweat, as in the distinct kind. A loofeness sometimes precedes the eruption, and continues a day or two after it.

On the third day, sometimes before, seldom later, the spots appear; and the sooner, the more will they run together. Sometimes the eruption is retarded till the fourth or fifth day, by some terrible symptom; such as, a most acute pain in the loins, like a fit of the gravel; in the side, like a pleurisy; in the joints, like the rheumatism; in the stomach, with a sickness and vomiting.

But the symptoms do not remit after the eruption, as in the distinct sort; but the fever and other complaints continue to molest the patient many days after. Sometimes the spots appear like an erysipelas, sometimes like the measles, but are distinguished from them by the time of the eruption. As the disease increases, they do not rise to any considerable height, being entangled with each other in the face; but appear like a red blister, and cover all the countenance, which swells sooner than in the distinct kind. Afterwards they seem not unlike a white pellicle glued to the face, and are not much higher than its surface.

The eighth day being past, the white pellicle grows daily more rough, and of a dusky colour. The pain of the skin becomes more intense, and at last, in the more cruel kind of this disease, they do not fall off in broad large scales, till after the twentieth day. But this in the mean time is worthy of observation, that the more the ripening pustules are of a brownish colour, they are the worse, and the longer in falling off; and the more yellow they are, the less they run together, and the sooner they disappear.

When the pellicle falls off, there is no roughness on the face, but branny scales soon appear in its room, of a very corrosive nature, which leave deep pits behind them, and sometimes ugly scars; sometimes the shoulders and back are quite deprived of their cuticle.

The danger of the disease is to be estimated from the number and multitude of the pustules on the face alone. The pustules of the hands and feet are the greatest; and the farther they are removed from the extremities, the less they are; in adults a salivation, and in children a diarrhoea, is a sign, though not always, of the confluent sort. The spitting sometimes begins with the eruption, sometimes two or three days after it; the matter is at first thin, but on the eleventh day it is viscid, and hawked up with difficulty; the patient is thirsty and hoarse, extremely sleepy, and his senses exceeding dull; he sometimes coughs when he is drinking, and the liquor regurgitates through his nostrils: then the salivation generally ceases, but the swelling of the face ought not to go down quite till a day or two after, when the spitting is over; if the hands do not begin to swell remarkably, and continue so for some time, the patient will suddenly leave the world.

The diarrhoea does not so soon attack children as the salivation does men. In both sorts of this disease the fever predominates from the first onset till the eruption; then it abates till the pustules are ripe, at which time it terminates.

The day on which the patient is most in danger, in the least crude and most common sort of the confluent, is the eleventh from the first attack of the disease; in the more crude, the fourteenth; and in the most crude, the seventeenth; sometimes, but very seldom, the patient does not die till the twenty-first. But in the space of time from the eleventh to the seventeenth, as the evening comes on, the patient is daily tormented with a fit of uneasiness.

In the management of the patient in the distinct sort, regard should be had to the season of the year, and the strength of the patient. Let this be a general rule, to keep the patient in bed during the first days of the distemper, taking care to defend him from the inclemency of the winter by proper means; and to moderate the excessive heat in summer by cool air. For the patient ought not to be stifled by heat and cloaths, nor should the eruption and perspiration be checked by cold. However, great care ought to be taken in general to supply him with pure and cool air; because a hot air causes difficulty of breathing, checks the secretion of urine, and increases the number of pustules on the internal organs of the body.

With regard to Diet, it ought to be very slender, moistening, and cooling; such as oatmeal or barley-gruel; and in the beginning, the best regimen is that which keeps the body open, and promotes urine. This end is obtained by boiling preserved fruits with their food, such as figs, Damascene plums, and tamarinds; and by giving them subacid liquors for drink; as small-beer acidulated with orange or lemon juice; whey turned with apples, boiled boiled in milk; emulsions made with barley-water and almonds; Mofelle, or Rhenish wine plentifully diluted with water; or any other things of this kind.

In the cure, Sydenham directs bleeding on any of the three first days to nine or ten ounces; and then an ounce, or an ounce and a half of emetic wine. But some physicians will not allow a vomit by any means, unless there is a nausea, and the head is much affected. Yet Hoffman judges it to be proper on the first day of the invasion, and prescribes two grains of emetic tartar dissolved in cinnamon water, to adults.

In youths and adults, it is often necessary to take away blood two or three times, only with an intermission of two or three days between each time. Blood-letting is so far from being an obstacle to the eruption of the pustules, if the patient is not too weak, that it forwards it considerably.

After Bleeding, a vomit should be given, if the stomach abounds with phlegm or bile, or be loaded with food unseasonably taken. Otherwise a purge may be prescribed before the eruption of the pustules: which may be the infusion of senna with manna, or manna alone, especially for children; for no disturbance is to be raised in the body.

To keep the inflammation of the blood within due bounds, and to assist the expulsion of the morbid matter through the skin,

Take half an ounce of bezoar in powder, 2 drams of purified nitre. Mix, and beat into a powder.

Half a dram of this may be taken by an adult three or four times in a day; diminishing the quantity for children in proportion to their age.

Sometimes equal parts of these ingredients may be prescribed; and if the effervescence of the fever runs very high, a proper quantity of the spirit of vitriol may be added to the patient's drink. But if there be any reachings to vomit, they will be removed by draughts containing half an ounce of the juice of lemons, with one scruple of the salt of wormwood.

When the eruption of the pustules is completed, which generally happens on the fifth day from the attack, let the patient take an ounce of diacodium every evening till the tenth day after the invasion. On that night, if the smallpox be of the confluent kind, the dose must be increased to an ounce and a half; and an ounce in the morning; and so an ounce and half every night till the patient is recovered.

Whatever are the fort, and at whatever time of the disease a phrenzy shall happen, it is to be curbed by paregorics, given one after another till the end is obtained, only waiting to see the effect of one dose before another is ordered.

In the mean time, if the patient is costive, which is generally the case, and the fever continues, the body is to be opened with a clyster every second or third day.

If the method is proper in the distinct small-pox, it will be found more necessary in the confluent, which is attended with greater fear and danger.

In every fort of this disease, it is proper to open the body on the decline, that is, on the ninth or tenth day from the eruption, because a putrid fever generally comes on about that time, while the pustules are drying, or upon the subsidence of the swelling of the inflamed skin, where there is no suppuration, which fever cannot be taken off with equal safety by any other means; but gentle cathartics alone are to be employed in this case, such as were directed before the eruption of the pustules.

It will also be of use at this time to take away some blood, if the heat be too great, and the patient have strength to bear it.

This putrid fever is by Sydenham called the secondary fever, which comes on with heat, inquietude, toiling, &c. and, unless prevented, takes off the patient in two or three days. He mentions this fever as coming on the eleventh day, or later; but this is to be understood from the time of the invasion, whereas Mead reckons from the time of the eruption. Sydenham prescribes large bleeding, and a cathartic two days after, viz., one ounce of lenitive electuary dissolved in 4 ounces of simple alexeterial water, together with the free use of paregorics.

If the spittle through heat is so tough that it cannot be hawked up, let a gargle be frequently injected into the throat with a syringe. It may be compounded of barley-water and honey of roses.

When the matter of salivation grows very viscid, and begins to clog the larynx and trachea, the best method is to boil marsh mallows, myrrh, and honey, in a sufficient quantity of water and vinegar, and to transmit the steam of the decoction into the patient's mouth, thro' a glass or tin tube, of such a shape and length as is most commodious for a recumbent posture.

From the eighth day to the end of the disease, garlic may be applied to the soles of the feet; which must be renewed every day, especially when the brain is affected.

When the pustules are perfectly dry and withered, the face may be anointed with a liniment, made of equal parts of oil of sweet almonds and pomatum, for two days and no longer.

Twenty one days after the invasion, let a vein be opened in the arm, and the next day give a cathartic, which may be repeated every other day three times more.

This is necessary, because no species of fever requires the body to be thoroughly cleared of the remains of the disease more than this. After the cathartics, the body is to be restored to its former state by a course of milk, especially that of asses, with suitable food, and the air and amusements of the country.

As there are particular accidents in the small-pox which do not commonly occur, it will be proper to say something of them. Sometimes the patient is seized with convulsions just before the eruption, which is rather a good than a bad sign in children. In this case, blood-letting is carefully to be avoided; but a blister is to be applied to the neck, and to the soles of the feet. Plasters made of equal parts of the cephalic and blistering plasters; not forgetting to give antispasmodic medicines inwardly. The chief are wild Valerian root, Russian catnip, and the spirits of volatile salts chemically extracted from animals.

In adults, the thing is otherwise; for they, if not too weak, may lose a moderate quantity of blood, and then be put into the foregoing method.

Haller Haller tells us, that camphire assists greatly in filling the small-pox of the confluent kind with petechiae; and Monro, that the Peruvian-bark does the same, that it filled the empty vesicles with matter, changed the watery fancies into thick white pus, made the petechiae or spots turn gradually to a pale colour, and caused the pox to blacken sooner than was expected. The dose in powder, is from ten to twenty grains, in some rich syrup, with an aromatic distilled water, every four or five hours. Children may take it in a clyster, with a small quantity of warm milk, after the bowels are unloaded with a preparatory clyster. If the clyster was retained too short a time, syrup of poppies was added, or diacordium. These injections were repeated morning or evening oftener. The bark has had good effects in mitigating the secondary fever. When the lungs are greatly stuffed, it is not to be given.

When the eruption appears without much fear or pain, it is not without danger; for the pustules frequently do not tend to maturity, and there is no suppuration made. Hence the fever increases, with inquietude of body, anxiety of mind, difficulty of breathing, and a delirium, which carry off the patient in a few days. In this state, the fever ought rather to be raised than checked; and then warm medicines are to be directed which promote suppuration, by increasing the motion of the blood, and thinning the humours, such as Virginia snake-root, contrayerva-root, saffron, asa foetida, myrrh, and the like.

But above all, Blisters must be laid on the limbs.

When the matter of the infection is over abundant, as it happens in bad cases, nature never fails endeavouring to throw off the load. Thus in adults a spitting comes on upon the first days of the eruption; whereas children have a looseness almost through the whole disease, which is not to be inconsiderately stopped. So in adults, if the spitting does not go on to our wishes, it ought to be promoted by medicines which stimulate the glands of the mouth, especially gargles made of a decoction of mustard-seed and pepper, with the addition of oxymel. For in the confluent and malignant small-pox, if this flux does not arise and continue to the end of the disease, it is a very bad sign.

The method of abating the rigour of this disease, and preventing the great mortality with which it was often attended, by inoculation, is now so well known and so generally practised, that a particular detail of it in this place is unnecessary.

Of the Erysipelas, or St Anthony's Fire.

An Erysipelas is an eruptive fever, from which no part of the body is exempt; but it chiefly attacks the face. It begins with chills and shivering, and other common symptoms of a fever. The part affected swells a little, with great pain, and intense redness, and is beset with a vast number of little pustules; which when the inflammation is increased, are converted into small blisters.

This disease has great affinity with a petilential fever; for it begins suddenly, with great shaking, heat, loss of strength, violent pain in the back and head; to which may be added vomiting, and a delirium; but this is to be understood of the worst sort. On the third or fourth day the malignant matter is thrown out on the surface of the body, and then the symptoms a little abate. There is often a pain, redness, and tumour in the inguinal glands, from whence matter of a hot fiery quality descends to the feet. If the head is attacked, the parotid glands are affected; if the breasts, the axillary. The mammary and axillary glands are not seldom ulcerated, and affect the joints with a virulent corruption. And likewise, as in the plague, there is nothing more dangerous than the return of the expelled matter back from the surface of the body to the inward parts.

In some, especially young persons, the matter is not so virulent, nor the fever so great; the glands remain unaffected, and the eruption happens on the second day. This is not at all dangerous.

An erysipelas is either true, or simple and spurious, which is likewise called scorbutic. The simple only affects the surface of the skin, and readily yields to proper remedies. But the spurious is more chronic, is harder to cure, and often degenerates into malignant ulcers. Besides, this disease is sometimes idiopathic, or a primary disease; and sometimes symptomatic, or a secondary one. For instance, in the anaerobic, the acutes, the yellow and black jaundice, a symptomatic erysipelas sometimes supervenes, and quickly kills the patient.

If it seizes the Foot, the parts contiguous will shine; if it be attended with great pain, it will ascend to the legs, and will not bear to be touched.

If it attacks the Face, it swells and looks red, and there are plenty of watery vehicles. The eyes are closed up with the swelling; there is a difficulty of breathing; the fauces and nostrils are very dry, often attended with a numbness and drowsiness: hence an inflammation of the brain is to be feared, or a mortal lethargy.

If it affects the Breasts, they swell, and grow almost as hard as a stone, with exquisite pain, and they are very apt to suppurate. There is a most violent pain in the axillary glands, in which an abscess is often formed.

In children the umbilical region generally suffers, with a fatal event.

If in a day or two the tumour subsides, the heat and pain cease, the rosy colour turns yellow, the cuticle breaks and falls off in scales, the danger is over. When the erysipelas is large, deep, and falls upon a part of exquisite sensibility, the patient is not very safe. But if the red colour changes into black and blue, it will end in a mortification. If the inflammation cannot be discussed, it will suppurate, and bring on fistulas and a gangrene. When the patient is cachexic, the leg will sometimes swell three times as big as the natural size, and is cured with great difficulty. Those who die of this disease, die of the fever, which is generally attended with difficulty of breathing, sometimes a delirium, sometimes with sleepiness; and this in seven days time.

Let the patient's diet be only water-gruel, or barley-broth, with roasted apples. If he drinks any beer, let it be very small; and let him keep out of bed some hours in a day.

Take away 9 or 10 ounces of blood, and the next morning let the patient take the common purging potion.

It is a constant rule among practitioners, in all acute and eruptive fevers, to keep the body in a gentle diaphoresis. The same method is to be observed in this disease.

If the patient is plethoric, addicted to spirituous liquors, and more especially if the disease attack the head, bleeding is necessary.

It will be safest to avoid external applications, unless a powder made of elder-flowers and liquorice sprinkled on the part; or lime water, mixed with a fourth part of spirit of wine and camphire, dipping a linen cloth in it several times doubled, and applying it hot to the part.

An infusion of scordium, elder-flowers, and fennel-seed, drank in the manner of tea, is useful to expel the morbid matter.

If the disease does not yield to the first bleeding, let it be repeated: if that will not do, let it be reiterated twice more; one day being interposed between.

On the days free from bleeding, prescribe a clyster of milk and syrup of violets.

Some think purges not necessary in the beginning of this disease; but in an erysipelas of the head, when it affects the brain with a coma and a delirium, either the case is desperate, or cathartics will succeed. However, first apply blisters to the neck.

If, after all, the tumor remains, and begins to turn livid; if the pain lies deep, and seems to reach the periosteum, and the part has a tendency to ulcerate; then it will be proper to promote a suppuration; at the same time endeavouring to stop the progress of the putrefaction. For this purpose the common plaster will be proper, with a sufficient quantity of camphire and saffron. When there is matter that lies deep, the tumour is to be opened with a lancet, and the pus is to be got out by degrees, not all together.

When the abscess is in a glandulous part, and has degenerated into a fistulous ulcer, after evacuating the matter, a balsamic liquor is to be injected, made of tincture of St. John's wort, tincture of balsam of peru, choice myrrh, and a few drops of the spirit of turpentine.

When there is a mortification coming on, give things inwardly that resist putrefaction, as nitre and a little camphire, [or rather the Peruvian bark.] Outwardly apply a mixture of lime-water, camphorated spirit of wine and vinegar with litharge; as also tincture of myrrh, [or of myrrh and aloes] made pretty hot, with a linen cloth doubled, and often repeated.

In the scorbutic erysipelas, which continues for some time, it will be proper to give gentle laxatives and purifiers of the blood, with diaphoretics. After the body has been opened for some days, give diuretics and diaphoretics alternately for a considerable time; and for common drink, order a temperate decoction of mucilaginous woods and roots with bitters; particularly succory roots, dandelion-roots, and raisins.

Of the Synochus, or Continual Fever without remission.

This fever, by some called Synocha, by others a Continual Fever, is an acute sanguineous fever, because it is raised by a congestion of the blood, chiefly in the nervous-membranous parts; which, unless timely discussed by the benefit of nature and art, produces a fatal inflammation,

It begins, in some, with a mild sense of cold, and is soon attended with very grievous symptoms, continuing without remission till the critical time, with a great and full pulse. If the blood is forced to the head, for it always affects one part more than another, the face will swell, the eyes will be red and full of tears; there is a pain in the head, with a pulsation of the temporal arteries, a vertigo, a sleepiness, torpor, or a raving. When the blood rushes impetuously into the ventricles of the heart and pulmonary vessels, causing a distention therein; then the breathing will be thick and difficult, with a straitness of the breast, as also an anxiety and palpitation of the heart, attended with a loss of strength, and a dejection of the mind. A slight inflammation of the oesophagus, with a spasmodic stricture of the glands of the fauces, will cause thirst, dryness and blackness of the tongue. If the inflammatory congestion happens in the stomach, it will create a nausea, a reaching to vomit, and sometimes a hiccup. If in the intestines, there will be inflammations grievously exacerbating the disease, together with a constiveness, or an ejection of fetid excrements. If in the vessels proceeding from the mesenteric arteries and vena portae, there will be a fixed pain at the first vertebra of the loins: if in the membranes of the spinal marrow, the patient will tumble and toss and lie irregularly in bed, and will have a torpor and languor of the limbs, sometimes attended with convulsions.

But all these symptoms never happen to all, nor is their violence constantly alike. Some distinguish this fever into the simple and putrid. The first is caused by a congestion of good blood in improper places. But when it attacks persons full of impure juices, who have been weakened by a preceding disease, constant anguish of the mind, excessive coition, or inordinate living, the symptoms are much more grievous, with loss of strength, and the disease will continue till the fourteenth or the twenty-first day, sometimes with eruptions, dusky or black spots, with immediate danger.

If the cause is not violent, this disease will often disappear, merely by the benefit of nature, on the fourth, seventh, or eleventh days, with a large sweat or bleeding at the nose, and, though very seldom, by a flux of the belly, unless it has something of malignity.

When the disease is rightly managed in the beginning, that is on the first, second, and third day, with bleeding and cooling things, and gentle diaphoretics, it will end on the fourth. But if the bleeding is omitted, or is too little, it may continue till the fourteenth or seventeenth day, with the more grievous symptoms, as also a delirium: but it will terminate at last by a sweat or looseness.

When it proves fatal, the patient generally dies of a spasmodic inflammation of the brain, or other parts, as the stomach or intestines.

The intentions of cure are, 1. To free the vital parts from too great a congestion of blood, which will either disperse a slight inflammation, or prevent a great one. 2. To appease the exsudation of the blood and the spasmodic affection of the system of the nerves. 3. To discul the stagnating and corrupted fluids, and to restore a free circulation of the blood, chiefly to the surface of the body.

To answer the first intention, the patient must lose blood. blood freely. Then the orgasm of the blood must be appeased with diluents, acids, and nitrous compositions. And certainly if any disease requires acids, and the juice of tart fruits, it is this, such as tamarinds, and the juices of currants, oranges, and lemons.

Take two pounds of water; rose-water, white sugar, and juice of oranges, of each one ounce.

The jelly of hawthorn made pretty thin, with the addition of orange-juice, sugar, and rose-water, will make a proper demulcent and cooling drink; or whey turned with juice of lemons or oranges.

To direct the motion of the blood to the surface of the body, gentle diaphoretics will be proper, such as the bzoardic or absorbent powders, sometimes alone, and sometimes with citron juice. Likewise infusions of the leaves of veronica, scordium, or cardus benedictus, with fennel-seed, drank in the manner of tea, especially to promote sweating on the fourth day, when the disease is like to terminate with this salutary excretion.

It will be necessary, whether this fever be simple or putrid, to keep the body open; for which purpose a clyster made of whey, honey, oil of sweet almonds, with a little nitre and salt, will be proper; for by this means the structure of the intestinal fibres will be relaxed, and flatus's will be discharged, which distend the colon. In the decline of the disease, when there are apparent signs of coction in the urine, a laxative of manna and cream of tartar, or castor and rhubarb, will be of great use.

Of the Bilious Fever.

The bilious is a kind of a burning fever. It begins with intense heat, thirst, anguish, and inquietude. There is likewise a vomiting, or a perpetual reaching to vomit, with frequent bilious stools, a coldness of the extremities, internal heat, and cardialgic anxiety. This fever is either acute, or very acute. In this the symptoms are more violent, the bilious purging upwards and downwards is very plentiful, joined to a cardialgia with fainting. It generally kills before the seventh day, with an inflammation of the stomach and duodenum; the signs of which are, a fixed igneous heat about the precordia, with a coldness of the extremities, high inquietude and anxiety, a hiccup, and a plentiful eructation of bile and salivary liquor, a jaundice-colour of the countenance, and a hippocratic face.

Some are not so acute, but run a greater length, with now and then a remission, and perhaps an intermission, and have an exacerbation, with vomiting, anxiety, and coldness every other day, or every third day, and ought to be called continual quotidians or tertians.

It is caused by a bilious fluid secreted plentifully in the liver, and poured out into the stomach and duodenum, where by its acrimony and corrosiveness it stimulates the nervous tunics, corroding and inflaming them; whence the symptoms proper to this fever arise, such as a burning heat, a cardialgic anxiety, a nausea, a reaching to vomit, and a violent purging upwards and downwards.

Hoffman, in the cure of the bilious fevers mentioned by him, would have the caustic acrimony of the bilious juices abated and sheathed by absorbent powders and nitre, which should be taken in a sufficient quantity of a liquid, and often repeated. He likewise recommends emulsions of almonds, of the cold seeds; elder flower water, rose-water, &c. as also jellies of hawthorn, milk and water, oil of sweet almonds, sweet whey, chicken broth.

After these things, medicines must be given to restrain the impetuous bilious excretions, and to abate the too quick sylaltic and peristaltic motion of the biliary ducts, and to prevent the too great excretion of the bile.

In the cure of the Bilious Fever of the camp, Pringle, before it becomes continual, depends on the proper use of evacuations, the neutral salts, and the bark. Bleeding is the first thing to be done in every case, and is to be repeated once or oftener, according to the urgency of the distemper. The vernal and later autumnal remittents are accompanied with rheumatic, pleuritic pains, and other symptoms of high inflammation, which require more bleedings than the intermediate season. To omit this, and give the bark too soon, will bring on an inflammatory fever. A vein may be opened safely either during the remission, or in the height of the paroxysm.

After bleeding, give an emetic in the remission or intermission of the fever, and rather soon after a paroxysm than before one. But emetics do harm when the stomach is inflamed, or when the disease has continued some time, and has assumed the type of a continual fever. However, we may safely give one when the fever intermits, or has considerable remissions. Ipecacuanha is safest, but antimonials most efficacious. If the remissions are small, or the fever great, or there is a tendency to vomit, the former is best. But when the remissions are distinct, or the remission perfect, the latter should be preferred; or it may be joined to the former; that is, two grains of tartar emetic, with a scruple of the powder of ipecacuanha. Those vomits are best which produce stools, especially if they procure a plentiful discharge of corrupted bile upwards or downwards.

If the body continues costive, a laxative will be proper, especially if there is a tenesmus, or pains in the bowels. The saline draught, with salt of wormwood and lemon-juice, will bring the fever sooner to regular intermissions.

Whenever the sweats are not profuse enough in proportion to the fits, the quantity of an ounce of spir. Mindereri may be given, divided into two or three draughts, before they go off. It promotes a plentiful diaphoresis, without heating.

As the fevers are never without an inflammation in the beginning, and then rarely have complete paroxysms, the bark is not to be given till the urine breaks, and there are entire short intermissions; nor yet before bleeding, as was observed above; nor before the first pallsages have been cleansed; otherwise the fever will return, or a tympanites will be produced.

It is best to give the bark in substance in Rhenish wine; or an ounce of it may be made into an electuary, with syrup of lemons, and a dram of sal ammoniacum. If the patient has not been purged, it will be proper to add as much rhubarb as will keep the body open for the first two or three days of using that medicine. It is chiefly useful when the bilious humours abound, as they mostly do in marshy countries. If the paroxysms are quotidian, and the intermissions short, it may be necessary to give the bark before the sweating is quite over.

If the disease has been neglected in the first stages, or if after the remissions or intermissions it changes to a continual fever, with a full and hard pulse, a vein must be opened. But if there is a pain in the head, or a delirium, and the pulse small, it will be best to apply leeches to the temples. But whether the patient is bled or not, blisters are the best remedy. If the prime visé are loaded, clysters or a laxative may be proper; but neither vomits nor purges; nor are those to be repeated without caution. To these remedies the saline draught may be added.

Sweating is the proper crisis: it is never to be promoted by theriaca or volatiles; but when the pulse sinks, and petechiae, or other symptoms appear, it will be proper to use the warmer alexipharmics, and to treat the disease like a malignant fever.

A loofeves is the least favourable crisis: yet if there are colic pains, or a tension of the belly, attended with dryness of the skin, it will be proper to procure stools by a clyster, or a gentle laxative, such as the infusion of rhubarb with manna; which is to be repeated as the patient can bear it.

Of a Causus, or Burning Fever.

The principal symptoms of a causus are, a heat almost burning to the touch, most remarkable about the vital parts, but more moderate towards the extremities, which are even sometimes cold: the breath is extremely hot; there is a dryness of the whole skin, nostrils, mouth, and tongue. The respiration is thick, difficult, and quick; the tongue is dry, yellow, black, parched, and rough; the thirst is unquenchable; there is loathing of food, a nausea and vomiting; an anxiety, inquietude, and great lassitude; a little cough, a shrill voice, a delirium, a phrenzy, a continual watching or a coma, convulsions, and on the odd days an exacerbation of the fever.

In this temperate climate these sort of fevers are very rare; those that are more common among us are the burning sanguineous, or the continual bilious fevers without remission.

This begins without any remarkable coldness or shivering, with great heat, thirst, watching, anxiety and inquietude. In sanguineo-bilious constitutions, and in bodies full of hot bilious blood, they terminate in critical days in health or death, being first preceded with a shaking. They terminate in a salutary manner, with a sweat or a bleeding at the nose.

On the third and fourth day it often proves mortal; it seldom exceeds the seventh, if violent.

It is often terminated by an hemorrhage; which if small on the third and fourth day, it is a fatal sign. It is best if it happens on a critical day.

A solution of this fever on a critical day, may also be by vomiting, stool, sweat, urine, or spitting thick phlegm. If the exacerbation of this disease happens on the second or fourth day, it is a bad sign; on the sixth, not so bad.

The urine black, small in quantity, and thin, is fatal; so is spitting or pissing of blood. A difficulty of swallowing is a bad sign; but the worst of all is coldness of the extreme parts. The face red and sweaty, is bad; a parotis not tending to suppuration is fatal; the body too loose is fatal. A tremor turning into a delirium is mortal; it often changes into a peripneumony with a delirium. When this disease succeeds gripings of the bowels, it is worst of all.

A critical determination of this fever is usually preceded by a rigor, or shaking.

The Cure of a burning fever is most easily obtained in a pure, cool air, frequently renewed: The patient must not be oppressed or stifled with bed-cloaths, but should sit up often. He should drink plentifully of soft, sub acid, aqueous, and warm liquors. His diet should be light, made of pearl barley, oatmeal, and sub-acid fruits.

Bleeding is necessary at the beginning, if there is a plethora, or signs of a particular inflammation, or the heat is intolerable, or the rarefaction too great, or a revulsion necessary, or the symptoms urgent, in which circumstances the disorder is hardly to be vanquished by any other remedies.

Soft, diluting, laxative, antiphlogistic cooling clysters, are to be repeated as oft as the heat, coitiveness, and revulsion require them.

The whole body is to be moistened by receiving into the nostrils the steams of warm water; by washing the mouth, throat, feet, and hands, with the same; by fomenting with warm sponges the places where the vessels are most numerous, and most exposed to the touch.

The medicines should be aqueous, soft, nitrous, gratefully acid, gently laxative, not promoting sweat and urine by their acrimony, but by their plenty; such as remove the contraction of the fibres, resolve the thickness of the humours and dilute, and temper their acrimony.

To appease thirst in this disease, and to moisten the tongue and parched sauces, there is nothing better than sweet whey, in a quart of which half a dram of pure nitre has been dissolved. Small draughts of this, a little cool, may be drank frequently, which will likewise extinguish the pernicious heat. The mouth and throat may also be washed with water, mixt with syrup of mulberries and nitre.

Purgatives are dangerous before the crisis, but clysters may be used, made of milk, honey, and a little nitre. After the crisis, which is known by the sediment in the urine, laxatives made with tamarinds, manna, rhubarb, raisins, or cream of tartar, are absolutely necessary.

Of the Burning Bilious Fever, or Yellow Fever of the West Indies.

The yellow fever begins with a momentary chillness and shivering, which is soon succeeded by a burning heat all over the body, but is felt more intensely about the precordia. The pulse is high, strong, and rapid; the eyes are heavy; with a throbbing pain in the head, and a violent beating of the temporal arteries, and a thick, laborious respiration: There is a nauseousness, and reaching to vomit; and when anything is thrown up, it is of the bilious kind: Besides these, great anxiety, pain in the back and loins, and an uneasy lassitude in all the limbs. About twelve hours after the invasion, the tongue is dry, harsh, rough, and discoloured, with insatiable thirst; there is a soreness all over the body, great restlessness, and a delirium.

In the last stage the patient labours under a great coma, oppression of the precordia, heaving of the lungs, an interrupted respiration, tremblings of the tendons, convulsions, and cold clammy sweats.

It usually terminates in a favourable crisis, or the death of the patient, about the fourth day after the attack.

The regular crisis generally discovers itself by a suffusion of the bile all over the surface of the body about the third day. The saffron tincture is frequently discovered in the eyes twelve hours after the invasion: the sooner it appears, the more favourable is the prognostic.

If the jaundice comes on too soon, it is bad; if with livid spots, which sometimes, though rarely, appear, it is fatal. If the skin continues obstinately dry and rough, the case is dangerous; and the more so, the longer it continues; for these very seldom recover, be the pulse ever so good. The pulse is not to be depended on; for many have a good pulse a few hours before death. If the vomitings are incessant, grow darker, and the hiccup comes on, it is generally fatal. If the face is greatly flushed; and the vessels of the white of the eye are turgid with blood, as in an ophthalmia attended with phrenzy, the patient is likely to die in a very little time, especially if the skin is dry.

But if the head continues clear, the pulse becomes soft, the pains, nausea, and anguish are relieved by bleeding; as also if the humours vomited up are carried downwards by laxatives; if then the inquietude ceases, the skin grows soft and moist, and the patient has better spirits; it is probable he will recover.

Bleeding is the first thing to be done, more or less, according to the force of the disease and the strength of the patient; and, if the symptoms continue in their full vigour, should be repeated once in six or eight hours, lessening the quantity proportionably each time.

After the first bleeding, give a vomit of ipecacuanha, quickened with three or four grains of emetic tartar, (or rather two grains,) which will bring up a great quantity of yellow, porraceous, and sometimes blackish bile, and carry the humours downwards.

After this the patient may drink plentifully of diluting, refrigerating, and subacid liquors, made with oranges, lemons, tamarinds, spirit of sulphur, spirit of vitriol, and such like, in barley-water, spring water, or other thin and cooling vehicles. He may likewise be allowed tartish juicy fruits; as ananas, granadilloes, Barbadoes cherries, and water-melons; as also plantains, and bananas, roasted for food, jelly of guavaes, &c.

Cooling tellaceous powders are likewise very beneficial.

Towards the evening it will be necessary to inject a clyster, made of the common decoction, with half an ounce of cream of tartar, an ounce of manna, or an ounce of pulp of casia added to it.

When the operation of the clyster is over, paregorics will be proper, as thus:

Take 2 ounces of mint-water, one ounce of cinnamon water, 25 drops of the tinctura thebaica, and a sufficient quantity of sugar.

The room should be kept cool, and sprinkled with vinegar, rose-water, and cooling herbs. Fresh air should be admitted, but not to blow directly on the patient's body.

Blisters are also of great efficacy at this juncture; which if applied before it be too late, a coma, the deadly symptom of this distemper, very rarely ensues.

The patient's diet should be nothing but thin panada and water-gruel, gratefully sweetened and acidulated.

Besides plentiful and frequent draughts of cooling liquor, the patient should be allowed preserved tamarinds, slices of lemon with a little sugar; but above all, penguins, which by their sharpness penetrate the thick tenacious scurf, whereby the glands of the mouth will be unloaded. Opiates must also be used in larger doses than in Europe.

Cooling and lenient clysters must also be repeated every eight hours.

When the patient begins to be comatose, the third and last stage of the disease is advancing; in which are, difficulty of breathing, oppression of the precordia, convulsive twitching of the tendons, interruption of the pulse, and at length its total cessation.

In this case, a compleat set of blisters must be immediately applied, or the old ones renewed; which must be laid to the nape of the neck, on the wrists, thighs, and legs, and a large one on the crown of the head. To the soles of the feet may be laid a cataplasm of salt-herrings and mustard.

With regard to the urgent symptoms; pains of the head, watchfulness, and deliria, are to be relieved by emollient and laxative clysters, gentle purgatives, cupping with scarification, opening the frontal vein, lotions of the feet, and narcotics.

Blisters are also useful for the same purpose.

Convulsions require much the same treatment externally; and internally, aurum muriatum, (the dose from four grains to a scruple.) To restore the strength of the patient, little more is required than a stomach purge or two, mild and agreeable bitters, and a restorative regimen of broths, jellies, and white meats.

If the yellow tincture remains upon the skin, give a vomit of ipecac, and a purge or two with the decoction of senna, tamarinds, &c. and allow the use of lemons, oranges, and other acid fruits. If this disorder proves obstinate, treat it as the jaundice.

Of the Senegal Fever.

The fever which chiefly prevails in this country in the months of July, August, and September, is of the worst kind. It usually begins with drowsiness, languor, and great rigors, which continue frequently three or four hours, and are succeeded by intense heat and sweats. For three or four days it remits, and both the shiverings and hot fits become more moderate. During this period, the pulse is quick and low; but afterwards becomes fuller, unless some evacuation intervene. At this time profuse sweats are easily brought on; in which case there are little hopes of recovery. A parched, dry skin, is as bad a symptom, if it continues more than a day; for an intermitting Intermitting pulse and a delirium succeed, and continue for seven or eight days, the frequency of the intermissions increasing every day; but if a general moderate moisture comes one at this, or any other time of the disorder, and continues, the patient recovers. A violent pain in the head and back, and difficulty of breathing, are general complaints. Sudden languors, and bilious vomitings, are frequent through a great part of the time.

Some are taken with a great heat, and a strong quick pulse, without any shiverings or remissions, as abovementioned. In this case the patient sooner dies upon the appearance of bad symptoms, and is longer in recovering upon the appearance of good ones.

The loss of eight or ten ounces of blood, in the first attack of these fevers, has sunk the pulse beyond a possibility of raising it afterwards, and that even in plethoric habits, attended with great pains of the head. It is, indeed, surprising how little these fevers will bear of evacuations of any kind, especially bleeding.

After profuse sweats, the pulse becomes extremely slow; and, though the sweating goes off, continues so for two or three days, with anxiety and restlessness; after which the pulse grows quick, the skin parched and hot, and a series of bad symptoms comes on.

The sick are always comatose and fluid; which symptom is little dangerous when attended with a warm moisture on the skin, but otherwise it is generally fatal.

It is of great consequence to keep up the pulse; but here the common cordial medicines are ineffectual; yet the decoction of the bark, with the camphorated julep, and spirit of vitriol, answers this purpose effectually, so as to render any other medicine unnecessary, except occasionally a gentle emetic or laxative.

Of the Inflammation of the Stomach.

The inflammation of the stomach is known by a burning, fixed and pungent pain in the stomach, which is exacerbated at the instant anything is taken into it; and is succeeded by a most painful vomiting and hiccup. There is always a violent internal heat, high anxiety, and a grievous pain about the precordia, chiefly at the pit of the stomach, an acute, continual fever, great thirst, difficult breathing, inquietude, tossing of the body, coldness of the extreme parts, a hard, contracted, quick, and sometimes unequal pulse.

It may be distinguished from other disorders of the stomach; for in the cardialgia, there is also a great anxiety about the precordia, a pressing acute pain reaching to the back, a coldness of the extremities, a constant stimulus to vomiting, with inquietude: But the heat in the region of the stomach is not so violent, nor is the thirst and dryness of the tongue so great, nor the pulse so quick and contracted, and the stomach can better bear and retain anything taken inwardly; nay, is frequently relieved thereby. An inflammation of the intestines has a pain or gripes more about the region of the navel, with frequent, frothy, bilious stools, or a little bloody, with a heat over all the surface of the body, and a quick large pulse: Whereas in this disease the extremities are cold.

If it be caused by drinking cold liquors when the body is hot; or from an effusion of the bile after violent commotions of the mind; the danger is not very great, as there will be room for suitable medicines to take effect: But that which arises from drastic purges, sharp emetics, or caustic poisons, kills quickly without speedy assistance. This disease likewise often proves fatal to the old, the infirm, the scorbutic, and persons full of grief, as also in the end of acute diseases.

When there is a restless tossing of the body; when liquids are immediately thrown up; when there is a hiccup, a fainting, an hippocratic face, an intermitting pulse, and convulsions, a fatal mortification will soon terminate the patient's life.

This disease, if not suddenly cured, is generally mortal: And therefore, as soon as it is discovered, plentiful bleeding is necessary, and must be repeated as the violence of the symptoms increases. Let the drink be very soft, antiphlogistic, and emollient; as also cataplasms of the same kind.

The patient should totally abstain from every thing that is acrimonious; even the cooling, nitrous salts, which are beneficial in other inflammations, irritate too much. Vomits, cordials, and spirituous liquors, are little better than poison.

Aliments should be given frequently, and by a spoonful at a time; for any distention increases the inflammation. A thin gruel of barley, oatmeal, whey, with very little sugar or honey, or chicken-broth, are proper aliments; whey-emulsions, barley-water, emollient decoctions, are proper drinks.

The indications of cure are, 1. To open the obstructions caused by tenacious juices impacted into incongruous vessels; 2. To remove the spasmodic strictures which contract the vessels, and to restore the equable and natural progress of the blood through the substance of the stomach. These ends are to be obtained by diluents, bitters, demulcents, antiphlogistics, and things that restrain the heat which thickens the fluids, and relax the constricted fibres.

But as there are more causes than one that produce an inflammation, they will require different remedies to bring about a cure.

Therefore, if it be owing to a caustic, septic, arsenical poison, or a strong emetic or cathartic, or to metallic medicines ill prepared, and thence the inflammation; oily fat things are proper, as new milk, cream, oil of sweet almonds, or olive-oil taken often and plentifully.

If from a spasm, succeeding a violent commotion of the mind, then a nitrous absorbent powder will be proper, in an emulsion of white poppy seeds. When the spasm is appeased, rhubarb with raisins will be necessary to carry off the bilious fortes.

When an eruptive matter is repelled and causes this disease, use emulsions of the greater cold feeds, with temperate bezoard powder; now and then adding a little nitre and a small matter of camphire.

If from a caustic bile, as in the cholera morbus, an inflammation is apprehended, earthy absorbents and hartsorn philosophically prepared should be given, with gelatinous decoctions of calves and neats feet, or hartshorn-jellies. jellies and water-gruel. Outwardly, the following liniment is useful in all cases:

Take of oil of sweet almonds 2 ounces, and a dram of camphor; mix and make them into a liniment, to be applied warm to the stomach.

Of the Quinsey.

A Quinsey is an inflammation of the faucés, with a burning pain, tumor and redness; a difficulty of breathing or swallowing; and a fever, proceeding from a stasis of blood, or a viscid acrid serum in the languineous or lymphatic vessels.

It begins with a fever, which is followed with a pain and inflammation of the faucés, causing the uvula, tonsils, and larynx to swell; whence great difficulty of breathing and swallowing ensues.

This disease may be seated at the root of the tongue near the os hyoidei; the foramina of the nostrils opening to the bone; the beginning of the oesophagus; the muscles of the pharynx; the internal and external muscles of the larynx; the greater and lesser glands; the tonsils, or the muscles moving the jaws.

When a quinsey affects the internal muscles of the larynx, and there is no outward redness about any part of the neck, but a burning pain inwardly, a loss of voice, and great difficulty of breathing; it often kills in twenty-four hours. This is called a cynanche. When it is seated in the internal muscles of the pharynx, it is called a cynanche; in which there is no external tumor and redness, but a great difficulty of swallowing and breathing, and whatever is drank returns through the nose. When there is an outward tumor and redness, and the external muscles of the pharynx are affected, it is a paracynanche; when the external muscles of the larynx, a parakyranche.

A quinsey is likewise distinguished into the true and spurious. The true arises from the stasis of the blood; the spurious or bastard from a congestion of the serum. The former is acute, always attended with a rigor and a fever. The latter has rather a lymphatic or catarrhal, than an acute fever. The first has not only a burning, pricking pain in the inner parts of the faucés, but the tongue is turgid with blood, and of a dark reddish colour; the face is likewise red; there is a great pulsation of the temporal arteries; sometimes a head-ach, a torpor of the senses; sometimes fainting.

When it is very violent, there is a difficulty of breathing, high anxiety, and coldness of the extremities; and is very dangerous, requiring speedy help. But in the spurious, these symptoms are either absent, or more mild; nor is the danger so great.

This disease may be caused by a suppression of some usual sanguineous evacuation; by admitting the cold air after a strong sudorific has been taken; and by lying in rooms new plastered or white-washed. Some caustic poisons affect the throat more than other parts. White hellebore attacks the faucés, and brings on strangulation. The same ensues from the salamum furiosum, and the bite of a mad dog. The fumes of arsenical and mercurial minerals, as also the vapours of mineral spirits, will have the same effects.

It sometimes comes on spontaneously, and is again the symptom of another disease, as the diarrhoea and dysentery, especially if the flux is hastily stopped. It has happened from the striking in of an erysipelas; or sometimes from the gout being injudiciously treated with topicks; as also from the smallpox, or a malignant or pestilential fever. The cause of the symptomatic disease is coltiveness, or suppressed perspiration, or the striking in of eruptions. When it is epidemic, it has something of malignity.

When the swelling, pain, and redness, appear more outwardly, and vanish by degrees, it is a sign of a happy solution of the disease. But when the external swelling suddenly disappears, without a mitigation of the symptoms, it shows the morbid matter to be translated elsewhere, and will change to a phrenzy or peripneumony. Or this disease may terminate in a suppuration or gangrene, or a schirrus. A frothing at the mouth, the tongue vastly swelled, and of a purple, blackish colour, portend death.

In these inflammations a slight diarrhoea relieves: Therefore aliments which promote it are useful, as tamarinds infused in whey; decoctions of farinaceous vegetables moderately acidulated, and such as abound with a cooling nitrous salt, are proper. Burnet is said to be a specific in this case. Mulberries are beneficial, and all acids.

The mouth and throat must be kept moist, and the nose clear, that the air may have clear passage through it. When the patient cannot swallow, he may be nourished by clysters.

Take away blood plentifully from the arm, and afterwards open a sublingual vein; but bleeding in the jugular yields the best assistance, and is much more safe. If the symptoms continue to be very urgent, the bleeding may be repeated in six or eight hours time, till they begin to be more mild.

After the first bleeding, lay a strong and large blister on the fore-part of the neck, or a piece of flannel dipt in the volatile liniment.

Then let the parts inflamed be touched with the following mixture:

1. Take a sufficient quantity of honey of roses and spirit of sulphur. Mix them.

Then the following gargle is to be used, held in the mouth till it is hot before it be spit out; which is to be repeated pretty often:

2. Take a pound of barley-water, 8 ounces of honey, and 2 drams of spirit of sal ammoniac. Mix them.

Emollient steams, or even the steam of hot water taken in at the mouth, are beneficial.

If the patient is not able to swallow any nourishment,

3. Take ten ounces of beef-tea, 10 grains of nitre, and 6 drops of spirit of salt. Mix and make them into a clyster.

Let it be injected every eighth hour, after the belly has been cleansed with a purging clyster.

If the tumour tends to a suppuration, it is best promoted by holding fat, dried figs in the mouth; and when the tonsils are full of an inflammatory ichor, honey of roses mixt with spirit of vitriol, and often applied to the part with a pencil, is excellent.

That That inflammatory pain which arises from a sharp salt serum in the glandulous parts of the fauces, with redness, and a copious flux of saliva, but without a fever, may be cured with a gargle of brandy alone. An inflammation of the fauces is sometimes cured with ten drops of camphorated spirit of wine, in which a grain of nitre has been dissolved, and suffered to pass slowly down the throat.

The acute and inflammatory quinsy may be defined, "An inflammation of some part or parts, either within or contiguous to the throat, rendering deglutition painful, impracticable; and, when it is of the most dangerous kind, likewise affecting respiration."

When only swallowing is impaired, the parts inflamed may be the tonsils, the velum palati, and uvula, the muscles of the pharynx, and those of the larynx, which raise it or pull it down in deglutition, but whose action is not concerned in moderating the aperture of the glottis; while the larynx itself and the aspera arteria remain free.

But when the respiration is pinched, besides other parts, these muscles, which are employed in opening and shutting the glottis, must be inflamed; and likewise, probably the inner membrane of the larynx, and those muscles and fibres that join the rings of the alpina arteria together: And sometimes these minute and remote parts are affected without any redness or tumour, either within the fauces, or outwardly on the throat: This kind of quinsy is the most dangerous and suddenly destructive of all.

The practitioner in every kind of quinsy ought to look carefully into the mouth and fauces, in order to discern where any redness and tumour is; that by comparing the appearance of the parts with the functions impaired, he may be enabled to form the better judgment with respect to the seat of the disease, the prognostic, and method of cure.

If the breathing is remarkably affected, there is absolute necessity of applying all the most efficacious remedies with the greatest briskness and speed possible. These are plentiful and repeated bleedings, a large blister between the lips; fomentations and cataplasm outwardly; steams to be received into the throat, the best ingredient in which is vinegar; smart, but cooling purges; or, if these cannot be got down, clysters of the same kind; bathing the feet and legs in warm water, and even semi-cupia not made too hot, for fear of raising the pulse too high.

But even though the respiration should not be affected at first, if the symptoms are otherwise violent, remedies ought to be smartly and quickly applied to prevent suppuration. For when the inflamed part tends to suppuration, the tumour keeps increasing: and when the pus is actually formed, the bulk may be so enlarged as to endanger suffocation, or the patient may be starved by a total privation of swallowing; so that suppuration should always be prevented, if possible.

If in the course of the distemper the patient should run a risk of being suffocated, the operation of bronchotomy becomes necessary. See Surgery.

Of the Malignant Quinsy, or Putrid Sore Throat.

This disease generally comes on with such a giddiness of the head, as often precedes fainting, with a chilliness or shivering like that of an ague fit, followed by great heat; and these alternately succeed each other for some hours, till at length the heat becomes constant and intense. The patient then complains of an acute pain in the head, of heat and soreness, rather than pain, in the throat; stiffness of the neck; commonly great sickness, vomiting or purging, or both. The face soon after looks red and swollen, the eyes inflamed and watery, as in the measles; with restlessness, anxiety, and faintness.

It frequently seizes the patient in the fore-part of the day; and as night approaches the heat and restlessness increase, continuing till towards morning; when after a short, disturbed slumber, the only repose during several nights, a sweat breaks out, which mitigates the heat and restlessness, and gives the disease sometimes the appearance of an intermittent.

If the mouth and throat be examined soon after the first attack, the uvula and tonsils will appear swelled; and these parts together with the velum pendulum palati, as well as the cheeks on each side, near the entrance into the fauces, and as much of the fauces and the pharynx behind as can be seen, appear of a florid red colour. This colour is commonly most observable on the posterior edge of the palate, in the angles above the tonsils, and upon the tonsils themselves. Instead of this redness, a broad patch, or spot, of an irregular figure, and of a pale white colour, surrounded with a florid red, is sometimes to be seen. This whiteness is commonly like that of the gums after having been pressed with the finger; or as if a matter ready to be discharged lay underneath.

Generally on the second day, the face, neck, breast, and hands, are of a deep erysipelasous colour, with a sensible tumefaction. The fingers are so frequently tinged in a remarkable manner, that it has been no hard matter to guess at the disease from a bare sight of them.

A great number of small pimples of a more intense colour than that which surrounds them, appear on the arms and other parts. Where the redness is least intense, they are larger and more prominent, which is generally on the arms, breast, and lower extremities.

As the skin becomes red, the sickness commonly goes off, and the vomiting and purging cease.

The appearance in the fauces continues the same, only the white place becomes of a more opake white, and is discovered to be a slough, concealing an ulcer of the same dimensions. These ulcerations are generally first discernible in the angles above the tonsils, or on the tonsils themselves. They are also often seen in the arch formed by the uvula and one of the tonsils; on the pharynx behind, on the inside of the cheeks, the basis of the tongue, which they cover like a thick fur. Where the disorder is mild, there is only a superficial ulcer, of an irregular figure, in one or more of those parts, scarce to be distinguished from the found part, but by the inequality of its surface. Likewise the redness and eruption do not always appear, and in some not till the third, fourth, or fifth day, or later. The parotid glands on each side commonly swell, grow hard, and are painful to the touch; If the disease is violent, the neck and throat are surrounded with a large oedematous tumour, sometimes extending itself to the breast, and by straitening the fauces increase the danger.

Towards night the heat and restlessness increase, and a delirium frequently comes on. This happens to some on the first night. It is very remarkable, that the patient commonly returns a proper answer to any question, but with unusual quickness; yet when they are alone, they generally talk to themselves incoherently. However, at the first tendency to this disorder, they affect too great a composure. This for the most part happens to those that sleep but little; for some are comatose and stupid, and take but little notice of anything that passes.

They continue thus for three, four, or more days, commonly growing hot and restless towards the evening. These symptoms and the delirium increase as the night comes on: a sweat, more or less profuse, breaks out towards morning; and from this time they are easier during some hours, with a faintness, which is their chief complaint.

Some grow easier from the first day of the attack; others have symptoms of recovery on the third, fourth, or fifth day. First the redness of the skin disappears; the heat grows less; the pulse, hitherto very quick, becomes slower; the external swellings of the neck subside; the sloughs in the fauces are cast off; the ulcerations fill up; the patient sleeps without confusion, is composed when awake, and his appetite begins to return towards more solid nourishment.

The pulse, during the course of this disease, is very quick, beating frequently 120 times in a minute. In some it is hard and small, in others soft and full, but not so strong and firm as in genuine inflammatory disorders.

If a vein be opened soon after the distemper comes on, the blood generally appears of a fresh and florid red; the effusamentum is rather of a lax, gelatinous consistence, then dense or compact; the serum is yellow and in a large proportion.

The urine is at first crude and of a pale whey colour; as the disease advances it turns yellower, as if bile was diluted in it; and soon after any signs of recovery appear, it commonly grows turbid, and deposits a farinaceous sediment.

They seldom have any stools if the symptoms are favourable, from the time the purging, which generally attends the accession, ceases. This discharge is remarkably bilious, yet without pain.

The thirst is commonly less than in other acute diseases; and the tongue generally moist, but not furred. Some have it covered with a thick white coat, and complain of soreness about the root of the tongue.

Though the uvula and tonsils are sometimes so much swelled as to leave a very narrow entrance into the gullet, and this entrance frequently surrounded with ulcers, or sloughs; yet the patient swallows with less difficulty and pain than might be expected. Soon after they are taken ill, they frequently complain of an offensive putrid smell, which often occasions sickness before any ulcerations appear. The inside of the nostrils, in those that have this disease severe, frequently appears, as high as can be seen, of a deep red or almost livid colour. After a day or two, a thin corrosive sputum, or with it a white putrid matter, of a thicker consistence, flows from it, so acrid as to excoriate the part it lies upon any considerable time. This is most observable in children, or in young and very tender subjects; whose lips are likewise frequently of a deep red, or almost livid colour, and covered on the inside with vesicles containing a thin ichor, which excoriates the angles of the mouth and cheeks where it touches them.

This acrid matter seems to pass with the nourishment into the stomach, especially of children; for if they get over the disease, a purging succeeds, yet attended with symptoms of ulcerations in the bowels: these, after great pain and misery, at length die emaciated.

The patients sometimes bleed at the nose towards the beginning of the disease; and the meninges often appear in the female sex, if they are of age, soon after they are seized, though at a distance from the time of their regular period. It brings this evacuation upon some that never had it before. This flux, in full strong habits, is seldom attended either with benefit or with manifest ill effects, unless very copious; yet sometimes it occasions great faintness, and an increase of the other symptoms. Hemorrhages of the nose and mouth have carried the patient off suddenly; but this does not happen till several days after the attack; and perhaps may be owing to the separation of a slough from the branch of an artery.

Children and young persons are more exposed to this disease than adults; girls more than boys; women more than men; and the infirm of either sex than the healthy and vigorous. Very few grown people have it. When it breaks out in a family, all the children are commonly infected with it, if the healthy are not kept apart from the sick. And such adults as are frequently with them, and receive their breath near at hand, often undergo the same diseases.

With regard to the cure, bleeding is generally prejudicial. Some admit of it at the first attack without any sensible inconvenience; but a repetition of it in the mildest cases seldom fails to aggravate the symptoms; it has sometimes produced very fatal consequences. It increases the heat, restlessness, delirium, and difficulty of breathing; nor do the swelling of the fauces, tonsils, &c., receive any benefit therefrom. On the contrary, though the fullness of these parts decreases, yet the sloughs thicken and change to a livid black colour, the external tumour grows large, and the spitting commonly diminishes. Indeed, the heat and quickness of the pulse may seem to abate at first by this evacuation; but they commonly return with greater violence, the patient is seized with a difficulty of breathing, falls into cold sweats, a stupor, and dies suddenly.

Nor is purging more beneficial; even gentle cathartics have brought on very dangerous symptoms. Upon procuring a few stools with manna, especially when the disease has continued two or three days, the redness of the skin has disappeared, and the flux to the throat has been surprisingly increased. If this discharge by stool continues, tinues, the swelling of the neck commonly grows larger, the fauces become flaccid, dry and livid; and the patient a few hours after this expires.

Nitrous cooling medicines frequently produce the like effects; they increase the faintness which accompanies this disease, and either dispose the patient to copious sinking sweats, or stools.

Upon the whole, it appears, that all evacuations which tend to lessen the natural strength of the constitution, are injurious; and those persons are commonly in the greatest danger who have been previously indisposed, or their strength impaired by grief.

If the purging, therefore, continues long after the first exacerbation of the disease, it is a dangerous symptom; for though it may sometimes be restrained for the present with opiates or astringents, yet it commonly returns with greater vehemence when their efficacy ceases, and in a short time exhausts the small degree of strength remaining. In this case they generally sweat very little; the fauces appear dry, gloomy, and livid; the external tumour grows large; they void their excretions without perceiving it, and fall into profuse sweats; the respiration becomes difficult and laborious, the pulse sinks, the extreme parts grow cold, and death, in a few hours, closes the scene. The eye loses its lustre, and becomes opaque and dim, sometimes several hours before death.

A copious flux of pituitous matter to the glands and other parts about the fauces, have seemed sometimes to be the cause of sudden death.

It is necessary that the patient should be kept in bed as much as may be, though the disease should seem to be slight; for a purging has come on for want of care in this respect, the redness of the skin disappeared, and a disorder which with confinement alone would probably have gone off in twice twenty-four hours, has been rendered tedious and difficult.

At the first, while the sickness and vomiting continue, it will be best to promote the discharge, by giving an infusion of green tea, camomile flowers, carduus, or a few grains of ipecacuanha.

If the symptoms do not abate by this means, give small draughts of mint-tea, with a fifth part of red port, frequently, together with some warm and cordial aromatic medicine, every four or six hours.

The diarrhoea, as well as vomiting, generally ceases in less than twelve hours from the first attack; if it continues longer, it is necessary to check it; otherwise it occasions great faintness, sinks the strength, and in the end produces dangerous consequences. The aromatic cordials commonly take off this symptom, if given plentifully, and the vomiting likewise.

Patients generally complain of an excessive faintness soon after they are taken ill. The urgency of this symptom seems to indicate the degree of danger; and an abatement of it is a pretty sure prelude of recovery. Aromatic medicines are likewise found useful in removing this symptom. Wine may be given in small quantities in whey, or mint, baum, or sage-tea, barley-water, gruel, panda, sago, and the like; for it is not only an antiseptic, but a generous cordial. When the faintness is excessive, it may be given alone.

Blisters likewise relieve faintings; they may be applied with advantage to the usual parts, and to the neck on each side, from below the ear almost to the clavicle, as occasion requires.

With regard to the ulcers, which demand our early and constant attention: When the disease is of the mildest kind, only superficial ulceration is observable, which may escape the notice of a person unacquainted with it. A thin, pale, white slough seems to accompany the next degree; a thick, opake, ash-coloured one is a farther advance; and, if the parts have a livid or black aspect, the case is still worse. These sloughs are real mortifications of the substance; hence, whenever they come off, they leave an ulcer of a greater or lesser depth, as the sloughs are superficial or penetrating.

The thin, acid ichor, which is discharged from under the sloughs, often proves of bad consequence, especially to children. If gargles are injected, they either prevent them from reaching the seat of the disorder with their tongues, or they swallow them and the putrid taint of the ulcers together; whence fatal purgings ensue, or fatal hemorrhages from the penetrating gangrene. Those that have a plentiful discharge from the fauces, carrying off this ichor, are seldom attended with sickness, vomiting, or excessive faintness; and where there is little or no discharge, the symptoms are commonly most dangerous.

Hence the great advantage of gentle stimulating aromatic gargles appears; because they promote the discharge of pituitous matter, and, doubtless, some part of the corrosive fluid along with it. To which, if we add antiseptics and detergents, to check the progress of the mortification, and to cleanse the sodid ulcers, every indication will be answered.

When the disease is mild, the symptoms favourable; the sloughs superficial, order a gargle of sage-tea, with a few rose-leaves in the infusion. Three or four spoonfuls of vinegar may be mixed with half an ounce of the tea, with as much honey as will make it agreeably acid.

If the sloughs are large, and are cast off slowly, they may be touched with mel egyptiacum, by means of an armed probe.

It is not uncommon for hectic heats, night sweats, want of appetite, and dejection of spirits, to attend those a considerable time who have had the disease in a severe manner. Asses milk commonly relieves them, together with a decoction of the bark and elixir vitrioli.

The cause of this disease seems to be a putrid virus, or miasma sui generis, introduced into the habit by contagion, principally by means of the breath of the sick person.

The intentions of cure in this disease is to keep up the vis vitae; to encourage the cuticular discharges; and to conquer the spreading putrefaction. Therefore, all evacuations which lessen the strength, particularly bleeding and purging, and all the nitrous antiphlogistic medicines, are highly improper.

And since a laxity of fibres predisposes persons to receive this disease, it is manifest, both with regard to the preservation and cure, tonic medicines are indicated; and among those the bark justly claims the first place. The only certain diagnostics of this disease are aphthous ulcers and sloughs on the tonsils and parts about the pharynx.

Most persons in the beginning have a nausea and vomiting, and some a looseness. Those who are costive, have, upon the use of the gentlest emetics, immediately been seized with a diarrhoea, difficult to restrain. All medicines which tend to move the belly, not excepting rhubarb, are extremely dangerous.

Those who have had the disease with most violence, have had the head always heavy and stupid, and the eyes foul and full of tears. Not a few have had the head covered with petechiae and purple spots.

The first thing to be done is to order the hot steam of a boiling mixture, of vinegar, myrrh, and honey, to be received into the throat, through an inverted funnel. If it is necessary to make it still more penetrating, add some of the spirit. Mindereri. This steam can scarcely be used too frequently, provided it is received with a due degree of heat.

If the prima via seem foul, or much loaded, it may be necessary to begin the cure by cleansing the stomach with carduus tea, in which a little sal vitrioli is dissolved, and some other gentle and quick emetic. No other evacuation seems proper, and this is only to be used at the very beginning of the disease. If the physician is not called in soon enough, it will be necessary to begin immediately by giving the bark, joined with the spir. Mindereri.

The bark is most efficacious in substance; but when the strength of the patient is much reduced, and the digestive powers weakened, which is usual in putrid fevers, on the very first seizure, the decoction or extract may be thought preferable; but this last is seldom to be had genuine. In making the decoction, it ought to be done with as gentle a heat as possible, and then evaporate very slowly to procure the extract, lest it be burnt too, and that the volatile parts may fly off as little as may be.

In the use of the spiritus Mindereri, care should be taken that it be exactly neutralized; or rather, as the disease is putrefactive, that it may incline towards the acid. This is particularly of use where the heat is very great, it being very attenuating and antiseptic.

When the putrefaction is sufficiently conquered, it will be necessary to cleanse the first passages with a small dose of rhubarb; which is to be repeated at proper intervals, continuing the bark, &c. on the intermediate days for a considerable time.

To complete the cure, the patient should enter into a course of balsamics, chalybeate waters, with elixir vitrioli, and the like, in order to strengthen the solids and invigorate the blood; for this disease is liable to return, especially if they have afterwards a fever of the putrid kind.

Of a Phrenzy.

A phrenzy, if a primary disease, is a true inflammation of the dura and pia mater; if symptomatical, the inflammatory matter is translated into the meninges of the brain from some other part.

The primary phrenzy is preceded by heat and a violent inflammatory pain within the head, a redness of the eyes and face, unquiet and troubled sleep, a slight degree of folly, watching, sadness, fierceness, sudden forgetfulness, a gathering of threads from the bedcloths.

A symptomatic phrenzy succeeds any acute disease; but it is worst when it is preceded by an inflammation of the pleura, lungs, or diaphragm. A black tongue, an obstinate costiveness, suppression of urine, white faeces, which is always a fatal sign, pale, discoloured, thin urine, a wildness in the looks and actions, with a red visage, a black cloud in the urine, and watching, are signs of an approaching inflammation in the head.

The symptomatic phrenzy sometimes appears in the state of malignant, eruptive, and spotted fevers, the smallpox, malignant catarrhal fevers, camp-fevers, particularly the Hungarian. It generally supervenes about the critical days, with a rigor, trembling of joints, tension of the precordia, and coldness of the external parts, with thin urine. The patient being weakened with the preceding disease and long watching, which debilitates the tone of the vessels of the membranes of the brain; whence the stases are not to be resolved, and whence the patient is generally killed on the third day.

A phrenzy is to be distinguished from that slight alienation of mind which happens in acute fevers before the critical eruption. This goes off readily, nor is the urine thin and watery, nor is it attended with a rigor and a refrigeration of the external parts. It is also to be distinguished from a delirium and raving, from a great loss of strength and weakness of the brain after the declination of an acute fever; for this will go as the strength returns, either spontaneously, or with proper remedies.

Both kinds, when present, have the following symptoms:

A deprivation of the ideas of sensible things, as also of the faculties of the mind and affections; an unruly fierceness and wildness; an unquiet and often turbulent sleep, a respiration slow and great, the face often exceeding red, the aspect grim, the looks fierce, the eyes wild and protruberant, a dropping of the nose.

A phrenzy is generally fatal on the third, fourth, or seventh day; which last it seldom exceeds.

When it does, and is violent, it often ends in madness; which increasing gradually, the patient becomes raving mad.

The aliment ought to be slender, of farinaceous substances, as water gruel acidulated; the drink, barley-water, small-beer, or the decoction of tamarinds.

This disease, of all others, requires the speediest applications. Profuse hemorrhages of the nose often resolve it; and copious bleeding, by opening the temporal arteries, is the most efficacious remedy.

The cure of this disease requires diligent attention to the following things:

Varices of the veins, or the bleeding piles, are beneficial.

A looseness is likewise good.

A pain in the breast and feet, or a violent cough supervening, often put an end to the disease; as also an hemorrhage.

Therefore plentiful bleeding is necessary, through a large large orifice; or open several veins at the same time, viz., the jugular, the frontal, and a vein in the foot.

Hoffman prefers the bleeding at the nose, procured by thrusting up a straw, a pen, or a skewer; or, as Pringle advises, apply six or seven leeches to the temples. The rest of the cure consists in blisters, and things common to other inflammatory fevers.

The cure of the symptomatic phrenzy, if the pulse will bear it, is by opening a vein; but if this cannot be done by reason of great looseness, it is to be attempted by leeches and blisters. It is usual to begin with blistering the head, but in military hospitals that is to be left to the last. The best internal medicines are nitre and camphor. Hoffman's proportion is six grains of nitre to one of camphor; small doses of which are to be often repeated.

The patient's drink should be sweet whey, or acidulated by turning the milk with citron or lemon juice, and sweetened with sugar, meconium. To every quart add a dram of purified nitre or sal prunella. Also emulsions are convenient, of the four cold feeds, with barley-water, to every quart of which add two scruples of nitre.

Antiphlogistic clysters are likewise proper; but if all these means fail, recourse must be had to cupping in the lower parts, to opiates, and mild blisters.

Of the Pleurisy.

The pleurisy is most predominant between the spring and the summer.

It begins with chills and shivering, which are soon succeeded by heat, thirst, inquietude, and the other common symptoms of a fever.

After a few hours the patient is seized with a violent pricking pain in one of his sides, about the ribs; which sometimes extends itself towards the shoulder-blades, sometimes towards the back-bone, and sometimes towards the fore-parts of the breast; and this is attended with frequent coughing.

The matter which the patient spits at first is little and thin, and mixed with particles of blood; but as the disease advances, it is more plentiful and more concocted, but not without a mixture of the blood.

The fever keeps an equal pace with the cough, pain, and spitting of blood; and in proportion as the expectoration becomes more free, it sensibly decreases; sometimes the body is colicive, sometimes too open.

The blood drawn from a vein, as soon as it is cold, looks like melted feet.

In this disease the pulse is remarkably hard, and seems to vibrate like a tense string of a musical instrument, which is the pathognomonic sign.

Hence pleuries are distinguished into the moist and the dry. It is likewise observable, that the pain in the side is more intense at the time of inspiration, but more mild at the time of expiration.

There is no fever wherein the crises are more regular than in the pleurisy and peripneumony: for in young persons, and those of a full habit of body, bloody sputtle generally appears on the fourth day, and on the seventh the disease terminates by a profuse sweat. But in the phlegmatic and more inactive, as also those in whom the disease has taken deeper hold of the lungs, it will continue till the eleventh or fourteenth day; going off partly by expectoration, partly by sweat; then the pulse becomes more soft, and the patient falls into an easy refreshing sleep.

But when on critical days the crisis is imperfect there is indeed a sweat; but it neither eases the patient, nor terminates the disease. When it continues till the twenty-first day, there is reason to fear a dangerous abscess in the breast. It is therefore a good sign when the expectoration proceeds from the bottom of the lungs, bringing up a viscid matter on the fourth day, mixed with blood, afterwards yellow, and sometimes purulent. The sooner the expectoration happens, the greater the hopes of recovery.

A loofenesis is not safe; urine without a sediment is a suspected sign; and a profuse sweat, unless on critical days, is still worse. On the eleventh and twelfth days a loofenesis is not much to be feared, unless too great, for it sometimes carries off purulent matter. If a bleeding at the nose happens about the fourth day, it is generally attended with a remarkable alteration of the disease.

Those who die of an inflammation of the lungs are suffocated, because the matter adhering to the vesicles and bronchial ducts cannot be coughed up.

In all inflammatory fevers, too hot a regimen is to be shunned, both with respect to the bedcloths and the heat of the room; nor must the patient be exposed to the cold air, nor drink things actually cold. Likewise all strong sudorifics, diuretics, and cathartics, are hurtful. Nor, if the patient has three or four stools, must the course of nature be stopped.

The Diet should be cooling, relaxing, slender, and diluting. Moistening things taken warm are preferable to all others. Hence, barley oatmeal gruel, sweetened with honey, is proper; as also sweet whey.

The indications of cure are, 1. To prevent the farther stasis and stagnation of the blood. 2. To dilute and dissolve the tenor of the blood in pleuritics. 3. To mollify, ease, and relax the spasim, pain, and copious afflux, in order to put the impacted blood again into motion by the help of the appulse of the arterial blood. 4. To promote the excretion of the viscid, bloody, and virulent matter, adhering to the bronchia of the lungs, so that it may be brought up and an abscess prevented.

Take away ten ounces of blood on the side of the part affected. If the physician is called before the third day, the patient lying on his back, must lose a large quantity of blood from a wide orifice in a large vessel, and fetch deep sighs, or cough, to promote its celerity; and the part affected should be rubbed gently at the same time. The bleeding should be continued till the pain relents, or the patient is ready to faint. It should be repeated as often as the symptoms return which it was intended to remove. The absence of the white inflammatory pellicle from the surface of the blood, when cold, shows it is time to leave it off. This Huxham confirms by his own experience; and adds, that after the fourth day bleeding is not safe. He likewise recommends fomenting the part; which often eases the pain, and terminates the disease. But if it is obstinate, he recommends slight scarifications; then cupping; and and afterwards a blister on the same place, which has been successful when the usual methods failed. An emollient cooling clyster should immediately succeed bleeding, especially if the body is coltive; and nitrous medicines, with a cooling, emollient, diluting regimen, should be forthwith entered upon. Thin whey, a decoction of barley and red poppies, and emulsions, will serve for drink.

Though the symptoms should vanish on blistering, it will be more secure to bleed again; unless a profuse sweat comes on with relief from pain, and makes all other remedies unnecessary. But if the lungs are likewise inflamed, the cure cannot be so speedy; for though the first bleeding and a blister should give ease, yet a repetition will be needful. Sometimes the stitch returns and fixes on the other side; but this may be treated as the first with the same success.

Huxham lays a great stress on camphor and nitre joined with small doses of the paregoric elixir; and if there is a vehement pain, he thinks opiates may properly be joined with them, as they have a great power of relaxing the over tense fibres, of moderating the too rapid course of the blood, and of promoting the concoction of the morbid matter. Hence, after the use of opium, there is generally a copious sediment of the urine.

It is necessary that the body be kept open, and the bowels free from spasms; to which purposes emollient clysters are proper, with oil of sweet almonds.

In the first stage of the pleurisy or peripneumony, laxative clysters and the cooler diaphoretics are proper; but all cathartics and warm sudorifics do harm. The time for attempting the diaphoretics is when the person finds ease by the blister: But whenever the spitting begins, the diaphoreisis must either be omitted, or joined to expectorants; whereof the chief is oxymel of squills; or, in great heat or drought, some more pleasant acid. But in lowfevers, after repeated bleedings, give salt of hawthorn joined to some oil: This will raise the pulse, and promote expectoration when it flags.

If, notwithstanding the discharge, the breast continues to labour, bleeding is still requisite: For the lungs are not to be overpowered by the omission of bleeding; nor is the suppression of the spitting to be hazarded by bleeding too freely. But with regard to blisters, there need little caution; as they are always seasonable, to raise, relieve the breast, and to promote expectoration.

In the course of expectoration, a vomit will sometimes be useful in discharging the load of viscid phlegm. If the phlegm is tough, or the patient coltive, and opiates are given, they must be joined with squills.

When the pleurisy ends in a suppuration, or abscess, the signs are, a slight vague shivering, which often returns without any evident cause; a remission of the pain, while the difficulty of breathing remains; a redness of the cheeks and lips; thirst; a febricula, or slight fever, especially in the evening; a weak, soft pulse.

When the abscess is actually formed, there is an obstinate dry cough, which increases after feeding or motion; the breathing is difficult, small, thick, short, and wheezing, worse after eating and motion; the patient can only lie on the side affected; a slow, periodical fever, which is exasperated with stirring and eating; a decayed appetite, great thirst, nocturnal sweats, paleness, leanness, and excessive weakness.

This either ends in a consumption; or the matter falls into the cavity of the thorax, and so becomes an empyma.

Of the Bastard Pleurisy.

Hoffman says, that the seat of every genuine pleurisy is in the lungs, as appears from the opening of those that die of this disease.

Therefore, if the inflammation occupies the externa parts only, it is a Bastard Pleurisy: if the externa surface of the lungs, like an erysipelas, it is a genuine pleurisy.

A Bastard Pleurisy is attended with a very acute and pricking pain in the side, which is exasperated by the touch; lying on the affected side is difficult; there is a dry cough, without the ejection of purulent or bloody matter, which, if strong, increases the pain. There is likewise a fever, with a hardish, depressed, and frequent pulse.

The cause does not seem to be in the blood, but rather in the stasis of an acrid serum at the connection of the ends of the fine azygous arteries and veins; as also of the lymphatic vessels of the pleura, and likewise in the periosteum of the ribs, where the sense is more acute.

Hence it is nothing else but a kind of rheumatism, and is common to those who are now and then troubled with catarrhs, rheumatic and arthritic pains, or a hemicrania; especially if they come out of a hot air into a cold, or the contrary, particularly in the evening.

This does not require bleeding, unless there is a remarkable plethora; but a diaphoreisis, and a more free perspiration. On the seventh day it generally disappears, and is without danger.

Lancifus advises to bleed plentifully in the arm, and to scarify the part affected. After this two cupping glasses are to be applied thereto, which will cure the disease as if by enchantment.

Hoffman observes, that those are apt to fall into a bastard pleurisy who are much exposed to a moist cold autumnal or wintry air: For there are no diseases or inflammatory fevers so soon generated by the intemperies, inequality, and change of the air, as those of the breast. When the summer has been hot and dry, and the weather has suddenly changed to cold, with a northerly wind, not only catarrhal defluxions have ensued, but rheumatisms and pleurisies, with bloody spittle and violent pains in the side, have been very frequent. For the air, from continual inspiration, immediately affects the lungs internally, and externally the thorax and ribs, which are beset with thin muscles, membranous nerves and vessels; for which reason spasmodic crispatures are readily induced, and the free circulation of the humours stopt.

The best way is to keep the part affected in a temperate and equal heat, in a warm bed; especially as the skin of every patient, as in the gout and erysipelas, cannot bear topics. Of a Peripneumony.

There are several kinds of this disease. For it may arise from a violent inflammation of the lungs, by a very fizzy dense blood obstructing very many of the pulmonic and bronchial arteries; or from an obstruction of the lungs by a heavy, viscid, putridous matter; which is called a spurious or bastard peripneumony; or from a thin, acrid defluxion on the lungs; and then it is a catarrhal peripneumony.

The symptoms common to all, are, a load at the breast, a short difficult breathing, and more or less of a fever. But in a true peripneumony, there is a more tenitive pain than in the pleurisy; besides, it is rather more obtuse and pressing than acute, and shoots as far as the back and scapulae. But the difficulty of breathing is greater, as well as the anxiety and expectoration, whereby a variegated spittle is brought up, which lay as it were deep; for in this disease the vessels of the lungs themselves, whereby the blood circulates from one ventricle of the heart to the other, are affected; being stuffed and obstructed with a thick blood, which is apt to grow more viscid and solid. Wherefore it is the more dangerous and fatal, especially if it attacks old persons, and if bleeding is not timely administered. Boerhaave says, the pulse is soft, slender, and in every sense unequal; and Huxham, that if the pulse is hardly felt before bleeding, it will afterwards beat very strongly.

In the cure, great regard must be had to the different stages of this disease, and the different symptoms that attend it. Bleeding is indispensably necessary at the beginning of a severe inflammation of the lungs; but if, after the second or third bleeding, the patient begins to spit a well concocted matter, freely tinged with blood, you must forbear to repeat it, otherwise the patient will be weakened, and a fatal suppression of the expectoration will ensue. But if he brings up a considerable quantity of florid, thin, spumous blood, by spitting; then bleed again, quiet the cough with diacodium, and give proper acids pretty freely, with soft cooling incrustants. If a thin, gleety, dark-coloured matter is expectorated, it is generally a mark of greater malignity, and that the blood is in a putrefying dissolving state, and will not bear a large loss of blood.

Generally the more violent the rigor or horror is at the attack, the more violent the succeeding fever will be, which will in some measure guide us in drawing of blood. If the symptoms are not relieved by the first bleeding, after eight, ten, or twelve hours, let it be repeated; or sooner, if they become aggravated. If the fever, anxiety, oppression, and difficulty of breathing, increase, bleed again, especially if it appears very firm and dense, or covered over with a thick yellowish coat or buff. However, it does not appear sometimes till the second or third bleeding, though the symptoms indicate a very high inflammation. This often happens from the blood not spouting out in a full stream. This appearance of the blood, with a firm strong pulse, will warrant the taking away more, till the breathing becomes free and easy.

If the crustamentum is of a very loose texture, and not covered with a buff coat, and the pulse on bleeding sinks, flutters, or grows more weak and small, it is time to desist. A bluish film on the blood, with a kind of a soft greenish jelly underneath, while the cruder itself is livid, loose and soft, with a turbid, reddish, or green serum, is a sign of a very lax crisis of the blood, and great acrimony, which will not bear great quantities to be drawn off. If the blood is very florid, thin and loose, with little or no serum after standing for some time, it generally argues a considerable advance to a putrid and very acid state.

A strong, throbbing, thick pulse, always indicates farther bleeding; at least till the patient breathes more easily, or a free expectoration of laudable matter is obtained. It often happens, that the pulse at the very beginning seems obscure and oppressed, irregular, sluggish, and sometimes intermitting, with weakness and oppression. But this does not arise from the defect, but from the too great quantity of blood; for the blood-vessels being over-loaded and distended, cannot act with sufficient vigour. This is succeeded with a dreadful train of symptoms, and even death itself, if not prevented with sufficient bleeding.

In some very violent peripneumonies, an immediate and excessive weakness comes on, with an inexpressible anxiety and oppression of the breast; a very small, weak, trembling pulse, coldness of the extremities, with clammy, coldish, partial sweats, the eyes staring, fixed and inflamed, the face bloated and almost livid. This has been followed with a stupor, delirium, and sometimes with a complete paraplegia.

Some kinds of peripneumonies will not bear large bleeding, especially the epidemic or malignant. The pulse and strength of these patients have sunk to a surprising degree; and the disease has turned into a sort of a nervous fever, with great tremors, subsultus tendinum, profuse sweats, or an atrabilious diarrhoea, with a black tongue, coma, or delirium; though at the beginning the pulse seemed to be full and throbbing, and the pain, cough, and oppression so very urgent, as to indicate bleeding pretty strongly. In these cases the blood was seldom buffy to any considerable degree, but commonly very florid, of a very loose and soft consistence, or very dark-coloured, and coated with a thin and bluish or greenish film, under which was a soft greenish jelly, and a dark livid cruder at the bottom. Sometimes the coat was much thicker and more tough, but of a pale red colour, resembling the cornelian stone, or a dilute jelly of red currants. When the blood is thus dissolved, abstain from farther bleeding, especially if the pulse or patient becomes more languid after it, though the oppression, load, or even pain, may seem to require it.

When the fizzy coat on the blood is excessively tough, and extremely yellow, or of a pale red colour, it threatens danger; for the inflammatory lentor will scarcely mix with any diluents. Sometimes, after repeated bleeding, the crustamentum has scarce been a sixth part of the volume of the blood, and yet as solid as a piece of flesh. This is generally mortal.

When the peripneumonic symptoms continue for four or five days or more, we may justly fear an abscess, or a mortification; and little advantage is to be expected from further farther bleeding. But if the pain returns with violence after having ceased a considerable time, it is a sign that a new inflammation is forming, which indicates bleeding as much as the primary, but not in the same degree. The strength of the patient and pulse, the violence of the pain and difficulty of respiration, are, in a great measure, to determine the quantity. When the pulse and strength seem to require bleeding, cupping on the shoulders will relieve the breast and head. Likewise the use of blisters, fuses, fetons, are very serviceable in inflammations of the lungs.

Laying a blister on the part affected is the proper cure of a pleurisy; but a peripneumony is naturally more dangerous; and the more so as the epispastic cannot operate so directly on the lungs as the pleura. But even in this case, blistering is most to be relied on after bleeding. You may first blister the back, and afterwards one or both sides. Epispastics tend to relieve the breast, not only when applied to the chest, but also to the extremities; and promote expectoration: Whereas bleeding must be used cautiously, if at all, after the spitting appears.

The fever and the inflammation require a cool, diluting regimen, and nitrous and relaxing medicines; together with a moderately cool, free air, and quiet both of body and mind. A close room is very inconsiderious; if it cannot be avoided, it should be prudently aired. There is nothing more proper than thin whey, a barley pitan with liquorice, figs, &c. the infusion of pectoral herbs, such as ground-ivy, maiden-hair, colt's-foot, hyssop, &c. These should be gently acidulated with juice of Seville oranges or lemons. Honey will render them more detergent. Any or all these things may be drank warm by turns in frequent small draughts, sipping them as it were perpetually. These relaxing, emollient drinks, and vapours arising from them, are in a more essential manner necessary, when the expectoration is very difficult and tough. When it is suddenly suppressed, and the difficulty of breathing greatly augmented, an emetic of oxymel of squills will be proper, if the violence of the fever is abated; but very little should be drank after it to promote vomiting.

When much sincere, florid, or frothy blood is spit up, take away as much blood immediately as the patient's strength will bear. If the haemoptoe continues, bleeding in the saphoena will be found of the utmost service. Then direct cooling emulsions, nitrous, demulcent, and mucilaginous medicines; and vegetable and even mineral acids, if the spitting of blood is very considerible. The drink may be a decoction of red poppies, colt's-foot, and figs, acidulated with elixir of vitriol. The cough may be appeased with diacodium, or a soft linctus. But strong astringents and large doses of opiates are bad.

In a CATARRHAL PERIPNEUMONY, the matter expectorated is extremely thin and crude, and the defluxion so very acrid as to excoriate the wind pipe, causing an incessant and very violent cough. Here, a great loss of blood is not necessary; but some should be drawn in the beginning to abate the inflammatory disposition. Blister should be applied early, and purgatives are proper to carry off the serous colluvies. A demulcent, pectoral pitan is proper to temperate the acrimony of the humours. It should be taken warm with mild diaphoretics. Coffee is a useful drink. Direct diacodium, or elixir paregoricum, to moderate the cough, in small doses often repeated; sphaera ceti, olibanum, myrrh, and camphor, tend to incrassate the thin catarrhal humour, and abate the irritation.

In the PUTRID PERIPNEUMONY the expectoration is livid, gleety, and fanious, frequently resembling the legs of red wine; sometimes more black, and sometimes very fetid. This is often the case of the highly scorbutic; particularly sailors, after a long voyage. Blood taken from these, appears to be in a dissolving putrefactive state. The craftsmenium is loose and tender, the serum turbid and reddish; the tongue is black; the teeth furled with a dark, thick fordes; the breath offensive; the urine high-coloured or blackish. Black spots, or a dysentery, frequently appear on the fifth, sixth, or seventh day. The pulse and strength sink after bleeding: sometimes a vast anxiety, fainting, a cold sweat, a thready intermittent pulse soon after. This has sometimes happened in pleuro-peripneumonies, where the pain of the side was violent, the load at the breast great, and the cough considerable.

This will never bear a second bleeding to advantage; seldom the first, unless there is a considerable degree of firmness and tension in the pulse. When there is reason to be diffident, order scarifications and cupping.

In this disease give a decoction of figs, colt's-foot, and red poppies, well acidulated first with juice of Seville oranges or lemons, and afterwards with gas sulphuris; or elixir vitriol, nitre, olibanum, myrrh, flowers of sulphur and bole may be administered, with conserva lugula, rob of elder, currants, mucilage of quince-seeds, and syrup de rubeo idaeo: camphorated vinegar, with syrup of elder or raspberries, is an excellent medicine. A spoonful or two of these latter should be given ever and anon. Sound cider, and wine and water with Seville orange or lemon juice, drank warm, promote expectoration when deficient. Tincture of roses with red poppy flowers, has moderated an inordinate defluxion of thin bloody ichor. However, oxymel of squills, and strong cinnamon-water, are frequently necessary to pump up the ichor, when a great rattling in the throat and difficulty of breathing indicate a vast quantity of it in the lungs. And yet the violence of the cough may be often appeased by elixir athmaticum or diacodium. The patient is to be supported with sago, panada, hartshorn jelly, roasted apples, cream of barley, or thick gruel, with a little wine and juice of lemons, giving a little at a time, and often. Strawberries, raspberries, currants, cherries, may sometimes be indulged.

At the close, the whole depends on a well-regulated diet. A toast with diluted red port wine, mulled with Seville orange-peel, mace, or cinnamon, and well acidulated, may be very useful. Blister are seldom beneficial in this case, but often mischievous.

A very thin yellow spitting, either shews that nothing but the thinnest part of the blood is strained through the arteries of the lungs, or that the whole mass of blood begins to dissolve; that its bilious principles are highly excited, and that all tends to a general putrefaction. It is commonly monly attended with a violent cough, and expectoration is performed with exceeding great difficulty. Many times it is succeeded by an hæmoptoe from the rupture of the vessels; particularly when the tongue appears very red, smooth, dry, and shining, with a kind of livid bladders at the top.

The concocted matter of inflammatory obstructions of the lungs is partly spit off, and partly carried off by thick turbid urine in large quantities, depositing much reddish or yellow-coloured sediment; and sometimes partly by bilious stools. Nothing promotes this urine, and these stools, more effectually than laxative clysters. Sometimes the morbid matter is critically translated to the legs, to the great relief of the breast; and therefore, in severe pulmonic disorders, a derivation of the humours to the legs may be attempted by tepid bathing and blisters. The discharge from the ulcerated blisters must not be suddenly suppressed; for then the difficulty of breathing and cough will return, or a very great purging or profuse sweats will succeed.

If the patient is not relieved in eight days, the inflammation will end in a suppuration, and an abscess of the lungs, and sometimes in some other part of the body; the symptoms of which are an obstinate dry cough, which motion and taking of food will increase. The easiest posture in lying will be on the affected side; there will be a slow fever, with chills and shivering at uncertain periods; exacerbations after motion or a repast; thirst, night sweats, a frothy urine, paleness, leanness, weakness. In this case, bleeding must be forbidden; the diet must be mild, soft, incrustating, and more plentiful. Tepid vapours should be taken into the lungs, of decoctions of proper ingredients.

When by the symptoms and time the impolthume may be judged to be ripe, the vapour of vinegar itself, and any thing which creates a cough, as oxymel, exercise, and concussion, are proper. The sooner it is broke, the less danger to the lungs.

In this state, which is not absolutely desperate, the aliment ought to be milk, and the drink milk and barley-water, with gentle anodynes, that the patient may have some rest. If the inflammation ends in a gangrene, the case is desperate; if in a schirrus, incurable.

Of the Bastard Peripneumony.

At the beginning of the fever the patient is hot and cold by turns, is giddy upon the least motion, and complains of a rending pain of the head whenever he coughs; he vomits up every thing that he drinks; the urine is turbid, and intensely red; the cheeks and eyes look red and inflamed; his breathing is thick and short; the whole thorax is full of pain, and the straitness of his lungs, as often as he coughs, is perceived by the bystanders: whence the free course of the blood is prevented, which creates a stoppage of the circulation, and takes away all the symptoms of a fever, especially in those of a full habit of body; this may also happen from the blood's being overloaded with a great quantity of pituitous matter, which oppresses it so as to prevent a febrile ebullition.

This disease sometimes steals upon the patient unawares, with a slight weariness, a weakness, a general prostration of the faculties of the mind, thick and short breathing, beginning with an oppression of the breast. The convulsions it excites are so small, that the heat and fever are scarce sufficient to make the patient sensible of his danger. Afterward, slight shiverings which come on by fits, and the attacks of a gentle fever, appear; whence the difficulty of breathing and weakness suddenly increasing; bring on death.

When perpetual, laborious wheezing, great anxiety and constant oppression on the precordia, comatous symptoms, cold extremities, and dark bad-coloured nails and visage come on, the patient is in immediate danger.

When comatous symptoms and a very difficult breathing remain after bleeding, cup and scarify the neck and shoulders. This has frequently had a surprising effect. When the case is very threatening, blister the scurfifications.

After bleeding, let the patient have the following clyster, which must be repeated daily till the lungs are relieved.

Take 3 ounces of honey, the yolk of an egg, and 8 ounces of barley-water. Make them into a clyster.

Let the patient's diet be very slender, such as weak broths, sharpened a little with orange or lemon juice, and he may drink a weak mixture of honey and water; the steams of warm water may be taken in at the mouth.

Likewise let the legs and feet be bathed, and large blisters applied. Sydenham advises a repetition of the bleeding and purging alternately, every other day, or at greater intervals, as the strength and symptoms require. But he has generally found twice bleeding sufficient.

Of the Inflammation of the Liver.

When the liver is inflamed, it compresses the stomach, diaphragm, and the neighbouring viscera of the abdomen; it stops the circulation of the fluids, hinders the generation and excretion of the gall, and all digestion. It produces a great many bad symptoms, as the jaundice, with all the diseases depending thereon; for the liver receives the fluent blood from almost all the parts of the abdomen, and is the chief instrument of almost all the digestions that are made there.

A fever, an inflammation, and pungent pain on the region of the liver and diaphragm, a tension of the hypochondria, yellowness of the skin and eyes, and a saffron-coloured urine, are signs of an inflammatory disposition of the liver.

It begins with cold and shivering, sometimes with vomiting and a fever, watching, difficult breathing, quietude, and costiveness. This is a kind of rheumatic or erysipelas fever, proceeding from a sharp viscid serum, lancinating the nervous fibrilla. It is sometimes accompanied with a bastard pleurisy, to which it is akin.

It is not very dangerous, and rarely kills, unless the viscera are unfound.

Narcotics and sudorifics are to be shunned.

This disease terminates as other inflammations, being cured by resolution, concoction, and excretion of the morbid matter; or else in an abscess, schirrus, or gangrene.

During the first state, a warm regimen and saffron are improper.

Cooling resolving liquors, taken inwardly, as whey with sorrel boiled in it. Outward fomentations, and frequent injections of clysters, bathing, and frictions, relax, and render the matter fluid. Honey, with a little Rhenish wine, or vinegar; the juices and jellies of some ripe garden fruits; and those of some lacteiferous plants, as endive, dandelion, and lettuce, are resolvent.

Fat oily epithems, and plaisters, are to be shunned. Camphor in crocated spirit of wine is only to be used in the beginning, or when the fever is moderate, and nature sluggish. Bleeding at first is necessary on the affected side, in the hand or foot.

Violent purging hurts; gently relaxing the belly relieves: diluents, with nitrous salts, are beneficial, or tamarinds boiled in warm water or whey.

A clyster purely oleous is beneficial, with a bladder-full of an emollient decoction. Inwardly, diluting and resolvent mixtures.

If it is attended with the jaundice, then apply epithems of carduus benedictus, scordium, wormwood, elder flowers, chamomile, seeds of lovage and cummin boiled in wine, and often applied.

Pringle says, the best remedy, after plentiful bleeding, is to lay a large blister over the part affected.

Bloody stools, not in an extreme degree, or streaked with blood, ought not to be stopped, because they help to resolve the distemper: bleeding at the nose often does the same.

The feverish matter is frequently carried off by urine; and therefore diuretics not highly stimulating are proper.

Sweating ought not to be promoted by hot cordials, but encouraged by warm diluting liquors.

The case is deplorable, when the inflammation terminates in a suppuration, unless the abscess points outwardly, so as it may be opened. For if the pus is evacuated into the abdomen, it produces putrefaction, or an incurable hepatic dysentery or bloody-flux.

Of a Paraphrenitis.

This disease is an inflammation of the diaphragm, and parts adjacent. A paraphrenitis is attended with a very acute continual fever, an intolerable inflammatory pain of the part affected; which is extremely augmented by inspiration, coughing, sneezing, repletion of the stomach, a nausea, vomiting, compression of the abdomen in going to stool or making water. Hence, the breathing is thick, short and suffocating, and performed only by the motion of the thorax. There is also a constant delirium; a drawing of the hypochondria inwards and upwards, an involuntary laughter, convulsions, and madness.

This disease terminates as in a pleurisy; but is attended with more violent symptoms, and is much more fatal. If the part affected suppurates, the matter will fall into the abdomen, and produce a purulent abscess.

The cure must likewise be attempted in the same manner as in a pleurisy.

Of the Inflammation of the Intestines.

This disease contracts the intestines, and stops up the passage through them. There is a vehement, fixed, burning pain; which is irritated by things taken inwardly. When the inflammation is in the upper part of the intestines, the stomach will be greatly distended by wind. When the pain is exasperated, it produces convulsions of the diaphragm and abdominal muscles, vomiting, painful inflations, with rumblings, and sharp gripping pains which may bring on the iliac passion, or twisting of the guts.

When there is a burning pain in the abdomen, with a preternatural heat of the whole body, as also a quick pulse, loss of strength, anxiety, and inquietude, the seat of the disease may justly be suspected to be in the intestines. If the sharp pain is above the navel and below the stomach, attended with a fever, nausea, and reaching, it is a sign that that part of the colon is affected which lies beneath the stomach, and is extended from the right to the left-side. If the pain lies in the right hypochondrium, under the spurious ribs, it shows that part of the colon to be inflamed where it joins to the ilium. When the complaint is of the left side, under the loins, where the psoas muscle is placed, it is a sign the colon and that part of the mesentery joined thereto is the seat of the disease, especially when it adheres to the peritoneum. But when the pain is in the middle of the abdomen about the navel, it shows the small-guts are certainly affected. In all these cases the pain is supposed to be attended with a fever.

When there is a fever, and a burning pain in the lower part of the belly, attended with a swelling, which ends in a copious, putrid, or purulent flux, with a great disorder of the bowels, it shows the seat of the disease to be in the mesentery.

This disease should carefully be distinguished from a choleric proceeding from a cold cause, because what is good for the latter is poison in the former. It must have a speedy remedy, or it will soon end in the iliac passion or a mortification.

Besides copious bleeding, there is hardly any other method of cure than fomenting and relaxing the bowels with emollient liquids, taken warm both by the mouth and in clysters, and this every hour. Yet acids in very desperate cases have been known to give relief; such as the juice of lemons taken by the mouth, and vinegar and warm water given in clysters. When the vomiting is excessive and continual, opiates should be given to quiet the convulsions.

Pringle affirms in this case, that the best method of cure is to lay blisters over the part affected; and it has been practised with success. In particular they are useful in the ileus, and seem to answer equally well in the fixed pains of the bowels, whether from an inflammatory or a flatulent cause.

Warm fomentations, or young, vigorous, and sound animals, applied to the body, are extremely beneficial.

Arbutus. The patient should only be nourished with broths, in which gently detergent roots have been boiled.

Boerh. It is a fatal error of some practitioners; when they find the body obstinately coltive, to give one purge after another; which not only exasperates the disease, but renders it mortal. Even the clysters should not be made of very stimulating ingredients; but of milk alone, with a little nitre; or rain-water, with syrup of violets; or of marshmallows, or roses solute. After bleeding and clysters, if the pain still continues violent, there will be no manner of danger in giving opiates, by which means the excruciating pain will be alleviated, the spasms appeased, and a breathing sweat will follow. When this is done, and the fever is abated, there will be no occasion to continue the diluting, relaxing, and moistening medicines, but rather the nervous and corroborating.

If the patient survives three days, and the acuteness of the pain abates, with a chillness or shivering throughout the body, it is a sign of a suppuration: then within fourteen days the impoulhume will break; and if it falls into the cavity of the abdomen, it will corrupt the whole mass of fluids, putrefy the viscera, and turn to an abscess; whence the patient will die of a consumption.

In this case, whey and chalybeate waters are likely to prove most beneficial.

If the fever continues, with clammy sweats, paleness, an ichorous diarrhoea, fetid, black, or at last the washings of flesh, a small intermittent pulse, and at last a total cessation of pain; they are signs of a gangrene and an approaching death.

Of the Nephritis, or Inflammation of the Kidneys.

The symptoms of a nephritis are, a great inflammatory, pungent, burning pain, in the place where the kidneys are situated, attended with a fever; the urine is made often, but small in quantity, and very red or flame-coloured, yet, in the highest degree of the disease, watry. There is a numbness of the thigh, and a pain in the groin and the testicle, of the same side; a pain in the ilium, bilious vomiting, and continual eructations.

When the inflammation is deep, the fever violent, the burning pain in the loins lasting, the difficulty of making water great, the body very coltive, the anxiety and strainness of the praecordia exquisite, the urine crude and white; likewise if the pain continues till the fourteenth day, the kidney will suppurate; which is known from the abating of the pain, and from the thick purulent sediment of the urine. This will sometimes last several years, till there is nothing left of the kidney but a bag: It is attended with a hectic fever, and the patient before he dies is almost reduced to a skeleton. If the bag happens to burst, it brings on a retention of urine, and intolerable pains, which end in death.

If it continues beyond the seventh day, an abscess is to be feared, which is known to be forming by a remission of the pain, succeeded by a pulsation in the part, and chills and shivering often returning.

When the disease is favourable, it is cured by resolution, of a copious, red, and thick urine discharged at one time, or by a large flux of blood from the haemorrhoidal veins, in the beginning of the disease.

It is cured by plentiful bleeding, revulsion and dilution; by soft, emollient, antiphlogistic decoctions.

When a burning and fixed pain in the loins continues for some time, it is a sign that the venal vessels are stuffed and obstructed with a thick blood, which requires immediate bleeding in the foot; or if there is a disposition to a haemorrhoidal flux, apply leeches to the anus.

Afterwards give such things as temperate the heat of the blood, and promote a free circulation, with a diaphoreis. For which purpose, emulsions, demulcents, diluents, antiphasmodics, diaphoretic powders, with cinnabar and nitre, are preferable to every thing else.

Emollient clysters, without any saline or purging stimulus, are the principal help in this disease. They may be made of milk, whey, or soft water, in which elder and chamomile flowers have been boiled; to which add an ounce or two of syrup of marshmallows, and a dram of nitre.

When there are convulsions, or excessive pain, opiates are proper. If the vomiting, a symptom of this disease, is too frequent, warm water sweetened with honey is beneficial.

The patient should avoid all acrimonious aliment; he should neither lie too hot, nor on his back.

When an abscess is formed, the medicines must be powerfully maturating and emollient: When the urine appears purulent, they must be diuretics of medicated waters, whey, and the like; together with balmatics.

Emulsions are likewise useful of the four cold seeds and sweet almonds. Some attribute a great virtue to cherry-tree gum dissolved in whey or water, and taken often. Also syrup of marshmallows is very useful. Add to these, the decoction of veronica, sweetened with honey, and mixed with powder of nutmegs.

Butter-milk, not very sour, has been reckoned a great secret in ulcers of the kidneys; and chalybeate waters have been beneficial to some. Spruce-beer is a good balsamic in this case.

Of the Inflammation of the Bladder.

The pathognomonic sort of this disease are, an acute, burning, pressing pain in the region of the pubes, attended with a fever, a continual tenesmus or desire of going to stool, and a perpetual striving to make water.

Other symptoms are, a rumbling of the bowels, gripping pains, great anxiety of the praecordia, difficult breathing, want of appetite, vomiting, coldness of the extreme parts, a hard, quick, unequal, contracted pulse, inquietude, and sometimes convulsions.

There is another kind which is more superficial, and is either rheumatic or erysipelasous, in which the fever is more easily and speedily cured by promoting a diaphoreis: And persons in years, or who are affected with the scurvy, gout, rheumatism, or violent head-aches, are most subject to it; especially if they catch cold by being exposed to the rigour of a cold north-wind.

The former arises most commonly from the stoppage of the menes, bleeding piles, or other usual sanguinary evacuations; and not seldom from a violent gonorrhoea unsuccessfully suppressed by astringents, or when treated by medicines of too sharp and hot a nature.

This disease is mortal, if it terminates in an ulcer or mortification.

The cure must be attempted with bleeding in the feet, if a suppression of the menes or haemorrhoidal flux be the cause.

If it proceeds from the scurvy, &c. recourse must be had to gentle diaphoretics, diluents, and remedies which obtund obtund the acrimony of the humours, such as decoctions of the roots of scorzonera, china, skirrets, and fennel; also infusions, in the manner of tea, of the tops of yarrow, flowers of mallows, winter-cherries, and seed of daisies, made with milk, and sweetened with syrup de althea. If the patient's body is colicive, manna will be proper, with nitrum stibiatum; to which rhubarb may be joined, as occasion requires.

Externally, antispasmodics and gentle discutients will be proper: For this purpose apply bladders filled with a decoction of the emollient flowers.

If the tenesmus and difficulty of urine arise from spasms, there is nothing better than the vapours of a decoction in milk of the flowers of melilot, elder, chamomile and mallows, and the tops of yarrow. This decoction may be put into a cloe-stool; and the patient sit over it.

Tulpius informs us, that a desperate ulcer of the bladder was cured by the constant use of spaw water.

Of the Opthalmia, or Inflammation of the Eyes.

An inflammation of the membranes which invest the eye is a very common disease, especially of the adnata or albuginous coat of the eye.

The eyes are very much inflamed, with great pain, tension, tumour, heat, and redness; and sometimes there is such a strong sensation of pricking in the eye, as if it was caused by a needle or thorn. The eyes at first are full of scalding tears; which are followed by a pituitous matter, which is sometimes small in quantity, sometimes more plentiful: aordes adheres to the greater angle of the eye; and when the disease is violent, the neighbouring parts will swell even as far as the cheeks, with a strong pulsation of the adjacent arteries. The small blood-vessels are visible, which in health are not to be seen, and all the white of the eye becomes red.

If, besides these external signs, there is an appearance of moths, dust, flies, &c., floating in the air, there is an inflammation of the retina.

As in all diseases of the eyes, so especially in their inflammation, the patient must abstain from all spirituous liquors, the smoke of tobacco and sternutatories; he must likewise avoid smoky rooms, and the vapours of onions and garlic, as also all vivid lights and glaring colours. The drink may be water alone, or a decoction of fennel-seeds, hawthorn, and barley; the aliment must be light of digestion.

Intemperance of all kinds renders persons liable to this disease; as also a keen north-wind, and looking earnestly at the fire, sun, or glaring colours: likewise smoky rooms, metallic vapours, cottivens, and unusual refrigerations of the extreme parts, especially in the time of menstruation. Sometimes it is owing to other diseases, as the small-pox, measles, scurvy, and the driving back the gouty matter.

A slight ophthalmia is easily cured; a more severe one generally continues a month or longer, and often leaves a spot in the cornea, or depraves the humours of the eye.

The lighter inflammations from dust or the sun are removed by fomenting with warm milk and water, and anointing the eyes with tatty ointment at night: if the eyes are weak and but little inflamed, they may be washed with brandy and water.

In all cases we are to look narrowly and often into the inflamed eye; since the inflammation may be either begun or be kept up by moats, or by hairs of the cilia falling in, or growing inwards, so as to cause constant irritation.

Take away 10 ounces of blood, and the next morning give the common purging potion, which may be repeated twice or more, with the interpolation of two days between each dose, and at night an ounce of diacodium.

On the days in which purging is omitted, let the patient take four ounces, three or four times in a day, of the emulsion of the four greater cold seeds, and white poppy seeds.

If the disease will not yield to repeated cathartics and bleeding, give an ounce of diacodium every night.

The lighter cases may be cured without bleeding; but if any degree of a fever is joined, or the inflammation is considerable, this evacuation is never to be omitted. The more violent inflammations are not to be cured without larger bleedings, unless we can make a derivation from the part affected without draining the whole body. For this purpose blisters are usefully applied behind the ears, especially if they are to lie on for two or three days, and if the sores are afterwards kept running. Two leeches should be applied to the lower part of the orbit, or near the external angle of the eye, and the wounds be allowed to ooze for some hours after they are fallen off.

This method will likewise do in ophthalmias from external injuries; but not when they proceed from a scrophulous or venereal cause. In bad cases, after the inflammation has yielded a little to evacuations, the coagulum aluminoform, spread on lint, and applied at bed-time, is the best external remedy.

In the mean while, blisters must be applied to the neck, and kept running for some days; and after that, fetons, or issues at least. It is hard to say, of what vast advantage blisters and fetons are in this disease.

The expressed juice of millepedes may also be given [25 are a dose] on the days purging is omitted, in four ounces of beer, or Rhenish or French white-wine: let them stand, when mixt, all night; and then take it with a little sugar in the morning, after the mixture is drained.

But according to the later experience of Dr Fordyce, Fothergill, and others, a strumous ophthalmia may be certainly and safely cured by half a dram of the bark given twice a-day.

The length of time in which the bark is to be taken is uncertain, for in some the cure is performed in less time than others.

Hoffman, besides blisters, fetons, &c., recommends cupping, with scarification, in the nape of the neck, and behind the ears; and in the violent sort of this disease, bleeding in the jugular; as also sinapisms of rocket-seeds boiled in wine, and then put into small bags and applied to the nape of the neck or under the armpits. For inward use, he prefers to all other remedies, an infusion, in the manner of tea, of valerian-root, liquorice, elder-flowers and fennel-seeds, drank plentifully; and before the drinking of it to receive the vapour or steam into the eyes.

Of the Apoplexy.

This disease is a sudden abolition of all the senses, external and internal, and off all voluntary motion, commonly attended with a strong pulse, laborious breathing, a deep sleep, and snorting.

There is no difference between a person asleep and in an apoplexy, but that the one can be awaked, and the other cannot.

The causes of this disease are a particular conformation of the body, as a short neck, for some have fewer vertebrae in their necks than others; a grofs, plethoric, fat, phlegmatic constitution; polypous concretions in the carotid and vertebral arteries, or about the heart, or within the skull, which are known by an unequal pulse, a vertigo, and sometimes a momentary loss of sight; an inflammatory thickness of the blood, preceded by a fever attended by the head ache, redness of the face and eyes, an advanced age, attended with a glutinous, cold, catarrhous, leucophlegmatic constitution.

The forerunners of an apoplexy in these last, are, dulness, inactivity, drowsiness, sleepiness, slowness of speech and in giving answers, vertigoes, tremblings, oppressions in sleep, night tares; weak, watery, and turgid eyes; pituitous vomiting, and laborious breathing on the least motion.

Other causes may be, whatever compresses the vessels of the brain; as, a plethora, a cacochymy, attended with fulness of the vessels; a hot constitution; tumors within the skull; the velocity of the blood increased towards the head, and diminished downwards; compression of the veins without the skull, which bring the blood back from the brain; the effusion of any fluid compressing the dura and pia mater externally; the effusion of any fluid within the brain, which by its pressure hurts the origin of the nerves; this is the most common cause of apoplexies, and proceeds from blood in the plethorical, from a sharp serum in the hydropical and leucophlegmatical, and from an atrophilous acrimony in the melancholic, the scorbutic, and the podagric. Violent passions of the mind, and intense study, are prejudicial to these.

There are three degrees of an apoplexy. The first is, when the vital fluids are, by the force of violent distensions, driven from the lower and outward parts of the body, to the external parts of the head, and to the brain and its meninges, by the carotid arteries; whereby their vessels are expanded, and the free circulation through them impeded. While this stagnation of the blood continues, the external and internal senses are abolished; and as the stoppage goes off they are gradually restored. Such are the fits that hypochondriacal and hysterical persons are subject to.

The second degree is, when the stagnation continues so long that the serum oozes through the vessels, and falls upon the sides of the medulla oblongata or spinalis, and so stops the influx of the nervous fluid, and produces a hemiplegia or a palsy.

The highest degree is, when the fine vessels of the pia mater are broke, and the extravasated blood occupies the basis of the brain.

The first may be cured by timely bleeding: the second, though it does not suddenly kill, yet it generally renders the patient infirm ever after: the third is almost always mortal.

The immediate forerunners of an apoplexy, are: trembling, staggering, a giddiness in the head, a vertigo, dimness of sight, a stupor, sleepiness, forgetfulness, noises in the ears, more deep and laborious breathing, the nightmare.

A slight apoplexy goes off in a profuse, equal, roscid, warm sweat; a large quantity of thick urine, by the bleeding piles, the flowing of the menses, a diarrhoea, or a fever. If it is more severe, it usually terminates in a paralytic disorder; and is seldom curable, but always leaves behind it a great defect of memory, judgment, and motion.

Bleed in the arm to 12 ounces, and then in the jugular to 7 ounces; immediately after which, give an ounce and a half, or two ounces, of emetic wine.

Apply a large strong blister to the neck, hold the patient upright in bed, and let the spirit of sal ammoniac, highly rectified, be held to his nose.

Let there be strong frictions of the head, feet, and hands; and let the patient be carried upright backwards and forwards about the room, by two strong men. Strong blisters should be applied to the head, neck, back, and calves of the legs. Sharp clysters should be thrown up into the body, which have a tendency to excite the patient, and to cause a revulsion.

Shaw advises, during the fit, to bleed largely in the arm, or rather in the jugular, to apply strong volatiles to the nose, to blow sneezing powders up the nose, as also to rub the temples with spirituous cephalic mixtures.

Likewise to blow in the mouth and nostrils the smoke of tobacco from an inverted pipe.

Those who have once had a fit of the apoplexy, are very liable to be seized with it again; and if they are plethoric, the best preservative is bleeding once in three months, and using themselves to a spare diet; taking medicines which strengthen gently, and abstaining from cares and all intense applications of the mind; not neglecting infusions and fusions, nor the drinking suitable mineral waters.

Of the Palsy.

A Palsy is a lax immobility of any muscle, not to be overcome by the will of the patient. Sometimes the sensation of the part is absolutely abolished, and sometimes there remains a dull sense of feeling, with a kind of tingling therein.

It may be caused by all things that bring on an apoplexy; that render the nerves unfit to transmit the animal spirits; that hinder the entrance of the arterial blood into the muscle. Hence the nature of a paraplegia or hemiplegia, and the palsy of a particular part, may be understood.

Hence a palsy may proceed from an apoplexy, an epilepsy, extreme and lasting pains, suppressions of the usual evacuations. evacuations, translations of the morbid matter in acute distempers; whatever distends, distorts, compresses or contracts the nerves, strong ligatures, luxations, fractures, wounds, gangrenes, inflammatory and other tumors of the coats of the nerves, in the ganglia, or the nerves themselves; extreme heat, violent cold, mineral effluvia, and the too frequent use of hot water.

Palsies of the heart, lungs, and muscles serving for respiration, are soon fatal; of the stomach, bowels and bladder, from internal causes, very dangerous; of the face is bad, and easily changes to an apoplexy.

If the part is cold, insensible, and wastes away, it seldom admits a cure; if attended with a violent convulsion and great heat of the opposite part, it is very bad.

The regimen in this disease ought to be warm and attenuating, consisting of spicy and cephalic vegetables, such as create a feverish heat, because it is necessary to dispel the viscidity. Soapy vegetables are best, and such as consist of an acrid volatile salt, and oil, mustard, horse radish, &c. Stimulating by vomits; sneezing; relaxing the belly; promoting sweat by such motions as can be used, or other means; by strong friction, &c.

The cure of the palsies is to be attempted by attenuants and discutients; such as, aromatic, cephalic, nervous and uterine vegetables; their fixed and volatile salts; as also by their oils; soaps made of their oils and salts; the strong scented parts of animals; the juices, spirits, oils, and tinctures of insects; fossil salts, metallic crystals, and medicines compounded of these.

Likewise by things which stimulate strongly, and which, by exciting a tremulous and convulsive motion of the nerves, drive out the impacted matter; to this class, sternutatories and emetics chiefly belong, especially if often used at first.

By purging with warm, opening, aromatic vegetables, with acrid foils, with mercurial and antimonial preparations, in a large dose, and repeated successively for several days, by the means of which a copious and lasting diarrhoea may be excited.

By filling the vessels of the body with drinking a large quantity of the attenuants above mentioned, and then by exciting a greater motion and sweat by the vapours of spirits set on fire.

Outwardly, frictions may be used, either dry and hot, till the part is red; or with spirits ended with a stimulating virtue; or with nervous oils, liniments, balsams, or ointments; vapour or immersive baths; acrid, aromatic, and drawing plasters; cupping, scarifications, blisters; whipping the part with rods; exciting a slight inflammation with nettles, and the like.

A course of electrification for some weeks has been known to have cured some inveterate palsies, though it hath failed in others. See Electricity.

Of the Epilepsy, or Falling Sickness.

Sometimes this disease comes on suddenly and unawares; but it oftener gives notice of its accession by some preceding symptoms; the chief of which are, a latitudine of the whole body, a heavy pain of the head with some disturbance of the senses, unquiet sleep, unusual dread, dimness of sight, a noise in the ears: in some there is a violent palpitation of the heart, a puffing or inflammation of the precordia, a stopping of respiration, a murmuring noise in the belly, fetid stools, a flux of urine, a refrigeration of the joints: in others, there is a sense, as it were, of a cold air ascending from the extreme parts to the heart and brain.

Then they fall suddenly on the ground, (whence the name of the falling sickness;) the thumbs are shut up close in the palms of the hands, and are with difficulty taken out; the eyes are distorted or inverted, so as nothing but the whites appear; all sensation is suspended, insomuch that by no smell, no noise, nor even by pinching the body, can they be brought to themselves; they froth at the mouth with a hissing kind of a noise; the tongue is lacerated by the teeth, and there is a shaking or trembling of the joints.

However, the convulsions vary, as well as the defect of the senses, both in degree and kind; for sometimes, instead of convulsive motions, the limbs are all stiff, and the patient is as immovable as a statue. In infants the penis is erected; in young men there is an emission of semen, and the urine very often streams out to a great distance.

At length there is a remission of the symptoms, and the patients come to themselves after a longer or shorter interval; then they complain of a pain, torpor and heaviness of the head, and a latitudine of all their joints.

These fits are more frequent or seldom, or longer or shorter, according to their different causes. Some return on certain days or hours, or even months, according to the quadratures of the moon, but especially about the new or full moon; in women, chiefly about the time of menstruation; and what is most remarkable, often upon a very slight occasion; for instance, any sudden perturbation of the mind, as a fright, anger, sudden joy, intense application, strong liquors, excessive heat or cold, or venereal exercises.

As to the prognostics; in boys, this disease terminates about the seventh, the fourteenth, or the seventeenth year, that is, about the time of puberty; in women, about the fourteenth, viz. the time of menstruation. Likewise it has been found by experience, that chronic epilepsy have spontaneously ceased by the change of place, diet, and way of life. Sometimes a quartan ague will put an end to an epilepsy and convulsion-fits. It is also remarkable, that the itch, or any other cutaneous distemper, such as the smallpox, measles, miliary eruptions, &c. will either abate the violence, or quite stifle this disease.

The patient therefore need not despair of a cure, if the disease is not of long standing, the fits short, the disorder not hereditary, and the years advancing to the time of puberty; or if it proceeds from a fault in the prime viz., from worms, from a bad regimen, or from a subcutaneous disease ill cured. Nor is the case desperate if the epilepsy be slight, and when the fit is foreseen by a sensation of cold air, arising from the extreme parts to the back, precordia, and head, and also when it is ushered in by anxiety, by want of strength, and a propensity to vomit; or when the senses are not quite abolished in the time of the fit, or when it comes on in the night, without the incurvation of the thumbs. It is a bad sign if the epilepsy makes its first attack after the twenty first year, but much worse if the fits grow more frequent; for then the animal functions are often destroyed, and not only the memory, wit, and judgment are impaired, but the patient grows stupid or foolish. It sometimes ends in melancholy or madness. When it turns to a palsy or apoplexy, it is mortal.

The epilepsy is extremely difficult to be cured in adults, but in children it is the reverse. Blisters laid to the back part of the head are of great use a little before the paroxysm is expected; and the time may more certainly be foreknown, as this disease is influenced by the moon, and attends upon its phases, especially the new or full moon. The most proper medicines to correct the juices seem to be native cinnabar, and wild valerian root; a dram of which may be given morning and evening for three or four months, and afterwards two or three days before the new and full.

However, it must not be forgot, that this disease owes its origin to so many different causes, and is bred in so many different constitutions of the body, and the same remedy which succeeds in one case often fails in another; and therefore different medicines are to be tried, especially on adults. And great regard must be had to the times in which the paroxysms usually return, in order to effect a cure.

If the vessels are full of blood, or it is carried with too great an impetuosity towards the head, then bleeding in the ankles will be proper, or leeches applied to the hemorrhoidal veins. This often happens to hypochondriacal or hysterical persons, to the melancholic, and women with child. Sometimes it will be proper to bleed in the jugulars; or to apply cupping-glasses with scarifications to the neck, and parts near the head.

It has its origin from a sharp, impure serum in the head, or in the membranes and vessels, as in cachectical or scorbutical persons, or those who have been inconsiderately cured of oedematous swellings of the feet, old ulcers, or issues dried up; the driving in of the itch, scabs, or the ulcerating humour of a scald head; then the cure may be attempted by cathartics, by purifiers of the blood, by evacuating the impure humours with fetos, issues, cauteries, and blisters.

If it proceeds from violent pain, as for instance, from a stone sticking in the ureter, from the tooth-ach, ear-ach, or spasms of the stomach and bowels; then clysters of oil of sweet almonds, or the like, are to be administered.

If, in children, it proceeds from gripes, or the breeding of teeth, nothing is better than to cleanse the prime via from filth, by milk-clysters, with a little venice soap dissolved in them.

If from worms, after antiseptics and soft oily things, anthelmintics must be given, such as tansey, garlick, camphor, afa fetida, worm-seed, mercurius dulcis, and ethiops mineral, or powder of tin.

When the fits return at certain periods, or at the quadratures of the moon, a clyster or a vomit will be proper first of all, of half a dram of ipecacuanha, in a decoction of raisins.

In the time of the fits, too free a use of volatiles, spirituous liquors, and strong smells, are hurtful, as causing the humours to flow too much to the head: The best method is to place the patient in an erect posture, and to rub the hands and feet pretty briskly.

The best drink is water, which will mitigate, if not cure the symptoms.

When the patient is so happy as to foresee the accession of the fit, then let him have immediate recourse to clysters and frictions of the lower parts.

A milk-diet alone has cured an inveterate epilepsy. Mistletoe is said to cure an epilepsy as sure as the bark an intermitting fever. The dose to grown persons is half a dram or more, in powder, every fifth hour, drinking after it a draught of a strong infusion of the same plant. If to every ounce of the powder, a dram of afa-fetida be added, the medicine will be still more effectual.

Cinnabar of antimony is greatly celebrated for the cure of this disease; and may be taken from four grains to a scruple, in conserve of rosemary flowers.

Ferreus and Jachinus affirm, they have cured many epilepsies with a simple decoction of guaiacum, giving six or eight ounces of it twice a-day, and the secondary decoction of the same for their ordinary drink. This decoction should be continued 30 or 40 days, to which may be added male piony root, or something of the same kind; and every dose may have a few drops of the spirit of vitriol added thereto.

After all, there is no medicine that can be depended more upon than Musk; for it is an excellent remedy in all diseases of the nerves, particularly cramps, convulsions, vertigoes, and epilepsies. Ten grains may be taken morning and night, made up into a bolus; if the same quantity of factitious cinnabar be added to each dose, it will not be the worse.

Of St Vitus's Dance, and other convulsive disorders.

St Vitus's dance is a sort of a convulsion, which boys and girls are sometimes subject to, from the age of ten years, to the time of puberty. It discovers itself first by a kind of lameness, or an instability of one of the legs, which they draw after them in a ridiculous manner, nor can they hold the arm of the same side still for a moment; for if they lay it on their breast, or any other part of their body, it is presently forced away from thence by a convulsive motion. If they are desirous of drinking, before they can bring the cup to their mouth, they use a thousand odd gesticulations like a mountebank; for they cannot bring their hand in a direct line to their mouth, but it is forced this way and that, till at length, if they have the good fortune to hit the mark, they throw the liquor down their throat as greedily as if they designed to raise laughter in the spectators.

In a convulsive paroxysm, the limbs are strangely agitated with various different postures and motions. Sometimes the hands are put behind them as if they designed to sit upon them, and soon after they seem to be beating the air; then their legs will be drawn hither and thither as if they were dancing some antic dance. Sometimes they will bend their backs like a bow, at the same time raising their breast as high as they can; then their whole body will grow stiff, and as immovable as a stone. They generally generally keep on their legs without falling; yet some will grovel on the earth like epileptic persons, and will weep, laugh, gnash their teeth, gape with their mouths, put out their tongues, roll their eyes, and whirl their heads about in a strange manner.

After the fit, some are inexpressibly weak; some faint away, others fall into a deep sleep; in others, again, the fit is terminated with eruptions, wind, vomiting, and throwing out plenty of water. Very often a mucus discharges from the nose, or blood issues from thence, or from the uterus or hemorrhoidal veins.

These persons have generally unquiet sleep, and full of dread and terror, an uncertain appetite, their bodies generally a little coltive; they sweat with difficulty, but are subject to great passions of the mind. The accessions of the fits keep exact pace with the phases of the moon. In women they precede or accompany the eruption of the menes. They are most frequent and worst after meals; and are easily excited by the passions of the mind.

The fits are generally preceded with a coldness of the feet and limbs, or a kind of tingling sensation; which also affects the os coccygis, and like cold air ascends up the spinal marrow; there is a distended flatulent pain in the left hypochondrium, and such a constipation of the body that neither wind nor excrements can make their exit, nor will the anus admit a clyster-pipe, or, if it does, the clyster and excrements are thrown up by vomit. The bladder is likewise so affected, that no urine can be made, or at least but little, and thin and white. In others, the accession begins with yawning, stretching, anxiety about the heart; a hard unequal contracted pulse, the heart-burn, nausea, vomiting, palpitations of the heart, difficulty of swallowing, pain of the head and teeth, noise in the ears, giddiness, &c., and then come on the convulsions.

Though this is a terrible disease, it never kills suddenly. When it is recent, the person young, and otherwise of a good constitution, there is the greatest hopes of a speedy cure. If usual evacuations of blood by the uterus or hemorrhoids are suppressed, the return will either mitigate or cure the disease. On the contrary, if the humours are thick and impure, the suppression obstinate, their temperament inclining to great sensibility, the age advanced, or the disease hereditary, or become habitual, the cure is difficult. Sometimes, through ill management, it degenerates into an epileptic or hypochondriac melancholy.

To cure the St. Vitus's dance, take away about 8 ounces of blood, more or less, according to the age of the patient; the next day give half, or something more of the common purging potion according to the age, and in the evening the following draught:

Take an ounce and a half of alexeterial water; 30 drops of compound spirit of lavender; a couple of theriac andromachi; and 8 drops of the tinctura thebaica. Mix and make them into a draught.

Let the cathartic potion be repeated thrice every other day, and the same draught in the evening. After which, bleed again, and repeat the cathartics three or four times; and this course may be pursued to the third or fourth time.

Apply to the soles of the feet emplastrum e caranna.

For fear of a relapse, at the same season of the next year, or a little sooner, in which the distemper appeared, bleeding should be again repeated, and purging two or three times.

Allen cured two girls of this distemper with the expression of millipedes and the Peruvian bark, after bleeding and a gentle cathartic.

As to the cure of other convulsive disorders, if the patient is plethoric, or the pulse great, it must be begun with bleeding either in the arm or foot; and if occasion require, it must be repeated two or three times, but not till the fit is over. The air should be dry and serene, with constant exercise; the aliment should be easy of digestion, and all hot spirituous liquors should be avoided. The constant drink should be the decoction of scorzonera roots, with thavings of hartshorn, or whey, or the Selter's mineral waters. Pediluvia are likewise proper, of river-water, wheat-bran, and chamomile-flowers. They should be used pretty warm and deep, at the time of going to bed, and afterwards sweating should be promoted.

The patient's body, if coltive, must be kept open with manna, or with oily clysters; and if the fomes of the disease is judged to be in the prima via, it will be proper, at the changes of the moon, to give a vomit with manna, that is, an ounce of manna with two or three grains of tartar emetic.

If, about the time of puberty, this disease proceeds from too early or excessive coition, or violent passions of the mind, all things which cause a commotion in the fluids must be avoided; such as, aromatics, sharp purges, emetics, spirituous liquors, inordinate motions of the body or mind, and all heating things in general. On the contrary, the diet should be soft, emollient, and nourishing; such as cow's or ass's milk, or whey; as also baths of sweet water mixed with milk. Likewise jellies, and decoctions of scorzonera, barley, hartshorn, ivory thavings, and viper's flesh, for ordinary drink, and chocolate.

If it proceeds from worms, the cure depends on their being killed and expelled out of the body: But all anthelmintics, or worm medicines, are not to be made use of in this case; such as garlic, vitriol, copper, aloes, sharp purges, and mercurials; because, if they are given inconsiderately, they are hurtful to the nerves. It will be better to use clysters, made of milk, sweet things, and oil; as also liniments of a purging quality applied to the navel and abdomen. Inwardly may be taken semen santonici. If mercurius dulcis is given with a cathartic, it will be necessary first of all to let the patient take a few spoonfuls of oil of sweet almonds.

If it is caused by a suppression of the menses, emmenagogues and hot medicines are to be forbidden; but bathwaters and bleeding will be proper; as also pediluvia, if made pretty warm; hot infusions of balm-flowers, and flowers of the lime-tree, tincture of castor, absorbent powders, antispasmodics, and anodynes.

If from a stoppage of the hemorrhoidal flux, besides bleeding and the above remedies, leeches applied to the anus will be of very great advantage.

In the observations of the medical society of London, we have an account of a deplorable convulsive case being cured by electricity. Of the Convulsive Asthma.

An asthma is an impeded and very laborious respiration, attended with unspeakable anxiety, and a straitness about the precordia, hindering the free circulation of the blood through the lungs, arising from variety of causes, and not without danger of suffocation.

There are several sorts of asthmas. One is, difficulty of breathing, proceeding from corpulency and a very full habit of body; and is most apparent after violent motion: but this is a slight disorder, and free from all danger. The next is the pituitous asthma, attended with a moist cough, and the bringing up pituitous matter; it attacks the patient at all hours, and in all positions of the body, and is owing to a plenty of a viscid mucus, stuffing the vesicles of the lungs, and hindering the free ingress and egress of the air through them. Another is owing to the convulsive contraction of the parts designed for respiration, and proceeds from various causes both within and without the thorax; and this is called the dry flatulent or convulsive asthma.

There is a heaviness of the breast, a loveness to perform customary labours, difficult breathing when going up a hill; the patients grow hoarse, cough, and are troubled with frequent eructations; they cannot sleep, and are scarcely warm in their beds. As the disease grows worse, the cheeks look red, the eyes grow prominent as if they were strangled; they snore or wheeze while waking, but much more when asleep; they are fond of cold air, they keep themselves in an erect posture, and seem to suck in the air with open mouth; they are troubled with sweating about the neck and forehead; then comes on a violent cough, and the patient brings up a little cold frothy matter. As they draw in their breath, the neck swells, and the precordia are pulled upwards; the pulse is small and quick. If it increases, the patient is in danger of suffocation; but if it grows better, the fits are seldom, and greater plenty of matter is coughed up; the urine is more plentiful, but without a sediment; the voice grows clearer, the sleeps longer than are necessary, the precordia are set at liberty; a pain sometimes passes to the shoulders; the breathing is slow and gentle, but with a sort of a wheezing.

The longer this disease continues, the more sharp and violent all the symptoms become. The patient's body grows more colicive, and the urine is thin and watry; most commonly the feet swell, then the hands, face and back; there is a numbness of the arms, the countenance is wan and livid, or of a leaden colour. Then comes on a little fever, which grows worse in the evening; the whole body is cachetic, with an oedematous swelling of the feet; there is a dropfy of the breast, or an ascites, or anaemia; at least there is a palsy on one side, or of the arm; or, instead thereof a palsy of the eyelids.

When the disease is recent, and is owing only to the spasmodic contraction of the precordia, there are hopes of a cure; especially if the matter of the gout, ulcers, and exanthemata, are sent back to their proper seats. When the menes or hemorrhoids which were stopped return, it yields relief, and, if the disease was not too far advanced, perfect health. If it is inveterate, or ill managed, it brings on a dropfy of the breast, obstructions of the lower belly, oedematous swellings of the feet, a cachexy, and an universal dropfy. In general, all convulsive asthmas portend a sudden exit, or suffocation, especially if there is a polypus of the heart; if it continues long, then the patient will die of the dropfy; in which case it will be soon fatal; when there is a slow fever, an unequal intermittent pulse, a palsy of the arms, a continual palpitation of the heart, little urine, a syncope or swooning, then death is at hand. Some are carried off by an inflammation of the lungs, and the more grievous the disease the more languid the pulse. The asthma, in old persons, continues till death.

In the paroxysm, because the body is generally bound, and the wind and humours are carried upwards, the speediest assistance is from emollient and carminative clysters.

Afterwards use frictions of the feet, which have an incredible efficacy; also let them be put into warm water; for the feet are almost always cold. When there is a violent spasm about the precordia, hot fomentations are necessary, or bladders filled with hot milk, and applied to the part affected; likewise nervous liniments are very useful, rubbed in with a warm hand.

Internally, antispasmodics should be given, with gentle diaphoretics.

And this is all that needs to be administered in the fit.

Out of the fit, if it proceeds from too great a congestion of blood about the breast, or from a polypus of the heart, bleeding in the foot will be proper, as also fomentations; in a suppression of the hemorrhoids, leeches should be applied to the anus; also gentle laxatives to cleanse the prime via; likewise bodily motion, slender diet, and soft drink. If there are hypochondriacal or flatulent symptoms, then gentle laxatives will be the more necessary, together with clysters. When the menes or hemorrhoids are suppressed, nothing is better than the bath-waters, both for bathing and drinking; or the waters of Selters taken warm and mixed with milk.

When the asthma proceeds from the driving back some impure matter from the skin, or from the drying up of ulcers, and the humour is translated to the nervous parts of the breast, then gentle diaphoretics will be necessary to send it back to the superficies of the body.

After which the patient may drink tea made of balm, or elder, or lime tree flowers, with the leaves of scordium, or veronica and fennel seeds, or any thing else of the same kind. Remedies compounded of sulphur are likewise very efficacious in driving back the morbid matter to the skin, though outwardly they are hurtful in cutaneous diseases.

The returns of the fits are to be observed and guarded against, by moderate evacuations, as bleeding, gentle vomits, laxatives, and sometimes cathartics; but every thing that heats the blood should be carefully avoided, especially about the usual times of the paroxysms; because there is generally then a lurking fever, which ought not to be exacerbated by heating food or medicines.

In a dry asthma proceeding from fumes of lead, an air-replete with exhalations from quick-lime, or the vapours of pitcoal; milk, cream, oil of sweet almonds, emulsions of Sperma ceti, the fat of animals used internally and externally, answer every purpose.

Country air, and following the plough, are beneficial to restore the debilitated tone of the lungs; and tea, made with hyssop, veronica, ground ivy, liquorice, and daisy flowers, cannot be enough commended. But sweet things, in every kind of asthma, are hurtful, especially in the humid or serous, and the hypochondriacal.

Of a Cough.

The cough now under consideration is a primary disease, which greatly disorders the whole body by its vehemence and obstinacy. Its cause is, a flux of serous humours from the outward parts and extremities of the body to the lungs, and is seldom without feverish heats and shiverings towards the evening.

It is either moist or dry: the former afflicts the phlegmatic, whose fibres are lax and muscles soft, and who abound with serous and pituitous humours. Women are more liable to it than men; as also infants, boys, and old men, more than those in the vigour of their age. The dry cough principally attacks the hypochondriac, the scrofulous, the cachectic, and those who are lean and slender, and subject to convulsive disorders, and whose bodies likewise abound with a sharp serum.

The most violent of these kind of coughs is the tussis convulsiva, or ferina, whose effects are so violent as almost to put the patient in danger of suffocation: In children, this is called the hooping cough. Sometimes it is dry in the beginning; or the patient brings up a little thin serum, more or less sharp. Sometimes it is moist; and then after a very laborious fit, the patient expectorates a sublivid, and commonly a moist tough mucus. The extreme parts grow cold, the body is coltive, the urine and the vital fluids are driven in greater plenty and force towards the breast and head; so that while the paroxysm lasts, the face is red and turgid with blood, the veins swell, the arteries beat quicker and stronger, the eyes are ready to start out of the head, the tears flow, the eyelids swell, and sometimes the blood, after sneezing, springs from the nose. Sometimes the very vessels of the lungs burst, and a spitting of blood ensues. Sometimes a hiccup supervenes, and then at the same time the patient is affected with laborious vomiting; some discharge their excrements and urine insensibly; and the coughing of others is so violent as to cause ruptures, especially in children.

As to the prognostics, a dry cough often turns to a moist, by hurting the digestion, and rendering the patient cachectic. When a moist cough becomes suddenly dry, and the breast remains oppressed, we may conclude that a putrid or hectic fever, or an exulceration of the lungs, are near at hand. In the convulsive cough of children there is danger of a suffocation; which cough sometimes happens in difficult dentition, and in the measles. It sometimes causes gibbosity and ruptures in boys; in women abortion; in adults a spitting of blood and a phthisis. Coughs that proceed from a schirrus of the lungs or other viscera, are incurable; if from driving in of exanthemata, or breakings out of the skin, it grows easy as soon as they are thrown out again. All coughs attended with loss of sleep are bad; as also that which is frequent, tedious, obstinate, and proceeds from a defluxion on the lungs. On the contrary, a moderate heat in the night time, with an equal breathing sweat throughout the whole body, a larger flux of urine, and the body open at the same time, a more quiet sleep, and an easier expectoration, are certain signs that the disorder is going off.

If the cough is recent, and there is no fever, nor other signs of a bastard peripneumony; or if it is not the consequence of a pleurisy or a peripneumony ill cured, by a neglect of sufficient bleeding; the patient need only abstain from wine and flesh for some days, and use the following remedy.

1. Take 10 drops of balsam of sulphur, with a bit of candied sugar; to be used twice or thrice in the day.

Recent coughs, after bleeding, are softened by a mucilage of linseed, or by any common sweet oil: But the oils are made more efficacious by the addition of a volatile alkaline salt, in this manner:

2. Take an ounce and a half of oil of olives, 6 ounces of water, 60 drops of spirit of hartshorn, an ounce of pectoral syrup: Take three or four spoonfuls every fourth hour.

If the cough will not yield to these remedies, then it will be to no purpose to rely on pectorals, especially if there is a fever along with it, or if it proceeds from a pleurisy or peripneumony; for then it is to be cured by bleeding and purging, in the same manner as the bastard peripneumony.

When there is a thin, salt, sharp defluxion, jellies are proper, and a decoction made of barley, shavings of hartshorn, viper-grass root, and liquorice; or the decoction of turpentine with sugar; and above all things, oil of sweet almonds fresh drawn.

When a tussis catarrhalis affects the whole habit or body, with a loss of appetite and a tabes, the cure must be attempted with asses milk or whey, or milk with equal parts of Selters waters, and especially riding.

In a moist, lasting, pituitous cough, the body must be kept open with manna, two ounces at least dissolved in any convenient vehicle, to which may be added, two drams of terra foliata tartari, and a few drops of oil of aniseed. If the stomach will not bear laxatives, clysters must be used.

When the cough is outrageous, saffron mixed with bezoards is very friendly to the breast; nor are storax pills, mixed with the aromatic pills, less beneficial. You may order about 6 grains of the storax pills, with a scruple of the aromatic, and give them at bed-time; in the mean while not neglecting the expectorants, oil of sweet almonds, and sperma ceti. Likewise the thebaic tincture mixed with spirit of hartshorn is not unuseful for the same purpose.

But the best opiate in this case, is the elixir paregoricum: the dose for children is from 5 to 20 drops; for adults, from 20 to 100 and upwards. It is peculiarly excellent for children in the hooping-cough or chin-cough.

The patient should, as much as possible, breathe a temperate air, shunning all salted and smoked dried meats, poignantly poignant sauces, for they render the blood and serum sharp and impure; he should also abstain from malt liquors, but more especially acid wines. The drink should be hydromel; or, if the patient is scorbutic, water alone, the cold being first taken off with toasted bread. The vulgar pour hot water upon wheat bran, and drink the infusion cold, not without success.

As to bleeding in this disease, it is necessary for those who are full of blood, and whose veins are very prominent; or when the usual excretions of it are suppressed; it is also a good preservative, though the person has past his seventieth year. Blitters may likewise be used, in obstinate cases.

Of a Phthisis, or Consumption of the Lungs.

If an ulcer of the lungs consumes them so far that the whole habit of body wastes away, it is called a consumption of the lungs.

This ulcer may proceed from any case which may detain the blood in the lungs so as to change it into a purulent matter.

The causes may be referred.

I. To that temperament of the body which tends first to spitting of blood, then to an ulcer of the part where the blood has made its way through. This consists,

In a tenderness of the arterial vessels, and in the impetus of a more or less acrimonious blood. This is known from a view of the tender and fine vessels, and of the slender make of the whole body, a long neck, a flat and narrow thorax, depressed scapulae; the blood of a bright red, thin, sharp, and hot; the skin transparent, very white and fair, with a blooming red in the cheeks; the wit quick, subtle, and early ripe with regard to the age, and a merry cheerful disposition.

In such a debility of the viscera as disposes their too tenacious contents to produce obstructions, putrefactions, and to grow acrimonious, whereby the vessels are corroded, first causing spitting of blood, and then ulcers. This is discovered by a slight febricula, a little dry cough, an unusual heat, a redness of the lips and mouth, a flushing in the face; which are most apparent when the new chyle enters into the blood; a propensity to sweating when asleep, a weakness, a shortness of breath increasing upon the least motion.

In that age when the vessels have attained their full growth, and will not admit of any further lengthening; when at the same time the blood increases in quantity, acrimony, and force; which happens between the sixteenth and thirty-sixth year of the patient's age.

In an hereditary disposition to this disease.

These dispositions to a phthisis are hastened,

By a suppression of accustomed evacuations, especially the sanguineous; as the hemorrhoids, menses, lochia, bleeding at the nose, usual blood-letting, chiefly in the plethoric, and those who have lost a limb.

By any violent shock of the lungs, by coughing, shouting, singing, running, violent efforts of the body, anger, and wounds.

By sharp, saline, aromatic aliment, or drink; by the particular manner of living; by another disease, whence the quantity, acrimony, velocity, rarefaction and heat of the blood are increased. Hence it frequently happens from acute fevers, the plague, small-pox, and fever.

II. Likewise this collection of pus may proceed from a peripneumony, which terminates in an apoplexy.

III. When there is an empyema formed, it may corrode, destroy, and consume the lungs, and so produce the same disease as if they were wasted away by an ulcer generated in their own substance.

The sign of an approaching phthisis is a dry cough, which may continue for some months; whereas a simple catarrh is attended with spitting, and is but of short duration. Vomiting, or a disposition to vomit after eating, excited by the above mentioned cough, is a most certain sign of a phthisis.

It invades persons from eighteen to thirty-five years of age; the whole body wastes away. There is a hectic fever, which is most apparent after meals, and is known by the quickness of the pulse, and the redness or flushing of the cheeks: The matter brought up by the cough is bloody or purulent; if it is spit into the fire, it yields an offensive smell; if into a vessel of water, it falls to the bottom. Though it is thick, it is not glutinous or tenacious, but fluid, and of different colours, viz., yellow, green, but most commonly of an ash-colour.

This disease begins with a slight pain, moderate heat, and an uneasy or oppressive strangeness of the breast. When blood is brought up by coughing, it is generally of a florid, scarlet colour, and frothy, and proceeds from the lungs with a remarkable noise. It is mixed with fibres, films, and small portions of arterial, venal, and bronchial vessels: The pulse is soft, small, and undulating; the breathing is difficult; and these symptoms are preceded by a salivary taste in the mouth.

Blood is coughed up from the lungs sometimes without any pain; and if there is a vessel broken, it most commonly flows out in a great quantity at the first eruption, and afterwards more sparingly.

Spitting of blood is cured by copious bleeding every third day, to the fourth time, or till the inflammatory pellicle entirely disappears. Sydenham advises the taking away 10 ounces of blood, to take the common purging potion the next morning, and at night an ounce of diacodium. Hoffman likewise advises gentle purging and pediluvia, as also putting the hands into warm water. For appeasing the orgasm of the blood, he thinks nothing better than spirit of vitriol, but more especially the tincture of roses acidulated therewith. Morton very judiciously prefers the Peruvian bark. Refrigerating, thickening, styptic lenient remedies, used a considerable time, are serviceable, with which may now and then be mixed the most lenient balsamies.

Hoffman advises the following powder, as preferable to everything else, in appeasing the spasmodic strictures of the lungs.

1. Take seeds of white horehound, and crab's eyes, of each a dram; 12 grains of nitre; and one grain of camphor. Make them into a powder.

A prudent use of the nonnaturals is likewise necessary, that may best oppose the cause of the disease; and chiefly a proper aliment, and manner of living; a milk-diet is preferable to any other. When the cure is performed, it will be necessary, by way of prevention, to bleed once in six months, for several years together.

But if, by reason of the violence of the disorder, or the unskilful use of styptics, there should, after the spitting of blood, arise a difficulty of breathing, which continually increases, a wandering shivering heat and redness of the cheeks, a dry husky cough, a slight hectic fever, a preternatural thirst, a weakness, or lente of weight in the breast, it is a sign that the wound from whence the blood flowed has already begun to change to matter about its lips. Then under the crust of dried blood pus is formed; and this collection degenerates into a latent Vomica; and that being broken, becomes an open ulcer of the lungs.

The effects of an ulcer of the lungs thus formed, are generally those which follow: An increase of the acrimony and quantity of the putrid pus, a dilatation and corroding maceration of the membrane or bag in which it is contained; a conversion of the blood-vessels and the bronchia into pus; a purulent consumption of the whole lungs, or of one of its lobes; a continual dry cough, or spittle shook off by the constant concussions of the cough; a conversion of the blood flowing into the ulcer into pus; an increase of the vomica in the lungs; the bursting of this vomica into the tube of the larynx; the sometimes suffocating discharge of the pus, or the daily coughing up of matter, which sinks in water, and is thick, sweet, fat, fetid, white, red, yellow, livid, ash-coloured, or streaked, and which, put into the fire, has the smell of burnt flesh. Sometimes the vomica breaks into the cavity of the thorax; from whence proceeds difficulty of breathing, and the other symptoms of an empyema. Then the respiration grows exceeding bad; the chyle and the whole mass of blood are converted into pus; the usual method of nourishment is destroyed, the solids continually consume and waste away; a hectic fever appears, with a small languid pulse, and the heat in the upper parts intense, the cheeks look red, and the face hippocratic. Generally there is an indescribable anxiety towards the evening; an unusual thirst; profuse nocturnal sweats; red pustules; a swelling of the feet or hands on the side affected; excessive weakness; a hoarse voice; a falling off of the hair; an itching throughout the body, with watery pustules; a debilitating diarrhoea, with yellow, fetid, purulent, cadaverous stools; a suppression of the spitting; and then death.

Hence the following prognostics may be formed.

An hereditary phthisis is the most dangerous of all, and is incurable unless the spitting of blood be prevented. A phthisis from external violence, that is, proceeding from spitting of blood caused thereby, is the slightest of all.

A phthisis in which the vomica breaks suddenly, and the patient easily brings up a white, concocted, smooth pus, and in quantity proportionable to the ulcer, without thirst, and with a good appetite and digestion, due secretions and excretions, is curable, though with difficulty.

Heavy, solid, stinking, sweet spittle, with night-sweats, livid cheeks, paleness of the face, the nostrils pinched up, sinking in the temples, incurvation of the nails, falling off of the hair, and a colliquative diarrhoea, are signs of approaching death.

When a vomica is known to be formed in the lungs, then the physician must endeavour to ripen and break it; which is to be done by milk-diet, riding on horseback, warm vapours and expectorants: Which done,

1. The blood must be guarded and defended against the purulent infection, by remedies which are moderately and agreeably acid and saltish, by vulnerary herbs, smooth balsamics given in various forms, in great plenty, and continued a long time.

2. The ulcer must be cleared as soon as possible from the purulent matter, the lips of it cleansed and consolidated, which is to be done by liquid medicines, by things which promote coughing, by motion, riding, country-air; these are expellents. The cleansers are detergent balsamics, used inwardly and outwardly. The consolidators are paregorics.

3. The aliment must be such as requires the least force to make it pass freely through the lungs, and be there assimilated, and at the same time be fit for nourishment. Asses milk is very suitable to this intention, as also buttermilk.

Small repeated bleedings are not only beneficial in old coughs, threatening consumptions, but also after purulent spitting and hectic symptoms have appeared. The quantity of blood to be drawn is from four to seven or eight ounces, once in eight or ten days.

Setons, or issues made in the side of the part that is most affected, are very beneficial.

We must endeavour to diminish the defluxion on the lungs, by bleeding and gentle purging, as well as pectorals, accommodated to the various states of the distemper, viz. by thickening medicines and attenuants, and such as temperate the hectic fever, with emulsions and asses milk, &c. and lastly, by healing the ulcer with balsamics, as opobalsamum; the dose is 20 drops upon sugar; but this is not to be taken before due evacuations have been first made.

After evacuations, great care must be taken that the cough be appeased, lest the lungs should be weakened by the continual agitation.

The most sovereign remedy to restore the lungs to their pristine vigour is to get on horseback every day; and he that will put himself upon this exercise for a cure, need not be tied down to any strict rules of diet, nor be debarred from any sort of meat or drink, since the whole stress of the matter depends wholly on the constant and continual exercise of riding. Long sea-voyages have of late been greatly recommended.

In the first stage of this disease, when the lungs, trachea, and glands, throughout the whole pulmonary tube, are stuffed with a putridous matter, separated from the mass of blood, and the patient is afflicted with a continual cough, especially in the night-time, all proper methods must be used to stop the influx of this catarrh, and to convey the humours already impacted.

First, Blood must be taken from the arm, from six to ten ounces, if the patient is plethoric, or accustomed to bleeding; this is to be repeated once, twice, or thrice, at proper intervals, especially if the flux of serum is like a suffocating suffocating catarrh, together with the copious expectoration of a crude phlegm; or where there is an athmatic difficulty of breathing, a pain in the side, or the signs of any disposition to a rheumatism, a pleurisy, or a peripneumony.

After bleeding, especially if there is a nausea, or an inclination to vomit, it will be necessary to give an emetic with oxymel of squills [or ipecacuanha wine, which will sometimes stop the progress of an incipient phthisis. The emetic, if it agrees with the patient, and there is occasion for it, may be repeated every third or fourth day. The best time is towards the evening; and after the operation is over, an opiate will be proper.

Nor must those remedies that soften, lubricate, thicken and concoct the phlegm, be omitted; such as sugar-candy, barley-fugar, old conserve of roses, juice of liquorice, the white and black troches of the London dispensatory; fresh butter in water-gruel, sweet oil or oil of sweet almonds, especially linseed oil cold drawn, of which the patient may take a spoonful every hour, unless there is a diarrhoea, or any other contra-indicating symptoms. He may also eat raisins and figs.

The air should be pure, far from bogs and marshy places, and the smoke of sea-coal; the aliment light of digestion; the drink small; for spirituous liquors should be avoided. The patient should use exercise, and keep his mind as free from passions as possible.

The second stage of this disease may be reckoned from the first formation of the tubercles, till they begin to inflame and putrefy, that is, while they remain in a crude state. This is known from the increase of the hectic fever; from the wasting and flaccid state of the mucus flesh, from the dryness of the cough, for the spitting considerably abates; and from the great weight and oppression which is continually felt in the breast.

In this stage all evacuations by vomit, stool, and sweat, are pernicious; for they increase the fever, and accelerate the consumption. Nor is bleeding otherwise proper, than as it prevents an inflammation, and then it must be used with a sparing hand, when there are pleuritic pains, or the patient hath catched a fresh cold.

Besides alterative medicines, taken in small quantities, and at stated times, endeavours must be used to cool the febrile heat of the blood, and decrease the quantity of the noxious humours. The diet must be such as will obtund the acrimony of the humours; as partridges, mountain-birds, poached eggs, oysters, calves-feet and jellies, and soups made therefrom; also craw-fish and other shell-fish, and broths made of their flesh. Likewise spaw-waters, pectorals, hydromel, a milk diet; asses milk, milk-water, milipedes, snails, and the like; together with juices, shaving the head, and proper plasters.

In the third stage of this disease little hopes remain of a cure, unless the ulcers are small and benign.

In this state of the disease, opiates should be sparingly used, even though the cough and want of rest require them, because they not seldom bring on sudden death. Jellies and broths are likewise to be directed; for, in short, there is now more help to be expected from the kitchen than from the apothecary's shop.

The diet should be water-gruel, ptifans of scalded apples, posset-drink, honey raisins and liquorice, table-beer warmed with toast, and the like. When the fever is on the decline, chicken broth, poached eggs, &c.

If there is occasion, the body must be loosed with clysters of sugared milk, with chamomile flowers, and repeated as occasion requires; then take away ten ounces of blood on the side affected, which should be boldly repeated every, or every other day, according to the urgency of the symptoms.

In colliquative sweats, pearl juleps may be freely given, to which may be added chalk, corals, dragon's blood, or other absorbents. But the Peruvian bark for this purpose, is much better than any other medicine whatever. The patient should not be permitted to sleep too long, the bed-cloths should be light, and he should be removed to fine subtle air.

Of the Nervous Consumption.

A nervous atrophy or phthisis, is a wasting of the body, without any remarkable fever, cough, or difficulty of breathing; but is attended with want of appetite and a bad digestion; whence the whole body grows languid, and is continually falling away.

At first the body is oedematous, and as it were stuffed with a vapid chyle; the face looks pale and bloated, and the stomach lothes everything but liquids. The patient is forced to keep his bed sooner than the progress of the decay of his flesh seems to require. The colour of the urine is uncertain, but it is generally very red and small in quantity; sometimes it is pale and copious.

No considerable fever is discernible either by the pulse, heat, or thirst, though the urine is ever so red.

The causes of this disease are generally violent passions of the mind, a too free use of spirituous liquors, and unwholesome air.

Stomachic and nervous remedies are only to be depended upon; such as, chalybeates, antiscorbutics, cephalics, and bitters. If the body be costive, two ounces of tinctura sacra may be taken every fourth evening, and from 30 to 40 drops of elixir aloes, in a glass of white-wine with bitters, before dinner. The elixir of vitriol is excellent in this case, 20, 30, or 40 drops is a dose, in any convenient vehicle, once, twice, or thrice a day. Also about half an ounce of the chalybeate wine, in some proper liquid, in the winter; in the summer, the spaw waters: the usual drink may likewise be made bitter with the vinum amarum; but nothing strengthens the stomach more than a decoction of wormwood.

Sometimes the patient may take eight or nine drops of opobalsamum, or spirit of hartshorn, or of sal ammoniac, as friendly to the nerves; nor must he forget exercise and cheerful company, with other diversions.

Of an Empyema.

An Empyema is a collection of purulent matter in the cavity of the thorax, between the lungs and the pleura, which always supposes the breaking of a vomica into the said cavity.

Such are the vomicae or abscesses of the lungs, proceeding from inflammations, from spitting of blood, from a thick matter which cannot be expectorated. Of the pleura, from an inflammation, from a wound therein, healed outwardly but open inwardly; from a bruise, or a concealed rupture of it, turning to pus. Of the diaphragm, when, after an inflammation, it suppurates, and breaks on its upper part. Also of the mediastinum and pericardium affected in the like manner.

An empyema may be foreseen from an inflammation of any of the above mentioned parts, which is not terminated and resolved by concoction, revulsion, a crisis, or medicines; but is followed by shiverings, a febricula increasing at night, a wandering heat, a sense of heaviness in the part that was pained, a difficulty of breathing, a want of appetite, and an unusual thirst.

An actual empyema is known from twenty days being elapsed since the inflammation began, without expectoration of the matter; from the signs of a vomica in the five abovementioned parts disappearing; from a new pain, cough, difficulty of breathing, and spitting, arising, and afterwards going off; from a dry cough, a weight on the diaphragm, not being able to lie but on one side, a noise made by the fluctuation of the pus, upon moving the body; from a slow fever, a flushing in the cheeks, hollow eyes, heat in the ends of the fingers, crookedness of the nails, and a swelling of the abdomen.

The consequences of this disease are, a continual accumulation of pus from the ulcer not yet healed; the matter increasing in its acrimony, putrefaction, rank smell, and thinness, by being shut up in a hot, moist place; an impediment in raising the diaphragm and extending the lungs; a shortness and difficulty of breathing, and not easily performed unless in an erect posture, a dread of suffocation when laid down; an inability of lying, but on the affected side; a constant dry cough, with anxiety; a maceration and corrosion of the lungs, pleura, diaphragm, pericardium, and even of the heart itself, converting them gradually into filthy corruption; whence a hectic fever, quick, small pulse, constant redness of the cheeks, loss of appetite, perpetual thirst, extreme weakness, and fainting fits. Hence all the fluids become unfit for nutrition, circulation, or any other office: The consequence of which is, a wasting of the whole body; a putrefaction of the fluids, which may be discharged through the corroded lungs, or carried downwards by a fatal sanious diarrhoea; night-sweats, pustules in the face, crooked nails, a shining yellowness of the skin, and a hippocratic countenance.

The cure of this disease is different, according to its different cause and state.

When a vomica or abscess is known to be formed in any of the parts before mentioned, all endeavors are to be used, that it may be speedily broken and determined to the outward parts, which must be attempted by actual or potential cauteries, or by incision and proper motion.

When the vomica is actually broke, then it is to be evacuated by the mouth, if nature seems to encourage it; or by urine, if there appear any signs in it of palling that way; or by an aperture of the thorax by a proper instrument. See Surgery.

In general, all inflammations of the lungs or pleura are followed by an adhesion of these parts, which allow nature to make a passage externally: And it is common in abscesses of the pleura and intercostal muscles to find them break outwardly; nor is it uncommon even in the lungs. Therefore, when there is an adhesion, no other operation is necessary than to open the tumour with a lancet, when the pus is formed; and if the suppuration is so plentiful as not to admit the healing of the outward ulcer, it may be kept open with a hollow tent.

Hoffman gives an instance of a person, who, after a periapneumony, fell into an empyema, and was cured by taking milk boiled with sugar of roses. The quantity was three pints a day. As also balsamic pills made of flowers of sulphur, oil of sweet almonds, sperma ceti, venice turpentine, fatron, and oil of aniseed. Likewise a powder made of crabs eyes, sperma ceti, sugar, myrrh, liquorice powder, and bole armoniac.

Of the Scurvy.

This distemper chiefly affects the inhabitants of cold northern countries, and especially those who live in marshy, low, fat and moist soils, near stagnating water, whether fresh or salt. Those who live idle sedentary lives are most subject, chiefly in the winter, to the attacks of this disease; as also those who feed upon salted and smoked dried flesh or fish, sea-biscuit, stinking water, unfermented farinaceous vegetables, peas, beans, sharp salt old cheese; likewise those who are subject to melancholic, maniacal, hysterical, or hypochondriacal disorders.

It is known by spontaneous weariness, heaviness of the body, difficulty of breathing, especially after bodily motion; rottenness of the gums, a stinking breath, frequent bleeding of the nose, difficulty of walking; sometimes a swelling, sometimes a falling away of the legs, in which there are always livid, plumbeous, yellow, or violet-coloured spots; the colour of the face is generally of a pale tawny.

The first state of this disease begins with unusual laziness, spontaneous weariness; the patient loves to be in a fitting or lying posture; there is a pain in all the muscles, as if he was over tired, especially of the legs and loins; when he wakes in the morning, all his joints and muscles seem to be tired and bruised.

In the second state, the gums swell, grow painful, hot and itching, and bleed upon the least pressure; the roots of the teeth become bare and loose; he feels pains in all the external and internal parts of the body, imitating distempers proper to the various parts.

In the third state, the gums at length grow putrid, with a cadaverous smell; when they are inflamed, blood dithers from them, and a gangrene ensues; the loose teeth by degrees grow yellow, black, and rotten; the sublingual veins become varicose, and like rings; there are often fatal hemorrhages, which break out from the external skin, without any appearance of a wound from the lips, gums, mouth, nose, lungs, stomach, liver, spleen, pancreas, intestines, womb, kidneys, &c. Obstinate ulcers arise, of the very worst kind, which no applications will cure, and which are apt to turn to a gangrene; they break out in all parts, but especially the legs, and are attended with a stench. There is a kind of an itch and dry scabs, with with a dry and mild leprosy. The blood drawn from a vein is black, grumous, thick, and yet wants its due confluence in the fibrous part; the serum is salt, sharp, and abounding with a yellowish green mucus on its surface. There are gnawing, rending pains, quickly shifting from place to place, which grow more violent in the night, affecting all the joints, bones, and viscera.

In the fourth state, there are fevers of various kinds, which bring on an atrophy; sometimes diarrhoeas, dysenteries, or violent stranguries; as also faintings and mortal anxieties, a droopy, consumption, convulsions, trembling, a palsy, contractions, black spots, voiding of blood upwards and downwards, a putrefaction and consumption of the liver, spleen, pancreas, mesentery. Now the contagion spreads very quick.

The first sign of the approach of this disease is commonly a change of colour in the face, which becomes pale or yellowish, and bloated, with a little flesh, and an aversion to exercise. The caruncles of the eyes appear of a greenish cast, and yet in other respects the patient seems in perfect health. However, the change of colour in the face does not always precede the other symptoms, though it constantly attends them. Then an universal lafitude supervenes, and a stiffness and feebleness of the knees, with a difficulty of breathing on the least motion. Soon after this there is an itching of the gums, which swell, and are apt to bleed on the least friction. Then they become livid, soft and spongy, and afterwards extremely purulent and fungous. This rottenness of the gums is an inseparable sign of this disease. These are not only subject to bleed, but there are hemorrhages from different parts of the body.

The skin is dry throughout the whole course of this disease, except towards the last, and in many it is rough. In some it appears like the skin of a goose; but it is most frequently smooth and shining. It is stained with blue, purple, livid, or black spots; some of which are small, and others of a hand's breadth, when the disease is advanced. They are chiefly on the legs and thighs, but sometimes on the arms and trunk of the body. Some have a swelling of the ankles in the evening, which disappears in the morning. In a little time it advances gradually up the leg, and the whole member becomes oedematous. Hurts, bruises, wounds healed up, and fractured parts, always become carbuncle first. Old ulcers will emit a thin fetid fumes, mixed with blood, and at length coagulated gore will lie on the surface of the sore like a cake. As the disease increases, they shoot out a soft, bloody fungus resembling bullock's liver, which sometimes will rise to a monstrous size in a night's time. The slightest bruises and wounds of scoriatic persons degenerate into such ulcers, and are easily distinguished from all others, by being putrid, bloody, and fungous.

To prevent the scurvy at land, it will be proper to choose a warm, dry, pure air, with a diet of easy digestion, consisting chiefly of a due mixture of animal and vegetable substances; for those are most liable to it who live in marshy, wet soils, and in places subject to great rains and fogs; or in damp, low apartments, unless they keep constant fires, and their chief food be flesh broths, with plenty of fresh greens or vegetables, and well-baked bread made of wheat flour; as also a cheerful glass of some good wholesome fermented liquor. Cleanliness, entertaining amusements, and moderate exercise, will also be good preservatives in these cases. In garrisons, the soldiers should be kept as dry, clean, and warm as possible, and their provisions should be as wholesome as can be procured, with plenty of good vegetables, particularly salads of garden-crews.

The best method of preventing the scurvy at sea will appear from the effects which Dr Lind has observed several medicines have had, especially those which have been greatly recommended as preservatives. On the 20th of May 1747, being on board the Salisbury at sea, he took twelve scurvy patients under his care. They had putrid gums, spots, and lafitude, with weaknesses of their knees. They had a proper apartment in the forehold: their diet was water-gruel sweetened, in a morning; sometimes mutton broth for dinner, sometimes light puddings, boiled biscuit with sugar, &c. and for supper, barley and raisins, rice and currants, sago and wine, and the like. Two of these were ordered each a quart of cider in a day; two others twenty-five drops of elixir of vitriol, three times a-day, upon an empty stomach, using a gargle acidulated with the same. Two others took two spoonfuls of vinegar three times a-day; having their gruels, other food, and gargles, well acidulated with it. Two of the worst patients, with the tendons of the ham rigid, were put under a course of sea-water, and drank about a pint every day, more or less, according to its operation, which was intended to be as gentle physic. Two others had each two oranges and one lemon given them every day, which they eat with greediness upon an empty stomach, at different times. This course was continued but six days, because no more fruit could be allowed. The two remaining patients took the bignefs of a nutmeg, three times a day, of an electuary made of garlic, mustard seed, balsam of Peru, and gum myrrh; using for common drink barley-water well acidulated with tamarinds; by a decoction of which, and cream, they were gently purged three or four times during the course.

The oranges and lemons had the best effect; for one of those who had taken them, was at the end of six days fit for duty; and he took nothing more but a gargle of the elixir of vitriol for his gums, which were not quite found, and so recovered his health entirely. The other being more recovered than any of the other patients, was appointed to look after them. Next to the oranges the cider had the best effects, though it was not very good, being prick'd; for those who drank it were in a fairer way of recovery at the end of the fortnight, the time allowed for making the experiments, than any of the rest. Elixir of vitriol did no good unless as a gargle, nor yet any of the rest of the medicines. Oranges are preferable to lemons; for by these the lord Anson's people were so speedily and surprisingly recovered at the island of Tinian. Besides, Mr Murray affirms, from experience, that oranges and lemons, when properly and sufficiently used, are an infallible cure in every stage and species of this disease, if there is any degree of natural strength left, and where a diarrhoea, licterity, or dysentery, are not joined to the the other symptoms. He observes farther, that at the island of St Thomas, fifty men belonging to the Canterbury, and seven to the Norwich, who were in all the different stages of this distemper, were cured in little more than twelve days.

But as oranges and lemons are apt to spoil, let the juice of these fruits be well cleared from the pulp, and depurated by standing some time; after which it may be poured off from the gross sediment. Let it then be poured into any clean open vessel of china or stone-ware, which should be wider at the top than at the bottom, that it may evaporate more readily. But a china basin or punch-bowl is most proper, on account of the form. Put this into a pan of water over a clear fire; let the water come almost to boil, and continue nearly in that state, with the bowl full of juice in the middle of it, till the juice is found of the consistence of a thick syrup when cold. The slower the evaporation of the juice is, the better; that is, it ought to continue twelve or fourteen hours over the fire: When it is cold, it is to be corked up in a bottle for use. Two dozen of good oranges weighing five pounds four ounces, will yield one pound nine ounces and a half of depurated juice; and when evaporated, there will remain five ounces of extract, which in bulk will be equal to less than three ounces of water. So that twelve dozen of oranges may be put in a quart bottle, and preserved several years. The same may be said of lemons. When this is mixed with water and made into punch, few are able to distinguish it from the fresh juice mixed up in the same manner. However, when the fresh fruit can be had, the fragrancy of the peel may contribute somewhat to the cure of the scurvy; and when these are wanting, the same thing may be obtained from a few drops of their essence, or the aromatic oil contained in their rinds; and if a small quantity of this be added to the extract, it will give it the smell and fragrance of the fresh fruit in great perfection. Or rather add a little of the outer peel to the extract a little before it is taken off the fire, and then the nicest taste will not be able to distinguish the difference between the fresh fruit and this. The virtues of this extract, thus made, lie in so small a compass, that a bottle will serve one man at sea several years; for in the making of it there is little or nothing flies off besides the water.

It will likewise be of great use to seamen to have gooseberries, and the like, preserved in bottles in the same manner as the pastry-cooks; as also small onions pickled in vinegar, cabbage, French beans, &c. may be preserved, by putting them in clean dry stone-jars, with a layer of salt at the bottom, then a thin layer of the vegetable covered with salt, and so alternately till the jar is full. Then the whole must be pressed down with a weight, and its mouth quite stoppered that no air or moisture may enter. Thus the vegetable may be kept fresh and green for a whole year. At the time of using, the salt is to be washed off with warm water. This is the manner by which they preserve that never-failing remedy, Greenland scurvy-grass. Every common sailor ought to lay in a stock of onions, for they are a great preservative at sea. The Dutch sailors are preserved from the scurvy by pickled cabbage. Portable soup may be carried to all places. When the scurvy begins to make its appearance, sailors should be abridged in the same degree of their allowance of beef and pork, and eat them with mustard and vinegar; but the pease ought always to be served out in full allowance. It must be observed likewise, that a soup of boiled cabbage and onions will cure an adventitious scurvy in its first stage, either at land or sea, in any part of the world.

Besides fresh and preserved fruits and vegetables, fermented liquors of all sorts are good, but more particularly cider. Among these are included many wines of every kind; or the juices of fruits may be fermented with ale. Poor people that winter in Greenland under vast disadvantages in point of air and diet, preserve themselves from the scurvy by spruce-beer, which is their common drink. Likewise the simple decoction of fir-tops has done wonders. The shrub black spruce of America makes this most wholesome drink just mentioned, and affords a balsam superior to most turpentine. It is of the fir kind. A simple decoction of the tops, cones, leaves, or even of the green bark or wood of these, is an excellent antiscorbutic; but perhaps it is much more so when fermented, as in making spruce-beer. This is done by molasses, which by its diaphoretic quality makes it a more suitable medicine. By carrying a few bags of spruce to sea, this wholesome drink may be made at any time. But when spruce cannot be had, the common fir-tops used for fuel in the ship should be first boiled in water, and then the decoction should be fermented with molasses; to which may be added a small quantity of wormwood and root of horseradish. The freer it is drank, the better. When other things are wanting, tar-water may be fermented in the same manner.

Those who have been weakened by long fits of illness should have the scurvy prevented by panada of bread newly baked, with a few drops of the extract of lemons, and a spoonful of wine; as also oatmeal and rice, gruels, plum-pudding, stewed barley, with raisins or currants, sago, and wine, &c. But more particularly pickled cabbage, and small onions boiled with the portable soup made weak. Most of their food ought to be acidulated with orange or lemon juice; and then as their strength increases, they should be indulged with more solid food. But before this, they should have a small quantity at a time and often, and they should be brought back to their labour by little and little. Exercise on a deal-board, with the ends laid on two chests, will be very proper; because it promotes the circulation, and strengthens the fibres, without any loss of spirits.

Bad air of any kind has a bad effect upon a ship's crew; to remedy which, a red-hot loggerhead should be put into a bucket of tar, and moved about, so that all the ship once or twice a-day should be filled with this wholesome antiseptic vapour. In a moist air, whatever promotes perspiration is proper; such as dry linen, cleanliness, using the flesh-pantry, garlic or raw onions before going into the rain, and keeping the bedding dry. Plenty of mustard and onions should be used with their victuals.

The cure of this disease has been in a great measure anticipated by the means of prevention, inasmuch that little remains to be said about it. The diet should be light light and easy of digestion, such as broths or soups made of fresh meat, with plenty of vegetables, such as cabbage, coleworts, leeks, onions, &c. The bread should be fresh and well baked; and salads of all kinds are beneficial, but more particularly dandelion, sorrel, endive, lettuce, fennel, and purslane; to which may be added, scurvy-grass, cresses, or the like, to correct the cooling qualities of the former. Summer fruits are all good, as oranges, lemons, citrons, apples, &c. The drink may be good found beer, cider, or Rhine wine. Physic is never necessary if the fresh broths and greens keep the belly open, and pass freely by urine, sweat, and perspiration. If otherwise, the patient may take a decoction of tamarinds and prunes with a diuretic salt; and on intermediate days he may be treated with camphorated boules of theriac, and warm draughts of a decoction of the woods, of twelve or fifteen grains of the squill pills of the Edinburgh dispensatory.

Milk of all sorts, if it agrees with the constitution, will be very beneficial, as well as whey, which is preferable. Sal polychrest is used as a mild purgative and excellent diuretic. The scurvy juices, qualified with the juice of Seville oranges, are proper, especially mixed with the clarified whey, with sweating twice or thrice a week with the said juice mixed with tack-whey; for this is an evacuation which scurvy persons bear the best. When there is no danger of an hemorrhage, warm baths, with rosemary, marjoram, thyme, &c., may be good. In the winter-time, genuine spruce-beer, with lemons and orange juice, is proper; or antiscorbutic ale, made of an infusion of wormwood, horse-radish, mustard-seed, and the like; and it may be made laxative with the addition of senna. It must be drank while pretty fresh or new. Van Swieten says, he has often seen whole families cured of the scurvy, in Holland, by the use of a cask of ale, in which were put heads of a red cabbage cut small, twelve handfuls of cresses or scurvy-grass, and a pound of fresh horse-radish previously infused.

When the gums begin to itch and are spungy, use a gargle of the bark infused in brandy. When the putrefaction increases, use barley-water and honey of roses, acidulated with a mineral acid. The fungus must be kept down and, when necessary, cut away. The ulcers of the gums must be checked with a touch of spirit of salt, or oil of vitriol diluted. When the legs are swelled, or oedematous, gentle frictions are to be used at first with warm flannel, or with woollen cloths charged with the fumes of benjamin and amber, provided the swelling be small, soft, and not very painful, rolling them up afterwards with an easy bandage from below upwards; but if they are much swelled, stiff, and painful, they must be fomented with a deficient fomentation, or rather the steam of the fomentation should be received through a blanket rolled round the limb. This operation, repeated night and morning, will render the contracted joints supple. After this has been continued for half an hour, the parts are to be anointed with palm oil. If a vegetable diet does not reduce the limb, sweat it with burning spirits, or bags of warm salt.

Ulcers of the legs must be treated with very gentle compression, to keep the fungus under; and the same ap-

plications must be used as to the rotten gums. Mr. Murray has found a strong tincture of the bark of great service in scurvy ulcers. In dangerous hemorrhages the mineral acids must be given by a little at a time and often; such as the spirit or elixir of vitriol, together with small doses of the Peruvian bark.

A scurvy diarrhoea should not be suddenly stopped at sea, but the peccant humour must be gently evacuated with small doses of rhubarb, and the perspiration kept up with a little theriac or diacordium, with other warm diaphoretic and strengthening medicines. In extreme cases, opium may be given more freely. The diet must be glutinous and subalimentary, with strong rough red wine diluted. Sometimes five grains of alum may be given with the diacordium, especially when blood is evacuated in great quantities. The most effectual remedy in scurvy dysenteries is an infusion of ipecacuanha in brandy, given in small doses, and often repeated.

Physicians refer the different symptoms of this disease to different salts; but their different and far-fetched corrections of these salts are plainly ridiculous. Water is the known solvent of all salts, and this intention will be best answered by pure and light simple water. The universal remedy for a scurvy consists in mineral waters.

After mineral waters, nothing is more effectual in correcting a scurvy acrimony than a milk diet, or whey alone, or impregnated with the juices of antiscorbutic herbs, such as scurvy-grass and water cresses.

As to evacuations, bleeding should be used with the greatest caution; and none but the gentlest purges should be given, such as senna, rhubarb, or manna. The diuretics should not be stronger than the decoction of the roots of parsley, celery, fennel, and asparagus. The safest diaphoretics are, dulcified spirit of nitre, flowers of sulphur, ethiops mineral; infusions, in the manner of tea, of Paul's betony, carduus benedictus, scordium, and elder-flowers.

In the hot or alkaline scurvy, scurvy-grass is too warm to be administered alone, and should be corrected with acids, such as wood-forrel, the juices of citrons, oranges, barberries and pomegranates. Or mix the conserve of scurvy grass with an equal quantity of the conserve of wood-forrel, and give it twice or thrice a day, with some antiscorbutic water. This should be accompanied with milk-meats, almond-emulsions, barley-broths, water-gruel, chicken-broths, with endive, lettuce, sorrel, and cresses, interposing, at proper intervals, gentle laxatives and diuretics.

When the scurvy proceeds from muriatic salts, which happens to those who live on smoked or high-salted fish or flesh, and have corroding ulcers, a stinking breath, putrid gums, a thick and fetid urine, as is generally observed in old sailors; then whey, long and copiously drank, produces happy effects; as also citrons, China oranges, and ripe fruits; whereas spirituous and volatile antiscorbatics are generally detrimental. Hoff.

But if crusty black ulcers require external remedies, we should only use preparations of the yolk of an egg, myrrh, olibanum, saffron, oil of roses, and Peruvian balsam. When there is an excessive impurity of the humours tending to putrefaction, scarifications will induce a gangrene, which may be prevented by lime water, exalted with camphorated spirit of wine and sal ammoniac.

But fomentations and cataplasm of the common hemlock, frequently repeated and duly continued, are found more effectual than all other remedies.

Of the Dropsy.

Dropsies are of various kinds; but those usually treated of by authors are the anasarca, afcites, and tympanites.

When the lymph stagnates throughout the whole habit of the subcutaneous fat, or is shed therein, it produces an anasarca, which extends itself also to the abdomen and scrotum.

When the water is collected in the duplicature of the peritoneum, in the cavity of the abdomen, between the peritoneum and the viscera of the abdomen, or in the dilated cavities of the glands and vessels contained in the abdomen, it is called an afcites. If the dropsy is owing to the rarefaction of some steam or vapour, arising from water, pus, ichor, or air, pent up and heated till they putrefy, then it is a tympany.

The cause of these diseases may be, a family disposition thereto; a hasty drinking too great a quantity of cold water, and its not being evacuated upwards or downwards, or by sweat, or urine excited by heat or motion; acute diseases, especially the most ardent, attended with unquenchable thirst, or otherwise; a licentious dysentery of a long continuance; all obstinate obstructions of the viscera; and a schirrus of the liver, spleen, pancreas, mesentery, kidneys, womb, or intestines; the jaundice; a violent quartan ague of long duration; a lientery; a diarrhoea; a long dysentery; the coeliac passion, an empyma; a consumption; the gout; too great evacuations, chiefly the blood; the drinking of sharp, fermented, and spirituous liquors; the feeding on tenacious and hard aliment; very large and numerous hydaticides hanging in the cavity of the abdomen; melancholy; the scurvy, and the like.

The first sign of the approach of this disease is the swelling of the feet and ankles, which in the evening will pit, if pressed with the fingers; which swelling disappears in the morning, especially if there begins to be a difficulty of breathing. And yet it must be remembered, that pregnant women, or whose menses are stopped, as also when suddenly freed from an inveterate asthma, are affected with the like swelling. When the feet and legs are distended to the utmost, the waters rush into the abdomen, and cause it to swell by little and little, till at length the more noble viscera are affected therewith, and the patient is soon overwhelmed with the deluge. In proportion as the diseased parts increase in bulk, the rest fall away: at the same time the difficulty of breathing, paucity of urine, and intense thirst, the three principal symptoms, grow more intolerable.

When the abdomen is swelled, it will found, when struck, if the disease is a tympany. In the afcites there is a noise of the fluctuating water upon bodily motion, unless the waters are inclosed in a cystis or bag.

Besides the above-mentioned symptoms, there is a heaviness, a torpor, a costive body, and at length a slow fever; the patient never sweats. In process of time, the stagnating waters, being pent up in a hot place, become acrimonious; hence ulcers, gangrenes, bleeding at the nose, a protuberance of the navel, a mortification of the viscera, and death.

The curative indications in an anasarca, as well as in an afcites, are to restore the humours to their natural fluidity; to invigorate the languid circulation; to brace up and strengthen the relaxed solids; to promote the secretions; and to carry off the redundant stagnating juices.

Strong drastic purges, steel medicines, absorbents, detergents and stomachics, are best suited to answer these intentions.

The first thing to be done is to evacuate the serous humours by cathartics.

There are two things of uncommon efficacy in the dropsy; these are, elaterium and antimonial wine, especially for those which are not easily purged; two grains of the former is a proper dose for most constitutions.

As for the antimonial wine, an ounce and a half, or two ounces, as the patient's strength will admit, given in the morning, will in due time free the abdomen from the load of water. If it does not purge downwards as well as upwards, mix it with syrup of buckthorn after the third or fourth dose.

Some greatly recommend Bontius's pills for the dropsy, the dose of which is from half a scruple to a scruple; but Heister prescribes them from half a dram to a dram.

Mayrane affirms, that mercurius dulcis, without doing any mischief to the body, acts directly upon the morbid cause, and if possible destroys it. If a salivation follows, it is not dangerous, but may be prevented if the mercurial be joined to an active cathartic.

Many praise the juice of the root of iris palustris lutea; and we have an instance of its efficacy in a most deplorable dropsy, in the Med. Ephys; eighty drops of which were given every hour in a little syrup of buckthorn, which brought away many quarts of water by stool the first night; the quantity was daily increased till it came to two drams, and at last was mixed with a fourth part of the syrup, and given by spoonfuls.

Sometimes purgatives are to be entirely omitted, when the patient is of a weak constitution, or women subject to vapours; and then diuretics only should be made use of; among which, those are most powerful which consist of lixivial salts.

Boerhaave likewise proposes to attenuate the humours by small doses of mercurial preparations, to be taken every other morning, in a little pulp of a roasted apple; as half a grain of turpith mineral, with ten grains of white ginger; or one grain of red precipitate, with six grains of nutmeg; or seven grains of calomel, with eight of winter's bark.

Some have been cured by a pertinacious abstinence from all liquids, living upon tea biscuit with a little salt, and a very little rich wine. Externally, frictions of the parts have been found beneficial. Of the Hydrocele, or Dropsy of the Scrotum.

The hydrocele, called the dropsy of the scrotum, hernia aquosa, and the dropsy of the testicle, is an aqueous tumour of the scrotum. Though authors mention several kinds, there are but two. The first is, when the water is contained in the tunica vaginalis; the second, when it is contained in the cellular membrane of the scrotum. This last is almost always complicated with an anaeroma, a kind of dropsy which consists in the extravasation of the water which lodges in the cells of the membrana adiposa. The hydrocele in this case is known without any difficulty; for the skin is shining and soft, yielding easily to a slight impression, which will remain pitted for some time; the penis is also sometimes prodigiously swelled by the liquor which infuses into the cellular membrane. There are none of these symptoms in the dropsy of the tunica vaginalis.

In the dropsy of the cellular membrane of the scrotum, some recommend the puncture with a trochar; others, to make small apertures here and there with the point of a lancet; others, to put a small cane of silk through the skin with a needle, and to let it remain as a fetor, till all the water is drained off. But the two first methods yield very little relief, and the last may be more likely to induce a gangrene. Nor is there occasion for any operation at all, because the cellular membrane of the scrotum is nothing but a continuation of the membrana adiposa; and therefore incisions made in the skin of the small of the legs will effectually empty the scrotum.

Yet sometimes there falls so great a quantity of water into the scrotum that the distention is very painful, threatening a mortification. Likewise the prepuce very often is so excessively dilated and twisted, that it hinders the patient from making water.

In these cases there should be an incision made on each side the scrotum, three inches in length, quite through the skin, into the cells which contain the water; and likewise two or three, half an inch long, in any part of the penis, with a lancet or knife.

The dropsy of the tunica vaginalis is caused by an excessive accumulation of a ferocity, which is naturally separated in the internal surface of that tunic in a small quantity, to moisten and lubricate the testicle. Authors have hitherto distinguished them into two sorts: the one on the inside of the tunica vaginalis; and the other on the outside, between that and the scrotum, which they suppose to proceed from water in the dropsy ascites. But anatomy shows the absurdity of this opinion, for besides that persons afflicted with this kind of hydrocele have seldom any other dropsy, and those who have the affections are free from this hydrocele; the tunica vaginalis is like a purse quite shut up on the outside of the abdomen, so that the water cannot infuse into it from any part.

As to the notion that the water falls from the abdomen into the interstice between the tunica vaginalis and the scrotum, it is equally impossible. For though in the intestine rupture the gut falls into this place, yet it brings the peritoneum along with it, and that will prevent the escape of the water. This is a circumstance the ancients were unacquainted with, and the moderns have not sufficiently attended to.

This disorder is seldom attended with pain in the beginning, contrary to what happens in the hernia of the epiploon, and of the intestine; nor is it often the effect of any accident. It never diminishes when once begun, but generally continues to increase; but in some persons not so quick as in others. In one person it will grow to a very painful distention in a few months; in another it shall not be troublesome in many years; nay, it shall cease to swell at a certain period, and afterwards continue in that state without any notable disadvantage. But this is rare.

In proportion as it enlarges, it becomes more tense, and then is said to be transparent; but this is not always the case; for sometimes the scrotum is very much thickened, and the water itself opaque; so that to judge positively if there be a fluid, we must be guided by feeling a fluctuation; and though sometimes it is not very evident, yet we may be sure there is a fluid of some kind, if we are certain that the distention of the tunica vaginalis makes the tumour.

When a gut, or the omentum, form the swelling, it is soft and phialable, unless inflamed, and uneven in the surface, and reaches from the scrotum into the very abdomen; whereas the hydrocele is tense and smooth, and ceases before, or when it arrives at the rings of the abdominal muscles.

When the testicle is increased in size, the tumour is rounder, and, if not attended with an enlargement of the spermatic vessels, the cord may be easily distinguished between the tumour and the abdomen; but without this pain or the very great hardness will discover it to be a disease of the testicle.

As to the cure, little is to be expected either from inward medicines or outward applications. Therefore it will be most adviseable to wait till the tumour becomes troublesome, and then to tap it with a lancet.

Of the Jaundice.

The jaundice is a disease which is principally discovered by the yellow tincture of the skin, but most distinctly in the coats of the eyes, where it gives the first notice of its invasion.

The symptoms are, heaviness, inactivity, languor of the whole body, anxiety, uneasiness about the hypochondria, sickness at the stomach, oppression in the breast, difficult respiration, a dry and harsh skin, coliciveness, hard white excrements, yellow high-coloured urine, which will tincture linen or paper with a saffron hue; there is a bitter taste in the mouth; and all objects seem to be discoloured.

The immediate cause of a jaundice is an obstructed excretion of the bile from the vesica felis and liver into the duodenum; which being forced back upon the liver, mixes with the blood, by which it is carried into the whole body, whence the skin and urine will be tinctured with the colour of the bile.

This obstruction may be occasioned by anything in the duct, which plugs up the passage, or by external pressure closes its mouth, or by a spasm contracting the fibres thereof. Hence we may conceive why the jaundice succeeds the flatulent colic, why pregnant women are...

Of the Bilious Colic.

A bilious colic is attended with the following symptoms; a hoarse voice, a cardialgia, a continual loathing of victuals, a vomiting of bilious porousaceous matter, hiccup, a feverish heat, inquietude, intense thirst, a bitter taste in the mouth, and the urine little and high-coloured.

Hoff. Add to these, a burning, acute, continual pain about the region of the navel, which either seems to bind the belly as it were with a girdle, or is contracted into a point as if the patient was bored through, which sometimes remits, and then grows more violent. In the beginning it is not so much determined to one point, nor is the vomiting so frequent, nor does the body so obstinately withstand the force of cathartics. But as the pain increases, the more it is fixed to a point, the vomiting is more frequent, the body more coltive, till at length it terminates in the iliac passion. At this time the pain is so intense as to occasion a singultus, a delirium, coldness in the extremities, and chilling, clammy sweats, which are always a dangerous omen in this disease.

It is distinguished from a fit of the gravel, as the pain in this lies in the kidney, and is extended from thence by the ureter to the testicle; after eating, the colic pain increases, the nephritic abates; evacuations upward or downwards relieve the colic more than a fit of the gravel. The urine in the latter is more clear and thin at first, afterwards there is a sediment, and at length gravel or small stones; whereas in the colic the urine is more thick in the beginning.

Bleed freely in the arm; and after three or four hours exhibit an anodyne, and the next day a gentle cathartic, which may be repeated every other day, to the third time.

Sydenham recommends riding, especially when the cure is only palliated with opiates.

If the disease is caused by a plentiful eating of summer-fruits, the patient should drink posset-drink plentifully, then take an anodyne, and bleed the next day.

Ruffel observes, that when the colic proceeds from costiveness without a fever, then a pint of sea-water, drank every morning, will cure it. But if the first onset of the disease is neglected, and it proceeds to an inflammation, with a fever, vomiting, and retention of the excrement, and there is reason to be apprehensive of the iliac passion; when black vomiting supervenes, and the faeces are thrown up by the mouth; as also when there is a quick weak pulse, and cold sweats supervene; then the patient will be carried off by a mortification. Sometimes after the rigors, pus will show itself in some place or other, which prevents immediate death; while a purulent tenesmus afflicts the unhappy patient.

Of the Hysterical Colic.

This is a common symptom of the hysteric passion, and is attended with a most violent pain about the pit of the stomach, as also with a vomiting of a greenish humour, and a great sinking of the spirits: After a day or two the pain goes off, but upon the slightest motion or perturbation of the mind it soon returns again.

Neither Neither bleeding nor cathartics have any place in the cure, for they exacerbate the distemper; nay, the most gentle clysters are prejudicial: For this disease seems rather to proceed from a disorder of the spirits, than from a fault of the humours. It will be proper first to advise the patient to drink upwards of a gallon of posset drink, to clear the stomach of its impurities, by throwing it up again, that the effects of the paregoric may not be hindered. Afterwards give 25 drops of the thebaic tincture, in an ounce of cinnamon-water. This last is to be repeated at due intervals, till the symptoms disappear; that is, the effect of one dose must be known, before another is given. Yet sometimes, in plethoric bodies, if the strength will permit, it is better to prepare the way, by bleeding and purging, or both, for an anodyne.

Of the Flatulent or Wind Colic.

If there is a fixed and tense pain in the right or left hypochondrium, or beneath the stomach, it is a certain sign that there is wind or excrements pent up in the flexures of the colon. If the pain is in the small guts, the abdomen will be wonderfully swelled and puffed up; and the force of the wind is often so great, and it distends the skin to such a degree, that the pain is exasperated merely by touching it; nor do there want instances of a naval rupture arising therefrom. The pains are very acute, the body extremely costive, there is a sense of a very great straightness or contraction; and if the stomach is inflated, the breathing becomes very difficult, and the eruptions are attended with some small relief. Afterwards there are cardialgic passions, and an ineffectual reaching to vomit.

If the disorder lies in the flexures of the colon, emollient and diaphoretic clysters will be proper, as also carminative and emollient liniments applied to the pained part.

When the body is opened, it will be beneficial to give some lenient purge, as manna, cream of tartar, terra foliata tartari, with a spoonful or two of oil of sweet almonds.

While the pain is violent, the infusion of chamomile flowers and yarrow, in the manner of tea, frequently drunk, is a very powerful remedy.

It will be also beneficial to apply hot bricks or tiles to the part affected; also bags with parched oats and carminative ingredients, as caraway seed, juniper and bay berries, with deoxygenated salt. A clyster of the smoke of tobacco, blown through a pipe into the anus, is reckoned an excellent thing.

When indurated faeces plug up the intestinum rectum, so that the wind and scybals can make no exit, then the anus is to be fomented with emollient decoctions; and saline suppositories, with fat, are to be used; also some ounces of linseed oil, with an emollient decoction in which venice soap has been dissolved, are to be injected as a clyster.

Of the Colic from Fumes of Lead.

This is a disease to which all workers in lead are subject; and is attended with an intolerable pain in the intestines, and a most costive body; the navel is drawn inward, there is the highest uneasiness and a contraction of the joints, attended with a nausea, and a constant reaching to vomit. It is apt to terminate in a kind of palsy, or a spasmodic asthma, and afflicts the patient a long time. It is sometimes owing to the rashness of medicaters, in giving preparations of lead in the gonorrhea and other distempers.

There is no better preservative against this disease, than by taking fat broth in a morning; the cure is to be attempted with oleous clysters, and a plentiful use of oil of sweet almonds taken by the mouth, with or without a solution of manna, by which the desired end will generally be obtained. For the cure for the paroxysm, baths of sweet water are necessary; after which the spine of the back must be anointed with a liniment made of the fat of a hog, expressed oil of nutmegs, saffron, and oil of rosemary, which is a speedy and a certain remedy.

This disease is called mill-reek by the miners at lead-hills in Scotland, which all the inhabitants there are subject to; but melters of lead have it with the greatest violence.

In the lighter stage of it, there is an uneasiness and weight about the stomach, particularly near the cartilago ensiformis, and sometimes it is like a colic in the intestines. The spittle of the patient is sweet, and inclining to a bluish colour, resembling that of a person who chews lead. The pulse is lowish, and the skin is all over cold, with frequent clammy sweats. The legs become feeble, with a pricking numbness; and the whole body is lazy and feeble. Sometimes a spontaneous diarrhoea carries off the disease; but if it continues long, it is very prejudicial. During this stage the patient is able to work.

When these symptoms continue long, and spirituous liquors are drunk on an empty stomach, or after the working of lead, the second stage comes one; and then there is a fixed pain in the stomach and guts, especially in the lower part of the belly, extending from one hip-bone to the other, with costiveness and a gnawing pain. The pulse then becomes weak, and the skin hot. There is likewise a giddiness and a violent pain in the head, which is succeeded by an insensibility and a delirium of the worst kind; for they bite their hands and tear their own flesh. Then their extremities tremble with convulsions; and at length they sink with an intermitting pulse, and die of a coma or apoplexy.

If proper medicines are given in the first stage of the disease, the patient generally recovers. If it proceeds till the giddiness comes on, the success is doubtful; but after that it almost always proves mortal.

Workers in lead should never go to their business fasting, and their food ought to be oily or fat. A glass of salad oil, with a little brandy, rum, or other spirit, is a good morning's draught; but spirits alone should never be taken while at work, nor immediately after it. Physick should be taken spring and fall, and no man should go into the cold air while hot with labour, and they should change their working-cloaths for others as soon as possible. Liquid aliment is best, such as fat broth with good meat; for low living is bad. They should now and then go a little way out of the tainted air.

If the patient is plethoric, the cure is to be begun with bleeding, bleeding, and then the prime via must be cleansed with a double dose of emetic wine, or emetic tartar, otherwise it will have no effect. They will even bear half a dram of glas of antimony in fine powder, with plenty of warm water during the operation. If the vomit works well upwards and downwards, the patient is in a fair way of recovery. Then a milder dose of ipecacuanha must be given with tartar emetic. If the dose does not work either way, he is generally the worse for it, and a stronger dose should be given soon after. If it vomits, but does not purge, an antimonial cathartic, or jalap and mercury should be exhibited in a larger quantity than ordinary, and then the patient should drink plentifully of warm broth. The vomits and purges should be repeated at proper intervals till the disease disappears. If they work too much, an opiate may be given at night, but with caution, for fear of rendering the patient coltive, which is the worst thing that can beset him. When purgatives do not operate sufficiently, emollient, laxative, and anodyne clysters must be injected frequently to empty the guts.

Of the Iliac Passion.

The iliac passion is a pain in the small intestines, apt to turn to an inflammation, in which their peristaltic motion is inverted, and their contents, and even the excrements themselves, are voided by the mouth in vomiting. Nothing will pass downward, not so much as a flatus.

It is preceded with costiveness, which is soon followed with most sharp and violent pains, with an inflammation, distension, and a tumour of the umbilical region, which feels hard to the touch; the body is so bound, that neither wind nor excretions can pass downward: Soon after, the wind first makes its way upward, then comes on a nausea and a frequent vomiting of a bilious and putridous matter: The breathing grows difficult, and whatever is eat or drank is soon thrown up again; reddish faces, with a stinking smell, are afterwards forced up by vomiting: This is succeeded by loss of strength, a supernatural heat, a hard and contracted pulse, with great thirst; the urine is red, and voided with difficulty. When the case becomes desperate, a hiccup and delirium appear; the nerves are distended, the body is all in a cold sweat, and violent convulsions and fainting fits put an end to the tragedy.

In some who have been distended, the gut seemed to be twisted; but most commonly one part of the gut enters into the other. This disease may also proceed from a rupture either of the scrotum or the groin; from poisons; from anything that stops up the passage through the small guts, such as hard dry food, quinces, pears, unripe acerb fruit, when eaten in large quantities; to which drinking little, a sedentary life, and a melancholy disposition of mind, will greatly contribute. These all tend to harden the feces. The gross intestines may also be plugged up with scybals; especially if a person, either through shame, or for want of conveniency, does not listen to the calls of nature.

As to the prognostics; there is hope of recovery while there is no inflammation, and while clysters are admitted into the body, and rendered back the same way; as also while the pain shifts from one place to another, and the pain and vomiting are not continual; likewise when the disease proceeds from feces obstructing the intestines. The hope is still greater, if laxative medicines begin to make their way downward. But if there is an inflammation, which is known from a fever, the vehemence of the pain, a suppression of urine, a hard and quick pulse, an unquenchable thirst, a tossing of the body, and extreme debility, with coldness of the extreme parts, the case is desperate. A sudden cessation of pain, and absolute want of strength, with a weak pulse, fainting fits, and a stinking breath, shew the intestines are mortified.

As to the cure; first of all it is necessary to bleed in the arm, and afterwards, in an hour or two, exhibit a powerful clyster. The smoke of tobacco blown into the bowels, through an inverted pipe, is very efficacious: This may be repeated after some time, unless the effect of the first renders it unnecessary. If the disease will not yield to this, a pretty strong cathartic is advisable.

If the patient cannot retain the cathartic, let him take 25 drops of the thebaic tincture in half an ounce of spirituous cinnamon water; and when the vomiting and pain remit, let the cathartic be repeated; if the pain returns, give the anodyne again, and repeat it every fourth or fifth hour till the intestines are easy, and the cathartic begins to pass downwards.

After the pain has been mitigated with anodynes, a cataplasm should be applied to the hypogastric region to stop the vomiting and hiccup; which may be composed of equal parts of old venice treacle and expressed oil of nutmegs, with the addition of oil of mint and camphor. This done, a gentle laxative of manna, cream of tartar, and oil of sweet almonds, may be given.

When there is an inflammation, nothing is better than six or eight grains of purified nitre, and half a grain of camphor mixed with some antipalmodic powder, and taken in a convenient vehicle. Outwardly apply a liniment of an ounce of axungia humana, [any other penetrating fat will do as well] and a dram of camphor.

But when other things fail in the cure of the iliac passion, recourse must be had to quicksilver, which sometimes has surprising effects; half a pound, or a pound at most, is sufficient, with fat broth or oil; and the patient should lie on his right side, or walk gently about the room, that its descent may be easier. But if there is an actual inflammation, the use of quicksilver should be forborne; if the patient dies, from what cause soever, the bystanders will probably affirm the quicksilver killed him.

There is no manner of danger in the use of opiates, to mitigate the pain, provided they are exhibited in the beginning, after bleeding, or before there are any signs of a mortification.

Clysters are generally very advantageous; for they relax the spasms of the gross intestines; and for this purpose warm water with syrup of marshmallows will be sufficient; and if the strength will permit, they should be injected every two hours, from the first day of the attack. They likewise restrain the inversion of the peristaltic motion, and soften the feces. Of Vomiting.

Vomiting is spasmodic, retrograde motion of the muscular fibres of the oesophagus, stomach and intestines, together with strong convulsions of the abdominal muscles and diaphragm. Those that are slight, create nausea; those that are strong, vomiting.

Vomiting generally begins with a nausea, a tension and weight in the epigastic region, a bitterness in the mouth, anxieties of the praecordia, plenty of thin saliva in the mouth, a trembling of the neither lip; to these may be added, a dizziness of the head, a sudden dimness of sight, redness of the face, a fruitless eructation; and then the contents of the stomach are discharged upwards.

Vomiting is caused by excesses in eating and drinking; by the acrimony of the aliments; by the translation of the morbid matter of ulcers, the gout, erysipelas, and other diseases, to the stomach; from a looseness or bloody flux too suddenly stopped; from a congestion of blood in the stomach, which happens to women in the first months of pregnancy, or when there is a suppression of the menses, or bleeding piles; from sympathy, by tickling or irritating the throat or oesophagus with the finger or a feather; from the colic, iliac passion, a rupture, fit of the gravel, worms; from poisons; from hurts of the brain, such as contusions, compressions, wounds or inflammations of the diaphragm, stomach, intestines, spleen, liver, kidneys, pancreas or melentery; from an unusual motion of the spirits in a cart, coach, or ship; from the idea of some nauseous thing, or which has formerly occasioned sickness or vomiting; from a regurgitation of bile into the stomach.

As to the prognostics; a critical vomiting is salutary; a symptomatic bad; and that which proceeds from a subtil caustic acrimony, which vellicates the nerves, worst of all. All violent excessive vomiting is bad, as it may occasion abortions, ruptures, &c. Bilious vomiting, especially the green, porraceous, and seruginous, consisting of a corroding acid, portends danger of an inflammation; vomiting from worms which gnaw the stomach, is generally pernicious; vomiting of dead worms, if at the same time the convulsions of the limbs and other grievous symptoms suddenly cease, shews a mortification. All fetid vomiting is a sign of internal corruption, and therefore bad.

When vomiting proceeds from crapula, late suppers, disturbed digestion by riding, and the like, it may be prevented by deep inspirations often repeated, by which the diaphragm is made to press on the stomach, and accelerate the discharge of its contents; but if an inclination to vomit, from the same causes, comes on unawares, a pretty strong and often repeated friction of the hypogastric region with the hand, will prevent it.

Pituitous vomiting, from crudities of the prime vice, is best cured by a vomit, and especially if there is a troublesome reaching to vomit; attended with a nausea and a cardialgia; then having first prescribed neutral salts, or squills, to incite the phlegm, give warm water mixed with unsalted butter, very plentifully, or powder of ipecacuanha.

Bilious vomiting, which proceeds from a depraved digestion, and has its seat in the duodenum, is cured by absorbents and gentle laxatives of manna and rhubarb. When it proceeds from too great a laxity of the biliary ducts, then cortex Peruvianus, cortex eleutheriae, and better tinctures and chalybeates, will be most efficacious; if from a coagulum or stone in the gall-bladder, mineral waters are more likely to succeed.

When vomiting is caused by a sharp matter vellicating the nerves of the stomach, proceeding from the gout, or an erysipelas, besides giving quieting medicines, it ought to be drove back by diaphoretic powders, with a small addition of camphor. Also externally, frictions, pediluvia, and clysters, are useful.

When it proceeds from poisons, nothing is better at the beginning than drinking large quantities of milk, and fat oily things, to sheath their acrimony, and bring them up by vomiting.

Vomiting from a suppression of the menses, or from the stoppage of the bleeding piles, is cured by absorbents, by gentle laxatives, by clysters and strengtheners; and more especially by bleeding or causing the flux to return. Emetics, in this case, are as bad as poison, and either cause a vomiting of blood, or a fatal inflammation of the stomach.

Morning reachings, caused by hard drinking, are cured by absorbents and anti-acids, and by strengthening the digestive faculty, by bitters, candied orange-peel, &c.

The immoderate and frequent vomiting of pregnant women requires bleeding in the foot, and rest both of mind and body.

Of the Vomiting of Blood.

Vomiting of blood is generally preceded with a ten- five pricking pain in the left hypochondrium; and the eruption itself is almost always attended with anxiety of the praecordia, and a compelling pain, as also a kind of girding on the same side. It is frequently attended with fainting fits, especially if the blood has an ill smell, or is corrupted.

The seat of this disease is in the stomach, though the spleen sometimes has a share in its production.

Persons more subject to it are the lean and slender; women irregular in their menses, and who have been hastily cured of intermitting fevers, which has brought on a suppression of the menses, and then have taken hot forcing emmenagogues; as also women about the time their menses leave them; likewise plethoric women in the time of pregnancy, and hard labour; and men of a weak constitution, subject to the bleeding piles, which either cease to flow, or flow in too small a quantity.

The danger which attends this disease, is not the same in all, though no hemorrhage is more dangerous than this. If there is no fever, and if it proceeds from suppressed evacuations, caused by a plethora, the case is not so desperate. On the contrary, if there is a fever; if the blood is corrupted, flinking, and black; if it proceeds from a large, diseased spleen, or an indurated liver, attended with swooning; there is no hope of recovery left. It is still worse, when the stools are black; then the seat of the disease is in the ilium, from a rupture of the mesenteric vessels.

In the paroxysm, if the patient is plethoric, bleed according to his age and strength. When there is an orgasm in the blood, and the pulse is impetuous and strong,

Take a pound of water, a dram of nitre, and half an ounce of syrup of wild poppies.

This, taken successively and temperately, will be very efficacious in perfecting a cure.

When the region of the praecordia, especially on the left side, is afflicted with pricking and vexillating pains, and spasmodic strictures, together with heat and thirst, emulsions will be proper. These must be made with the four cold seeds, and white poppy seed; to which must be added a little nitre, and a proper quantity of diacodium.

Likewise, in order to relax the spasmodic strictures of the intestines, and to divert the flux of the humours from the part affected, emollient clysters, frequently injected, will be proper, with a gentle stimulus, and the addition of nitre.

Outwardly, to relax the spasms and strengthen the stomach, nothing is better than the oil of camphor; which is made by dissolving a dram of camphor in an ounce of oil of sweet almonds, and then by adding twenty drops of oil of rhodium. Let the region of the praecordia and the left hypochondrium be anointed with this oil; and afterwards lay a bag on the part affected, filled with camomile and elder-flowers, with mint and wormwood, boiled in vinegar of roses or red wine pretty hot.

If blood is thrown up in great quantity, with loss of strength, ligatures made upon the joints may be serviceable, as also putting the legs and arms in cold water.

When the paroxysm is off, half a dram of rhubarb will be highly beneficial, either with or without terebinthaceous powders; or twelve grains of compound powder of amber, with half a grain of camphor taken twice a week, at night going to bed, in a draught of spring water. Rhubarb is a kind of a specific in opening obstructions. The patient, instead of tea, may drink a decoction of yarrow, liquorice, and fennel seeds. The common drink may be spring water, in which iron has been quenched, or acidulated whey.

If this disease proceeds from a suppression of the menses; bleed in the foot, and give clysters prepared of mugwort, pennyroyal, wall-flowers, bay and juniper-berries, pretty frequently.

If it is caused by sharp acid liquors corroding the vessels of the stomach, then terebinthaceous alkaline powders are proper; and starch boiled in milk will heal the vessels.

Opiates must be shunned in these cases, because they bring on great weakness and loss of strength, to the great detriment of the patient. Likewise all styptics, astringents, and virtuolic medicines, must be studiously avoided: these indeed, will stop the eruption of blood; but then it will stagnate and putrefy in the vessels, with danger of inflammation and mortification; or at least, if the patient is cachectic, it will hasten a dropfy.

Of a Diarrhoea, or Looseness.

A Diarrhoea is a frequent and copious evacuation of liquid excrements by stool; and may proceed from aliments, or humours of various kinds, derived from different parts into the intestines.

The cause is a stimulus which irritates the viscera, occasioning the expulsion of their fluids; and may therefore proceed from the vesicles of the liver, pancreas, mesentery, and intestines; when at the same time the mouths of the mesenteric veins and the lacteals are obstructed. Or there may be an extraordinary laxity of the intestinal fibres; or, lastly it may arise from a stoppage of other excretions. It is frequently attended with gripings. The patient is weak, makes but little urine, has a depressed pulse, a depraved appetite, and is sometimes feverish.

In a diarrhoea arising from sharp fermenting juices in the prime vis, which accelerate the peristaltic motion of the intestines, the first indication is to discharge the stimulating matter; which may be effected by a dole or two of rhubarb.

At night the patient may take fifteen drops of the thebaic tincture, in two or three spoonfuls of simple cinnamon water. The rhubarb is to be repeated till the loofens abates, which is generally after the second dose.

If there is a saburra of ill-concocted matter in the stomach, a vomit will be necessary of ipecacuanha, [or an ounce of its wine]

If the diarrhoea continues to be violent, it will be proper to mix astringents with the rhubarb.

If the diarrhoea proceeds from suppressed perspiration; and if the stools are thin, and the patient feverish; first bleed, then give an emetic, afterwards a purge of rhubarb, and last of all astringents.

But the best and safest astringent of all is logwood, given in decoction.

A bilious diarrhoea ought not to be too suddenly stopped, but the humours are to be corrected gradually; for which purpose, a scruple of rhubarb slightly toasted, with a few grains of nitre, is very useful. Likewise half a dram of the expressed oil of nutmegs, either alone or mixed with a grain of opium, and given in broth, is very efficacious. The humours are likewise corrected with thin emulsions of almonds and white poppy-seeds, with the addition of diacodium.

When a diarrhoea is very obstinate, after toasted rhubarb has been given for some days, prescribe a sweat with a dram of new venice treacle, and twelve grains of burnt hartshorn, calx antimon, and purified nitre.

An habitual diarrhoea is greatly relieved by wearing a flannel shirt, and keeping the body warm.

In Vol. I. of the London Medical Observations and Inquiries, Dr Pye proves, by a long enumeration of instances, that in all loosenesses where emetics are advisable in every age and sex, though the patient be in the weakest circumstances, ipecacuanha, from half a grain, to four or five grains, may be given with the utmost safety, and will seldom fail of answering the intention of the prescriber; and adds, that for many years he had experienced the great efficacy of it, in curing or resisting in the cure of diarrhoeas in children, when administered in clysters. Of the Cholera Morbus, or Vomiting and Looseness.

A Cholera, or vomiting and looseness, is a sudden violent purging upwards and downwards, proceeding from a convulsive contraction of the stomach and intestines, caused by sharp caustic matter of various kinds.

It generally begins in August, and seldom reaches the first weeks of September, unless it be a spurious kind which arises from excess.

It discovers itself by enormous vomiting, and a voiding of vitiated humours by stool. There is a violent pain, inflation and distention of the belly and intestines, as also a cardialgia and thirst; the pulse is quick and frequent, small and unequal; there are heat and anxiety, a most troublesome nausea, sweating, a contraction of the legs and arms, fainting, coldness of the extreme parts, and the like, which kill the patient in twenty-four hours.

Though this disease is generally preceded with acid, ridiculous belchings, pungent and cardialgic pains in the stomach and intestines; yet soon after, all of a sudden, and at the same instant, the vomiting and looseness make their attack. The remains of the last meal are voided first; afterwards bilious humours, mixed more or less with mucus; then those that are yellow, then eructuous, then black, often exceeding acid, and almost corrosive, together with frequent eruptions and wind, and sometimes blood itself. The returns of the evacuations are very frequent. Besides, there are most acute, wringing, gripping, gnawing, biting pains, with inflation and rumbling of the intestines, chiefly above the navel, and most racking cardialgias. As the disease increases, the thirst becomes great, the extreme parts grow cold; there is a palpitation of the heart, and then hiccups; the urine stops, and the body is covered with a cold sweat. It is common for the patient to swoon away, and to fall into terrible convulsions.

There is no disease, except the plague and pestilential fevers, that kills sooner than this, especially if it attacks old persons, or children, or such as are weakened with diseases. The more caustic the matter is which is voided, the more intense are the thirst and heat, and the more certain the danger. If it be black bile, and mixed with black blood, death is inevitable. The case is as bad when there are faintings, hiccups, convulsions, coldness of the extreme parts, and cold sweats. Nor is anything better to be expected from a stoppage of the evacuations, while the rest of the symptoms continue. But if the vomiting ceases, and the patient sleeps soon after, or the disease is protracted beyond the seventh day, he may recover; if he begins to break wind downward, it is a good sign.

This disease requires the most speedy assistance, and therefore the physician cannot be called too soon. The indications of cure are, 1. To correct and heal the morbid matter, and to fit it for evacuation. 2. To appease the irregular spasmodic motions. 3. To strengthen the nervous parts which the disease has weakened.

Boil a large chicken in three gallons of water, that so there may be scarce any taste of the flesh and give the patient a large quantity of it to drink; or, for want of it, warm posset-drink; and also repeated clysters of the same liquor; now and then an ounce of syrup of violets may be added to the draught or clyster. These operations may be completed in three or four hours, and then a paregoric will crown the whole.

But if the physician is not called in time, and the patient has been exhausted with vomiting and purging for many hours, and the extreme parts begin to grow cold, then immediate recourse must be had to liquid laudanum in a large dose. And when the symptoms cease, it is to be repeated morning and evening, till the patient's strength returns.

Neither cathartics nor emetics, properly speaking, are of use in this disease; but the vomiting may be promoted by drinking a large quantity of warm water mixed with fresh butter or oil; and the purging by oily and emollient clysters. Or the patient may drink small chicken-broth. Whey is of great use to quench the thirst; to which may be added, the absorbent and tastaceous powders.

If the patient is not too much exhausted, make him drink plentifully of warm water three or four times, to dilute and blunt the acrimony of the humours, and to bring them up by vomit: Then he must take as freely of a decoction of oat bread, baked without leaven or yeast, carefully toasted, without burning, as brown as coffee; which decoction ought to be of the colour of weak coffee. This is grateful to the stomach, and is seldom brought up again.

When the patient is much exhausted with evacuations upwards and downwards, give him a large draught of the decoction; and, when the nausea is pretty well settled, two thirds of a grain of opium, more or less, according to the strength and age of the patient.

But if the patient is convulsed, the extreme parts cold, and the pulse weak and intermittent, twenty-five drops of liquid laudanum, in an ounce of strong cinnamon water, is more proper; and afterwards a draught of any wine in an equal quantity of the decoction. After this, he may take the decoction to quench his thirst, and a little wine now and then as a cordial.

To prevent a relapse, repeat the opiate in a moderate quantity for some days, morning and evening; and care must be taken not to overload the stomach, or to eat any thing but what is of good nourishment, easy to digest, and grateful to the stomach.

Of the Dysentery, or Bloody-Flux.

A Dysentery begins with shivering and shaking, succeeded by heat of the whole body; which are followed by griping of the guts, and soon after by frequent voiding of slimy stools, attended with violent pain, and a most troublesome pressing down or seeming descent of all the bowels, and this every time the patient has a stool. In process of time the stools are mixt with blood, and afterwards pure blood is only evacuated, and the intestines are affected with an incurable gangrene. Yet sometimes there has been no blood through the whole progress of the disease.

If the patient is in the flower of his age, or has been heated with cordials, he is very feverish, his tongue is whitish, whirish, and beset with a thick mucus; sometimes it is black and dry; he becomes excessively weak, and is quite destitute of spirits; aphtha or a thrush appear in his mouth and throat, especially if the evacuation of the morbid matter has been preposterously prevented by astringents, and the fumes of the disease has not been expelled by cathartics. Sometimes, when a fever is abated, the gripes lead the van, and the rest of the symptoms follow.

Those whose stomachs are loaded with much indigestible matter, are troubled with nausea, reachings and vomiting; many have an intolerable heartburn and anxiety of the praecordia. All are afflicted with a perpetual desire of going to stool, and such a violent tenesmus as is not seldom attended with a precordial pain.

In some, the extreme parts are cold, while the inward seem to burn, and a perpetual sense of heat and a pulsation torture the intestines. To these succeed hiccups, cold sweats, a pale countenance, wasting of the body, inflammations, and aphtha of the fauces. At last, all pain ceases at once; the thirst vanishes, the stools come away insensibly with a cadaverous stench, the pulse becomes slender, and death is at hand. This disease is often contagious.

Prognostics. Dysenteries are dangerous to pregnant women, to old men, and to boys. There is commonly little hope when it attacks the scrofulous, the consumptive, and the cachectic; those that are weak and afflicted in mind, or troubled with worms. When it begins with vomiting, succeeded with hiccups, there is danger of an inflammation of the stomach. Nor is the case better when the stools are green, black, mixed with carbuncles, and of an offensive stench. It is a fatal omen when clots are immediately returned, or the anus so obstinately closed that nothing can be injected; for it is a sign of a palsy of the rectum. When the pulse is weak, the extreme parts cold, and the inward burn, or are without sense, nothing good can be expected. When swallowing is attended with a murmuring noise, it shows the approach of a delirium, an inflammation of the fauces, aphtha, or a palsy of the whole oesophagus. It is necessary to know, that this disease sometimes quickly terminates, especially if there be a malignant fever, and then it kills in seven, nine, or fourteen days; sometimes it does not cease till the fortieth or upwards; when it continues a long while, it either kills the patient, or brings on a dropsy, a lientery, the coeliac passion, a tabes or hectic, which are incurable.

The common method of curing a dysentery, is first to bleed, then to vomit with ipecacuanha, afterwards to purge with rhubarb, and last of all to give astringents. Hoffman directs a scruple or half a dram of the ipecacuanha, with a testaceous powder, drinking a large quantity of warm water after it. This vomit is sometimes to be repeated. It is the modern practice, after the first vomit, to give two or three grains of ipecacuanha every eight or ten hours, in a bolus, with discordium, or the like, with some proper julep. Hoffman would have the rhubarb given in substance, that is, half a dram in powder; Dener gives it twelve hours after the vomit, repeating it in small doses.

Mr Ray says, that the fungous substance between the lobes of a walnut, dried and powdered, and given in a moderate quantity in wine, cured the English army of a terrible dysentery in Ireland, when all other remedies failed.

Justus says, a thick yellow bark, called simaruba, has been found successful in the cure of a dysentery. The dose is a third part of a quart of a decoction made with two drams of the bark. And Cramer affirms us, we may depend upon the same effect from the decoction of common millet-feed, called St Ambrose's syrup, which Luther looked upon as a cure for the colic. Count Argenton took it first by his advice, merely to quench his thirst, in the manner of tea, by which means he got rid of his thirst and dysentery in twelve hours time.

Another specific is the vitrium antimonii ceratum, which has been in use for some time, but was kept a secret till it was communicated by Dr Young of Edinburgh to the public.

The manner of preparing it is as follows:

Take of glas of antimony in powder, one ounce; beeswax, one dram: melt the wax in an iron ladle, then add the powder: let them on a slow fire without flame, for the space of half an hour, continually stirring them with a spatula; then take it from the fire; pour it upon a piece of clean white paper, powder it, and keep it for use.

The ordinary dose for an adult is ten or twelve grains; but for greater safety begin with six.

Never give opiates in the beginning, especially where there is great sickness; because, though opiates give relief to some, yet at other times both the sickness and purging increase the following day.

Bontius, in his account of the diseases of the East-Indies, affirms, that extract of saffron is a specific in the dysentery of those parts, even though it should proceed from poison.

Of the Head-Ach.

The head-ach is a most troublesome sensation in the nervous membranes of the head, produced by various causes, and attended with different symptoms, according to its different degrees, and the place where it is seated.

The most common seat of this disease is the pericranium; a membrane which invests the skull, coheres with the muscles next the skull, and is joined to the dura mater by some fibres which pass through the sutures. It is a thin nervous membrane of exquisite sense. It may likewise be in the skin that covers the skull, and in the dura matter. This last but seldom happens; but when it does, it is very dangerous. There may likewise be a very acute pain in the thin membrane which covers the sinus of the os frontis.

If the head-ach be slight, and affects a particular part of the head, it is called cephalalgia; if the whole, cephalgia; if one side only, hemicephalia; if there is a fixed pain on the forehead, which may be covered with the end of the thumb, it is called clavus hystericus.

The general cause of the head-ach is a hindrance of the free circulation of the blood through the vessels of the head. When the blood rushes with impetuosity, and in too great plenty into the membranes, which may happen to the plethoric, to those whose usual bleeding at the nose is suppressed, and to young persons, there is a pain in the whole head, which becomes hot, swells, aches, and looks red; the vessels swell, and there is a strong pulsation in those of the neck and temples. The nostrils are dry and parched, there is a burning heat and drought in the fauces.

When the vessels of the head are stuffed with a mucous serum from a stoppage of the running of the nose, then there is a heavy, obtuse, pressing pain, chiefly in the forefront of the head, in which there seems to be such a weight, that the patient can scarce hold it up. Sometimes the skin is so swollen, that it will pit.

Sometimes it happens from the ferous, sharp, caustic matter of the French disease, which infects the pericranium, and often causes a caries in the skull.

Sometimes it may proceed from matter of a saline caustic nature, driven back from the external parts; as, in the gout, itch, erysipelas of the head, gutta roacea; in the small-pox and measles, before the morbid matter is expelled to the outward skin, or, which is worse, when it is driven back. In these cases, when a small quantity of caustic matter causes the pain, it rather proceeds from a violent stricture of the membranes than from their distension.

There is likewise a most violent, fixed, constant, and almost intolerable head-ach, which brings on a debility both of body and mind, hinders sleep, disturbs digestion, destroys the appetite, causes a vertigo, dimness of sight, blindness, a noise in the ears, convulsions, and the epilepsy; and, by consent of the other nervous parts of the body, produces vomiting, coliciveness, coldness of the extreme parts, and the countenance of a dying person.

Sometimes the head-ach is symptomatic, and attends upon continual and intermitting fevers, and especially the quartan, irregular flowing of the menes, the hypochondriac passion, and the like. A hemicraniaca generally proceeds from a fault in the stomach, from crudities or indigestion, and commonly appears when digestion is performed.

The head-ach is not always without danger: If the cause of the pain is within the skull, and is violent and constant, attended with a fever and want of sleep, it portends a phrensy. If it suddenly attacks the hypochondriac; or those that are prone to melancholy, especially if preceded by a violent passion of the mind, and deprives the patient of sleep and appetite, and is joined to difficulty of hearing, and an internal pulsation of the vessels, and all these without a fever, it prefigures madness. But when the pain in the head is sudden and very acute, with a noise in the ears, difficult walking, a weakness of the knees, an impediment and slowness in speech, it is the forerunner of an apoplexy or a palsy; in which last the pain is greater on the well side than the diseased, because the latter has lost all sensation.

The curative indications are, 1. To divert the impetus of the blood and humours from the head, and to disperse them by suitable remedies. 2. To relax the spasmodic strictures of the membranes of the head, the cause of which is a sharp caustic matter, that the fluids may have a freer circulation. 3. To correct the peccant matter, and evacuate it gently through the most convenient emunctories. 4. To prevent a return by strengthening the whole nervous system by proper remedies, and especially by an accurate diet and a suitable regimen.

When the blood rushes to the head in too great quantity, bleeding is necessary, more particularly under the tongue, in the forehead, in the jugulars, or by leeches behind the ears. If the body abounds with too much blood, it will be best to bleed in the ankle first, and the next day, or the day after, in a vein about the head. But first of all cleanse the body by any emollient clyster, or by giving an infusion of rhubarb and manna, with cream of tartar.

To restrain the orgasm of the blood, it will be proper to give a diaphoretic and absorbent mixture, with diaphoretic antimony, purified nitre, burnt hartshorn, and diacodium, diluted with a sufficient quantity of suitable simple distilled waters.

When there is an intense pain remaining fixed in one place, lying pretty deep in the membranes, the herb ranunculus, used as a vulnerary, has a wonderful efficacy. It is the upright meadow-crawfoot, with leaves like the anemone, and, if taffed, is extremely biting to the tongue. The leaves must be bruised in a marble mortar, and the part, if hairy, shaved; then a sticking plaster is to be laid on it, with a hole about the bigness of a silver penny, and the leaves over that; just in the same manner as a caustic. This is an experiment of Chefnau's; and like success may be had by mixing equal parts of volatile sal ammoniac and powder of mustard-seed, laying it on the part in the same manner.

When it is caused by a suppression of a coryza or running of the nose, a smelling-bottle of volatile salts should be held frequently thereto. Or the patient may take herb-snuff, with the addition made of flowers of benjamin and powder of cloves.

When the head-ach arises from a corrupted mass of blood and an impure serum, as in the scurvy and lues venerea; a decoction of the woods with crude antimony may be serviceable, after evacuations, fasting a day now and then, with labour and exercise, will likewise be useful; as also a sudorific.

A hemicraniaca, especially a periodical one, is generally owing to a foulness in the stomach and prima via; for which gentle emetics will be beneficial, as also purgatives to derive the humours from the head; afterwards stomachics. If it proceeds from profuse evacuations of the menes or hemorrhoids, those fluxes must be reduced within bounds.

If the head-ach is so intolerable as to endanger the patient's life, or is attended with continual watching, fainting-fits, a fever, an inflammation, or a delirium, recourse must be immediately had to opiates with native cinnabar, after a clyster has been first given.

When there is an intolerable pain in the sinuses of the nose, or the bony sinuses of the head, produced by an extravasation of some fluid, the only cure is scarification of the nostrils, or causing the nose to bleed with a straw suddenly thrust therein. If there is an extravasation under the pericranium, and the humour is so sharp as to begin to render the bone carious, then recourse must be had to an incision, as in a whitloe.

In some kinds of head-ach, it will be proper to open the frontal vein.

When the patient's strength will not bear the loss of blood, temperate pediluvia will be beneficial, and strong frictions of the feet with a coarse cloth; as also cataplasm of horse-radish and salt laid therein.

Of the Heart-Burn.

The heart-burn is a pain more or less violent about the pit of the stomach, with anxiety, a nausea, and often a reaching, or actual vomiting.

The causes are, vitiated humours in the stomach, vellating and gnawing the stomach itself, or its left orifice, which the ancients call cardia. The stomach thus irritated, a painful sensation is excited, and spasmodic constrictions, which occasion a nausea and vomiting. But common heart-burns are generally without vomiting. The heart-burn may also proceed from wind and indigestion, and now and then from worms; but more frequently from congestions of blood about the stomach, which may happen to those who are full of blood, but more especially to the hypochondriac and hysterical, when vomiting of blood not seldom ensues.

The cure of a common heart-burn from indigestion and the acrimony of the contents of the stomach, which chiefly happens in a morning with wind, may be performed only by drinking tea or coffee, or a decoction of camomile flowers; as also by taking bitters, or a dram of powder of orange-peel, or camomile flowers, in a small glass of wine made pretty hot, and sweetened with sugar. The terebraceous and absorbent powders are excellent in this case; such as the tabellas cardialgiae, or lozenges for the heart-burn, which may be carried in the pocket and taken at pleasure; about a dram is sufficient for a dose.

When it arises from a crapula, gentle emetics will be useful. If the patient begins to vomit without them, large draughts of warm water will assist to cleanse the stomach; or carduus benedictus tea taken freely.

If the cardialgia proceeds from a congestion of blood, and the painful spasms then arising, bleeding will be convenient, and emetics hurtful. If the meninges are stopped, bleed in the foot.

Nor must anodyne and emollient clysters be omitted. It will likewise be proper to apply a bladder filled with a decoction of chamomile, pretty hot, to the stomach. After recovery, riding will be convenient to regain the lost strength.

If worms are the cause of the heart burn, no acid anthelmintics must be given, but warm milk mixed with oil of sweet almonds, which, if drank in sufficient quantity, may cause them to be thrown up.

Of the Tooth-Ach.

The tooth-ach is caused by impure serum, which corrodes and rends the ligaments and nerve-glandulous coats, by which the roots of the teeth are kept firm in their sockets, and wherewith they are invested.

It is a kind of rheumatic disorder; for we have often observed that pains of the joints and shoulders have shifted to the side of the head, and have invaded the teeth and gums with violent pain. On the contrary, pains of the head and teeth have fallen into the arms and shoulders.

The seat of the tooth-ach may also be in the cavity or internal parts of the teeth themselves, that is, in the little vesicular cord composed of the nervous membrane, an artery, a vein, and a lymphatic vessel, which may either be defended by stagnating serum, or be affected with a spastic contraction, especially if the tooth is carious, and the caries reaches the said cord.

As in the gout there is a pain, redness, a tumour, and a little fever, so they sometimes appear with the tooth-ach. There is also frequently a copious discharge of saliva, which proceeds from a painful spasm, which constringes the lymphatic and venous vessels.

As the rheumatism appears in temperate, and a sudden change of weather; so it is with the tooth-ach, especially when the weather is hot and cold by fits.

The whole intention of cure consists in deriving and diverting the impure scorbatic serum from the head, and then carrying it off through proper emunctories; and afterwards in strengthening the parts.

This is to be done by saline, emollient, purgative clysters; by warm pediluvia of rain-water and wheat bran, with venice soap, and used just before bed-time; by laxatives of manna and caffia dissolved in whey or asses-milk or mineral waters. If the patient is plethoric or full of blood, bleeding in the foot will derive the humours from the head.

Sudorific remedies are also proper, but more especially an electuary made of rob of elder-berries, burnt hart's-horn, diaphoretic antimony, and a few grains of nitre, which cannot be too highly praised. Or an ounce of the rob may be taken in broth to promote a diaphoresis; and it may be used externally, dissolved in beer, in the manner of a gargle, which will yield immediate relief to the patient.

Outwardly may be applied bags, filled with paregoric and emollient species, such as elder, melilot, and camomile flowers, bay and juniper-berries, carraway and millet seeds, and decrepitated salt. They must be laid on warm, and are very safe.

A drop or two of oil of cloves, or box, applied to a carious tooth with cotton, are medicines not to be despised. Camphorated spirit of wine mixed with saffron, castor, and opium made into a liniment, and laid to the gums and hollow teeth, often gives the patient ease.

When the tooth-ach proceeds from a rotten, hollow tooth, it will be best to burn the little nervous cord, which is the seat of the pain, with an actual cautery; and then the cavity may be filled up with a mixture of wax and mastic.

If this cannot, or is not permitted to be done, the only remedy left is to have the tooth drawn. But if the patient is plethoric, it will be safest to bleed first, for fear of a fatal hemorrhage. A small pill, made of equal quantities of camphor and opium, and put into a hollow tooth, is often beneficial. Some greatly recommend a small plaster of tacamahac laid on the side of the face, upon the articulation of the jaw-bone, or upon the temples.

But above all, the root of iris lutea, or the yellow water flower-de-luce, rubbed upon the tooth that is painful, or the root itself chewed in the mouth, in an instant, as if by a charm, drives away the pains of the teeth, arising from what cause soever.

It is now become a practice, especially in France, upon drawing a sound tooth, to replace it in its socket; where, with proper precautions, it will falten again. Mugrave is the first who recommends this practice. After the extraction of the tooth, he advises a gargle of honey, mixed with the juice of the herb mercury, common salt, and spring-water, and then to put it in its former place; and adds, it will become more useful than before.

The French operators have improved this hint; and when the tooth is rotten, or otherwise unfit to be replaced, they put another sound human tooth in the room of it, when it can be had; otherwise one of any other animal that is of a size suitable for the purpose.

De la Motte, in the tooth ach, advises to make a small round sticking plaster, about the bigness of a silver groat, and to put a flat bit of opium in the middle of it, of a size not to prevent the adhesion of the other. This is to be laid on the artery near the cavity of the ear, where the pulsation is most sensible. He affirms, there are few cases that this will not relieve.

Of the Ear-Ach.

The ear-ach is a grievous pain in the meatus auditorius, or cavity of the ears, proceeding from a sharp extravasated serum affecting the nervous membrane which lines the meatus auditorius.

This disorder frequently attacks those who are subject to rheumatic and febrile defluxions; or it may arise from a sudden suppression of sweat, or from the head being exposed to cold winds when it is moist with sweating. The cause is often an inflammation or ulcer of the ear, attended with a remarkable heat, and intense beating pain, a redness, a fever, and even sometimes a delirium. Sometimes it is excited by worms; and then there is a wandering, cutting, gnawing pain.

The ear-ach is sometimes so violent as to cause a delirium, with the highest inquietude and anxiety, inasmuch that the patients often fall into an epilepsy through the violence of the pain.

The ear-ach is sometimes a symptom of acute fevers, when the morbid matter is translated to the ear, as in the Hungarian disease, when deafness or difficulty of hearing arises. When it happens in the declension of a fever, it is a certain sign of recovery; but then the disorder is in the internal part of the ear, and the auditory nerve. When the matter is translated to the external part, then the ear-ach arises; which, unless speedily appeased, may deprive the patient of life. Those who have the ear-ach from a fall, and a famous matter runs out of the ear, are all carried off.

The principal scope is to ease the pain, which may be done with nitrous and cinnabarine powders, and with emulsions of the greater cold feeds; but if these are ineffectual, we must have recourse to opiates, such as the storax pills, or the thebaic tincture.

Outwardly, lay a plaster to the temple of the affected side, composed of mastic, galbanum, saffron, expressed oil of nutmegs, and opium. Afterwards let the ear be held over the vapour of milk, with the fragrant and emollient spices. Also, fill a hog's bladder with the decoction of milk of flowers of mallows, mullein, elder, melilot, camomile, linseed, and a little saffron, and apply it to the part affected. Likewise the smoke of tobacco blown into the ear, and an infusion of milipedes in salad oil, are thought to be of great efficacy when the inflammation is caused by a sharp ferment.

Camphorated spirit of wine, especially with saffron, made pretty hot, and a few drops of it put into the ear with cotton-wool, is a great solvent; it should also be rubbed into the parts behind the ear. Or oil of almonds with camphor may be used in the same manner; laying over either of them a hot bag filled with solvent herbs, as sage, penny-royal, wild thyme, wild marjoram, camomile flowers, Florentine orris, fennel and caraway seeds, with camphor. When the patient is plethoric, bleeding is convenient.

The most violent ear-ach, from taking cold; may be infallibly cured, in a very short time, by applying the ear close to the mouth of a bellied jug, filled with a hot strong decoction of camomile-flowers.

When the inflammation will not resolve, a poultice of white bread and milk, or onions roasted under the cinders, or the like, may be often laid hot to the part affected, till it breaks, or the abscess is evident to the eye.

If the ear-ach is caused by any thing got into the ear, it will be best to relax the membranes by oil of almonds, and then cause the patient to sneeze, which forces it out.

When there is a copious flux from the ear after an abscess, the humours must be diverted by gentle laxatives, blisters, cupping, and pediluvia, if the patient is an adult. It should not be suddenly stopped by externals.

Of the Stone in the Gall-Bladder.

The signs of it are a fixed pain in the right hypochondrium in the region of the liver, which is constant, pressing, heavy, and sometimes acute; often attended with an ill colour in the face. The pain sometimes reaches to the epigastric region and the pit of the stomach. And the exacerbation is so great, at certain intervals, that the gripes and torture affect the whole cavity of the abdomen; joined with inappetence, a nausea, reaching to vomit, anxiety of the precordia, cardialgic anguish, coliciveness. At length, if the disease is obstinate, and will not yield to the best remedies, the jaundice supervenes. Some of these patients are continually afflicted with gripes, and live in this condition for many years, and generally die of the dropsy. Some feel a heavy, obtuse, deep, obstinate pain, with a tense weight, when the gall-bladder is greatly distended with small soft stones.

If the pain continues very intense and sharp, it draws the whole system of the nervous parts into contort, causing spasmodic strictures, not only of the adjacent parts, but also of the remote; distentions of the arms and joints, epileptic convulsions, and likewise a fever with a hard quick pulse, which shews a large rough stone is firmly fixed in the biliary ducts, that will soon hurry the patient out of the world.

But nothing is a more certain sign that these terrible disorders proceed from gall-stones, than when they are voided with the excrements; and then all the symptoms cease at once, except the jaundice, which disappears by little and little, or is easily cured.

If the stones are soft, and of a light colour; or topaceous and like mortar of platter, they most probably proceed from the hepatic ducts: If they are rough, hard, angular, and of a deep colour, they proceed from the gall-bladder, especially if attended with most cruel symptoms in their passage through that slender canal. However, stones have been found in the gall bladder after death, which have produced no extraordinary symptoms.

There are two times of the disease, which require two different methods of treatment; in the fit, and out of the fit.

In the fit, the spasms are to be appeased with anodynes and demulcents, such as oil of sweet almonds, and fresh sperma ceti, internally; externally, the fat of a wild cat, or a beaver, &c.

Demulcents are, milk, sweet whey, emulsions of the cold seeds, infusions or decoctions of marshmallow roots, with wild poppies, elder, syrup of marshmallows.

Powders may be made with crabs' eyes, cinnabar, and nitre, with a little saffron, powder of earth-worms, elkshoofs, &c.

Externally, emollient epithems, and succuli, filled with carminative ingredients. As also lenient clysters and laxatives of manna, rhubarb, cream of tartar, and the like.

Out of the fits, opening infusions and decoctions; which resolve, disperse, and promote excretions; such as tincture of rhubarb, dog-grafts, asparagus, parsley, pimpinel, afterwards adding rhubarb, terra foliata, tartar, or sal. polychrest, and syrup of marshmallows, which must be used a long while.

Some praise the roots of dog-grafts, and the juice of dog-grafts, as a specific.

Some use the powder of millepedes with neutral Salts.

Epithems made of camomile flowers, leaves of scoridum, wormwood, and carduus benedictus, elder-flowers, water and red wine, used often in a day, are beneficial.

But if these fail, after long use, the only refuge is in mineral waters, among which the Pyrmont is not the least ineffectual.

These are also properly used by way of prevention, with exercise, and decoctions of the aperient roots.

Of the Gravel and Stone.

A nephritic paroxysm is attended with a fixed pain in the region of the loins, bloody urine, voiding of gravel or small stones, a numbness of the thigh on the side of the part affected, a drawing up of the testicle on the same side, a nausea and vomiting. After the stone is fallen into the bladder, the urine presently becomes very thick, turbid, blackish, and in great quantity.

When the stone or gravel begins to move and make its way into the ureters, then the pain begins, which is more or less sharp according to the size and figure of the stone. It is sometimes so violent, that, besides a coldness of the extreme parts, there is a nausea, vomiting, and a spastic constriction of the precordia, a difficulty of making water, a constipation of the belly, a straitness of breath, a stupor of the thigh, a retraction of the testicle to the os pubis, inquietude, loss of strength, a syncope, convulsion-fits, or a fatal stoppage of urine.

When the violent pain has continued for several days and nights without intermission, and has brought the patient exceeding low, attended with an entire suppression of urine, with a coldness of the extreme parts and convulsions of the tendons, it is a sign that death is at hand.

Nor is it a good sign when the stone has continued a long while in the ureter; for then the appetite decays, and a nausea and reaching to vomit supervene, till the patient is consumed with a hectic heat, and the approach of death is hastened. Sometimes the pain is attended with an inflammation of the stomach or intestines. Some, from a stoppage of urine, fall into a dropsey of the breast, a lethargy, or convulsions.

The whole intention of cure consists in the easy exclusion of the stone, and the preventing the breeding of others.

Hoffman.

If the patient is of a sanguineous temperament, take away ten ounces of blood on the affected side; and then let him drink, as soon as possible, a gallon of posset-drink, in which two ounces of marshmallow roots have been boiled. Then gave an emollient clyster.

When the posset-drink has been vomited up, and the clyster returned back, give a pretty large dose of an opiate; that is about 25 drops of the thebaic tincture, or 15 grains of the pil. faponaceae.

Also let a bath or semicupium be prepared, of a decoction of althea roots, linseed, fenugreek seeds, and chamomile flowers; to these may be added, a few white poppy heads.

In the nephritic disorder, the grand point is the evacuation of the salubrious matter lodged in the pelvis of the kidneys, or in the ureters. Bleeding serves to remove the tension and inflammation; and emollient clysters are of a double service, because, by fomenting the slender tubes, they relax the contraction, and, by unloading the lower bowels, they remove the pressure against the ureters. The warm bath opens the passage yet more, greatly relaxing the abdominal muscles, peritoneum, and intestines; the bladder is also relaxed by it, and consequently the oblique inclination of the ureters through its several membranes is less liable to obstruct the evacuation of this sandy matter into its cavity.

By moderate diuretics, and emollient medicines, this discharge is assisted; while anodynes suspend the pain, and procure a paralytic resolution or a spasmodic contraction of the ureters, and thereby contribute not a little to open the passage.

These appear to be the most considerable methods for the relief of this disorder, which is but imperfectly managed without the united assistance of all, and which, used together, seem the utmost that art can furnish. A turpentine clyster is generally accounted very serviceable in a fit of the gravel.

Heister recommends the solution per deliquium of the sal diureticus, or the terra foliata tartari, mixed with a fifth part of the thebaic tincture, of which 50 or 60 drops may be given now and then, which will ease the pain, and gently expel the stone or gravel.

When the stone is too big to pass, the diet ought to be cool and diluent, to hinder the growth as far as possible. The diuretics that gently resolve, are parsley, fennel, scorzonera, mallows, and tea; dandelion, succory, oats, barley, honey, honey and vinegar; nitrous salts, as diluted spirit of nitre: The most soft cooling diluter is whey; the best emollients are a decoction of marshmallows and linseed tea.

When a small stone passes through the ureters into the bladder, it is generally expelled; but if it happens to stay in the bladder, it increases by the apposition of fresh matter, or in an orbicular manner, while the original stone remains like a real kernel. These additional coats are either red, white, ash-coloured, or bluish.

The stone in the bladder may cause an inflammation, with its symptoms; as also prelusions, attritions, ulcers, purulent urine, stranguries, obstructions of the urethra, an inability to discharge the urine, unless in a supine posture; a hectic fever, and a consumption. Sometimes the stone gets into the urethra, and plugs up the passage.

A stone in the kidneys may be known from a dull obtuse pain therein; from bloody urine after walking in a rough way, or after violent motion of the body, especially by being shook in a coach or other wheel'd carriage; from having voided stones formerly; and from the urine's being mixed with carbuncles, pus, and filaments.

A stone of the bladder is known from a pain at the time of, as well as before and after making water; from the urine coming away by drops, or stopping suddenly when in a full stream; by a violent pain in the neck of the bladder upon motion, especially on horseback, or in a coach over the stones; from a white, thick, copious, flanking, mucous sediment; from an itching in the head of the penis; from a tenesmus while the urine is discharged; by searching, with introducing the finger in the anus, or with a catheter; as also from the effects produced by the stone before mentioned.

As to the cure of the stone in the bladder, the medicines of Mrs. Stephens were lately much in vogue as a dissolvent; and Dr. Hartley, by leaving out the superfluous part of them, has reduced them to the following form.

1. Take 2 or 2½ scruples of calcined egg-shells, thrice a day, in any convenient liquid, drinking after each dose a third part of the following decoction:

2. Take 2 or 2½ ounces of Spanish soap, and dissolve it in a sufficient quantity of boiling water; filter, and sweeten with honey or white sugar.

The powder may be taken in three or four spoonfuls of any liquor that is not acid; If the largest quantity of the decoction is taken, it will be best to divide it into four doses.

The egg-shells must be calcined in a crucible eight or ten hours, to bring it to a lime; and then be exposed to a dry air, for six weeks or two months, that is, till they slacken or fall off into an impalpable powder, which must be sifted and put into bottles well corked.

The taking of these medicines must be continued for some time after the complaint ceases, lest any part of the stone should remain, which would be then rugged and unequal, and occasion exquisite pain afterwards.

It is common, after a few days use of these medicines, to have a great increase of pain in making water; at which time, opiates, emollients, warm baths, fomentations, a soft diet, and rest, are proper.

Dr. Hales, after several trials of the different ingredients of Stephen's medicines, found that the dissolving power of them lay in the lime. And Dr. Jurin, having taken soap-pees, the ingredients of which are potashes and lime, beginning with a few drops, and increasing the quantity, till he took an ounce, or an ounce and a half, every day in a proper vehicle, was cured of bloody urine, pain, &c., and passed several stones; after which he had no uneasiness. Hartley thinks the capital soap-pees are best taken in milk, half an ounce of which requires half a pint of milk. He thinks an ounce and a half, or two ounces, may be taken thus every day with perfect safety.

But Hales rightly conjectured, that lime-water alone was likely to have a good effect in dissolving the stone; which put Dr. Whytt upon making experiments therewith, which have happily succeeded; whence he proposes the following method of cure.

Let the patient swallow, in any form, an ounce of Alicant soap every day, and drink three pints or more of oyster or cockle shell lime-water. If the soap be taken in pills, it may be divided into three doses: the largest may be taken early in the morning fasting, the second at eleven before noon, and the third at five in the afternoon, drinking after each dose a large draught of lime-water, the remainder of which may be drank at meals, instead of the usual liquors.

The disagreeable taste of the lime-water may be mitigated by adding a very small quantity of new milk to it; and is quite destroyed by washing the mouth immediately with a little vinegar and water, and carefully spitting it out again. A dram and a half or two drams of juniper-berries, infused in every quart bottle, will mend its taste much. But if the patient dislikes pills, let him dissolve an ounce of soap in a pint and a half of warm lime-water made of shells, which have been long exposed to the weather; and take this at three different times, drinking the rest of the lime-water by itself.

If the shell lime-water cannot be had, let him take the same quantity of stone lime-water, with at least an ounce and a half of soap, because it increases its dissolving power.

If there is an invincible aversion to soap, there is reason to think, from experiments that have been made, that oyster-shell lime water alone, taken in larger quantities, will have greater effects in dissolving the stone, than stone lime-water even when assisted by soap.

At first the patient should begin with smaller quantities of lime-water than that mentioned above, which he may increase by degrees, and ought to preserve in the use of it, especially if he finds any abatement of his complaints or symptoms of the stone's dissolving, for several months, or, if the stone be large, years; during which he should abstain from acid or fermented liquors. For his drink, he may use milk and water, or a potion made with roots of marshmallows, parsley, and liquorice. But if he has been accustomed to more generous liquors, he may drink small punch made without acids. Spirits must not be drank at all, nor the weak punch but very sparingly. It will be also proper to forbear the use of salt meats, honey, and acid fruits, or at most to use them sparingly. Artichokes, asparagus, spinach, lettuce, succory, parsley, purslane, turnips, carrots, potatoes, radishes, green peas, may be safely used; but onions, leeks, and celery, should be preferred to most other vegetables.

The patient ought to drink no more of any liquor than is sufficient to quench his thirst; and he should retain his urine as long as he can without uneasiness, that it may have the greater time to act on the stone.

If the lime water occasions coliciveness, it will be necessary now and then to take a purgative; the most proper are aloes, manna, rhubarb, fennel, or jalap.

Such as have a stone in the bladder, should, while they are taking the medicines, have four ounces or upwards of tepid shell lime-water injected into the bladder every day, and retain it as long as they can without pain, and should evacuate their urine immediately before injection.

Were it not for the trouble of introducing the catheter, an injection might be made at least twice a-day; and if a flexible catheter were always kept in the bladder, it might be done at pleasure, and the dissolution of the largest stone quickly procured.

That the injection of the bladder may be more safe, and attended with less uneasiness, a dram of starch may be boiled in six or seven ounces of lime-water, and just be brought to boil over the fire. The fourth part of the yolk of an egg, being mixed with six ounces of lime-water, does not weaken its virtues any more than the starch, and may be occasionally used in its stead.

Such as have no stone in the bladder, but are frequently troubled with fits of the gravel in the kidneys, may probably prevent them, by drinking every morning a pint of shell lime-water, two or three hours before breakfast; and though it may be too small a quantity to dissolve the stone, yet it may prevent any new concretions.

Of the Rheumatism.

The rheumatism chiefly attacks persons in the flower of their age, after violent exercise, or a great heat of the body from any other cause, and then being too suddenly cooled, but spares neither men nor women, old nor young, especially if the person is full of blood depraved with any kind of acrimony. The disease is nearly akin to the gout.

It begins with chills and shivering, followed by inquietude and thirst. Which is preceded with spontaneous lassitude, a heaviness of the joints, and coldness of the extreme parts. When the fever appears, there is an inward heat, chiefly about the precordia, attended with anxiety. The pulse is quick and strait, the appetite is lost, and the body coltive. In a day or two, sometimes sooner, the patient feels a racking pain, sometimes in one joint, sometimes in another, but more frequently in the wrists, shoulders, and knees; frequently shifting from place to place, and leaving a redness and swelling in the part visited last. The pain is exasperated upon the least motion; it sometimes attacks the loins and cox-ndix.

When it seizes the loins, it is called the lumbago; and there is a most violent pain in the small of the back, which sometimes extends to the os sacrum, and is like a fit of the gravel, only the patient does not vomit. If this disease is unskillfully treated, it may continue several months or years, but not always with the same violence, but by fits. If it continues and increases, it may cause a stiff joint, which will scarce yield to any remedy.

Its proximate cause seems to be the inflammation of the lymphatic arteries, of the membranes near the ligaments of the joints, but not so violent as to bring on a suppuration. The blood is like that of persons afflicted with the pleurisy.

Take away ten ounces of blood on the side affected. This must be repeated three or four times, or oftener, once every other or every third day, according as the strength of the patient will bear.

The diet must be very thin, and an emulsion of the four cold seeds may be prescribed; and also a poultice of white bread and milk, tinged with a little saffron, may be laid on the parts affected.

If the patient cannot bear frequent bleeding, after the second or third time, give the common purging potion every other day, and an ounce of diacodium at night, till the patient recovers.

If the rheumatism begins with a febrile effervescence, temperate diaphoretics, with nitrous things, in a moderate dose, and often repeated, are beneficial; such as crabs-eyes, burnt hartshorn, amber, cinnabar, purified nitre, with diazoic and gently anodyne waters, also citron-juice, or its syrup. The common drink should be whey acidulated with citron-juice or cream of tartar; or decoctions of the shavings of hartshorn, roots of scorzonera, succory, liquorice, or fennel-seeds.

To purge, it may be proper to chew or eat rhubarb, from two scruples to a dram, with raisins or currants.

In an incipient rheumatism of the shoulders, nothing is better than a blister laid between the scapulae.

But if the patient happens to be plethoric, nothing is better than a decoction of the sudorific woods, to the quantity of a quart a-day, for a month or six weeks together.

This lait is good in the venereal rheumatism, when assisted with crude antimony and mercurius dulcis.

Young persons who are temperate liverers, and not addicted to strong liquors, may be cured by a simple refrigerating diet, and moderately nourishing, as certainly as by repeated bleeding; for instance,

Let the patient live four days upon whey alone; and after that white bread may be allowed for dinner, and, on the last days of his illness, he may be allowed it for supper. When the symptoms cease, he may be allowed boiled chickens, or other things of easy digestion; but every third day he must live upon whey only, till his strength returns.

Boerhaave's method of cure is to the same effect, only he advises warm baths and strong blisters to be laid upon the part affected, nay, even cauteries themselves.

Arbuthnot ARBUTHNOT says, cream of tartar in water-gruel, taken for several days, will abate the pains and swellings considerably, by its acidity correcting the alkaline salts of the blood.

RIDLEY used mercurius dulcis in rheumatic cases, as a purge, with good success, giving a scruple in conserve of violets over night, and three pints of epion waters, evaporated away to one half, in the morning.

Dr. James has wrote a treatise to prove the efficacy of mercurial preparations, as well in the rheumatism as in the gout, which is supported with very good authorities.

And HUXHAM says, that the obstinate rheumatic pains, which remained after the epidemical fever of 1737, would yield to mercurial cathartics; but he preferred to every else what he calls the essence of antimony, which is nothing else but emetic wine made with glaas of antimony, with the addition of a little spicy stomachic. This, given to 20 or 30 drops, operates by gentle sweats, and purges in a larger dose very mildly.

HOFFMAN likewise recommends mercurials and antimonial in particular cases; that is, when a violent and obstinate pain afflicts the lower parts of the body, about the osseous and the os coccigis, and the patient is of a robust constitution, then the more powerful chemical medicines may be made use of, such as mercurius dulcis, the solar precipitate rightly prepared, or the medicinal regulus of antimony, to which a decoction of the sudorific woods may be added. From such medicines as these great relief may be expected.

CHEYNE says the hot and inflammatory rheumatisms have all the symptoms of the gout, and like it change from place to place and by violent evacuations may be transmitted upon the noble organs. And by the way it may not be amiss to observe, that excessive bleeding, and other violent evacuations, constantly bring on a hectic or dropy on the patient in this case; diseases of a much more dangerous nature in themselves, and far more difficult to be cured, than the original one. And therefore in this disease, only promising so much bleeding as will prevent a fever and mortification, and somewhat abate the pain (which gentle doses of calomel and gum guaiacum will do more effectually, though not more speedily, than bleeding itself) the rest is to be done by large doses of the bark and Ethiops mineral mixed; and a relapse prevented by gentle doses of gum guaiacum, with antimony diaphoretic, and cinnabar of antimony.

PRINGLE observes, that rheumatisms are generally mild, though they sometimes appeared with all the violence taken notice of by Sydenham. For which reason the first fort were generally cured in two or three days by twice or thrice bleeding, and promoting a diaphoresis by the cooler medicines, particularly by vinegar whey. But if it was intended with an inflammatory swelling of the joints, fweating was improper, and the cure was only to be obtained by repeated and almost daily bleedings. But then it is to be carefully remarked, that those were afflicted with it who were best able to bear these evacuations; and in this disease he thinks frequent bleedings weaken the body less than in any other.

If the pain and swelling of the joints remain after this treatment, three or four leeches must be applied to the part where the inflammation and tumour are the greatest, and the blood is to ooze till it stops of itself. This may be repeated freely without danger. But unless there is both an inflammation and swelling, leeches will do no service. The best internal medicines, in a true acute rheumatism, are neutral salts, with very small doses of camphor. The diet must be of the lowest kind. All outward applications are to be omitted as long as any fever or inflammation remains.

The chronic rheumatism is either the remains of a rheumatic fever, or a continuation of pains that proceeded at first from lesser but neglected colds. The blood in this case is fizzy. It is an obstinate disease, but bleeding is the most efficacious remedy. Eight ounces of blood is to be taken away once in eight or ten days, as long as it is fizzy, or the complaints remain.

Bleeding has been repeated, in many cases, three or four times, to no manner of purpose; nor would the pains abate without deobstruents, diaphoretics, purges, and anodynes. Sometimes they have yielded to the cold bath alone.

Dr. Clerk of Edinburgh declares the Arthritis Vaga, or flying gout, erroneously called the Scorbutic Rheumatism, may be often distinguished by the urine of the patient; for certain filaments float in it not so transparent as the urine itself, but when taken out they appear as pellucid as crystal. They will rope to a great length, and when dried turn to a white calx. This he takes to be the morbid matter of the gout, gravel, goutish sciatica, and all true arthritic pains, distinct from the rheumatism. Soap is the best dissolvent of it yet known, half an ounce of which to an ounce may be taken in a day for a month together, if necessary, in the sciatic and other arthritic pains.

Of the Gout.

The gout is a very painful disease, whose seat is in the joints and ligaments of the bones of the feet; the principal times of its invasion are the spring and the autumn.

In treating of this disease, we shall first give an account of the regular gout, and afterwards of the irregular.

The regular gout usually seizes the patient in the latter end of January or the beginning of February all of a sudden, and without any previous notice, unless the patient has been troubled with crudities of the stomach and indigestion for some weeks before; the body likewise may have seemed to have been puffed up with wind, with a kind of heaviness, which daily increases, till at length the fit comes on; a few days before which, there is a torpor, and as it were a delusion of wind down the muscles of the thigh, with a kind of spasmodic affection of them. Likewise, the day before the fit, the appetite is more voracious, but not natural.

Though the patient seems to go to bed in good health, yet about two in the morning he is awakened by a pain which most commonly affects the great toe, sometimes the heel, the ankle, or the calf of the legs, which pain resembles that of dislocated bones; there is likewise a sensation as if water almost cold was poured on the membranes of the part affected. Soon after, a shivering and shaking supervene, with a feverish disorder. The pain which at first is tolerable, becomes more violent in proportion as the shaking decreases, and grows more intense every hour till night, and then it is at the height; settling itself about the little bones of the tarsus and metatarsus, whose ligaments it affects. Now there seems to be a violent extension of the ligaments, or there is a sensation of their being lacerated, or gnawed by a dog. Sometimes they seem to be pressed or squeezed together. At this time the part affected becomes so exceeding sensible, that they cannot bear the weight of the sheet, nor the shaking of the room by a person's walking about.

The patient is now in great torture, and is continually shifting his foot from place to place in hopes of ease. His body likewise is in as constant agitation as the part affected. This always happens at the accellion of the fit. But the pain continues without remission till two or three in the morning, that is, twenty-four hours from the first onset, at which time he begins to be at ease, which he is willing to attribute to the last posture in which he placed the affected member. Now he falls into a gentle breathing sweat, and gets a little sleep, and, when he awakes, perceives the part to be swelled, and the pain much abated; for before, the veins of the member, being turgid, were only more conspicuous than usual.

The next day, or perhaps two or three days afterwards, if the gouty matter is copious, the part affected is a little in pain, which grows more violent towards the evening, and abates at the crowing of the cock.

In a few days the other foot begins to be affected in the same manner; and, if the pain has ceased in the first, the weakness which is left behind soon vanishes. The same tragedy is now acted over again. Sometimes, when the gouty matter is in great plenty, it attacks both feet at once, but it generally seizes one after the other.

After both the feet have been tormented, the fits which follow are out of rule, both as to the time of invasion and the duration; only the pain grows more intense at night, and remits in the morning.

From a series of these small fits arises what is called a fit of the gout, which is longer or shorter, according to the patient's age. For it is not to be supposed that, when a patient has been laid up with the gout two or three months, that it is a single fit, but rather a series or chain of small fits, which continually grow shorter and milder, till the peccant matter is at length consumed, and the former health restored. This happens to the more vigorous, and whom the gout seldom visits, in fourteen days; to persons advanced in years, who have often felt its rage, in two months; but those who are debilitated with age, or the long stay of the disease, it does not leave, till summer, being pretty far advanced, drives it away.

For the fourteen days the urine is higher-coloured, and deposits a sediment like gravel, and not above one third of what the patient drinks passes off by urine; the body on the first day is coltive, the appetite decayed, there is a shivering towards the evening, as also a heaviness and troublesome sensation in the parts not affected. When the fit goes off, there is an intolerable itching in the affected foot, chiefly between the toes, from which and from the feet fall branny scales, as if the patient had swallowed poison.

The disease thus terminated, the patient's good habit of body and appetite return in proportion to the severity of the pain in the last fit; and in the same proportion the next fit will be either accelerated or retarded; for, if the last fit was very severe, the next will not come on in less time than a solar revolution.

Hitherto you have an account of the regular gout, and its genuine phenomena; but when it is disturbed by incongruous medicines, and the patient is worn out by the long continuance of the disease, it becomes irregular, and the substance of the body is as it were changed into a fomes of the disease, and nature becomes unequal, to the task of conquering the malady thus changed, in the accustomed manner.

The feet were at first the seat of the disease, but now it attacks the hands, wrists, elbows, knees, and other parts of the body. Sometimes it so distorts the fingers, as to make them resemble a bunch of parsnips, and at length stony concretions appear about the ligaments of the joints, which, breaking through the skin, resemble chalk, or crabs eyes. Sometimes the gouty matter invades the elbows, and creates a whitish swelling of the size of an egg, which soon assumes a red colour, and becomes inflamed. Sometimes it affects the thigh in such a manner, as if a great weight was hanged thereon, and yet without any remarkable pain. From thence it descends to the knee, which it handles more roughly, hindering all motion, for the patient continues in the same place and posture as if he were nailed to the bed.

Now the gout afflicts the patient all the year, except two or three months in summer; and the particular fit, which did not last above a day or two, continues ten or fourteen days; and the first or second day after the onset, he is disturbed with sickness as well as pain, and a total loss of appetite.

His limbs also begin to be contracted and unapt for motion; and though he can stand, and perhaps creep about a little, yet so slowly, that you can scarce perceive he gets forward at all. If he strives beyond his strength, hoping by exercise to regain his legs, and to become less susceptible of pain, the fomes of the disease will attack the viscera in a more dangerous manner. The urine is like that of a person troubled with a diabetes, and there is a troublesome itching in the back and other parts, especially at bed-time.

Nature being at length oppressed with the disease and old age, the fits begin to grow more mild, and, instead of the usual pain, there is a kind of sickness, with a pain in the belly, a spontaneous weariness, and sometimes a disposition to fall into a diarrhoea; which symptoms vanish as often as the pain returns to the joints. And thus, the patient being alternately afflicted with pain and sickness, the paroxysm becomes very long and very tedious.

This disease seldom invades any patient till he is upwards of thirty, and men are more subject to it than women; as also persons of acute parts, who follow their studies too closely, especially in the night, with an intense application of mind. Likewise those who live high, and indulge their appetites, drinking plenty of rich generous wines; or who use acids too freely, or white eager wines; or who have been addicted too early to venereal pleasures; or whose bodies are large, gross, and full. Those also are liable to it, whose sweaty feet are too suddenly chilled; or who suffer their feet to sweat in wet shoes and stockings. Hence hunting and riding in the cold are pernicious. It may likewise be received by contagion, and is hereditary, descending from father to son.

The curative indications require, first, that the primæ via be set free from a load of indigested crudities, and the viscera be restored to their pristine vigour; that by these means the aliments may be duly concocted and assimilated into healthy fluids, and such as will pass freely through the smallest vessels; while whatever is unfit for nourishment may pass off by perspiration, in due time and quantity. Secondly, that the fluid stagnation in, and stuffing up the smallest vessels, may be expelled the body, and a free passage through the contracted vessels be restored.

The first intention may be answered by vomits and gentle cathartics, repeated as occasion requires; by bitters, aromatics, antiscorbutic medicines; by alkaline fixed salts, taken in small quantities for a long time; by aliments and drinks that are nourishing, light, easy of digestion, quickly assimilated and taken in due quantity; by powerful exercise often repeated and long continued, and especially by riding in a dry, pure, serene air; by friction, by motion of the affected parts, by going to sleep at early hours.

The second intention may be answered partly by the preceding article, as well as by procuring gentle sweats, by bathing in natural and artificial baths; by fomenting in a bagno; or by the use of volatile salts, and copious drinking of attenuating liquors actually hot, in the morning while in bed, in order to procure a sweat; as also by mercurial purges, taking a large quantity of diluents after them; by frictions of the whole body, especially the parts affected, with hot, dry linen cloths, till a redness appear; by cold baths, and the like. These things being used with prudence, and according to the various temperaments of the patient, will yield no small relief, even in the nodous gout itself.

As the proximate cause lies in the vitiated state of the smallest nervous vessels of the body, and of the fluid that passes through them, it is no wonder that bleeding will not reach the matter, state, or cause of the disease; yet it may sometimes do good by accident, by causing a small revolution, and by abating the urgent symptoms.

Nor will emetics or cathartics yield so much relief as is commonly thought, because they often raise a disturbance in the nervous fluid, diminish the other fluids, and weaken the expulsive faculty. But much greater benefit may be expected from sudorifics rightly administered.

Nothing is more fatal than to hinder the gouty matter, now grown mature, and remaining unexpelled, as well as uncorrected by proper medicines, from falling on the usual parts, which indeed cause great pain, but no danger. If it invades the brain, it will occasion apoplexies, palsies, a delirium, weaknesses, dozing, tremors, or universal convulsions: If it attacks the lungs, it produces an asthma, a cough, or a suffocation: if the intercoils and pleura, a convulsive pleurisy; if the abdominal vis-

cera, nausea, anxieties, vomiting, belching, gripings, or spasms of the viscera. It is almost incredible how many diseases it creates, which are suddenly mortal; or at least not to be cured but by reviving the fit of the gout, which had been disturbed, and rendering it as severe as possible.

These last mentioned evils happen from injudicious applications of narcotics, refrigerants, astringents, or irritants; or from medicines which cause a revulsion from the diseased part, or from debilitating, evacuating, or suffocating remedies. Hence bleeding, purging upwards or downwards, plasters, poultices, of the nature above mentioned, and all opiates, produce these effects; as also a spontaneous weakness brought on by extreme old age; or from the extreme parts being so obstructed, corrupted, withered, or perished, that the morbid matter cannot pass through them any longer.

To abate the excessive pain in the part affected, if there be an absolute necessity, opiates may be given internally, and the patient may drink plentifully of hot whey, or any other liquor of the like nature. External emollients and anodynes may be used laid on pretty hot, or the part affected may be beat with nettles, or it may be anointed with terebinthinated balsam of sulphur, or tow may be burnt thereon.

Though there is nothing of any moment to be done in the fit, yet it will be proper to abstain from flesh for some days, and to live upon water-gruel, or such like diet; but no longer than the stomach is averse to flesh, for fear of bringing on a disturbance of the animal spirits; but then great care should be taken in the diet, both as to quantity and quality.

As soon as the pain is almost gone, and the swelling and the weaknesses only remain, nothing can be better than warm stomachic and spicy purges, dosed and repeated according to the strength of the patient. This being permitted, if the patient's strength is impaired, and his flesh wasted, give after milk with pearl, half a pint or a pint in a morning early, and at five or six o'clock in the afternoon; and to keep up the appetite which the milk commonly pall, and to prevent its cooling effects on the stomach, a light bitter made of gentian, cinnamon, and orange-peel only, the last double to the other two, infused in sherry or white wine, and taken two hours before meals, may be used most conveniently. This course may be continued two or three weeks; after this a course of Bath or German-spa waters with steel, riding, a light white food diet, and generous wine drank temperately, will be most proper.

Out of the fit, those things are most proper which promote the concoction of the aliment, whether by medicines, exercise, or diet.

In the diet there is a medium to be observed: the patient should neither eat more than the stomach will digest, nor be so abstemious as to debase the parts of such a proportion of aliment as is necessary to maintain the strength and vigour. As to the quality of the food, the patient's palate is to be consulted: but he should dine upon one dish of meat only; for several kinds of flesh, eaten at the same meal, disturb the digestive faculty more than the same quantity of any one sort. As for other things, the patient may feed upon what he likes best, provided it is not sharp, nor salted, nor seasoned with spices. He should eat no supper; but instead thereof should drink a draught of good small-beer, whereby the breeding of the gravel may be prevented. If the patient is troubled with the gravel or stone, and makes bloody water, he may purge with manna once a week, and take a paregoric at night.

The most suitable drink is such as is not so strong as wine, nor so weak as water, for the latter by its coldness will deprive the stomach. Of this sort is the London table-beer, or water with a little wine. But, when the gouty matter has seized the whole body, he must abstain from all fermented liquors, though ever so mild and small.

But if the patient has been used to strong or spirituous liquors, or is advanced in years, or through weakness cannot digest his aliment, he may, at meals, indulge himself with a draught of Spanish wine, which is better than French.

Regard must likewise be had to the symptoms, which, in the fit, endanger the patient's life. The most common is a weak and languid stomach, attended with sicknesses and gripes, as if from wind. In this case nothing is better than a glass of Canary drank now and then, together with exercise. But, if the symptoms will not admit any true, give twenty drops of the thebaic tincture in spirituous alexiteral water, provided the head is not attacked, and let the patient compose himself to rest.

If the nephritic pains should come upon the gout, which often happens, let the patient omit all other medicines, and drink a large quantity of posset-drink, in which the leaves and roots of mallows and marshmallows have been boiled. Then let a clyster be given, and afterwards a large dose of laudanum.

When the gout has seized on the head, it is to be treated as any other head-ach, or as an inflammation of the brain and its membrane; bleeding in the arm or jugular, cupping on the back, and blistering between the shoulders, but especially on the ankles, to give the gouty humour a vent downwards. In young and strong constitutions mercurial and antimonial vomits will do wonders. Likewise gentle stomach purges are to be poured down continually, that is, two or three spoonfuls every third hour, till the effect is obtained.

Mercurial vomits are not only proper for the gout in the stomach, but they are absolutely necessary as well as mercurial purges, when the gout becomes fixed to, and permanent in a place, as also when it is dispersed all over the habit like a rheumatism. These active medicines must first render the humours fluid, which gum guaiacum, with diaphoretic antimony, perfused in, will afterwards carry off.

Of the Sciatica, or Hip-Gout.

The sciatica is a violent and obstinate pain in the hip, chiefly in the joint where the head of the thigh-bone is received into the acetabulum of the coxendix. The pain will sometimes extend itself to the lower part of the loins, to the thigh, leg, and even to the extremity of the foot; yet, outwardly, there is no swelling, no inflammation, nor change of colour in the skin.

Sometimes there is such a spasm of the muscles on the side affected, that the patient cannot stand upright, without the utmost pain.

When the sciatica has continued very long, there is such a collection of pituitous humour in the cavity of the joint, that, by relaxing the ligaments, it often causes a luxation. Sometimes it causes an aridura, or wasting away of the adjacent parts.

When the pain leaves the hip, and moves downwards, it is a sign that the spasms are resolved. A violent motion of the body generally exacerbates the pain.

After a gentle cathartic, or clyster, bleeding will be proper, especially in the ankle; also leeches applied to the hemorrhoidal veins have been found beneficial. Strong purges are hurtful; but mercurius dulcis given with scammony, or some other purgative, will be of service.

If the patient is old or weak, lenient purges will be most proper; and on the intermediate days a dose of calomel, which is afterwards to be purged off; and so repeated alternately for some time.

Baglivi observes, that if nothing else will do, in pains of the external parts, recourse must be had to caustics, particularly the leaves of ranunculus, or a mixture of quicklime and soft soap, which are beneficial in the hip-gout.

Cheyne observes, that when the gout is dispersed over the whole habit, or is fixed and settled on a particular joint, mercurial vomits and purges are necessary to dislodge it; but the sciatica will not yield to this, and but rarely to any other methods of use; but, by the following method, a perfect cure may always be obtained, if the distemper is a genuine sciatica, though of many years standing.

It consists in taking one, two, or three drams, to half an ounce, according to the strength of the patient's stomach, of the ethereal oil of turpentine; which is that which comes off between the spirit and the oil in drawing off the common oil of turpentine; this is to be taken in triple the quantity of virgin honey, in a morning fasting, for four, five, six, or eight days at farther, intermitting a day now and then, as the patient's occasions require, or his stomach suffers by it. Large draughts of sack-whey must be drank after it, to settle it on the stomach, or carry it into the blood; likewise every night must be taken a proper dose of Matthew's pills [or half a scruple of the pil. saponaceæ] that is, if the oil has been taken in the morning.

To remove the grosser remains and strengthen the weakened part, the patient must take a dram or two drams of flower of brimstone, for some time twice a day, in a tea-cup full of milk. If through great intemperance, or a violent cold, the patient relapses, let him repeat the former medicines for a day or two. Then, to strengthen the prime vice and enliven the spirits, let him drink the Bath or Spaw waters with steel, and bitters with volatiles.

Of a Virulent Gonorrhoea.

A virulent Gonorrhoea, or Clap, proceeds from impure coition with an infected woman.

This distemper begins and makes its progress in the following manner. The patient, sooner or later, according as the woman with whom he has had conversation was more more or less infected, and according to his constitution, by which he may be more or less disposed to receive the infection, is first seized with an unusual pain in the genitals, and a kind of sensation like a rotation of his testicles. Afterwards, if the prepuce constantly cover his glans, there appears an eruption or pustule, which by its size, colour, and figure, resembles a spot of the measles; presently after appears a weeping matter like semen, which daily changes colour, and becomes more purulent and more yellow, till at length, if the disorder be highly virulent, it assumes a greenish hue, or appears like a thin fumous matter mixed with blood.

The pustule at length becomes an ulcer, commonly called a chancre, at first not unlike the thrush in children's mouths, which, daily eating deeper and wider, at last is encompassed with hard and callous lips.

Those whose glans is uncovered, seldom have such a pustule, either because it is hardened by being continually exposed to the air, or by the frequent rubbing of the shirt, and so is less liable to imbibe the infection.

The running brings on a heat or smarting in making water, which is most violent when it is over, for then it seems to burn the whole duct of the urethra.

Another symptom is the cordee, or contraction of the frenum, by which the penis is bent downwards. There is likewise, when the penis is erected, great pain as if compressed transversely with a strong hand. This chiefly happens in the night, when the patient is warm in his bed.

Sometimes the urethra being eaten and excoriated with long running of the acrimonious pus, nature breeds a soft spongy flesh, to supply the defect, which daily increasing forms carbuncles or carnoties, so far as to plug up the urinary passage and stop the urine. However, the little adjoining ulcers continue to pour forth a kind of an ichor; and this state is not only troublesome to the physician, but almost as bad as death to the patient.

It also often happens, through some violent motion, or the ill-timed use of astringents, that the fancies which should be carried off by the gonorrhoea, is translated to the scrotum, and causes one or both of the testicles to swell and inflame with intolerable anguish and pain; the running at the same time decreasing, while the scalding of the urine is as great as ever.

To these symptoms may be added the phimosis, which happens when the prepuce cannot be drawn back to uncover the glans; but this the case of many in a healthful state. Also the periphimosis or paraphimosis, when the prepuce, being swelled, cannot be brought forward to cover the head of the penis. There are sometimes also watery bladders or vesicles called crystallines, and at length buboes or swellings of the glands in the groin. When these last appear, the lues venerea is generally supposed to begin.

Women are not subject to such a variety of symptoms as men; their chief complaints being a difficulty of urine, and a running; however, they are liable to chancres and venereal warts as well within as on the outward parts of the labia pudendi, as also to buboes in the groin. As for the coagulation of the sphincter vaginae, pursing up as it were the external orifice, this is not a phimosis, though by some improperly so called.

The cause of a virulent gonorrhoea is a taint by impure coition, conveyed from a woman infected with a malignant gonorrhoea, or the lues venerea, first to the genitals of a man, and afterwards through the pores to the lymph or seminal liquor; the due crisis and natural mixture it entirely destroys, by inducing partly a caustic and corroding, and partly a putrid state thereof. Hence arise the pains and heats, the tumours, the inflammations, and the ulcerations of the genitals: For at first the glans is only affected, whilst, in coition, the poison insinuates itself into the open pores. Then it soon proceeds to the glans of the urethra, then to the prostates, which are porous, and afterwards to the vesiculae seminales.

If the infected lymph is conveyed to the inguinal glands through the lymphatic vessels, which Cowper discovered to run from the prepuce to the groin; then a venereal bubo is formed, which is a hard tumour without pain. But if the seat of the gonorrhoea is deeper, and an inflammation arises at the beginning of the urethra, where the vesiculae seminales discharge the seminal fluid, then these vessels are so comprised by the tumour, that the semen cannot be conveyed to them from the testicles, whence it happens that the testicles swell.

As to the prognostics, we must observe, that the greater the infection is, the more violent and obstinate the disorder will prove; though it seldom brings on a pox unless the discharge is imprudently stopped by the prepotentious use of lodorfics and astringents; for, immediately on the suppression of the discharge, buboes, tumours of the scrotum and testicles, carbuncles of the urethra, and other terrible symptoms appear, together with a confirmed pox. The more regular the discharge is made, the more mild all the symptoms are.

But when the running is small in quantity, the urine is highly fetid, and the matter yellow or green, it is a bad sign.

It is a certain sign the disorder is mitigated, when the painful constriction of the penis in erection, and the heat of urine, are removed; as also when the impaired strength begins to return, and the countenance, which before was pale, assumes a florid or a natural colour.

It is a sign the gonorrhoea is cured, if, upon compressing the penis, a drop or two of thin limpid liquor, like the white of an egg, is discharged.

The regimen, during the time of the cure, requires the patient to abstain from all oily food; and he must also avoid every thing which by its acrimonious quality stimulates to venery; such as spices, bulbous roots, flesh, eggs, fish, and fermented liquors; for the inflation of the penis retards the cure. This is of the utmost consequence; and therefore all venereal incitements, such as obscene books, and whatever else inflames the fancy, should be shunned like death.

Water and whey are the best drink, and seeds and summer-fruits the best aliment.

All possible care must be taken that cold never reach the penis; and that it be kept always moist, lest the pores contracting repel the flux of matter. An emollient and somewhat antiseptic cataplasm will be beneficial.

In the place of mercurials given internally, Astruc directs He proposes to cure it by mercurial purges, to carry off the humour; in the mean time rubbing a mercurial ointment into the part, to dissolve the induration; which he thinks is more gentle and easy, than to promote the suppuration by ripening poultices, and then opening the tumour by a caustic, giving mercurials inwardly at the same time.

De Salt cures all the symptoms by rubbing into the parts a strong mercurial ointment, causing the patient to anoint himself from the anus all along the urethra to the glans and prepuce. The following day he gives a strong dose of jalap, that is, from two scruples to a dram. His diet drink is to be spring-water in which mercury revived from cinnabar has been boiled. If the patient cannot bear much purging, he may have a truce for a day or two, but the ointment is to be continued every night. The first friction gives considerable relief, the second yet more, the third commonly makes the pain cease, and the fourth and fifth generally silence the complaints. Five or six weeks generally perfects the cure.

In buboes, the patient is to rub the ointment into the groin, scrotum, and parts in either sex; purging every day, and drinking the mercurial water; by which means the buboes melt away, the phimosis, paraphimosis, and chancres disappear, and the former health returns. If there is matter already formed in the bobo, then he allows it must be opened. Heister's method is much the same.

III Of Caruncles and Carnosities in the Urethra.

The obstructions which hinder the free passage of the urine, according to Astruc, are these which follow. 1. Ulcers in the urethra. 2. Cicatrices left behind after the healing these ulcers. 3. Caruncles. 4. A schirrus on the verumontanum, or caput gallinaginis. 5. Indurations of the prostate and vesiculae semifinales. 6. Carnosities rising in and straitening the canal.

He proposes to cure the ulcers by the same regimen as the first period of a gonorrhoea, viz. by repeated bleedings, lenients and refrigerants, to abate the fluxion, and take off the inflammation.

Turner, in the worst cases, would not have the urethra laid open, but only have the perineum well greased with the mercurial liniment, by which he has known many large callosities insensibly dissolve, while the candle or leaden probe, smeared also therewith, has been kept within.

But there has been lately introduced into practice by Daran a new method of curing these disorders with bougies, the composition of which he keeps a secret.

According to him, if the canal of the urethra be open enough to admit the extremity of the bougie, a suppuration will ensue from the diseased part of the urethra, which will in time relax and open the stricture; or, if the stricture opposes the entrance of the bougie, yet still the mere point of the bougie will suppurate it in a small degree, and by and by, though much more tediously than in the other case, by relaxing, open it.

The first discharge procured by a bougie is generally very sanious, and evidently flows from the place where the obstruction is; that part of the bougie only being covered covered with matter that answers to the obstruction. Again, the cordee, excited by the use of the bougie, is infinitely more painful where the obstruction is, than in the other parts of the penis. It will, it must be owned, produce a cordee in a sound penis; but then it extends through every part of it, and is by no means so painful as the other.

If the symptoms of the strictures, callous scars, carbuncles and tumours of the corpus spongiosum urethrae are essentially different, those differences are not mentioned by any writer; except that, when the urethra only is affected, the patient, in making water, voids matter before his urine; but when the prostate glands or vesiculae seminales only are concerned, matter follows the last drop of urine. But it frequently happens that one is complicated with the other.

The properties requisite in a bougie, are a sufficient degree of firmness, that it may be introduced with some force: A suppleness and tenacity, that it may conform to the motions of the body without breaking: A lenient suppurative disposition, to bring on a discharge without pain: And, lastly, a smoothness of surface, that it may not only be introduced with more ease, but that it may lie easy in the passage till it begins to dissolve.

That chiefly made use of is as follows;

B. Emplast. commun. cum pice Burgund. zij. Argent. viv. 3j. Antimon. crud. pulv. 3i. M.

The emplast. com. or diachylon, must be made with oil and a little Burgundy pitch added to it, to render it sufficiently tenacious: the antimony must be finely levigated, that it may give a smoothness and good consistence to the bougie.

The quicksilver, whether it be divided in half. sulph. or honey, must not be put into the plaster till the moment before the bougies are made, nor must the plaster be boiling hot at that time. When the quicksilver is mingled with the plaster moderately hot, slips of fine rag must be ready to dip in the composition. They must be of different lengths, from six to nine or ten inches, and about three inches broad. Roll them up loosely, and, taking hold of one extremity with the left hand, let it fall gently on the surface of the plaster, and then draw it out gently. As it is drawn out, it will unroll, and take up a quantity of the plaster upon its surface, equal to the thickness of a silver groat. It may be proper to assist the unrolling with a spatula. The plaster must be hot enough to soak through and discolour the rag. The ladle in which it is melted ought to be broad and flat at the bottom; and the plaster must be kept stirring to preserve it in equal consistence. The bubbles on the surface of the cloth may be smoothed with an iron spatula a little warmed.

One rag will make six bougies of a moderate size; they are best cut with a knife and ruler. They should be made taper at the end, by cutting off a slope about an inch and a half long. When they are rolled up, it must be with that side outward which is covered with plaster; and they must be first rolled up with the finger and thumb as close as possible, before they are rolled upon a board or marble. In the winter it will be proper to hold them a little before the fire to facilitate their rolling.

Before a bougie of any kind be introduced into the ure-

thra, it will be necessary to smear it with sweet oil, that it may go in easily, and not stimulate too much at first. The patient may either stand or lie down in the posture of being cut for the stone; then the surgeon must grasp the penis near the glans, and extend it gently, that the urethra may not be wrinkled, and then it will meet with no impediment but what is occasioned by the disease.

It often happens at the beginning, that the bougie cannot be too small; and then the end must be round, that it may readily slip over the pipe of the urethra; it is also exceedingly desirable that it enter within the obstruction. However, it is necessary to desist from pushing it when once it begins to bend. When it meets with any resistance, to avoid the bending, turn it round with your finger and thumb several times, and, as you turn it, press it a little forwards. If by this method it advances, continue to do the same thing till it stops. But it must be owned that the operator in this case may be easily deceived.

The bougie must be confined in the penis by some kind of bandage, or rather we may keep it fixed in the urethra by a cotton string tied about its extremity, and then passed round the penis; no other thread is necessary.

When the patient is timorous, or the part tender, it may be left in two or three hours in a day only at first, but otherwise fix or seven. When the patient finds he cannot bear it, it may be discontinued two or three days, according to the nature of the symptoms.

There are instances of its having first cured, and then brought on a fresh strangury. In this case, forbear its use for two or three days, and the strangury will cease.

Some have been able to wear it night and day without intermission; and as they withdrew one, introduced another. And this is a prudent step; for the more suppuration is procured, and the longer the urethra is kept distended, the cure is more likely to be radical. When this cannot be done, the day is better for its use than the night, because in the night it is more subject to erections.

Two bougies in a day generally answer the purpose; one in the morning, and one in the evening, as more suitable to the patient's avocation; though some can walk about with them.

If the testicles should inflame, or any feverish disorder come on, they may be kept in an hour, or half an hour in a day, to prevent the urethra from contracting again till the symptom is removed; to prevent these disorders, the patient should observe a cooling regimen during the treatment.

Some are relieved by the bougie in a few weeks, some not till many months. Generally the cure may be performed in seven, eight, nine, or ten weeks. This is known by the removal of every symptom of the disorder; for some degree of running will generally continue as long as the bougie is employed.

When the patient judges himself well, it will be best to desist gradually, wearing it at first only an hour or two in a day, and then two or three times a week, after which it may be entirely left off. If any gleet still remain, or any obstruction threatens to return, it will be necessary to use the bougie four or five weeks longer.

In suppressions of urine it will be always advisable to introduce the catheter if possible, and indeed to keep it in the bladder two or three or four days; after which, the canal will perhaps admit a bougie, and then, a suppuration being once procured, it may easily be preserved open.

IV. Of a Gleet.

In what manner, says Sharp, a gleet is furnished, cannot well be determined, without first ascertaining the exact seat of a gonorrhoea. That the lacunae of the urethra are usually ulcerated in a gonorrhoea, is now generally admitted. Yet though all allow the existence of ulcers during that disease, they will not admit that a gleet is the discharge of an ulcer.

But it is most probable, that the running is not all of it a purulent matter, but partly matter, and partly a discharge from the secretory organs, as also from the vesiculae seminales, when they or their ducts are affected. For the running is produced in less time after the infection than is requisite for the formation of matter in every other instance; and the appearance of matter is frequently the first alarm in a gonorrhoea, the heat of urine and other symptoms of an inflammation and ulceration following sometimes two or three days after.

For these reasons, it is supposed, that the venereal poison, in its first operation, irritates only, and thereby increases the secretion; especially as the same thing happens to the glands of the intestines from purgatives, from the salivary glands, from smoking, &c. As the poison operates more strongly, the inflammation increases, and the ulcers form and extend, when not only the matter from the ulcer is fomentous, but all the secretory vessels communicating with the ulcerated lacunae separate a thinner fluid than usual; and both the matter and secreted fluids continue to be thin so long as the inflammation is violent.

It is even possible that in some slight gonorrhoeas, which disappear in a few days, the venereal poison may not have activity enough to bring on an ulceration of the urethra, but only a mere irritation of the lacunae. Besides, in other cases, the quantity of the running is generally much greater, if we may judge by analogy, than a few ulcers in the urethra could possibly furnish. Of this we have almost ocular proof in women; for, though the gonorrhoea be exceeding plentiful, yet, upon the nicest inspection, we often cannot find the least degree of ulceration of the vagina, though, if the discharge was purely the digestion of ulcers in that part, it is likely some few of them may be visible.

When the inflammation ceases, and the ulcers of the urethra heal at the same time, the cure of a gonorrhoea is perfected; on the other hand, if the inflammation be only removed, and the ulcers remain open, a gleet must ensue.

It is upon this principle of ulcers subsisting in the urethra, that Daran accounts for the action of his bougie, supposing it to have the property of healing them with a sound cicatrix after the urethra is opened. And, if in the operation it can be understood when there are ulcers, it will not be difficult to comprehend it when there are none; since it seems to have the power of opening every unfound cicatrix of the urethra, and bringing them immediately into an ulcerated state.

There are many who imagine that the prodigious increase of certain gleets at particular times, lasting only for two or three days, and then suddenly abating to their wonted quantity, is inconsistent with a purulent discharge; and therefore conclude a gleet to be nothing but a preternatural excretion from the relaxed vessels of the urethra. But it is probable, that however the matter of a thick gleet may be furnished by secretion, still the stimulus provoking the secretion is kept up by the subsistence of ulcers; and also that, when the gleet is very thin and in small quantities, it is the mere discharge of those ulcers. A temporary increase of a gleet is not wonderful, because habitual ulcers of every other part of the body are often in a fluctuating state, and generally suffer from excesses of every kind.

Astruc, in this disorder, recommends milk, either of asses, goats, or cows, to be drank morning and evening for some time; then mineral waters, whether chalybeate or vitriolic, for 15 or 20 days; and afterwards balmatics, to deterge and cicatrify the ulcers concealed in the urethra, such as balsam of capivi, from 6 to 12 drops, made into a bolus with powder-sugar; last of all, astringents to dry up the ulcers, and to recover the lost tone of the parts, such as infusions of the leaves of mint, horehound, agrimony, plantain, red roses, shepherd's purse, sage, &c. or the mint-water of Quercetan, so often recommended by Riverius against obstinate gleets.

V. Of Chancres.

Astruc observes, that chancres were the caries pudendorum of the ancient writers, and are generally seated on those parts which have a fine and tender covering, through which the virulent fumes, issuing from the ulcerated genitals of either sex, has the easier admittance. Such are the inward duplicature of the prepuce, the inside of the pudenda in women, the nipples of nurses, the lips and tongue of prostitutes. In very bad cases they will appear on the dorium penis, as well as on the pubes and inside of the thighs.

In the cure of the recent chancre, he first orders bleeding, to abate the inflammation; then fomentations, to resolve the induration; not omitting mercurials in the mean time, but so as to avoid a salivation. After which he advises the use of sudorific decoctions of china, sarsaparilla, guaiacum, and sassafras boiled with antimony.

Turner formerly used red precipitate sprinkled on a proper ointment.

Of late years, he says, he always found smoking the parts with cinnabar successful in chancrous ulcerations on the glans and preputium of men, as well as the labia and sinus pudoris of women. His method was to throw a dram of cinnabar on a heater or hot iron, letting the fume ascend through a funnel, or a seat perforated like a cloche-stool, all round the diseased parts. This was done every day, and sometimes twice a day for a week. The iron was hot enough to raise flame with smoke, but not so fiery red as to make it instantly consume away in flame alone.

VI. Of the Phimosis, Paraphimosis, and Crystalline.

These are disorders proper to men, except the crystalline; but Astruc affirms, that women have something of the same nature; and even extends them to their nipples, where the ulceration confining the area or circle round about them irritates the same. The phimosis of women is the constriction of the entrance into the vagina.

He begins the cure with bleeding and gentle purgatives, such as castor cum manna and merc. dulc. instead of brisker cathartics and emetics, which, as Turner thinks, by making a stronger revulsion, afford speedier relief.

He then advises anodyne emollient fomentations and cataplasm to relax and soften, and afterwards difficulties to breathe forth the humours; and, if the penis is soaked therein an hour or two twice a day, the effect will be more certain; but if a stagnation is threatened, and thence a gangrene, the prepuce is to be divided in the phimosis on each side the glans, and the folds of it to be cut through in the paraphimosis; by which the strangulated glans may be set free, and the chance, if any, brought into view. The like must be done for the crysalline, in order to discharge the imprisoned lymph, and forward the subsidence of the prepuce, thereby inflated and puffed up.

The affected parts in women should likewise be fomented with the like emollient and mucilaginous decoctions, of the roots of marsh-mallows, white-lily, water lily, and the leaves of branc urbine, mallows, linseed, &c., several times a day. Afterwards, a peffary made of linen or sponge dipped in the emollient liquor should be introduced into the vagina.

VII. Of Tubercles and Scirrhouss Cords.

The tubercle is a callosity remaining after healing the chances of the glans, which hinders the free play of the foreskin over the glans. If this will not yield to a strong mercurial unction, the only remedy is circumcision.

The scirrhouss cords are tubercles which arise where there has been an ulceration; and may be left under the skin of the penis, sometimes round, and sometimes like a cord. They arise gradually, and disappear with the help of a little mercurial unction, and a course of mercurial purging, unless complicated with other symptoms of a worse kind.

VIII. Of the Porri, Condylomata, Christae, and the like Excrencences.

The venereal porri, whose seat is the pudenda, if they are recent, small, and soft, sometimes dry and fall off of themselves, after the poison has been destroyed by mercurial frictions; but if they are hard, large, and have deep roots, they will sometimes continue after them, and grow like warts in other parts of the body. In this case they must be cut with the point of the scissors as near the skin as possible, and a mercurial plaster must be prepared with a large proportion of mercury, and mixed with diach. cum gum. to promote a suppuration, and to dissolve the callosities at the bases of the porri, before a cicatrix is formed.

But if the basis is hard, and surrounded with hard and deep callosities, slight mercurial frictions must be used; and the wound must be dressed with balsicon, sprinkled with red precipitate, to consume the callosities by little and little, to soften the edges of the ulcers and dispose them to heal. If this should fail, stronger corrosives should be used.

Vol. III. Numb. 74.

The same directions are applicable to the whole tribe of condylomata, christae, mora, sici, either about the pudenda or anus.

Of the Lues Venerea, or French Pox.

When a gonorrhoea has continued a long while, or long enough for the poisonous matter to make its way into the blood, or, by astringents given unseasonably, it cannot make its exit, then the patient is infected with the pox.

The buboes in the groin constitute the first degree; then follow pains which cruelly torment the head and joints of the shoulders, arms, and ankles, coming on by fits, but at no certain intervals, unless in the night when the patient is warm in his bed, seldom leaving him till towards the morning.

There are also scabs and scurf in various of the body, which are as yellow as a honey-comb, and which distinguish them from all others. Sometimes they have large surfaces, answering the description which authors give of the leprosy. But the more these scabs are dispersed over the body, the less he is tormented.

All these symptoms gradually increase, especially the pain; which becomes so intense, that the patient is unable to lie in bed. Afterwards nodes or exostoses arise in the skull, shin-bones, and bones of the arms, which, being attended with constant pain and inflammation, at length grow carious and putrefied.

Phagedenic ulcers likewise seize various parts of the body; but generally first begin with the throat, and from thence gradually creep by the palate to the cartilage of the nose, which they destroy, and the nose, being destitute of its prop, falls down flat.

The ulcers and pain daily increasing, the patient sinks under the torment; and being not able any longer to struggle with stench, rottenness, and the lofs of one member after another, his mangled offensive carcass is hurried into the grave.

Besides the symptoms proper to the pudenda and parts adjacent, which have been already mentioned, the following are observable in a confirmed pox; which however do not appear in all patients, nor at the same time.

1. The skin, especially about the neck and breast, and between the shoulders, is covered with flat spots like freckles, of a rosy, purple, yellow, or livid colour, sometimes distinct, small and round like lentils, sometimes more large and extended.

It is full of itchy pustules, tettering, and ringworms, a serpigo, a herpes miliaris, and exedens. There are chaps in the palms of the hands and soles of the feet, with itching, from whence proceeds a clear serous liquor, and the epidermis peels off in large flakes.

It abounds with hard, callous, round pustules, rising a little on the top, generally dry, but sometimes moist, scaly, branny, and yellow; frequently on the corners of the lips, and the sides of the nostrils, but more especially on the forehead, temples, and behind the ears, where they appear in rows like a string of beads, and gradually creep among the hair.

The hair not only falls off from the head, but all parts of the body where it grows. Then the nails become un- equal, thick, wrinkled, and rough; afterwards ulcers arise which cause them to fall off.

II. The inside of the mouth, throat, and nose, are also affected; the uvula and tonsils become painful, hot, inflamed, and ulcerated; pustules appear in the roof of the mouth, which degenerate into round, malignant, phagedenic ulcers, which rot the bone as far as the nostrils. The pituitary membrane is likewise liable to putrefaction, which produce malignant ulcerations that infect the bones of the nose with a caries, particularly the vomer; which being eaten away, the nose falls down; the voice becomes hoarse and low; the gums being covered with aphthae, ulcerate and rot; the teeth ache, grow rotten, and fall out; and the breath is very offensive.

III. The patient is excruciated with pains in the nighttime, when in bed and covered with cloths; these are either tense, pricking, pulsative, or rending; fixed or wandering; which sometimes occupy the muculous and membranous parts like the rheumatism, sometimes the tendons and ligaments about the joints resembling the gout; sometimes they are with tumour or inflammation, sometimes without.

IV. The bones are affected in various manners; in the middle exostoses arise, either soft or hard, sometimes with intense pain, sometimes without. The heads of the bones enlarge every way, but unequally, which produces tumours, pains, difficulty of motion, and stiff joints. As the caries increases, they become brittle, and break upon the least effort. Sometimes they are so far dissolved, as to bend like soft wax.

V. When the lymph is infected, the lymphatic or conglomerate glands become hard and callous, and form, in the neck, armpits, groin, and mesenteries, hard, moveable, circumscribed tumours, like the king's evil. The lymphatic vessels are dilated, extended, and enlarged by a thick stagnating lymph, and form soft encircled tumours or gummatous. In the tendons it causes nodes, in the nerves ganglions, and in the ligaments of the joints tops.

VI. Neither do the ears and eyes escape the fury of this disease; for the latter are externally affected with pain, redness, itching, and lividity; and internally, being loaded with humours, the sight is destroyed, and sometimes a suppuration supervenes. If the vitreous humour of the eyes is thickened, it causes a glaucoma; if the crystalline, a cataract; if the aqueous, hairs or spiders' webs seem to float in the air.

The ears are affected with a ringing noise, hardness of hearing, deafness, and pain, whilst their internal substance is exulcerated and rendered carious.

After this catalogue of symptoms, it is no wonder that all the animal, vital, and natural functions should be depraved, the face be pale and livid, the body emaciated and unapt for motion, and that the patient should fall into an atrophy and marasmus.

Women have disorders proper to the sex; as, cancers in the breast, a suppression or overflowing of the menses, the whites, the hysterical passion, an inflammation, abscesses, scirrhus, gangrene, ulcer and cancer of the womb. They are either barren or subject to abortion; or the children they bring into the world have an universal erysipelas, are half rotten, and covered with ulcers.

The methods of curing the pox are principally four:

1. The common, by salivation; 2. By giving quicksilver pills; 3. By mercurial fumigations, which are to be purged off before a salivation is raised; 4. By sweating, with a decoction of guaiacum.

The safest and most commodious method of salivation is by mercurius dulcis six times sublimed, given inwardly in the milder pox; or by mercurial unction, when the disease is got into the bones.

Fifteen grains of mercurius dulcis may be given in a morning, and the like dose at night, with electar. e scordio. After three, four, or five days with this management, we usually observe the fauces to inflame; the insides of the cheeks to be tumid, or high and thick, being ready to fall within the teeth, upon shutting the mouth; the tongue looks white and foul, the gums stand out, the breath stinks; and the whole inside of the mouth appears shining, as if parboiled, and lying in furrows.

The inside of the mouth thus beginning to be whealed, you may expect soon to see them ulcerated, especially about the salivary glands, which empty themselves thereinto. Now it may be proper to desist a day or two, to observe the increase of the ulcers, what sloughs are like to be raised, and what their depth and dimensions are like to prove; from which a near conjecture may be made of the duration as well as quantity of the spitting now begun, and the confluence of the drilling lymph whether more or less fluid.

When the salivation is thus begun, your only business is to encourage your patient cheerfully to go on. Let his diet be small chicken-broth, water gruel, and panada. His drink, small fack-whey, or posset-drink, with a draught of good small-beer with a toast between whiles.

Thus, after some days respite, if, after the spitting comes on, you find the patient hearty, his chaps but little swelled on the outside, and as little sore within, the ulcers not increasing, with few or no sloughs appearing therein, the flux also inconsiderable in quantity, you may now give a scruple of merc. dulc. in elect. e scord. at going to rest, repeating it two or three days following, as you find occasion, and then wait the issue again. This is the safest and most prudent method.

If he should have taken half an ounce of calomel, with little alteration as to the swelling and soreness of his mouth, and as little appearance of his slavering, his pulse and other circumstances favouring the same, and no ill symptom appearing, you may vomit him with viij or x grains of turpeth mineral in conserve of roses, or mixed with x or xv grains of calomel, encouraging the operation with small draughts of common posset-drink between whiles, upon each motion to reach, but not loading the stomach therewith, as is customary in other emetics. If there is occasion, it may be repeated two or three days after, which will forward the salivation more effectually than more doses of calomel simply repeated would have done.

If a salivation cannot be raised to any quantity, as in some it cannot, you must forbear and purge it off, and give calomel once or twice a-week, and purge it off the next day, or two days after.

When the spitting goes well forward, it may be left to take its course till it declines of itself; which, in proportion portion to the ulcers and thickness of the sloughs about the parts of the mouth, may happen at the end of twenty-one days, or a month from its rising; that is, from the time of spitting a pint and a half a day, till it comes to three pints, or even five pints, in twenty-four hours, when it gradually goes off again. For often the first four or five days, or a week, are spent in bringing it to the first proportion.

In the more stubborn and rebellious pox, attended not only with cruel night pains, gummatas, topes, nodes, and also rotten or foul bones, if the patient has been used to mercurials, or if salivated before, then the cure must be attempted with salivation by unction.

You may mix an ounce of quicksilver with three ounces of azuric; of which, an eighth part is to be used night and morning, letting the patient rub it in with his own hands gently by the fire, beginning with his ankles up to his shins and knees, all round his joints, and so to his thighs, which are presently after to be covered with yarn-stockings and flannel drawers; then let him use what remains of his eighth part about his elbows and shoulders, wiping his hands clean about the glands of his arm-pits, or those of his groin. His body, during the unctions, should be screened from the cold with a blanket hung behind him, and then be wrapped up in a warm flannel; that is, he must have a flannel shirt, waistcoat and drawers, a cap, a muffler pinning it up thereto behind, and covering all his throat, chin, and cheeks before, to defend them from the cold air. The same things are requisite in the former way. The weak need only be anointed once a day.

If, when the ointment is divided into four parts, after the third unction the patient begins to complain of his chaps, you must stay a day or two before you proceed farther: The same when gripes or bloody stools approach.

Where there are a gummatas, topes, and nodes, the ointment must be chased particularly into those parts, and then apply the mercurial plaster upon them. If the spitting declines too suddenly, give a scruple of calomel every day, or every other day, for two or three times, as you shall see occasion.

When he is a little recovered, and his chaps pretty well, he may eat a little chicken, veal, rabbit, or mutton, well roasted, without sauce or gravy.

The patient should be prepared for a salivation by a lenitive purge or two; and, if plethoric, he should bleed; likewise bathing in warm water, for some hot, lean, emaciated people, has been found serviceable. Women should be laid down just after their menstrual flux is over. Temperate weather is the most suitable.

If the patient is troubled with sickness and vomiting; if mild, give him freely of a small chicken-broth, posset-drink, or thin water-gruel, refreshing him with a little mulled wine between whiles. But if there is a cardialgia, and intolerable pains at the mouth of the stomach, with incessant vomiting, spasms of the members, fainting, cold sweats of the forehead and eyebrows, the patient is in the utmost danger, and you must cease giving mercury, and if possible turn it downwards, by directing the common clyster with 2 or 3 ounces of brown sugar, and as much oil-olive.

To prevent the jaws from being locked up, it is necessary to use a bit of stick covered with a soft rag, which must be held between his backward teeth: But, if there should happen an adhesion of the inside of the cheek to the gum, hindering the patient from eating and opening his mouth, the same is to be carefully divided.

If, during the salivation, a blood vessel bursts open, make a little pellet of lint, and cover it with the fine powders of alum or vitriol, or dip it in the tinctura styptica, and thrust it close down into the cavity, which will secure the effusion, being held tight with the finger for a little while. If it happens from the separation of the sloughs from the side of the cheeks, a little oxycrate held in the mouth will do the business, or an astringent decoction of oak bark.

If the patient has been without a stool for some days, give an emollient clyster of warm milk, sugar, and oil. At this time he may drink freely of small beer with a toast, barley water, small sack-whey, or posset-drink. For diet, water-gruel, oatmeal-caudle, small chicken or veal broth, a roasted pippin, or a few stewed prunes.

If, notwithstanding your care in giving small doses of mercury, the sores should suddenly inflame and tumefy, endangering a suffocation of the patient, the most certain relief is to bring the humours downward by sharp clysters, and, if he can swallow it, a cathartic by the mouth.

An ozena, or ulcer of the nostril, is best cured by a cinnabarine fumigation, which subdues the malignity, dries up the ulceration, and dispofeth the caries, if any, to a separation beyond all others, after which, and sometimes before, calomel must be given and purged off; or, if there are other symptoms of a profound infection, you must salivate by unction.

The like method must be used for ulcers of the palate, uvula, and tonsils. The fume rarely fails to stop the farther erosion, and therefore it is always to be directed, though a salivation is intended. It cures, in two or three days time, the most putrid and corrosive venereal ulcers, or after the second or third smoking.

Astruc disapproves of any other method of salivation but by frictions; and he would have pure mercury ground in a mortar, with just so much turpentine as will reduce it into a brown or black powder, and mix with it equal parts of fresh lard, and so well mixt, that the particles of the mercury shall not be visible by a magnifying glass. He also allows that occasionally there may be double the quantity of lard.

He distinguishes the frictions into weak and strong; for the strong he allows not less than two drams of the ointment, nor more than four. The first time, the patient is to be anointed from the feet to the calves of the legs; two days after, from thence to the middle of the thigh; then the third time, as far as the buttocks. If after the seventh day there appears no sign of a salivation, you must proceed to the fourth friction, from the buttocks along the loins and back to the neck, with a large quantity of ointment. If on the ninth day nothing appears, another friction must be from the wrists to the shoulders.

During the salivation, he allows the patient, if he has strength, to get up sometimes, and sit by the fire; or, if he cannot, to sit up in bed: when he lies down, he would have have him lie in as prone a posture as he can, that the saliva may be evacuated more easily, and not fall into his stomach.

In the weak or slight friction he allows from one to two ounces of the ointment. The first friction is to be only on the feet; the second on the legs; the third on the knees; the fourth on the thighs; the fifth on the buttocks and perineum; the sixth on the loins; the seventh on the back and between the shoulders; the eighth and ninth, if there is occasion, from the arms to the wrists. There may be three, four, five, or even six or seven days between each friction, if the patient is very weak: But the rule is, to look into the patient's mouth before a new friction, that you may be certain not to bring on too plentiful a salivation. The dose of the ointment must be so managed, that, after the fourth or fifth friction, a salivation may come on that is gentle, easy, governable, without a swelling of the head; with only a few aphthae in the mouth, or at most a few superficial ulcers, and the patient not spitting above a pint or two in twenty-four hours: and to this point it must be kept up, with a new friction, if there be occasion. Likewise it may be kept under with clysters and plentiful drinking of the pifan; and, if necessary, with lenitive purges. This treatment may be continued, pro re nata, from 30 to 50 days, or longer.

Till the salivation comes on, the patient may be indulged in weak soups, rice, cream, panada's &c. and even milk for breakfast; but after that they must be left off; and he must drink a large quantity of pifan to dilute the blood. He may sit up all day, if his room be warm.

If, after a due repetition of mercurial frictions, a salivation does not appear, it generally happens that a loofenels, a flux of urine, copious sweats, or at least a plentiful transpiration, will supply that defect, and serve in its stead. In this case, the patient may think himself exceeding happy and fortunate, that he has obtained a complete cure by a method more certain and convenient than by salivation, and without its inconveniences and dangers.

The second method of curing the pox is by a quicksilver pill. This was brought into reputation by Billoffe; and though he has kept the composition a secret, yet there is no reason to doubt but it is quicksilver mixed with a certain proportion of a cathartic.

The third method of curing the pox is by mercurial frictions, which De Salt gives as follows:

When the patients have a pox of a long continuance, and the venereal poison is dispersed all over the body, they should be prepared by bathing and drinking whey. But in a recent pox the bath is not necessary, or at least need not be used long, because the blood is sufficiently diluted.

After this, instead of raising a salivation, bring on a flux of the belly; the whole secret of which consists in keeping the body open by clysters of a decoction of senna and the pulp of castia, before the frictions are administered; by which the intestinal glands being opened, the mercury will more readily tend that way. When the loofenels does not answer the number of the frictions, nor the quantity of the mercury made use off, purge the patient with powder of jalap, and procure copious stools, which secure the mouth. While the loofenels is going on, the friction does the office of a purge; and in proportion as they are repeated, the flux of the belly revives; and when it slackens or stops, have recourse to the clysters and purges of jalap. Pursue this method till the symptoms cease, and till, by the abundance of the evacuations, the venereal poison is entirely drained off.

The last method is sweating with strong decoctions of guaiacum. This we have the first account of from Sir Ulrick Hutton, who pursued it himself. A pound of guaiacum is to be boiled in a gallon of spring-water to one half, and the scum referred to anoint the fores, and a secondary decoction was to be used for common drink.

But, when salivations and other mercurial courses have failed, the best method of cure is by the root of sarsaparilla; which discovery we owe to Dr Hunter, who put Mr Fordyce, a surgeon in the army, upon making a trial of it; the result of whose experience is as follows.

1. It will commonly relieve venereal head-ache and nocturnal pains in a very short time; and, if persisted in, he believes it will always cure.

2. In emaciated and consumptive habits, from a venereal cause, it is the greatest restorer of the appetite, flesh, colour, strength, and vigour, that he knows.

3. When the throat, nose, palate, or the spungy bones in general, are affected with a slough or caries, it will commonly complete the cure, if persevered in long enough, provided a mercurial course by unction has preceded the use of the sarsaparilla.

4. When the body is covered with dry blotches or moist sores from a venereal cause, it will greatly promote the cure, nay often complete it; but, without the assistance of mercury, there will be danger of a relapse.

5. In simple chancres it will do little service; but, if it is given in cases where the chancres or buboes will not heal or dissolve after the use of the mercurial unction, it will often cure, and do always manifest service.

6. It will often answer, and that speedily, without sweating, confinement, or any strict regimen, at all seasons of the year, when mercurial unctions and long continued courses of strong decoctions of guaiacum, either by itself simply, or compounded with a small proportion of sarsaparilla, have failed.

7. It seems probable, that sarsaparilla root is the only medicine to be depended upon in venereal cases where mercury has failed, or at least has preceded the use of the decoction; for it is not to be trusted alone. When no mercury has been given, it and this decoction may be administered together, and then there will be no room to doubt of success.

8. Mercury alone will cure most venereal complaints, and sarsaparilla will perhaps always cure them when they resist the power of mercury; and therefore a proper combination of mercury and sarsaparilla will probably cure every case that is truly venereal.

The method of using it is this; to three ounces of the sarsaparilla root, which has not been spoiled with age, worms, sea-water, or moisture, add three quarts of river-water, and make it boil as speedily as possible, in an open vessel, till two pints of the strained liquor remain, that is, about two pounds avoirdupoise weight; a little liquorice- The yaws are not dangerous, if the cure is skilfully managed at a proper time; but if the patient has been once salivated, or has taken any quantity of mercury, and his skin once cleared thereby, the cure will be very difficult, if not impracticable.

The negroes who have been cured in Africa never have them again in America.

As soon as the yaws begin to appear on a negroe, he must be removed to a house by himself; or, if it is not certain whether the eruption is the yaws or not, shut him up seven days, and look on him again, as the Jews were commanded to do with their lepers, and in that time you may be commonly certain.

As soon as you are convinced that it is the yaws,

Take a scruple of flowers of sulphur; five grains of camphorated spirit of wine; a dram of Andromachus's treacle; and a sufficient quantity of syrup of saffron. Make them into a bolus, to be taken at bedtime.

Repeat this bolus every night for a fortnight or three weeks, or till the yaws come to the height; that is, when they neither increase in size or number: Then throw your patient into a gentle salivation with calomel given in small doses, without farther preparation; five grains repeated once, twice, or thrice a-day, is sufficient, as the patient can bear it. If he spits a quart in twenty-four hours, it is enough. Generally, when the salivation is at this height, all the yaws are covered with a dry scaly crust, or scab; which, if numerous, look terribly. These fall off daily in small white scales, and in ten or twelve days leave the skin smooth and clean. Then the calomel may be omitted, and the salivation permitted to go off of itself. A dram of corrosive sublimate dissolved in an ounce of rum or brandy, and the solution daubed on the yaws, will clear the skin in two days time. After the salivation, sweat the patient twice or thrice.

He may likewise drink the decoction of guaiacum and sassafras fermented with molasses, for his constant drink.

Sometimes there remains one large yaw, high and knobby, red and moist; this is called the matter-yaw. This must be consumed an eighth or a tenth part of an inch below the skin, with equal parts of corrosive mercury and burnt alum, and digested with an ounce of yellow basilicon and a dram of corrosive mercury, and cicatrized with lint pressed out of spirits of wine, and with the vitriol stone.

To children under six or seven years old, at the proper time of salivating, [when the yaws are come to their full growth,] give a grain or two of calomel in white sugar, once a-day, one in two days, or once in three days, so as only to keep their mouths a little sore till the yaws dry, and, falling off in white scales, leave the skin clean. This succeeds always, but requires a longer time than in adults.

The venereal disease and the yaws seem to be very distinct distempers; but the symptoms, in consequence of the yaws ill cured, coincide so exactly with the symptoms of an invertebrate French pox, that in most cases it will be very difficult if not impossible to distinguish them.

Of the Scrofula, or King's Evil.

The King's evil is attended with hard, seirrrous, and often often indolent tumours, which arise by degrees in the glands of the neck, under the chin, armpits, groin, hams, arms, and wrists; but it is most commonly seated in the neck, and beneath the ears.

Likewise cold tumours, which appear on the joints and bones, as on the knees, elbows, hands, and feet, but more particularly on the fingers, are disorders of the scrophulous kind: as also the greatest part of those obstinate fluxions, which fall gradually on the joints, without a manifest cause; and which are attended with an abscess, a caries, and swelling of the bones, called the spina ventosa; especially of the apophyses and epiphyses. Of the same kind are likewise the oedematous or white swellings which arise in the arms, legs, and feet, principally about the joints. They consist of a jelly or coagulated lymph, which puffs them up, but do not pit when pressed with the fingers like dropical swellings.

In the eyes the scrofula creates inflammations; in the eye-lids a puffing up of their edges with great soreness and small ulcers; in the angles of the eye a fistula lacrymalis, by ulcerating the gland planted there for the percolation of tears; in the lips, excessive and preternatural thickness; in the nose it often creates the crusty ulcer called oxena. All which, except the last, are often the forerunners of this disease, antecedent to the great swellings and foul ulcers which appear in its maturer state.

The glands of the external parts are not alone attacked with this disease; for those of the mesenteries are almost always affected; which appears from the opening of persons dying of this disease. Sometimes the disease begins in the mesenteries; and sometimes the liver, spleen, womb, lungs, windpipe, brain, and other internal parts, are scrophulous: Hence scirrhouss tumours, incurable cancers, obstinate fluxions, rebellious ophthalmies, malignant abscesses, fistulous ulcers, dangerous quinsies, terrible epilepsies, mortal consumptions of the lungs, stubborn jaundices, dropsies, cholics, hypochondriacal and hysterical affections.

The scrophulae are hard tumours, because they are produced by a thick coagulated matter; they are cold, because they are caused by a stagnation of the lymph in the part affected.

The scrophulae may be said to be benign, when they are superficial; when they do not much raise the skin, nor change its colour; when only the glands are puffed up, and are soft, moveable, without adhesion and indolent.

The malignant scrophulae are evident from the largeness of the tumour, its hardness and adhesion; from its becoming livid or red; from its being painful; and, when ulcerated, from the callosity of the lips of the ulcer, and from their difficult cure.

As to the prognostics; the benign scrophulae admit of an easy cure, especially if they are seated in the conglomerate glands, and are moveable, superficial, and soft. Those which attack the joints, the tendons, the ligaments, the bones, which are near large vessels, or compress the aorta arteria, or the oesophagus, are very difficult to cure. The internal scrophulae are much more dangerous than the external; for when they turn into an abscess, they are incurable. They are also more or less troublesome in proportion to the progress they have made, the parts which they attack, and the temperament of the patient. If the struma have been long ulcerated, and are become sinuous and virulent, and if they lie near one another, they often find a communication, though they appear distinct: In this case the lips grow callous, and the ulcers corrosive, frequently furred; and the cure is not to be expected as long as one cysitis remains of the vessels that feed them. Those who are seized with struma in the neck after forty years of age, seldom recover.

If strumous tumours arise from a caries in the bones of the fingers or hands, the cure is difficult; but more so in the feet and toes. If in the os calcis, joint of the ankle, or astragalus, or in the knee-bones, or itchia, or the like, where they cannot be safely laid open, the case is deplorable, and the patient generally dies of a marasmus.

In the cure, the diet should be thin and attenuating, light and easy of digestion; and all salt and smoke-dried meat should be carefully avoided; as also beef, pork, fish, hare, cheese, and in general all things that are hard of digestion, or which yield indifferent nourishment. The air should be pure, sweet, and dry; and the body should be kept always open.

The cure may be begun by bleeding, especially if the patient is plethoric, and then a mercurial or antimonial vomit; after which he should take a gentle purge, often repeated, such as the common purging potion of Sydenham; and, as almost all remedies which are good in venereal cases are useful in this, mercurial vomits and purgatives will be proper.

Some give ethiops mineral alone for three months; beginning with twelve grains, and increasing the dose gradually to a scruple, or half a dram, and decreasing in the same manner.

It is certain that the united force of mercurials and antimonials will do wonders in these cases, if prudently given and long continued; always beginning with small doses at first.

Some make use of the decoction of sponge; the dose is four ounces: others, burnt or calcined sponge; the dose is half a dram morning and evening. Turner mentions a cure from an electuary made of the most gritty and fabulous sponges that could be got, which were dried in an oven so much as to be fit to pulverize. The dose was a spoonful night and morning.

Others recommend the absorbent powders and diaphoretic antimony; others again, tincture of antimony in a glass of the decoction of the woods; Dr Francis Fuller, the decoction of colts-foot used for a long time. Fallopia praises the root of butchers-broom; the dose is a dram with x. gr. of the root of common flower-de-luce. Ann. de Villanova looks on the root of scrophularia or figwort as a specific; the dose is a scruple in powder. And Allen mentions two cures performed by white archangle, boiled in milk, which it coagulates; the whey of which must be drank, and the curd applied to the sores. Of late the mineral waters of Moffat in Annandale have been drank with great advantage.

Epsom salt dissolved in a pint of water in such a quantity as to keep the body open, and taken like sea water, has often cured this disease.

After all, we have another medicine whose virtues in curing this disease have been lately celebrated, viz. the jesuits bark.

1. Take of the best rhubarb, half an ounce; of florentine rentine orris, an ounce; of dried red roses, a dram and a half. Infuse these, after they have been cut and bruised, in two quarts of small ale; and let the patient drink a glass of the colature twice a day, with the quantity of a nutmeg of the following electuary:

2. Take of the powder of the Peruvian bark, six drams; of sassafras bark in powder, two ounces. Make them into an electuary with a sufficient quantity of the syrup of sugar.

Dr. Fothergill has likewise long given the bark in scrophulous disorders, and affirms that it may not only be given with safety, but to manifest advantage in many of these cases.

He gives the bark in a liquid form, in the following manner:

3. Take of Peruvian bark in powder, an ounce; and boil it in a quart of pure water to a pint. Towards the end, add of sliced liquorice-root half an ounce. To the colature add of nutmeg-water two ounces, and mix them. The dose is two, three, or four spoonfuls, with ten, twenty, to forty drops of the volatile tincture of guaiacum, twice or thrice in a day.

A small quantity of winter's bark, added to this medicine, gives it a grateful warmth, and renders a quantity of the compound water less necessary; and a little liquorice, a few raisins, gum arabic, or the like, added to the decoction before it is taken off the fire, by making the liquor viscid, enables it to suspend more of the fine particles of the bark, and at the same time renders it less disagreeable.

The swellings of the joints, commonly called white-swellings, are of the strumous kind, and of two sorts: they are both made by congestion, and increase gradually; the one arises externally upon the tendons, and between them and the skin, or between them and the bone; the other internally, within the bone itself.

That which arises externally affects the ligaments and tendons first; and sometimes relaxes them to such a degree, that the heads of the joints frequently separate one from another, and the member wastes away and grows useless. But most commonly the humours, by over-moistening the ligaments and tendons, produce a weakness and uneasiness in the joints, raising a tumour externally, and, in its progress, the membranes and bones are corroded by the humour. It will be more certain that the tumour is the offspring of the king's evil, if there are strumous symptoms in any other part of the body.

In order to the cure, in the beginning of the fluxion, apply astringent and drying plasters of red lead and boric acid, moderate bandage, and place the member in such a position as may prevent the descent of the humours. The internal remedies may be the same as in the general cure. Cheyne and Allen say, water pumped on the tumour is a certain remedy.

Of the Cancer.

A cancer is a hard, round, unequal, painful, and generally immovable tumour, of a livid, blackish, or leaden colour, surrounded with swelled, crooked, varicose vessels, in some sort resembling the feet of a crab, from whence this tumour takes its name.

A cancer is either occult or manifest. An occult begins at first with a small and almost indolent tumour, about the size of a pea, or a hazel-nut, which does not change the colour of the skin, and sometimes lies dormant for several years without making any progress.

But as soon as the virulent humour begins to become more active, the small tubercle becomes all of a sudden a large, round, livid tumour, with an unequal superficiality. It is generally attended with an intense shooting pain. At length it begins to eat and break through the skin, and so becomes a manifest or ulcerated cancer, from whence proceeds a foetid, viscid, bloody, fomorous or ichorous matter, attended with an intolerable stench.

Though a cancer may infest any part of the body, it generally appears in the breasts, armpits, behind the ears, in the lips, nose, and private parts: women are more subject to them than men. Its general seat is the glands, and is akin to a scirrhus.

An occult cancer is known to be formed, when, after the signs of a preceding scirrhus, a titillation, itching, heat, redness, are gradually perceived, with a shooting, burning, pricking pain. The colour of the skin likewise changes from a carnation to a deep red; then it becomes purple, blueish, livid, and at length black: The part feels very hard, unequal, and rough; then it rises with an apex in the middle; the swelling increases, and the adjacent veins become tumid, knotty, varicose, thick, and black.

When it begins to break, the skin is excoriated, and there transudes through it a thin sharp ichor.

After this the sound vessels on the edges of the cancer, being distended by the rising of the tumour, are broken; hence arises a putrefaction, which turns into a subtil, sharp, fetid, cadaverous stench, which, corroding and eating away the sound parts, makes a progress in depth as well as in circumference, and feeds forth malignant roots, by which it takes fast hold; the lips become tumid, parched, and offensive to the sight; the pain is intolerable, with a sense of burning, pricking, and gnawing; the colour becomes cineritious, livid and black. Afterwards arise occult cancers communicating with the glands; hemorrhages; convulsions; a slow fever; a general wasting; loss of smell; callous tubercles in the ears without pain; fainting fits. The parts being thus eaten away and consumed, death ensues.

In persons of a good habit, an occult cancer may be pretty easily borne; but if it be disturbed, the preceding ravage must be expected.

A small, incipient, free cancer, seated in a suitable place, not joining to large vessels, arising from an external cause, in a juvenile, sound body, and being the only one in the body, should be extirpated without delay.

Outward applications of all kinds, except the plumbous and narcotic, are to be shunned, because they have a tendency to ulcerate an occult cancer.

If the cancer be large, old, adherent, in a place unsuited for extirpation, growing to or lying upon large vessels arising... arising from an internal cause; and the patient being old, disposed to these kind of disorders, and having more than one; neither excision nor topics are proper.

For unless it be extirpated, root, branch, and seed, it will be exasperated, and strike inwards, generate others, and increase those already formed.

The cause of a cancer must be taken away with it, or before an attempt of that kind is made.

A cancer of the fauces, palate, armpits, or groin, is incurable; of the lips is hard to cure.

When a cancer is large, &c., as above-mentioned, all we can do is to leave it at rest, and to appease the symptoms.

The first point is obtained by defending it from external injuries, by applications consisting of plumbous ingredients and narcotics; by diminishing and correcting the cause. For this purpose cathartics with mercurials in a small, and sometimes in a double dose, will be proper; as also diluents, aperients, and subalkaline remedies; taking care not in any manner to increase the cause.

When the cancer is ulcerated, if it cannot be taken off, it should be kept as clean as possible, and be appeased with the most soft satyrine applications.

Mr Gataker has found, that the folium hortense, as well as the lethal, otherwise called belladonna, has had surprising effects in the cure of obstinate pains, ulcers without malignity, scrofulous eruptions, and even cancerous ulcers of the face, and scrophulous sores on the thighs. Junker affirms belladonna has cured a most deplorable cancer of the breast. The dose of either is a grain or two at night going to bed, which sometimes makes the patient giddy at first. Three will often vomit, sweat, or purge the patient moderately. Boiling water must be poured upon the herb, which must be afterwards squeezed out.

Of the Elephantiasis, or Leprosy of the Arabians.

The leprosy is said to be of two kinds; that of the Greeks, and that of the Arabians. The latter is called elephantiasis, from the roughness, inequalities, and tubercles in the skin, resembling that of an elephant. Lucretius supposed it to be generated in Egypt, and nowhere else; but if the leprosy of the Jews is the same as that of the negroes, which is highly probable, then we may affirm that it is endemic to the southern and inland parts of Africa.

That it was contagious, all histories agree, as well feared as profane; and the Persians would not let a leprous person come within the city-walls.

Pliny informs us, that the first appearance of the elephantiasis is in the face, particularly a small speck appears on the nose or nostril; and, as the disease increases, the whole body is full of spots of various colours; the skin is thick in one place, and thin in another, hard and rough, with scabs. In process of time, the skin turns black, and the disease eats away the flesh to the very bones. Celsus observes, that the spots grow tumid and red, and then turn black, and the skin is covered, as it were, with scales. Then the body falls away, the mouth, legs, and feet swell, and the fingers and toes are hid with a swelling; even the bones themselves do not escape; afterwards a fever arises, to which the patient falls an easy victim.

But to set this matter in a still clearer light, it will be necessary to add the description of this disease from Guido de Chauliac. The leprosy, says he, commonly begins in the face and forehead, in which filthy tubercles make their appearance, and by degrees spread all over the body. The eyebrows frown; the nostrils grow wider outwardly, and straighter inwardly; the lips are disfigured with an unsightly tumour; the voice is hoarse and snuffling; the ears are turned back; the forehead is protuberant; the face is of a purple colour; the veins under the tongue are varicose and black; the muscles between the forefinger and the thumb are eaten away; the hair falls off from the head and eyebrows; afterwards the skin of the whole body becomes black and full of spots, rough and unequal, with crusty scabs full of knobs and fissures, of horrible aspect, which makes it appear like the skin of an elephant. After this, the fingers and toes begin to swell; and then the legs, which, being covered with rugged inequalities, seem like two sacks for magnitude. Besides all this, the patient is insatiable with regard to venereal pleasures. The blood is fetid, spotted and black, and will not coagulate.

This disease is hereditary and infectious: for it may be caught by the saliva of a leper, if a sound person drinks after him; by touch; by lying in the same bed; and by coition.

An inveterate leprosy was judged to be absolutely incurable. But Areteus says, when the disease is new and recent, there are hopes of a cure. What he and Celsus prescribe in order to the cure, are not worth repeating; for, if any medicines will do, they must be of the Herculean kind. Authors are excessive in the praise of viper's flesh, which Hoffman judges to be quite insignificant. Joel advises bleeding and purging, with six grains of the extract of black hellebore, or six gr. of the glaas of antimony in conserve of roses; but the vitrum ceratum is more safe, and may be given in a larger dose. Towne confesses, that antimonial preparations yielded most relief in Barbadoes; but he could not say that they perfected the cure. On the other hand, mercury exasperated the distemper, irritated the ulcers, and made them spread the faster.

Of the Impetigo, or Leprosy of the Greeks.

This distemper begins with red pimples or pustules breaking out in various parts of the body; sometimes they appear single; sometimes a great number arise together, especially on the arms and legs: as the disease increases, fresh pimples appear, which joining the former make a sort of clusters, all which enlarge their borders and spread in an orbicular form. The superficies of these pustules are rough, whitish, and scaly; when they are scratched, the scales fall off; upon which a thin ichor oozes out, which soon dries and hardens into a scaly crust.

These clusters of pustules are, at first, small and few, that is, three or four in an arm, or leg only, and of the size of a silver penny. But, if the disease is suffered to increase, they become more numerous, and the clusters enlarge their circumference to the bigness of a crown-piece, but not exactly round. Afterwards it gradually increases in such a manner that the whole body is covered with a leprous scurf.

Willis Willis blames all dried and salted meats, especially hog's flesh; and fish, particularly shell-fish, because the poor people in Cornwall, inhabiting near the sea coast, were formerly much subject to leprous diseases, and had many hospitals erected on that account.

In the method of cure, says Hoffman, we should endeavour to discharge out of the body the mafs of corrupt, glutinous, and acrid humours, by sufficient bleeding and abstinence, and by purges, as well gentle as drastic; then, by proper aliment and a good regimen, promote the generation of wholesome juices; and, likewise by external, defensive; consolidating, and drying remedies, to free the parts from pains, tumours, itching, and ulcers.

The purges may consist of the root and the resin of jalap, the extract of black hellebore, elaterium mixed with calomel, or ethiops mineral, and gum ammoniac.

Among those things which stimulate the solid parts to an excretory motion, and more powerfully melt down the tenacious humours, the lignum and cortex guaiac, exceed all others, as they will generally alone cure the lues venerea. The most considerable, besides these, are the tartarized and acrid tincture of antimony, sulphur of antimony, cinnabar, and, if a venereal taint is suspected, a decoction of crude antimony. Which medicines, in a convenient dose, in the morning, with purifying decoctions drank in bed, afford very great relief.

But, if these fail, recourse must be had to mercury, which some, after extinction, mix with flowers of sulphur and camphor, and rub it on the joints to promote a salivation: others more properly give mercurius dulcis, with double the quantity of crabs-eyes and calx of antimony, rising gradually from three or four grains to a scruple, in order to salivate; with the usual precautions. The cure may also be performed with alternative and diaphoretic preparations of mercury, such as mercurius solaris and jovialis; of which a few grains may be exhibited every morning in conserve of roses for some weeks, drinking in bed after it a pint of some proper decoction.

But it must be observed, that each of these methods of cure requires an air very temperate, a spare thin diet, and an abstinence from fat, and boiled flesh, and acids.

Of the Itch.

The itch is a cutaneous disease, arising from a corruption of a ferous lymphatic matter, sometimes attended with mild, sometimes with more obstinate and dangerous symptoms. The itch of the milder sort appears either with moist or dry pustules, at first about the joints, and from thence spreads by degrees over all the body, the head only excepted. In the moist sort, to which children and the sanguineo-phlegmatic are most subject, the pustules are more full of a purulent matter, attended with a slight inflammation, which is manifest from the redness which appears round about them till it suppurates. The dry sort chiefly attacks those that are lean, old, or are of a melancholic-holeric constitution: In these, the pustules are much less, and excite a most intolerable itching, especially in the night-time. The most usual places where the eruptions appear very numerous, and the itching is greatest, are between the fingers, on the arms, hams, and thighs.

This disease is, truly and properly speaking, a disease of the skin; because it often is safely cured by topics alone, if timely applied. It is contagious, and may be caught by drawing on a glove or stocking, wiping on the linen, or lying in sheets after persons infected with this malady. Some think it owing to an impurity in the serum, and some to animalculæ. But however that be, it often affects such who have been long kept in prison, who lead inactive lives, and are used to live in a fluttish nasty manner, or who constantly eat fish or flesh dried in the smoak or sun, and use any other unwholesome food or drinks; or who live in a cold, moist, and cloudy air, which, hindering a free perspiration, causes a stagnation of humours in the superficies of the body, which are for that reason liable to corrupt.

The milder sort of itch is no way dangerous, and very easy to cure; but the moist more easy than the dry. While it is recent and superficial, it much sooner yields to remedies, than when it is deep, and has infected the mafs of blood; and the case is still worse, if there be any fault in the viscera: it is more difficult in old persons than young; in a leuco-phlegmatic or hydroical disposition, as also in a very dry hectic one, it is hard to cure; and, when it becomes universal, it may bring on the leprosy.

The patient should avoid shell-fish, and all salted and high seasoned meats; as also wine, spiritous liquors, strong beer, and every thing else that may inflame the blood. For this reason a slender diet is best, unless perspiration be obstructed.

If the body is phlethoric, we are to begin by bleeding, and afterwards to pursue it by purging, which cannot safely be omitted.

Instead of repeating purging, it is common to give flowers of sulphur in milk, or treacle, with good success.

Willis and many others have a great opinion of the efficacy of sulphur used both internally and externally; to which Turner assents, except in hectic and consumptive cases. But Shaw thinks it is not to be depended on when outwardly used. Yet it is very certain that poor people find a great deal of benefit who drink it inwardly with milk, and use it outwardly with butter, or hog's-lard.

Turner prefers the salt of tartar to most other remedies, it thoroughly purging and cleansing the blood taken inwardly, and, made into a lixivium with spring water, is an excellent wash outwardly.

When the blood is thought to be foul, it will be proper to use diet-drinks, through the whole course, of the roots of china, farfarailla, oxylapathum, scorzonera, chichoreum, glycyrrhiza, polypondium, the barks of saf-safra, cinnamonum, the shavings of the woods of saf-safra, and the like; which will strengthen the solid parts, and dry up superfluous humidities.

It has been a very common practice to cure the itch by quicksilver girdles; but Turner thinks them too hazardous to be brought into regular practice, and Shaw seems to be of the same opinion.

But after all this, if the disease should prove so stubborn as not to give way to the most powerful of the preceding methods, recourse must be had to salivation as the dernier resort, which will prove effectual when everything else fails; which, however, is not to be made use of till the case is so desperate as to render it absolutely necessary.

Of Hemorrhages in general.

The blood, which flows spontaneously, generally proceeds from those places which are of a fine and thin texture, in whose surface the slender vessels creep along with various meanders; such as the inward part of the nostrils, the bronchia of the lungs, the flesh of the gums, the left side of the stomach, the gut ilium, and the extremities of the rectum, as also the external substance of the womb and vagina. When these parts are distended, and the small arteries open, the blood often breaks out with violence.

Sometimes, though but seldom, hemorrhages happen in other places where the vessels lie deeper; as from the little finger, from the hand and knee, the breasts in the time of menstruation. There are likewise instances of periodical fluxes from the penis in men.

They generally happen to persons whose bodies are of a soft, fleshy, tender texture, and whose vessels are turgid with blood and serum. These were formerly said to be of a sanguine constitution, and are subject to hemorrhages as long as they live. But the choleric, who have larger vessels, whose fibres are more strongly braced, and whose blood circulates with greater rapidity, are liable to a spitting of blood in their youth. The sanguineo-melancholic are subject to the bleeding piles; and women who are sanguineo-phlegmatic, are obnoxious to vomiting blood.

Boys and youths are most subject to bleed at the nose; in young men the blood seeks an exit from the lungs, whence hæmoptoea and consumptions; the middle-aged are more liable to hemorrhoidal evacuations, and decrepid old men to spitting of blood.

Hemorrhages are most frequent at the spring and fall; hence sanguineous apoplexies at those seasons, which are nothing else but eruptions of the blood in the middle of the brain. Vomiting and spitting of blood are more frequent in the autumn. In some, these excretions happen periodically.

When hemorrhages proceed from a fulness of the vessels, they conduce to the preservation of health; but when they are caused by a poisonous acrid matter, as in malignant and spotted fevers, they are exceeding dangerous. Also when they are derived from an infarction, induration, and corruption of the viscera, especially of the liver, spleen, or lungs, they are generally fatal, because they bring on a cachexy, dropfy, the black disease of Hippocrates, and a mortal hectic.

Of Bleeding at the Nose.

A Hemorrhage at the nose is owing to the more plentiful appulse of blood to the nostrils by a strange motion of the heart, whereby the small arteries in the pituitary coat become turgid, and too much distended, till at length they gape, and the blood rushes out.

A bleeding of the nose may be promoted when persons of sedentary lives that indulge their appetites, and so become plethoric, put their blood into extraordinary agitation by violent passions and exercise, by spirituous liquors, spices, heating volatile medicines, hot baths, or suddenly chilling their feet.

Likewise the sudden change of air from hot to cold, and cold to hot, by fits, especially at the equinoxes, may cause this bleeding; as also when from cold and moist the air becomes highly elastic, and vice versa. Those, moreover, are liable to it who are afflicted with rheumatic, nephritic, arthritic, and ichthyoid pains, or who have fevers or spasms. It sometimes happens before the eruptions of the smallpox and measles; and to those who have lost a large limb, or who labour under obstructions of the liver and spleen; hence, in an inveterate fever, dropsy, and cachexy, there often happens a fatal hemorrhage.

It differs much as to the quantity; some lose only a few drops, some several ounces, and some five or six pounds. No hemorrhage is more apt to return; which it does to some in a few days, to others in a few hours.

To the plethoric it is generally salutary; and there are many instances of a vertigo, a scotoma, dull heavy pains of the head, a phrenzy, and even an epilepsy, being carried off by a bleeding at the nose. On the contrary, from its suppression there have arisen vertigoes, apoplexies, epilepsies, convulsions, noise in the ears, and hardness of hearing, and even a gutta serena.

These hemorrhages are critical and salutary in a synochus on a semicritical day, that is, between the third and fourth, or on a critical day, viz. the seventh: for, as these fevers are generally caused by a plethora, they are carried off that way.

But enormous and long-continued bleedings at the nose, when they arise from spasms of the internal parts, and are preceded with coldness of the extreme parts, and fainting fits, generally terminate in death.

After a revulsion by bleeding, there is nothing equal to nitre to appease the orgasm of the blood, and to relax the spasmodic stricture. Next to these are vegetable acids; such as the juice of Seville oranges, barberries, the water and juice of wood-forrel; but more especially the diluted spirit of vitriol, tincture of roses, made with the water of wood-forrel and the spirit of vitriol, and drank with spring-water. [Five or six spoonfuls of the common tincture of roses may be given at a time, and repeated as occasion requires.]

If the bleeding is very inordinate, it will be proper to use cooling emulsions, gentle or stronger opiates to moderate the spasmodic strictures, as occasion shall require. Camphor, mixed with nitre and calx of antimony, will be highly necessary, if the matter of exanthemata or cutaneous eruptions is the cause of the hemorrhage, as is often the case.

A revulsion may be made from the head, by bleeding in the lower parts; then by temperate pediluvia, and putting the hands into warm water.

As there is often an acrid bilious matter lodged in the hypochondria, the parent of wind and spasms, the powder of rhubarb will be proper, mixt with a few grains of tartar-vitriolate and nitre; as also emollient and carminative clysters, with a due proportion of oil.

Externally, refrigerants may be mixed with discutients, and applied to the forehead, nose, and neck. But it must be noted, that, when the patient is plethoric, the bleeding must not be stopped hastily, if at all; nor when the menses in women have been suppressed, or the lochia, or the bleeding piles in men accustomed thereto; much less must a stoppage be attempted when the bleeding itself is periodical.

In persons of a bilious constitution, cold water alone, drank freely, has had a good effect.

The cachexic should persist long in the taking of rhubarb, either alone, or mixed with digestive salts, such as tartar-vitriolate. If there is any scorbutic disorder in the viscera, besides rhubarb, the patient should drink plentifully of whey.

If any disease proceeds from the cessation of this cutaneous hemorrhage, it should be promoted with a pen or a straw thrust into the nose.

Some recommend the weaker spirit of vitriol, and would have eight or ten drops of it be given in every draught of liquor. But perhaps the best method of all in obstinate hemorrhages is that recommended by Mead in the bloody small-pox; or the Peruvian bark alone will generally be sufficient.

Of the Bleeding and Blind Piles.

A Flux of blood from the hemorrhoidal vessels is called the bleeding piles; when the vessels only swell and discharge no blood, but are exceeding painful, they are termed the blind piles.

All copious fluxes of blood from the anus are not to be reckoned of the morbid kind. For the habit of body, strength, age, and temperament, are to be considered. That which is enormous and excessive to one person, may be moderate and salutary to another. That only is to be esteemed pernicious, which continues too long, and enfeebles the patient; whereby digestion, nutrition, and other functions are hurt, and there is reason to fear the production of dangerous chronic diseases.

An excessive hemorrhoidal flux is generally preceded by a heavy pressing pain of the back and loins; sometimes a numbness of the legs and thighs; a contraction of the external parts, with a slight shivering, and a subsidence of the vessels therein; a hard contracted pulse; a dryness of the mouth and fauces; the urine diminished in quantity, and most commonly pale; a sense of weight about the anus extending to the perineum; a weakness of the stomach; a flatulency in the lower belly; a frequent desire to make water and to go to stool, with sometimes an exclusion of white bilious mucus; the old and weak have a procidentia ani.

In this case, the blood is generally at first black and very grumous, and sometimes comes away in large clots from the varicose vessels; afterwards it becomes red, and at last feroce; sometimes it is putridous, or like the white of an egg. There are instances of voiding a pint or a quart of blood daily; it often continues long, from twenty to thirty, or even forty days.

This flux entirely proceeds from the hemorrhoidal vessels. The external or blind piles seldom bleed, but turn to painful varices; which being opened weep a little, but will not yield much blood. But the internal piles, which are the offspring of the splenic branch, and are extended to the inner substance of the rectum, and as far as the sphincter of the anus, together with the small arteries derived from the lower mesenteric, not only bleed plentifully, but, when the flux is suppressed, create diseases of the liver, spleen, pancreas, mesentery, and intestines.

The persons subject to this disease are those of a loose, spongy texture, of a bulky size, who live high, and lead a sedentary life; or to whom it is hereditary. Sharp purges, aloetics, high-seasoned food, free drinking of sweet wines, neglect of customary bleeding, anger, fatigues, hard riding, and the like, will usher in this disorder.

This hemorrhage is dangerous, because it decays the strength, wastes the body, and produces a sense of weight in the thighs. The sleep is laborious, and the precordial oppression; there is a rumbling in the belly, and a weak pulse. When it continues long, the ankles swell, and the countenance is ghastly; there is a strangeness of breathing; and last of all it terminates in a cachexy, dropy, or a slow and hectic fever.

If the patient is plethoric, bleed; and let his drink be cold water of the chalybeate kind, or whey turned with orange-juice; or juleps made with tincture of roses, cooling waters, and syrup of roses; likewise nitre in powder, with absorbents and strengtheners; and, to appease the spasms, opiates of the mildest kind.

If it continues long, and the flux begins to be ferous, then give rhubarb with curants or tamarinds, or, which is much the same, with cream of tartar. Then gentle diaphoretics may be compounded of burnt hartshorn, calx of antimony, wine-vinegar mixed with crab's-eyes, water of elder-flowers, simple alexiteral water, and diaforicum; or hot decoctions of yarrow, veronica, &c., may be taken in bed, in order to sweat; also half a grain of camphor, mixed with nitrous and bezoaric powders.

In the Blind Piles there is a most intense pain, especially at the time of going to stool, and the excrements are tinged with blood. Sometimes tumours like warts lie hid in the sphincter, or appear in the verge of the anus.

Sometimes the veins, in the blind piles, are so much dilated with blood as to be very painful and raise tubercles as large as peas, grapes, or eggs: They appear vivid, and black, from the stagnation of a thick blood, and, when pressed with the fingers, feel like a bladder filled with liquor. Some are soft and indolent; others hard, inflamed, and painful; render the patient unable to walk, stand, or sit; and produce such a spasm in the anus as not to admit a clyster. Sometimes they bleed, or turn to troublesome itching ulcers, and occasion an abscess or a fistula.

Linen dipped in warm spirits of wine, and emollients, are often of infinite service; and, when they fail, leeches may be applied to exhaust the blood: If they are not at hand, and the parts are inflamed, the lancet must be used; then dressings must be made with lint, with compresses and the bandage. The tubercles, which are full and large, may be removed by a ligature, unless inflamed. Sometimes they are high in the rectum; and then a speculum ani must be used; in which case they must be either scarified with a lancet, or divided with scissors, that the thick noxious blood may be discharged, and the pains relieved. Of the Immoderate Flux of the Menses.

The symptoms which attend this disorder, are loss of strength, anxiety of the precordia, fainting, coldness of the extreme parts, paleness, convulsions, suffocations; and, when it is inveterate, oedematous swellings of the feet, a cachexy, dropfy, the fluor albus, a hectic fever, and an atrophy.

Sometimes the flux returns twice in a month; and at others continues several days longer than usual. It comes sometimes before and sometimes after abortion. Sometimes florid blood rushes out with impetuosity, most frequently before a miscarriage, and after it from a retention of part of the after birth, which keeps the orifices of the vessels open. Sometimes clots of blood come away of the size of an egg, when the menses have been stopped for two or three months. A black, grumous, coagulated blood will now and then come away on the first days of child bed, when the patient is slender and plethoric. In the cachectic, the flux will be often thin and watery; in the scorbutic corrupt and fetid, attended with sharpness and pain.

It is sometimes caused by a great afflux of blood to the uterus, which is not returned in due quantity by the veins; for which reason the vessels often burst. The same happens from a plethora, and from hard labour. About the fiftieth year, when the menses cease spontaneously, a great and sometimes dangerous flux will happen, and then quite disappears. If it should suddenly and unexpectedly return about sixty, with flooding, it brings on a fatal hectic fever.

This disease is generally preceded and accompanied with a tension and inflation of the hypochondria; a heavy, pressing pain about the loins, with a chilliness; as also a coldness of the extreme parts, a subsidence of the vessels, a paleness, a quick pulse, an inward heat, a costiveness, and little urine.

If a child-bed woman is not sufficiently cleansed at her lying-in, a great hemorrhage will follow some months after, with fainting fits, and will not terminate till the excretion of a carious mass as big as one's fist, which the sex call a mole.

If the body is cacochymic, and full of depraved juices; scorbutic, or infected with the venereal lues; when the viscera are unsound, and the liver, spleen, and mesenteric vessels are stuffed with a black, thick blood; this disease is not without danger. The patient's life is greatly in danger when the child is dead before delivery, and a great flux of blood happens. It is dangerous when caused by a violent extraction of the after-birth; or when pieces of it are left behind, which afterwards become moles, and greatly vitiate and increase the menstrual flux.

If the patient is plethoric, bleed in the arm. If there is an orgasm in the blood, diluents, humectants, and refrigerants, will be most efficacious; in this case spring-water may be drank alone, or with a little nitre, or with spirit of vitriol and syrup of poppies; the spasms require gentle opiates. To carry off the impure serum, two ounces at least of manna must be given, with a dram of cream of tartar in an aqueous vehicle. If the flux is obstinate, recourse must be had to astringents.

Thomson of Montrose recommends an improvement of Helvetius's styptic powder; which consists of two parts of crude alum, and one of dragon's blood; whereas Thomson's is equal parts of each; and the alum is to be burnt in a crucible, and the dragon's blood added to it, and afterwards powdered. Mead has three parts of burnt alum to one of dragon's blood.

He says he never found this medicine fail in uterine hemorrhages, whether to correct the too frequent return of the menses, or their too great abundance, or to stop the flooding of women with child, or to moderate the flux of the lochia.

The quantities which he gives are more or less, according to the exigencies of the patient. In violent bleedings, half a dram every hour; and three drams or half an ounce seldom or never fail to stop the flux.

Of a Hemorrhage from the Urinary Passages.

This disorder is commonly called pissing of blood; and is an emission of blood with or without urine, from the vessels of the kidneys or bladder, which may be either enlarged, broken, or eroded. It is more or less dangerous, according to the different circumstances which attend it.

If pure blood is voided suddenly without interruption and without pain, we may conclude it proceeds from the kidneys. It likewise comes from the kidneys, if the urine is coffee-coloured or more florid, and generally precedes a fit of the gravel, but sometimes accompanies the passage of a stone through the ureters. But if the blood is small in quantity, and of a dark colour, with or without purulent matter, chiefly if it is emitted with heat and pain in the pubes, it certainly proceeds from the bladder. This is sometimes attended with fainting, difficult breathing, a low, small, and frequent pulse, a nausea, anxiety, and cold sweats.

When it proceeds from the ureters, which are hurt by a large, rough stone, and a small quantity of blood is mixed with the urine, there is a sharp pain in the loins and ilia, and a difficulty of making water, which when made has a fabulous sediment, and other signs of a stone sticking in the ureter. When the coats of the bladder are hurt by a stone, and a little blood follows, it is attended with a most acute pain and a previous stoppage of the urine, together with grumes and fabulous concretions; which also sometimes happens when a stone is firmly fixed in the kidney.

It may be occasioned by a stoppage of the hemorrhoidal flux; from violent motion of the body, especially riding; from a stone concealed in the kidney; from an erosion and ulcers of the bladder; from external violence; from griping pains caused by violent purges; from sharp diuretics, especially cantharides.

All bloody urine has some degree of danger; but it is most so when mixed with purulent matter.

If the patient is plethoric, or if it proceeds from the suppression of a sanguineous evacuation, bleeding is necessary; as also cooling nitrous draughts, and purified nitre mixed with absorbents, with whey for a vehicle, or barley-water, water, or small-beer, acidulated with some drops of the spirit of vitriol. The body must be kept open with laxatives, as rhubarb with currants, or with cream of tartar; as also emollient clysters. The relaxed vessels must be agglutinated with decoctions of vulnerary herbs; such as agrimony, ground-ivy, yarrow, golden rod, and the roots of comfrey dulcified with virgin-honey, to which milk may be occasionally added. Almond milk is likewise good, especially if used as a vehicle with bole-aromatic.

If there is an ulcer in the kidneys or bladder, medicines must be given that sheathe the acrimony; such as syrup of marshmallows; also infusions of the vulnerary herbs above mentioned; likewise of the bark of the roots of acacia and cherry tree gum.

When grumous blood plugs up the passage of the ureters into the bladder, or the sphincter of the bladder, and occasions a difficulty or stoppage of urine, warm water drank plentifully, and baths of the same, are useful; likewise warm water should be injected into the bladder with a syringe, that the sharp humour may be diluted and the grumes dissolved. But, if the urine should be quite stopped with a spasm, then give emulsions of the four cold feeds, with crab's-eyes and calx of antimony; or a powder made of sperma ceti, crab's-eyes, and nitre. Externally, apply a bladder filled with the decoction of emollient flowers in milk to the abdomen; and keep the body open with manna, or an emollient oily clyster.

Milk and whey are likewise excellent in these disorders, if a dram of bole artemisia is taken in every draught.

Of the Lethargy, Carus, and other sleepy diseases.

The lethargy has some affinity to the apoplexy and palsy, and often attends them.

By sleepy diseases are meant a preternatural propensity to sleep, sometimes attended with, and sometimes without a fever: The immediate cause of which is a very languid and diminished influx of the animal spirits from the cortical part of the brain into the medulla oblongata, and from thence into the nerves destined for sense and motion.

There are several kinds of these disorders, the principal of which are a coma vigil, a coma somnolentum, a carus, and a lethargy.

A coma vigil is known by these signs: a burning and extensive pain in the head, attended with a sense of ebullition therein; they have a strong inclination to sleep, and yet either don't sleep at all, or, if they do, awake immediately with little relief, but have no delirium. This coma differs from the pervigilium, which is frequent in acute fevers, for in this there is no propensity to sleep. This disorder is always symptomatic, and often attends acute, burning, and malignant fevers; as also an inflammation of the dura mater, and ushered in a phrensy.

In a coma somnolentum, the patients are languid, and their chief complaint is a constant drowsiness. They often fall asleep at their meals, in conversation, and in the midst of business, and, when they are awaked, soon fall asleep again. This disorder principally seizes old men, who live luxuriously, and neglect bleeding. It is a primary disease, and without a fever.

A carus is a profound sleep, out of which the patient cannot be roused by clamours, shaking, nor even with the pricking of a needle; or, if they are sensible of the pain, they continue silent, and fall asleep again. It is sometimes a primary disease, and sometimes symptomatic. When it is symptomatic, it is of three kinds: The first happens in acute fevers, in the beginning or increase; and, if the convulsions and hiccups supervene, it is soon fatal. The second comes after acute fevers; and, when the patient is exceeding weak, the sleep will continue for several days; being awakened, he will answer questions, but immediately fall asleep again. When he recovers, he remembers nothing that he said. If it happens in acute fevers, on critical days, with a sweat, it is a good omen. The third happens a day or two before death: for, the patient's strength being exhausted, he lies deprived of sense and motion, as it were in a profound sleep, and under that expires.

A lethargy is a heavy and perpetual sleep, with scarce any intervals of waking. It is attended with a stupidity, and so surprising a forgetfulness, that, when the patient yawns, he forgets to shut his mouth; or, if he takes the chamber-pot to make water, he forgets to do it, and falls asleep.

A lethargy is attended with a fever, which is a symptom thereof, and is chiefly discovered by the frequency of the pulse; whereas a carus is often a symptom or a consequence of a fever, and is likewise attended with insensibility. It does not invade so suddenly as an apoplexy, which is attended with an abolition of all sense and voluntary motion, and kills sooner than a lethargy.

In the cure of these diseases, three intentions should chiefly be regarded; 1. To rouse the patient from sleep. 2. To remove the difficulty of circulation, and the stagnation or extravasation of the blood or serum in the head. 3. To restore the strength of the membranes and vessels of the brain.

Those remedies are efficacious in the first case, which act on the nervous parts, by inducing a tremulous and oscillatory motion through the whole nervous system: such as powerful acids, mixed with tincture of caffor; volatile salts; fetid things, as galbanum, burnt partridges feathers; cold water thrown on the head; cataplasm made with vinegar, rue, bay-leaves, tops of savory, mustard-feed, caffor, and camphor, applied to the head, forehead, and temples.

The ferous colluvies is derived from the head by sternutatories; the best is ten grains of salt of white vitriol dissolved in half an ounce of marjoram water, and drawn up the nose; blisters on the feet and neck; cupping-glasses, either with or without scarification; strong frictions on the lower parts; stimulating clysters, with the addition of sal gem, common salt, or the root of squills.

To remove the stagnation, and promote the circulation, if the vessels are turgid with blood, venesection is necessary; then gentle laxatives, and nervous medicines with diaphoretics. A powder made of salt of hartshorn, salt of amber, cinnabar of antimony, and bezoar mineral, has very great and salutary effects.

A carus, especially the first species of it, requires plentiful bleeding; and the patient must be roused by clysters, rendered stimulating with the powder of squills; by blisters; by putting distilled vinegar in the nostrils; and by appeasing the orgasm of the fluids with cooling fixed diaphoretics and acids. The second species requires but little or no assistance; and the third is incurable, at least if blisters fail.

A coma somnolentum is divided into serous and sanguine. The first requires the natural serous evacuations to be restored or promoted. Gouty fits are to be invited by frictions of the feet, blisters, relaxing applications, and warm baths. Sternumatatories are of great use, as they discharge the serum through the nose, and stimulate the nerves. When a viscid phlegm offends the stomach, vomits are useful, with half a scruple or a scruple of powder of squills, or ij gr. of emetic tartar, with a laxative potion.

In a sanguine coma somnolentum, when the blood circulates slowly, or stagnates in the head, as in the hypochondriac or scorbatic, all hot spirituous remedies are as bad as poison: But bleeding, clysters, gentle laxatives, cooling and nervous powders, are useful.

A red face, eyes turgid with blood, indicate bleeding. Warm baths are bad in all sleepy disorders; likewise fagron, poppies, and opiates of all kinds.

Of the Catalepsy.

The catalepsy is also called catocus, and catoche; and whoever is affected with it is in an infant rendered as immoveable as a statue, without sense, and without motion; and continues in the same posture they were in at the moment they were seized.

The proximate cause of this disease is the immobility of the common sensory from the time of the first attack; therefore there is an absolute ref of the blood in the brain, of the glands of the brain, and of all its emissaries; whereby all the functions of the brain are injured, as well as those that depend thereon: The muscles only remain tense as in the beginning; the respiration and pulse indeed continue, but they are very faint.

But Hoffman asserts, that the pulse is natural, and the breathing free and easy; that the limbs are moveable, but remain in the same situation in which you place them. They neither hear nor see, though their eyes are open; nor feel, though they are pricked ever so much; yet, if you thrust anything into their mouths, they will swallow it: But their bodies are so bound, that you cannot thrust the finest pipe into the anus. The colour of the face continues florid. At last they fetch deep sighs, and come to themselves, and tell wonderful things of what they have seen and heard during the paroxysm; some declare they have enjoyed exquisite pleasures, or seen tragical sights, or have had divine visions, and the conversation of angels.

This disease is generally preceded by obstinate intermittent fevers, especially quartans; by a dry, melancholy, lean temperament of body; by a retention of the mentes, and hemorrhoids; by great and sudden frights; by a profound, constant, fixed meditation on one object, or by strong fevers in persons of a sanguine constitution.

The method of cure is various, according to the different causes. The patient should be excited with things that greatly strike the senses; such as light, noise, stimulating things, volatile salts, pain, frictions, continual agitations; by cauling an hemorrhage of the nose; by promoting the hemorrhoidal or menstrual flux; by sternutatories and emetics; by blisters; by issues; by setons; by a moistening diet.

Of the Vertigo.

A vertigo, giddiness, or swimming in the head, is a disorder in which all visible objects seem to turn round, attended with staggering, or danger of falling.

A giddiness, when it is not an original disorder in the head, is caused by a long turning round of the body; by looking from a high place; in some, by passing over a broad river, by riding in a coach, by sailing in a ship or boat, and by drunkenness.

A higher degree of a vertigo is a scotomia, when the patient is seized with a sudden dimness or temporary deprivation of sight. The highest degree of all is, when he falls down in the fit: This borders nearly on the epilepsy.

But it may be doubted whether a scotomia is always a symptom of a vertigo, properly so called; because it often follows great hemorrhages, long fasting, and very hard labour.

A vertigo will sometimes arise by consent, from disorders of the stomach; and, as Etmuller observes, often merely from fasting, and then a morsel or two of bread will drive it away.

An inveterate vertigo, beginning without any manifest external cause, foretells in young men an epilepsy, in old men an apoplexy.

The vertigo often arises from a congestion of blood in the head, when the patient is plethoric; or where any usual evacuation of blood is suppressed, or from an omission of bleeding when accustomed thereto. It affects some whose heads are debilitated with hard study, or whose stomachs are loaded with vitiated, especially bilious, humours.

In plethoric cases, laxatives, bleeding in the foot, peluduvia, resolving attemperating powders, cinnabar, nitre with an infusion of tea or betony, are proper. If from a suppression of an usual hemorrhage, it is to be promoted; but, if this cannot be done, bleeding must be substituted.

Outwardly, camphorated spirit of wine alone, or mixed with spirit of hartshorn, applied to the top of the head and temples, will be useful; or Hungary-water, or volatile salts, or spirit of lavender, may be held to the nose. The same things are good when it proceeds from hard study, with moderate diet and frequent exercise. As also a glass or two of wine at meals, and other strengtheners. But because many learned men have been hurt by the external use of volatile and fragrant spirits as well as apoplectic balms, these are to be tried with great caution.

If a vertigo proceeds from crudities in the stomach, they should be prepared or dissolved by neutral salts, such as tartar vitriolate; and then they should be evacuated by an emetic; but, if anything forbids, by a purge. Afterwards give stomachics and cephalics, and advise a moderate use of wine at meals, a sparing aromatic diet, and exercise of the body. Pyrmont water is excellent in this case.

Of the Hysteric Passion.

The hysteric passion is a spasmodico-convulsive affection of the nervous system proceeding from the womb, and caused caused by the retention or corruption of the blood and lymph in its vessels; and more or less infecting the nervous parts of the whole body, by means of the nerves of the os sacrum, the loins, and the whole spinal marrow.

This disease has been very improperly confounded with the hypochondriac passion; for a strangulation of the fauces, an intercepted breathing even to suffocation, a fainting away, a loss of voice, a profound sleep, are the true, proper, and essential signs and symptoms of this uterine disease.

An hysterical fit is generally preceded with a pressing pain in the forehead, temples, or eyes, with an effusion of tears and dimness of sight, a dulness of the mind and senses, and a loathing of all things. When the fit comes on, the patient is exceeding coltive, and yet has a strong stimulus to discharge her urine, which is as clear as water; the breathing is uneasy, difficult, and short; and a languor seizes the whole body. To these succeed a pain in the loins, and a great shivering and shaking; the belly is hard and inflated; afterwards the navel is drawn inwards, and outwardly leaves a great pit; then they feel a sort of a globe arise from the lower part of the belly to the hypochondria and diaphragm. Soon after, the heart begins to flutter and beat, with a hard, unequal, and sometimes intermittent pulse; the extreme parts grow cold; the fauces are strained, and seem to be bound with a cord; the face is pale, the breathing exceeding difficult, the voice ceases, the pulse is almost imperceptible; and there is such a stricture of the belly, that no flatus can be emitted, nor no clyster given. In some there are convulsions of the head and limbs; others lie in a profound sleep, without sense or motion; others have their face and neck look red and inflamed, with a strong pulse; and others again break out into immoderate laughter, and, regaining their voice, say a great many silly things.

When they begin to come to themselves, the pulse, which was before weak, languid, and obscure, becomes brisk, soft, and strong; heat returns to the extreme parts; the face which was pinched in and pale, begins to expand and look ruddy; the wind forces its way upwards; there is a rumbling in the belly; and at length the patients, waking, as it were, out of a profound sleep, have their voice, senses, and motion restored. Yet they complain of a heavy pain in the head; a languor of the body, feet, and thighs; some have continued in a fit so long that they have been laid out for dead, and have been even buried.

The hysterical passion attacks women that are pregnant, in child-bed; widows that are full of blood, after some grievous passion of the mind; or maids, after a sudden suppression of the menstrual flux. It likewise oftentimes comes on so suddenly, violently, and at unawares, that being deprived of all sense and motion, they immediately fall down.

This disease may be caused by whatever promotes a more plentiful and rapid afflux of blood and the genital fluid to the uterine parts, or impedes the eruption of the menses, or occasions their suppression: hence maids and widows are most subject thereto; also women of a sanguine or bilious constitution who live high, drink generous wines, feed on high-seasoned aliments, and are subject to violent passions and commotions of the body and mind. On the other hand, those who live a sedentary life, feed on coarse, acid, low diet, who have omitted usual bleeding, who are oppressed with sorrows, cares, and disappointments, are liable to this disease; for by these the blood is thickened, the solid parts weakened, and consequently the flowing of the menstres rendered more difficult. Likewise sudden terror, and the body being exposed to uncommon cold during the time of the menstrual flux, by giving it a check procure hysterical spasms.

However dreadful and cruel this disease may appear, yet it is not very dangerous in itself, unless ill managed, or the patient be exceeding weak and valetudinary: it is most apt to turn into convulsions and an epilepsy. When it proceeds from abortion, or hard labour, it is very liable to return from any slight irritation of the nervous system. Nor is it very uncommon for the hypochondriac and hysterical disorders to be united, and then the cure is very difficult. This happens to women who lead a sedentary life, indulge extravagant affections of the mind, and are guilty of errors in diet and regimen.

In the cure, it must be carefully observed whether the woman is plethoric, or exhausted of blood and strength. In the former case, the spasms or convulsions are more violent, and copious bleeding is a present help; and many have been brought to themselves who were seemingly dead, if the florid colour of their faces had not shown the contrary.

In the fit, it will be proper to apply fetid things to the nose; such as afa-fetida, preparations of castor, partridges feathers burnt, &c. For women in childbed, a girdle made of Russia leather, and bound pretty tight, is excellent. Likewise clysters made with roots and seeds of lovage, which are specifics, camomile flowers, elder-flowers, veronica, the carminative seeds boiled; to which may be added oil of elder, dill, or camomile.

Externally, plasters made of opoponax, bdellium, galbanum, sagapenum, and afa-fetida, may be applied to the navel; or,

Some greatly commend fumigations for the uterus of musk, civet, storax, and benjamin.

Inwardly, the patient may take 30 or 40 drops of tincture of castor in cold water.

Some hysterical disorders observe the lunar phases, and partake of the nature of an epilepsy: They seldom require bleeding, and purging should be used with caution: Emetics are of greater service, especially a little before the fit. In the fit, the best medicines are those which repair the loss of spirits, as Russian castor, gum-ammoniac, salt of amber in pills.

Out of the fit, native cinnabar and wild valerian root are most proper for correcting the juices.

To prevent its degenerating into a chronic disease, particularly the hypochondriac passion, care must be taken to keep the menstres regular; which must be done by balneacies, composed of myrrh and amber, with bitter and carminative extracts, especially zedoary and orange peel, made into an elixir, with a moderately spirituous menstruum. This, frequently taken, helps the digestion, and promotes a regular menstrual discharge.

But it is necessary to observe, that in hysterical cases remedies have a different effect on different women. Some cannot bear fetid medicines, which to others are an immediate mediate relief. Some have fallen into a terrible syncope, and have come to themselves by sprinkling cold water on the face, when more powerful and spirituous things have failed. Others cannot endure hot things inwardly nor outwardly, as baths, fomentations, liniments, and nervous applications. Anodynes and opiates, which procure ease and rest to some, are very injurious to others who are greatly debilitated, and whose nerves are weak. Some have recovered from a violent paroxysm, by a draught of cold water; which, given to others, has increased the disorder.

Peruvian bark given morning and evening, a scruple at a time, is an excellent remedy in hysterical convulsions.

Of the Hypochondriac Passion.

The hypochondriac passion is a spasmodico-flatulent affection of the stomach and intestines, arising from an inversion or perversion of their peristaltic motion, and by a consent of parts, throwing the whole nervous system into irregular motions, and disturbing the whole animal economy.

This disease is attended with such a train of symptoms, that it is a difficult task to enumerate them all; for there is no function or part of the body, that is not soon or late a sufferer by its tyranny. It begins with tensions and windy inflations of the stomach and intestines, especially under the spurious ribs of the left hypochondrium, in which a pretty hard tumour may sometimes be perceived.

With regard to the stomach, there is a nausea, a loathing of food, an uncertain appetite, sometimes quite decayed, and sometimes strong; the aliments are ill digested, breeding acid and viscid crudities; there is a pressing, heavy pain in the stomach, chiefly after meals; a spasmodic constriction of the gullet, a frequent spitting of limpid phlegm, an impediment of swallowing, a violent heart burn, a heat at the stomach, very acid belchings, a reaching to vomit, vomiting, bringing up such acid stuff, that the teeth are not only fet on edge thereby, but the very linen or sheets are sometimes corroded.

In the volume of the intestines, especially the small ones about the navel, there are felt heavy excruciating pains, wrappings, grippings, with a rumbling murmuring noise; in the grofs intestines the pains are more acute. Sometimes there is a looseness, sometimes a most obstinate coliciveness, with a retention of the wind; which, when it breaks out either upwards or downwards, is attended with an alleviation of the symptoms, but they soon rage again with as great violence as ever. When there is a frequent urging to go to stool, tubercles generally arise, and the blind piles beset the anus; nay, sometimes a symptomatical flux of blood will burst out. Making water in some is difficult and painful; the urine is thin, limpid, and pale; sometimes it has a copious sediment mixed with fabulous concretions, and often resembles a fit of the gravel.

In the breast there is a great straitness, constriction, excessive difficulty of breathing, sometimes with a sense of fulness, a fluttering and palpitation of the heart.

As the disease increases, the head is molested with an head-ach, hemicranium, various fixed spastic pains, and what is commonly called the clavus hystericus. A noise in the ears, with difficulty of hearing; the eyes are clouded with a scotamia; some have double vision, or a pain and dryness of the eyes. In the tongue there is a most troublesome burning pain fixed to a certain space, with a plentiful excretion of spittle, as if the patient was in a salivation.

At length the animal functions are impaired; the mind is disturbed on the most trivial occasions, and is hurried into the most perverse commotions, inquietudes, anxieties, terror, sadness, anger, fear, or diffidence. The patient is prone to entertain wild imaginations and extravagant fancies; the memory grows weak, and the reason fails.

Persons are most liable to this disease from twenty to fifty, and whose solids are soft, lax, and flabby, and their blood-vessels small; as also who are naturally languid, or have been weakened by tedious maladies. Likewise those who lead sedentary lives, and study too hard; in somuch that this is the peculiar disease of the learned.

The remote causes of these disorders are the suppression of the hemorrhoids and menes, and other periodical fluxes of blood; an hereditary disposition thereto; a cold and moist constitution of the air; grofs impure, flatulent diet; a sedentary, studious life; sadness, cares, troubles, intense thinking on a single object; tedious diseases not rightly treated; hard labour in child-bearing.

As to the prognostics, if the disease be recent and left to itself, it is rather troublesome than dangerous; but if it be inveterate, and not skilfully treated, or a bad regimen is followed, it is attended with more grievous symptoms, producing obstructions and chirrui of the viscera, a cachexy, a dropsy, an hectic, a convulsive asthma, an incurable melancholy or madness, a fatal polypus, &c. But if it is caused by a suppression of the menes, or bleeding piles, the restoring the flux is the cure of the disease.

As continual fear and diffidence are symptoms of this disease, the patients are always foreboding terrible things, and live in constant dread of death; which render them fickle, impatient, and prone to run from one physician to another. Therefore, when a cure is attempted, they must be admonished to be constant and patient; and then the following indications may be pursued:

1. To correct and evacuate the acid, viscid, bilious filth, and flatulent fords from the prime viz, which yield continual fever to this disease.

2. The spasms being appeased, to restore the natural order of the peristaltic motion of the intestines, and to recover it from a languid state, that there may be a due concoction of the aliment, and a laudable chyle and other fluids generated.

3. To disperse the stagnated juices; to render the circulation of the blood equable through the abdomen and the rest of the body; and to free the fluids from all acrimony, after facilitating the excretions by urine and through the skin.

4. And lastly, to corroborate the whole nervous system.

To answer the first intention, nothing is better in the fit than cliffers made with emollient herbs, water gruel strained, camomile-flowers, the tops of yarrow, the oils of sweet-almonds, dill, camomile, linseed, &c. adding a carminative species made of caraway, dill, but more especially cumin seeds. These should be repeated, if the spasms render them ineffectual. If the faces are hardened... ed, it will be proper to give oil of sweet almonds and water gruel inwardly. Nor must gentle laxatives of manna, rhubarb, and cream of tartar, be neglected, with a few drops of oil of juniper.

If there is a great deal of acid filth in the stomach, crabs' eyes alone will purge.

To correct the fortes in the prima via, give the absorbent, precipitating, and antispasmodic powders, such as crab's-eyes, mother of pearl, pulvis marchionis, purified nitre, prepared amber, cinnamon, tartar vitriolate, with a little caltor. It will also be proper to take a decoction of any of the following things in the morning in bed, to promote a diaphoresis, viz. balm veronica, betony, agrimony, scordium, carduus benedictus, tops of yarrow, daisy flowers, camomile flowers, fennel seed, &c.

To restore the digestive power of the stomach, give essence of orange-peel, tincture of tartar, dulcified spirit of nitre, &c.

The paroxysms are relieved by tepid pediluvia, made of wheat, bran, water, and camomile flowers. The feet must be put pretty deep therein.

Out of the fit, to disperse the stagnation of the blood, bleeding in the foot will be necessary, especially at the equinoxes, and at other times as occasion shall require; but this should be after laxatives and pediluvia. If there is a disposition to an hemorrhoidal flux, leeches should be applied every month to the anus; and the patient should also take balsamic pills, with antispasmodic nitrous powders.

To strengthen the nervous system, nothing is better than chalybeates; for they, by a gentle attrition, restore the nerves to their former strength. Outwardly a saponaceous plaster, with camphor, may be laid to the hypochondria with no small advantage.

Nothing is more friendly, nor gives greater energy to the blood and spirits, than riding on horseback almost every day, and for a considerable time together. Nor does riding in a coach want its share of salutary effects.

Of Melancholy and Madness.

Melancholy and madness may be very properly considered as diseases nearly allied; for we find they have both the same origin: that is, an excessive congection of blood in the brain: they only differ in degree, and with regard to the time of invasion. Melancholy may be looked upon as the primary disease, of which madness is only the augmentation.

When persons begin to be melancholy, they are sad, dejected, and dull, without any apparent cause; they tremble for fear, are destitute of courage, subject to watching, and fond of solitude; they are fretful, sickle, captious, and inquisitive; sometimes niggardly to an excess, and sometimes foolishly profuse and prodigal. They are generally coltive; and when they discharge their excrements, they are often dry, round, and covered with a black, bilious humour. Their urine is little, acrid, and bilious; they are troubled with flatulencies, putrid and fetid eructations. Sometimes they vomit an acrid humour with bile. Their countenances become pale and wan; they are lazy and weak, and yet devour their victuals with greediness.

Those who are actually mad, are in an excessive rage when provoked to anger. Some wander about; some make a hideous noise; others shun the sight of mankind; others, if permitted, would tear themselves to pieces. Some, in the highest degree of the disorder, see red images before their eyes, and fancy themselves struck with lightning. They are so lascivious, that they have no sense of shame in their venereal attempts. When the disease declines, they become stupid, sedate, and mournful, and sensibly affected with their unhappy situation.

The antecedent signs are, a redness and suffusion of the eyes with blood; a tremulous and inconstant vibration of the eye-lids; a change of disposition and behaviour; supercilious looks, a haughty carriage, disdainful expressions, a grinding of the teeth, unaccountable malice to particular persons; also little sleep, a violent head-ach, quickness of hearing, a ringing of the ears; to these may be added incredible strength, insensibility of cold, and, in women, an accumulation of blood in the breasts, in the increase of this disorder.

These things being duly considered, together with the state of the brain in persons who died of this disease, we may conclude, that melancholy is a strong and lively working of the fancy, with a fixed attention of the mind to a particular object, which it continually dwells upon; together with a delirium, a long continual dejection, dread and sadness without any manifest cause, arising from a difficult circulation of blood through the vessels of the brain, where it is too copiously congeged and becomes stagnant. Madness is a violent rage, attended with rashness and preternatural strength, caused by an impetuous motion of a thick melancholic blood through the vessels of the brain. It differs from phrenzy, which is a delirium accompanied with a fever, and arises from an inflammatory stagnation of the blood in the brain: for we learn from experience, that all the shining faculties of the mind are changed or depraved, diminished or totally destroyed, when the blood and humours, receding from their natural temperament and due quantity, are not conveyed to the brain in a moderate and equable manner, but on the contrary with an impeded, slow, and languid motion, or with too brisk and violent an impetus.

Both these disorders suppose a weakness of the brain, which may proceed from violent disorders of the mind, especially long continued grief, sadness, dread, uneasiness and terror; as also close study and intense application of mind, as well as long protracted lucubrations. It may also arise from violent love in either sex, especially if attended with despair; from profuse evacuations of the semen; from an hereditary disposition; from narcotic and stupefactive medicines; from previous diseases, especially acute fevers. Violent anger will change melancholy into madness; and excessive cold, especially of the lower parts, will force the blood to the lungs, heart, and brain; whence oppressive anxieties, sighs, and shortness of breathing, tremors and palpitations of the heart; thus vertigo and a sensation of weight in the head, fierceness of the eyes, long watchings, various workings of the fancy intensely fixed upon a single object, are produced by these means. To these may be added a suppression of usual hemorrhages, and omitting customary bleeding: bleeding; hence melancholy is a symptom very frequently attending hysteric and hypochondriac disorders.

The causes which contribute to the generation of a thick blood, are idleness and inactivity, which weaken the body, impair the functions, diminish the salutary excretions, and render the humours thick, viscid, and stagnant: All which are heightened by solitude, which is apt to give rise to various fantastic and gloomy ideas in the patient's mind.

Likewise acid humours in the stomach will increase the appetite, and tempt them to feed on coarse, grofs, flatusulent aliments, without drinking enough to dilute them sufficiently, whence a matter proper to nourish these diseases will proceed. It is evident from observation, that the blood of manic patients is black, and hotter than in the natural state; besides, the serum separates more slowly and in less quantity than in healthy persons. The excrements are hard, of a dark-red or greyish colour, and the urine is light and thin.

Diseases of the mind have something in them so different from other disorders, that they sometimes remit for a long time, but return at certain periods, especially about the solstices, the times at which they first appeared. It may likewise be observed, that the raving fits of mad people, which keep the lunar period, are generally accompanied with epileptic symptoms.

This disease, when it is primary or idiopathic, is worse than the symptomatic that accompanies the hysteric or hypochondriac passion, which is easily cured; as is that also which succeeds intermitting fevers, a suppression of the menses, the lochia, the haemorrhoids, or from narcotics. When the paroxysms are slight in the idiopathic kind, the cure is not very difficult; but if it is inverterate, and has but short remissions, it is almost incurable; which is often owing to this, that they reject physicians and their medicines as poison. It is a bad sign, if, after a profound sleep, the patient still continues delirious, and is insensible of cold, or is unaffected with strong drastic medicines. If after want of sleep and long abstinence the patient is exceeding weak, or becomes epileptic, convulsive, or lethargic, death is not far off. Mad people are seldom subject to epidemic or other disorders, and some have lived seventy years and upwards in this unhappy state.

Sometimes this disease terminates by critical excretions of blood from the nose, uterus, or anus. Sometimes diarrhoeas and dysenteries will terminate these disorders. Pustules, the itch, and ulcers, have also done the same.

In the cure, bleeding is the most efficacious of all remedies; and where there is a redundancy of thick, grumous blood, a vein is first to be opened in the foot, and a few days after in the arm; then in the jugular vein, or in the nostrils with a straw; and, last of all, the frontal vein with a blunt lancet, for fear of hurting the pericranium, a ligature having been first made round the neck to render the veins tumid.

Tepid baths are also convenient, to drive the blood from the head to the inferior parts; and before the patient enters the bath he should have cold water poured on his head, or it should be covered with a cloth dipped therein; for cold water pumped or poured on the head constringes and corroborates the vessels of the brain weakened with stagnant blood, and promotes the more easy discussion of the humours congested therein.

Purgatives are likewise useful; but the lenient are preferable to the drastic: Thus manna, cassia, rhubarb, cream of tartar, tartar-vitriolate, are most convenient when the disease arises from the hypochondriac passion, and a stagnation of the blood in the intestines, and the ramifications of the vena porta; especially when they are taken in decoctions and infusions, not all at once, but at repeated intervals, so as to operate in an alternative manner.

Some kinds of mineral waters are also highly efficacious in melancholy and madness; for since madness generally derives its origin from the melancholy, and melancholy from the hypochondriac passion, and the hypochondriac passion from impure and peccant fluids slowly circulating through the intestines and viscera of the abdomen, the circulation of the blood ought to be rendered free and easy. It is no wonder therefore that mineral waters have been held in high esteem for the cure of these disorders; for these being impregnated with a highly pure alkaline and neutral mineral salt, if they are drank in a due quantity, they not only change the peccant humours, but incide such as are thick, render the glutinous fluid, and open the obstructions of the vessels; they also relax the tense fibres of the solids, and corroborate the weak and tender, as well as, by stimulating the emunctories, they restore all the salutary excretions. The waters of Selters mixed with asses or goats milk have not their equal in these cases. They should be drank in the spring and fall for five or six weeks. - The proportion is one part milk to three of water.

But, after all, there is nothing better to remove the cause of these disorders than depurated nitre, but especially in that species of madness which inclines to melancholy; for it corrects the bilious acrimony of the humours, allays the tumultuous motions of the solids, by diminishing the preternatural heat. Sennertus and Riverius affirm, that nitre, given with a little camphor, is a specific in madness.

Particular medicines among vegetables are, balm, betony, vervain, brook-lime, sage, wormwood, flowers of St John's wort, of the lime-tree and camphor: from animals, affes blood dried: among minerals, steel, cinnabar, sugar of lead, and the calx and tincture of silver.

Camphor is much praised by the moderns, particularly by Ermuller.

And Dr Friewald affirms, that with a few doses of camphor, of xvj grains each in pills, he has cured several mad patients, even in inverterate cases.

Stahl recommends a powder of the following cephalic and nervine herbs; vervain, sage, betony, with plaintain and white maidenhair.

As to diet, the patient should carefully abstain from salt and smoke-dried flesh, whether beef or pork; from shell fish; from fish of a heavy and noxious quality; from aliments prepared with onions and garlick, all which generate a thick blood. In general, he should eat no more than is necessary to support nature. Small-beer or pure cold-water are the best drink. Sweet and strong wines are highly prejudicial; as is also excessive smoking tobacco, tobacco; for it not only penetrates thick blood, but throws the fluids into preternatural commotions. Change of air and travelling may be beneficial.

Though in deliriums bleeding is highly useful, yet it agrees best with those that are plethoric, bilious, and in the vigour of youth: these likewise will bear frequent purges of corrected hellebore; but then the strength must be repaired by cordial, corroborating, and anodyne sedatives. When the patient is exhausted, bleeding is hurtful, and restoratives good.

As a high degree of the itch has terminated these diseases, it will be proper to make issues in the back, or to procure ulcers with a potential cautery near the spine of the back.

Sedative medicines are good; but not opiates and narcotics, for these induce stupidity and folly. Those that are good in an epilepsy, will be beneficial here; such as caltor, shavings of hartshorn, the roots and seeds of piony, and anti-epileptic powders, the valerian root, flowers of the lily of the valley and of the lime tree.

And to the other sort of madness, which proceeds from being exhausted and weakened by autumnal, violent, and obstinate intermittent fevers, and from their being injudiciously treated with bleedings and purgings, it is only to be cured by restoratives, cordials, and corroboratives, long persisted in.

Of the Hydrophobia.

This disease, as it generally proceeds from the bite of a dog, is called rabies canina, or the canine madness; and from its most terrible symptom, the dread of water, hydrophobia. It almost always arises from the infection communicated by the bite of a mad animal: yet it has been observed to arise spontaneously in some animals affected with acute diseases.

Almost all kinds of animals may be afflicted with this disorder, and may infect other animals, and even men; as dogs, cats, wolves, foxes, horses, asses, mules, horned cattle, hogs, monkeys, and cocks; but it most frequently attacks the dogs, wolves, and foxes, without any previous contagion.

A hot climate, excessive heats and sudden colds; a long and dry season; feeding upon putrid, stinking, verminous flesh; want of water; worms generated in the kidneys, guts, brain, or nostrils; are the preceding causes of madness in these animals.

When they are going to run mad, they appear dejected, shun company and hide themselves; they will not bark, but seem to mutter or murmur, and are averse to food and water; they will fly upon strangers, but retain some regard for their master; their ears and tails hang down, and they walk along as if they were sleepy. This is the first degree of the disease; and, though the bite is then bad, it is not at the worst. Afterwards they begin to pant, hang out their tongues, froth at the mouth, and gape. Sometimes they seem dull and half asleep; sometimes they will run, but not directly forward, and soon cease to know their matters. Their eyes are dejected, look watery and dull, their tongues are of a lead colour, they fall away suddenly, and grow raging mad. A bite at this time is incurable; and the nearer they are to death, with the more dreadful symptoms it is attended.

There is scarce any poison infectious so many ways as this: for it takes effect through the cloaths, without fetching blood; by the breath of the animal drawn into the lungs; by a touch of the froth, if recent; and by applying it to the lips or tongue, when it has been long dried; or by kissing a dog that is mad; or by handling the wound or instrument which was the death of the animal; or by handling things which have been infected by any of the former means.

Again, there is scarce any poison which produces such terrible effects, and causes such a wonderful change in the person infected. When it begins to work, it is most violent and quick; and yet, as it is said, it will sometimes lie dormant for years together before it exerts itself. This diversity depends on the heat of the season, the degree of the disease of the infected animal, and the temperament of the person bit. For the bilious are soonest affected by it; the phlegmatic and hypotonic the least; likewise something may be attributed to the way of living, diet, and medicines.

A healthy man, infected with this contagion, finds the effects of it discover themselves in the following order. There is a pain in the place where he was bit, or received the contagion; and then wandering pains in the other parts, chiefly those that are near it; a languidness, heaviness, listlessness of the whole body; inquiet troubled sleep, and terrible dreams, with convulsions, and subluxation of the tendons; continual inquietude; sighs, sadness, love of solitude: This ends the first degree of the disease. Afterwards all the former symptoms increase, with a prodigious straitness or oppression about the praecordia; a difficult sighing respiration; horror; a shaking and trembling at the sight of any liquid, or bright, pellucid thing; loss of appetite; a possibility of swallowing anything solid; but, if any liquid is touched with the lips and tongue, it occasions an incredible anxiety, trembling, and terrible convulsions, almost forcing the patient into a rage; then a vomiting of dark, bilious, viscid matter, or purulent bile; an increased heat, a fever, continual watching; a priapism; a confused series of wild, extravagant thoughts: Here the second degree of the disease may be said to terminate. Now all the symptoms grow worse and worse: the tongue hangs out, and is rough; the mouth is wide open; the voice is hoarse; the thirst great; strange horrors, starting, and wild looks, at the sight of water; a frothing at the mouth; an involuntary inclination to spit at the bystanders, as also to bite them, which the patient cannot resist. He foams at the mouth, and gnashes with his teeth; and would do mischief, if not forcibly withheld. His pulse and breathing fail: there is a cold sweat, and the highest fury: yet during all this time, which is wonderful, the patient continues in his senses, and is afraid of doing any harm. On the fourth day from the first degree of the disease, the patient falls into convulsions, with great difficulty of breathing; and then dies.

The dissection of persons who died of this disease has shewn, that the organs of swallowing have been in some measure inflamed; that various kinds of bilious viscidities are collected in the stomach; that the gall-bladder is full of a black bile; that the pericardium is dry; that the lungs are incredibly distended with blood; that the heart is full of an almost dry blood; that the arteries are full, and the veins almost empty; that the blood is very fluid, and will hardly coagulate when exposed to the air; whereas that which was drawn from a vein three days before, coagulated as usual; that all the muscles, viscera, brain, cerebellum, and spinal marrow, are more dry than common.

The prevention and cure of this disease, except in a few instances, are very doubtful and uncertain: which may be attributed to the boasting pretences of some to specifics, and the neglect of a due method of cure, founded on the history of the disorder.

So far therefore as may be conjectured from the preceding history of the disorder, and from comparing it with other diseases, as also from the few instances which have been attended with a happy event, it seems chiefly to consist in an affection of the nerves, which most nearly resembles convulsions, which occupy the viscera and the vessels thereof; whence arises a disorder in the blood and humours, which is not unlike a gangrenous inflammation. The seat of the disease is chiefly about the stomach and the neighbouring parts.

The preventive cure consists in making deep scarifications, as soon as possible after the bite, in the part affected, and those adjacent to it; that they make a considerable discharge of blood, and apply large cupping-glasses thereon; or it may be burnt pretty deep with an actual cautery. Then it should be made to suppurate by some corrosive application proper for that purpose; and during all that time it should be continually fomented with a pickle made with vinegar and salt: this should be continued for six months at least. The garments he had on at the time of the bite should be cautiously laid aside or destroyed. He should likewise with all convenient speed be dipped in a river, or the sea, making him believe that he is going to be drowned. This is to be often repeated; for the effect consists in terrifying the mind, not in the salt-water, as we have learnt from experience. Then he should also be often and strongly purged with rhubarb, agaric, and the juice of elder-bark.

The patient should also be put into a sweat every morning fasting, with a mixture of aromatic vinegar, sea-salt, and hot water. His feet and hands should also be daily fomented in a warm bath; and he should wash his head, mouth, and fauces.

Let him often drink cold water, and throw it up again by vomiting; and let his drink be acidulated. His aliment should be moist, light, and laxative, and often taken in such a quantity as to vomit it up again. He should likewise abstain from things that are too spicy, from wine, from heating things, from violent exercise, and from commotions of the mind.

The cure should be attempted when the disease is in the first degree, and in the beginning of the second, by treating it as highly inflammatory, by letting blood from a large orifice even to a delirium, by giving clysters soon after with nitrous or moderately salt water.

After this let the patient be blind-folded, and thrown into a pond of cold water; or let cold water be thrown upon him till the dread of it almost ceases; then let a large quantity be forced down his throat: let this be his treatment daily, and at night let sleep be procured. And this method is better than that pernicious one of giving him the most acrid heating and drying medicines; which exasperate the nervous system, and are in this case as bad as poison, to a patient already almost parched with heat.

Celsus informs us, that it was the practice of old to put the patient bit by a mad dog into a bath, and there to let him sweat as long as his strength will permit, at the same time keeping the wound open, that the virus might be discharged from it; and then to give him plenty of good generous wine. This being done for three days, they judged him out of danger.

This may give some light into the nature of the pulvis antilyffus published by Dr. Mead, and received into the dispensatory of the college, wherein pepper is one of the ingredients:

1. Take four drams of ash-coloured ground liver-wort, and two drams of black pepper, beat into a powder.

This is to be divided into four doses, whereof one to be taken in warm milk in a morning, fasting, for four mornings successively. After this he is to be put into a cold bath, pond, or river, for thirty days together, early in the morning before breakfast.

Another famous specific is the East-india medicine; which is doubtless an egregious antipasmodic, and is as follows:

2. Take native and fictitious cinnabar, of each 24 grains, and 16 grains of musk. Make them into a powder.

This is to be taken in a tea-cup full of arrack or brandy, and is said to secure the patient for thirty days, at the expiration of which it is to be repeated; but, if he has any symptoms of the disease, it must be repeated in three hours, which is said to be sufficient for a cure.

Dr. Wall of Worcester has found two doses of musk, of xv grains each, to produce very happy effects on two persons labouring under a subfultus tendinum, with extreme anxiety, and want of sleep, from the bite of a mad dog; for it perfectly relieved them from their complaints. We have a singular case of a woman actually seized with an hydroprobia, given by Dr. Nugent; who was cured. He ordered this powder to be taken in honey every three hours, after she had lost 15 ounces of blood, and a pill of 2 grains of pure opium along with the powder, till rest was procured.

Of Poisons.

There are three essential marks of poisons which distinguish them from other things that are noxious to human bodies. The first is, that they consist of most subtile parts, and consequently are pernicious in a small quantity. The second, that they pervert, in a short time, the regular motions of the solids and fluids throughout the body, and induce the most grievous symptoms, even death itself. And the third, that they exercise their cruelty on the most subtile fluid, and the most nervous parts.

All the three kingdoms have poisons peculiar to themselves; but the animal kingdom affords the most subtile, which are communicated by the bite of mad or venomous The bite of a Rattle-Snake, hitherto looked upon as a most terrible accident, may now be cured in a simple, easy manner. It is the invention of a negro; for the discovery of which, he had his freedom purchased, and an hundred pounds per annum settled upon him during his life by the general assembly of Carolina.

Take of the roots of plantane and horehound (in the summer the roots and branches together) a sufficient quantity; bruise them in a mortar, and squeeze out the juice, of which give as soon as possible one large spoonful; if the patient be swelled, you must force it down his throat. This generally will cure; but, if he finds no relief in an hour after, you may give another spoonful, which never fails.

If the roots are dried, they must be moistened with a little water. To the wound may be applied a leaf of good tobacco moistened with rum.

The mineral kingdom furnishes very few real poisons: the only natural one is cobalt; the factitious ones are arsenic, corrosive sublimate, and glaas of antimony.

Cobalt is a kind of a marcasite, which is found in great plenty in the mines of Minia; and is well known for its poisonous quality, so fatal to insects, brutes, and men. In making the blue glaas, or enamel, called fmailt, from this mineral, a sort of white flowers arises, which, being melted in a stronger fire, is called white arsenic. If this be melted again with an eleventh part of sulphur, it becomes yellow arsenic, and, with a sixth part of sulphur, red. Of these, the white is the most deadly poison.

As for the true mineral poisons, they were entirely unknown to the ancients; for they reckoned quicksilver, crude antimony, all kinds of vitriol as well as cerufts, and the lapis lazuli, in that class; but orpiment, which they called arsenick, as Celsus testifies, and looked upon as a poison, is void of all virulence and deleterious qualities; and sandarach they termed red arsenic, which is made of melted orpiment, but is no more noxious than the former. Indeed, it must be owned, that the above catalogue are not altogether friendly to human nature, or may be endued with a corroding quality; but they want the true characteristic of poisons.

Quicksilver, dissolved in acid mineral spirits, is likewise a poison, though of itself it is entirely innocent. This has chiefly appeared from errors in practice, when the mercury has not been rightly prepared and corrected.

Likewise glaas of antimony reduced into powder, and exhibited, causes enormous vomiting, with most cruel gripings, which often end in death.

Arsenic, taken inwardly, creates a pricking, wellicking, irritating, burning sensation, with a heat and most violent pain in the stomach, a racking torture in the bowels, vomiting, unquenchable thirst, a roughness and dryness of the tongue, fauces and gullet, with hiccups: then follow most cruel anxieties, palpitation of the heart; fainting, coldness of the extremities; sometimes black vomits, and stools with a fetid cadaverous smell; a gangrene and mortification of the stomach and intestines, which usher in death.

Milk is very useful against all corrosive poisons, by its soft, oleous contexture, blunting their acrimony; and is a good vehicle to bring them up by vomit. In all cases where a person is suspected to have been poisoned by swallowing any substance of a corrosive nature, oil with milk for a vehicle yields the most certain relief; and even when acid mineral spirits are taken by mistake, they will blunt or sheathe the acrimony sooner than fixed salts and terebinthaceous powder will change their nature: besides, fallad-oil is generally at hand in all places as well as milk; and the sooner it is given, the less is the danger.

The most dangerous vegetable poisons, are wolf's-bane, the deadly night-shade, henbane, and datura; to which may be added the roots of oenanthe cicuta facie, or hemlock dropwort, cicuta vulgaris or common hemlock.

Hoffman affirms, that milk in a large quantity is an universal remedy against all poisons that kill by inflammation, and if taken in time will prevent the direful consequences. Allen thinks a vomit with warm water and oil, taken in large draughts and often repeated, will be of great service; as also warm water with fresh butter, milk and oil, or milk and butter. If the above things will not provoke the patient to vomit, oxymel of squills, salt of vitriol, or a decoction of tobacco, may be used, as having a more immediate effect. It is hardly safe to give even the most gentle cathartic.

The stomach being thus emptied of all, or as much as possible, recourse must be had to generous wine and alexipharmics, such as venice-treacle, confectio alkermes, the bezardic powder, &c. When there is a suspicion that the coats of the stomach or intestines are corroded or ulcerated, it will not be proper for the patient to use spices or vinegar, nor to indulge in too much wine, but to take a decoction of barley with raisins, or a decoction of china-root, sassafras, &c.

The same method is most likely to answer when any other deleterious herb or root has been eaten by mistake, though the particular species should not be known; and Hoffman affirms, that when the patient has been stupified by the narcotics, the best remedies are vomits mixed with oil, to facilitate the operation.

Of a Gutta Serena.

A Gutta Serena, or amaurosis, is an abolition of the sight, when no fault appears in the eyes, except in the pupil which is larger than usual and more black, nor will it contract, though any luminous object is placed directly before it, but continues quite immoveable. It may be distinguished from the disorder of the eyes proceeding from the vertigo; for the objects seem to turn round: From a cataract; for then an opacity of the crystalline humour is perceivable, and the pupil will contract in a glaring light.

When this disease comes on suddenly, it generally proceeds from external causes, as blows, falls, and the like. When it comes on by degrees in old persons, it arises from a hemiplegy or palsy; as also in other weak and languid constitutions. Sometimes its concomitants are pains in the head, the vertigo, sleepiness, noise in the ears, and sometimes it comes on without any preceding symptoms.

From dissections it has appeared, that the optic nerves have been in fault; that is, they are wasted away or much less than common; as also compressed by extravasated fluids, or hard tumours about their origin.

The indications of cure are, to disperse the stagnating humours, which compress the nerves, and then to strengthen the affected parts.

Heister affirms, it is to be cured by aromatics, carminatives, and attenuants; chiefly eye-bright, veronica, hyssop, rosemary-flowers, sage, fennel, and aniseeds, valerian root, sassafras, cinnamon, wood-lace, either in infusion or powder; the juice of wood-lace newly expressed, and taken for some weeks, increasing the dose, is of excellent use; as likewise mercurials, taken in very small doses, and a long while together.

If it arises from a suppression of usual haemorrhages, they are to be restored; but, if this cannot be done, artificial bleeding is to be substituted.

Externally, infusions are held to be good, clysters and fomentations, especially in the phlegmatic. The eyes may be washed with fennel, valerian, eye-bright, or rose-water, spirit of wine, Hungary water, and sal-volatile oleoform diluted, or an infusion of fennel-roots in wine, with bags of strengthening herbs and fennel-seeds often put therein. Sneezing powders may likewise be proper, especially florentine orrisce, or horse chestnuts; likewise spirits of hartshorn, or sal-volatile oleoform, may be applied to the nose.

In all disorders of the eyes, but particularly in this, the body must always be kept open, that the humours may be invited downwards, with laxative pills mixed with calomel. Likewise strong clysters are of very great use.

Of a Suffusion, or Cataract.

A Suffusion, or cataract, is an obstruction of the pupil, by the interposition of some opaque substance, which diminishes or extinguishes the sight: Some are thicker than others; some are white, black, citron-coloured, or brownish. It is always contained between the uvea and sclerotica, where it sometimes swims and fluctuates like a bit of lawn in the aqueous humour, and sometimes it adheres close to the coats. It is generally an opacity of the crystalline humour.

The medicines above mentioned, in an incipient or recent cataract, from thick or viscid humours, may do good, especially if they arise in the crystalline humour, as Heister affirms, because they attenuate, resolve, and render the humours fluxile, and increase the spirits. A grain or two of mercurius dulcis, given with twice the quantity of prepared oyster-shells for thirty days together, has destroyed the rudiments of a cataract. But, if these have no effect, and the cataract grows inveterate, ripe, or perfect, it is to be depressed; for which, see Surgery.

Of a Glaucoma.

A Glaucoma is a change of the crystalline humour into an azure colour, from its dryness and condensation, as some affirm: but Heister says, it arises from an opacity of the vitreous humour, which becomes of a whitish green colour; for, in a suffusion, an opaque body is placed behind the pupil, or is next to the uveous part.

Sennertus says, this malady is known from a very remarkable whiteness appearing in the eye, and lying deep behind the pupil, and all things are seen as through a smoke or cloud; it is said to be incurable. Of the Amblyopia, or Obscurity of Sight.

The amblyopia is an obscurity of sight, and is four-fold: myopia, or short-sightedness; presbyopia, or seeing only at too great a distance; nyctalopia, or seeing only in the night; amaurosis, of which before.

Myopia proceeds from the too great convexity of the cornea, or crystalline humour, or from the eyes being larger than common, as we learn from optics. This is best assisted by concave glasses.

Presbyopia proceeds from the contrary causes, and receives assistance from glasses of a convex form.

Nyctalopia is a twofold malady, in which the complaints are contrary to each other. In the first species, the sight is best in the night, and in obscure places; but in a clear light the sight fails, and they can hardly see anything at all. In the other fort, which is improperly called a nyctalopia, they see nothing at all, except in a clear and bright light. This infirmity arises from a naturally bad formation of the eye, and is therefore incurable. The presbyopia may likewise be assisted by cephalic and strengthening medicines, by watery and vinous infusions, and comforting eye-waters.

Of a Strabismus, or Squinting.

A Strabismus, commonly called squinting, is an unequal contraction of the muscles of the eye, either from a spasm, an epilepsy, or a palsy, whereby the axis of the pupil is drawn towards the nose, temples, forehead, or cheeks; so that the person cannot behold an object directly. Infants readily contract this distemper, sometimes for want of care in the nurses, who place the cradles in a wrong position, with regard to the light. Children likewise, while growing up, sometimes fall into this disorder, either from ill customs contracted in playing, or by looking on others who are affected with it.

This disorder is very difficult to cure; therefore the utmost care should be taken to prevent it, and the cradle should be so placed, as not to occasion the child to look awry. Egineta contrived a mask, and so adapted it to the face, that nothing could be seen except through two holes straight forward; and for the same purpose what we call goggliers are used.

Of the Albugo, or Spot in the Eye.

An Albugo, or leukoma, is a whitish spot of the transparent cornea; the broader and thicker it is, the more it obscures the sight; when it is superficial, it appears the whiter; and, when it is deeply rooted, it tends to blackness, and is scarce curable. That which is in reality a cicatrix, or scar, left after a wound or ulcer in the eye, is very difficult to be dissipated; that which follows an inflammation of the eye often goes away of its own accord.

It may be distinguished from a cicatrix, because this is of a shining white and without pain; whereas the albugo looks like chalk, is attended with a slight fluxion, and some degree of an inflammation with pain. It is generally the forerunner of an ulcer.

The intentions of cure are answered by emollients, resolvents, and discutients, which must be used with great caution. To take away a cicatrix, the sharpest topics, nay, cathartics, are sometimes to be used, with a very prudent hand: but, first of all, mild things may be tried; and, if they fail, we may proceed to stronger.

Of a Suggillation, or Bloodshot Eye.

A Suggillation first appears of a reddish colour, and afterwards livid or black. It is caused by a stroke or fall, or violent vomiting, whereby the blood is extravasated in the coats of the eye. If the cornea is affected very much, all objects appear of a reddish colour; for some veins run to the cornea, in the part towards the iris, or the blood may be poured out into it from the neighbouring vessels.

If the disorder is great, there will be occasion for bleeding and purging, for the grumated blood in the suggillation is to be resolved and discussed, which may be done by discutients, such as juice of fennel, with balsam of Peru, juice of celandine, simple honey-water, mixed with other eye-waters.

If from this or any other cause there should happen to be an ulcer of the eye, Demours recommends coarse sugar as a good ingredient for deterring those of the cornea, in which astringents are hurtful; but it must be mixed with collyria. When the aqueous humour of the eye is evacuated at a wound or ulcer of the cornea, he exposes the patient to the light, from time to time, till the cornea is again raised by the aqueous humour; for the light occasions a motion in the iris, which may prevent its adhesion to the cornea.

Of the Epiphora, or Lippitude of the Eyes.

An epiphora is a defluxion of a salt sharp humour upon the eyes, attended with itching, pain, and redness; as also a dimness of sight. It is but slight when there is no defect in the bulb of the eye, when the eye-lids swell and look red, when the matter of the fluxion is thick and sometimes glues the eye-lids together in the night, continuing in this state for some time.

Children are often afflicted with this disease, particularly those who have had a scald-head improperly cured; or who have swellings in the glands of the neck or about the ears, and then it cannot be cured until these tumours are discussed. It sometimes likewise succeeds the small-pox and measles.

The seat of this disease is in the glands of the eye, especially in those called the lachrymal glands.

This disease may be certainly cured in the beginning, by a plentiful drinking the infusion of the leaves of veronica, in the manner of tea, for some time. When it is inveterate, the patient must be very regular in his diet, and must avoid every thing salt, sharp, acid, wine, strong-beer, and drams. His common drink may be a decoction of hawthorn and fennel-seeds, using warm pediluvia at night going to bed.

Externally a grain of vitriol may be mixed with unsalted butter, to which a small portion of sugar of lead may be added and put into the greater corner of the eye. This is a most useful medicine. When the lippitude is of the dry kind all acid applications must be avoided, and the eyes must be covered with a poultice of white bread. bread and milk, with a little saffron mixed with it. The success of serums and issues is uncertain, but a perpetual blister on the nape of the neck is of great service. But it must be continued for a considerable time.

Of the Fistula Lachrymalis.

The fistula lachrymalis is a disease which attacks the great caruncle in the inward corner of the eye, and stopping up the natural passage of the tears, forces them to run down the cheek; but this is the first degree of the disease. The second is, when pus is mixed with the tears, which proceeds sometimes from an opening in the skin between the nose and the great corner of the eye. The last is, when the pus has not only corroded the neighbouring parts which are soft, but has affected the bone which lies underneath. This sort of fistula sometimes turns cancerous; and Riverius advises not to meddle with it at all.

Whatever may be the cause of this disorder, whether the small-pox or the French disease, it always stops up the nasal conduit, which is opened by an operation. See Surgery.

Of Deafness.

The causes of deafness are a cutting off the external ear, or an obstruction of the auditory passage from wax or other things; from a rupture of the membrane of the tympanum, or when it is corroded or ulcerated, or the auditory nerve is obstructed or compressed. External causes are, falls from high places, excessive noise, such as the explosion of cannon; likewise acute disorders near their state, which are like to terminate by a critical hemorrhage.

As to the prognostics, those who are born deaf are rarely cured. A real deafness is hard to remedy. A deafness in acute diseases, with crude urine, foretells a delirium; but, when the signs of coction are good, it portends a critical hemorrhage.

With regard to the cure; if the obstruction be in the external cavity of the ear, it is discernible by the sight. If there is occasion to syringe the ear, a decoction of sage and rosemary flowers will be proper, with equal parts of water and white-wine; but great caution should be used. Some pump the head with warm bath waters. Some say, the eggs of ants bruised and put into the ear, with the juice of an onion, cure the most inveterate deafness. Others affirm, that a salivation will sometimes perform a cure.

A critical deafness will cease of itself. Etmuller recommends amber and musk.

Hoffman says, deafness sometimes arises from a slackness of the auditory nerves, which often happens from too great a humidity, which, if neglected, will terminate in a perpetual and incurable deafness, and may be dispersed, if taken in time, by proper cephalics and sudorifics. Some for this purpose recommend equal parts of spirit of lavender and hungary water, which should be dropped warm into the ear. Lindanus advises the gall of an eel mixed with spirit of wine; and others, the fumes of sulphur conveyed into the ear, with a pipe or funnel. But regard must be had to the cause, if discoverable.

Of a Tinnitus, or Noise in the Ears.

Hoffman observes, that this is caused by spasms of the coats of the ear, which line the inward parts, such as the labyrinth, cornea, and auditory passage, which is often attended with intolerable anxiety.

The cure is to be performed, says Heiliger, by temperate diaphoretic powders, and resolving essences, commonly called anticatarrhales; as of amber, the woods, rosemary; together with diaphoretics and alexipharmacs, taken often in a day, with tea of betony, with rosemary flowers, sage, or lavender and saffrafnas. In the morning, and at noon, the essences are to be taken; and at night the powders.

Outwardly, essence of amber may be applied, either alone, or with a few drops of oil of amber, or one or two drops of camomile put into the ear with cotton, morning and evening; or a grain or two of amber and musk, or castor in cotton, either alone or with Peruvian balsam; or carminative oils, such as anise, fennel, carraways, or calomel; not neglecting pediluvia, and frequent rubbing of the feet and head.

Of a Coryza, or Catarrh of the Nose.

A Coryza is too great a moisture of the nose, by a thin sharp serum, which gradually becomes thick, and sometimes coloured.

The cause of this disorder proceeds from the lymph and mass of blood, most commonly in the winter-time, which hurts the nostrils; at first it arises from a thin, sharp humour, which excoriates the parts, which, becoming more thick, almost stops the nostrils and hinders breathing. Sometimes it arises from sternutatories too often taken, and from mineral fumes; this is accompanied with spitting and a cough. Sometimes the effluvia, affecting the nostrils, have the nature of a ferment, and become infectious.

As to the prognostics, it is without danger, unless the lymph is exceeding sharp and ulcerates the nostrils, and so degenerates into an ozena, or forid ulcer of the nostrils. Hoffman says, this excretion is often salutary, and is exasperated by purges.

With regard to the cure, the irritation is to be stopped in the beginning, by joining laxatives with sudorifics, according to the condition of the patient, the season of the year, and the reigning diseases. To stop the irritation, oil of aniseed is very proper; but if the nostrils are red, painful, and excoriated, it must be mixed with barley-flour well dried. Camphor dissolved in oil of almonds is likewise good externally applied, and the smell of horns when rasped, as well as the vapours of gum-anime, received into the mouth and nose. The vapours of amber, frankincense; mastic, and benjamin, are likewise useful. A coagulation of the mucus may be evacuated by distilled oil of marjoram, amber and aniseed, mixed with leaves of marjoram, and made into snuff; or, by a sternutatory of calcined white vitriol, twelve grains of which may be mixed with two ounces of marjoram water, and filtrated. If the nostrils are obstructed, the vapour of vinegar upon hot iron will be profitable. If the head is heavy and dull, the vertex should be anointed with balsam of Peru, which may may be made stronger with oil of amber. To preserve the mouth, troches may be held therein, made with nitratae and alburnum.

To preserve the fauces and windpipe, it is common to take tannis steeped in spirit of amied.

Of the Ozena,

The ozena is a sordid ulcer affecting the nostrils; wherein the humour is very acrid or corrosive, intolerably fetid, fainous, and often mixed with a bloody mucus.

With regard to the cure, the leaves of tobacco, or tobacco ointment, are very useful: If it gathers to a crust, it may be removed by oil of sweet almonds. Some make use of the fumes of cinnabar, or inject mercurius dulcis; others use precipitate mixed with an emollient ointment, and applied with tents. Some use an injection of oil of sweet almonds, an ounce with a dram of oil of castor to soften the acrimony of the humours. If the pain be great, they add a scruple of camphor and saffron, with half a scruple of opium. To take away the crust, they make a powder of rosemary and lavender flowers, dried lemon-peel, and common snuff.

When the matter is well digested, the running abated, and the pain gone, it may be cicatrised with lotions, and washed with warm milk.

Of Watching,

Watching is produced by too great a determination of the nervous fluid to the organs of the senses: from its too great influence in the brain, while the lower parts are obstructed with colds or other causes, as in hypochondriac, melancholic, and mad patients, whose lower parts are cold; by any irritating body, in whatsoever part it is placed, which disturbs the senses, and especially the brain: from too great a motion of the humours, while the passages of the brain are open; from disorders, in which the causes above-mentioned are predominant; as fevers, phrensy, melancholy, pains, suppurations, and such-like disorders.

When the cause is known, it must be removed, if possible; and the irritated spirits must be appeased with emulsions, especially of poppy seed, or with the thebaic tincture, or theriaca and other opiates in general, not neglecting the original diseases. In fevers, a moist softening diet is beneficial; as also preparations of barley, emulsions of poppy-seeds, and almonds, decoction of scorzonera-roots, almond cream, and winter-flummery, used as aliment; likewise tea made of cowslip-flowers, and gentle laxatives. When the patient is restless and wakeful the night before a crisis, no hypnotics should be given.

When there is no other disease, the patient should shun all care, and intense thinking, especially in the evening; he should use exercise, and eat light suppers. If it is caused by pains, they should be appeased by antispasmodics, things which temperate, and diaphoretics: if these will not do, mild opiates must be added. In old persons, all care and solicitude should be banished, the mind should be quiet, and the moderate use of generous wine may be allowed in the evening; likewise medi-

cines of amber and musk will be proper, and confecio alkermes or theriaca with wine. The drinking of hot water, and principally coffee, must be forbid after dinner.

Of the Incubus, or Night-mare,

Willis observes, that the incubus rarely seizes any one, except during sleep, and when the stomach is oppressed with aiment of hard digestion, especially if the patient lies on his back.

Those that are seized with it, seem to have a heaviness on their breasts, and about their precordia; and, if they want to speak, they cannot: sometimes they see spectres of various forms, and cannot get rid of the load, or move their body, but after a long struggle: at length they awake, and the imaginary weight vanishes; but sometimes they find a tremor of the heart, and many times a quick and violent vibration of the diaphragm.

Heister observes, that those who have troubled dreams, or walk in their sleep, are to be cured in the same manner, as proceeding from the same cause, and should purge, bleed, and use a spare diet.

Emuller is much of the same opinion, and advises the patient to eat slight suppers, and to lie with their heads raised pretty high. If it be very troublesome, anti-epileptics may be used, as well as medicines prepared of steel. It frequently affects children, because they eat more than they can digest. There are some instances of its being mortal; though it is generally without danger. Dr White has proved that the incubus is owing to wind in the stomach and bowels; and therefore recommends a dram of brandy before going to bed.

Of the Syncope, or Fainting,

Heister observes, that this disorder may arise from want of strength from profuse bleeding, from sudden and violent terror and dread, or from the sight of any greatly affecting thing. The patient is deprived of sense and motion, either wholly or in part, with paleness of the face, and a very weak or low pulse. They are generally roused by shaking and pulling, or by volatile medicines; which distinguishes it from the apoplexy.

There are two kinds; the one flight, the other grievous. The flight kind is attended with paleness of the face, disturbed vision, ringing of the ears, and sometimes with a vertigo; the strength fails, and the patient is almost deprived of sense, falls or sinks down, till some proper remedy is applied to the nose and mouth. The more grievous sort is, when the patient falls into a delirium, and is deprived of all sense and motion, except breathing, and a very small pulse; but yet he may be roused by spirituous medicines and other means, much more easily than in the apoplexy.

Besides the causes already mentioned, there may be added the hysterical passion, which seems to proceed from spasms; some of this sort are thus affected with the smell of sweet things. Some incur this disorder by deep study, great inanitions, and fasting.

With regard to the prognostics, it has generally more terror than danger attending it, unless it proceeds from profuse bleeding, or wounds, or a lefe of strength by o- ther diseases, or a most violent terror. The lighter fainting-fits have little danger; and patients are brought to themselves by volatile medicines, taken by the mouth, or applied to the nostrils.

As to the cure, if the lighter sort happens when a vein is opened, or from the sight of blood, wounds, ulcers, or any chirurgical operation, which proceeds from horror and fear, affecting the imagination, it often happens that changing the room, and going into fresh air, will perform a cure. But if anything hinders this, that they can neither walk nor leave the room, the smell of hungry water alone, or volatile spirits, or wine and strong vinegar, or sprinkling the face with cold water, or a draught of generous wine, will bring them to themselves.

In more grievous fainting fits, where gentle cordials are of little use, the stronger sort must be applied, such as spirit of sal ammoniac to the nostrils, temples and pulses, with strong frictions; or 40 or 50 drops of volatile spirits may be given inwardly, to which may be added cinnamon water, orange-flower-water, or the like; not forgetting a draught of generous wine, with vellications and frictions of the extremities of the nose, ears, head, hair, &c. till they recover.

When the patient is hysteric, none but fetid things should be applied to the nose, such as caltor, afa-sectida, partridges feathers burnt, or burnt leather, horn, or the like; as also fetid spirits, in a grievous fit; not omitting vellications and frictions of the aforesaid parts.

Of the Spasm of the Lower Jaw.

In the spasm of the lower jaw, when the patient can neither open his mouth, nor eat, as when persons are wounded, and something foreign is lodged therein, or when the nerves are hurt, or when sharp things, such as vitriol, are applied to stop the blood, the cure must be performed according to the diversity of causes, as particularly treated of in surgery. But when this happens spontaneously in infants, they generally die, though the best nervous and antispasmodic medicines have been used both inwardly and outwardly.

Of the Cynic Spasm, or Convulsion of the Muscles of the Mouth.

A Cynic spasm, if it proceeds from vegetable poisons, as it generally does, they are to be expelled immediately from the body by a vomit, and then giving generous wine, warm with ginger or pepper. If it happens from other causes, it must be treated with antispasmodics and nervous medicines, both inwardly and outwardly; and chiefly with plaster of betony and bay-berries, prepared with oil of amber, and applied to the temples, and behind the ears.

Of the Palpitation of the Heart.

The heart often palpitates so much as to be heard at a distance by the bystanders, which they suppose to be an affection of the thorax. This may sometimes happen, from a violent motion of the body, chiefly when ascending high places, and principally in those who are plethoric and hypochondriac. Sometimes it is caused by fear or dread, when the blood is forced too violently to the heart. When it proceeds from violent motion or terror, and returns often, it causes a kind of polypus, as is evident from the dissection of those bodies who have died of this disease. Hence, almost a continual palpitation arises. Sometimes it proceeds from a bad conformation of the heart and the neighbouring vessels, such as an aneurism of the aorta, when it becomes boney.

Others affirm, it sometimes may be caused by wounds in the ventricles or abscesses in the heart; or from wind, or a disorder of the animal spirits, inducing spasmodic affections.

In the beginning of the cure, if the patient is plethoric, or when usual bleedings have been kept, it will be proper to bleed, by way of preservation, in the spring and autumn.

Besides this, saline, nitrous, and cinnabarine temperating medicines are to be used, particularly antispasmodics, to appease the motion of the heart, and render the blood more fluid. The aqueous infusions of tea, balm, veronica, primroses, or citrons, are likewise proper, especially with the essence of scordium, carduus benedictus, citron, or orange-peel, with a little dulcified spirit of nitre, taken morning and evening; as also temperate pediluvia, moderate frequent exercise, riding, moderate diet, plenty of thin drink, whey, mineral waters, especially the chalybeate kind, are very useful in this disease.

Of a Polypus of the Heart.

A Polypus is a mass composed of various pellicles and fibres, generated in the heart and large vessels. They are generally founded in acute as well as chronic diseases; and there are few bodies to be met with, wherein they are not to be found after death. Its principal seat is in the heart, pulmonary artery, and the aorta.

They principally attack the sanguine constitutions, and patients who have smaller vessels, soft fibres, of a sedentary life, who drink little, or are free in the use of acid wines and spirituous liquors, as also those who eat large suppers.

The beginning of a polypus may be known by a compression of the breast, a fixed pain about the heart, and when it increases there is a frequent palpitation of the heart, from a slight cause, and the pulse is strangely unequal and often intermits. When there is a violent motion of the body, or the patient has taken a medicine which disturbs the blood, or the mind is violently affected, a shortness of breath and an incredible anxiety of the heart will arise. Lastly, there are frequent faintings without any evident cause, or from a certain position of the body. If the blood is let fall into hot water, it will congeal like jelly, and cleave into white filaments.

In the cure, an exact regimen and diet must be made use of, with a frequent exercise and motion of the body, and mineral waters, especially those of the chalybeate kind, and abounding with alkalious salt.

Of the Hiccup.

A Hiccup is a spasmodic affection of the stomach and diaphragm, arising from anything that irritates and vellicates their nervous coats. When it proceeds from a slight error in diet, it will soon end spontaneously, or by drinking any thing which dilutes the acrid matter. Sometimes it is of a more grievous kind, and may proceed from a hurt of the stomach, poison, an inflammation of the stomach, intestines, bladder, diaphragm, or the rest of the viscera. Sometimes, immediately before death, it may proceed from gangrenes of the outward parts. In acute fevers, and chiefly the malignant, a hiccup is frequent, and often fatal.

When it happens in old or weak persons, from a plentiful meal, especially from hard and flatulent aliment, a draught of generous wine, or a dram of any spirituous liquor, will generally take it away. Likewise stomachic powders mixt with Peruvian bark, and taken in generous wine, are profitable; as also if it proceeds from cold, or drinking cold liquors.

When it proceeds from other causes, especially from acid humours in the stomach, absorbent and alkalious medicines are good. If it proceeds from an acute fever, or an inflammation of the stomach, it is a dangerous disease. However, dulcified spirit of nitre, joined to an alexipharmac, and given often, is proper; a dram or two of diacordium, given in the evening, may perform a cure. If it proceeds from a gangrene or mortification, it is generally incurable; but Peruvian bark, with medicines against internal inflammations, is most likely to succeed. If a poison is the cause, plenty of milk must be taken with oil, as has been already taught.

Of the Soda, or Heart-burn.

This disorder is a heat or troublesome burning about the pit of the stomach, or its left orifice, which sometimes is extended the whole length of the oesophagus, with a pressure or spasmodic constriction, usually attacking the patient by fits. The cause is generally fat aliment, if cold drink be taken soon after. In some it proceeds from acids, in others from aromatics, spirituous liquors, or bilious humours. It frequently torments pregnant women. This disorder is generally slight, and vanishes of its own accord; but in some it is of long duration.

In the cure, the cause must always be attended to: If from acids, absorbents are proper, particularly crab's-eyes and prepared shells, mixed with a fourth or fifth part of powder of nutmeg, given to half a dram. It is common to take chalk alone, or mixed with nutmeg; but care should be taken not to be too free in its use. Oil of tartar pér deliquium, given from 20 to 30 drops, in tea, coffee, broth, or warm beer, is usually efficacious; as also tincture of tartar and spirit of hartshorn. If it proceeds from bilious humours, 30 or 50 drops of dulcified spirit of nitre in water, tea, or coffee, will take away the pain. When it is caused by fat things, and draughts of cold liquor, a dram of brandy is good. Now and then laxatives should be given, to carry off the humours. In sanguine constitutions, bleeding may be proper.

Of the Cardialgia, or Pain of the Stomach.

Of all pains of the stomach, the cardialgia is the most severe. It is a spasmodic pain of the orifice of the stomach, sometimes of the right and sometimes of the left. One kind of this disorder may proceed from a sharp caustic, or poisonous matter; sometimes it arises from a redundant or caustic boil, or from a dysentery. At other times it may proceed from the blood, when any usual evacuations are suppressed, and the nervous membranes of the stomach are distended thereby. Hence it often happens to women after the fiftieth year; and, in the cure, bleeding or scarifications are proper; on the other hand, if it is deduced from a caustic matter in the stomach, oily appeasing things, as milk, an infusion of camomile flowers, cream, with absorbents, are proper. It must be distinguished from a painful inflation of the stomach, in which there is a tumour like a bladder under the false ribs, chiefly on the left side, and under the pit of the stomach; but the inflation is generally on the right side, with great difficulty of breathing. This is common in infants before they are weaned; but more so in hypochondriacs, if they are too luxurious.

If it proceeds from the remains of the aliment grown sharp, whence flatulencies arise, it generally gives way to tea or coffee alone, or a decoction of camomile flowers, especially mixed with stomachics; likewise preparations of fennel, anise, orange peel, and other carminatives are useful; as also a dram of the powder of orange peel, or camomile flowers, with a few grains of saffron, in an ounce or two of wine.

When the stomach is too much filled with aliment difficult of digestion, or fat things, a gentle emetic will be necessary, especially if there is a nausea or reaching to vomit; after which, a sufficient quantity of warm water must be drank, to wash the stomach: this will be best promoted with a decoction of cardus benedictus, or half a dram of tartar-vitriolate, salt of wormwood, and the like; after which stomachics must be given.

In a very violent cardialgia, from congestions of blood, vomits are improper, but bleeding necessary, with anti-spasmodics of tartar-vitriolate, nitre, cinnamon, crabs eyes, and the like, in a proper vehicle; as also spirit of hartshorn mixt with tincture of tartar to 50 or 60 drops. To these may be added emollient and anodyne clysters, and a bladder of hot milk, with camomile flowers, applied to the pit of the stomach.

Of Flatulencies and Eructations.

The cause of these disorders is generally a weak stomach, and crude flatulent aliment, such as peas, beans, lentils, celeriacs, turnips, radishes, hard fat flesh, and the like; which degenerate into wind, creating great anxiety, if not evacuated, and difficulty of breathing. It is a disorder familiar to hypochondriacs, and, the stomach being strongly contracted, the wind breaks out with violence.

Another cause of flatulencies are congestions of blood in the branches of the vena porta; whence proceed anxieties of the pectoral region, difficult breathing, colic pains, and the cardialgia, and, by consent of the stomach with the head, pains in the head, the vertigo, and watchfulness.

If it arises from crudities in the stomach, evacuations are necessary first of all; and then strengtheners, aromatics, bitters, and carminatives, such as have been mentioned in the preceding diseases; with a sparing diet and exercise.

If it proceeds from congestions of the blood in the branches of the vena porta, which is the case of hypochondriacs, or when usual bleedings are suppressed, a vein... must be opened; if the body is costive, an emollient clyster or a gentle laxative will be proper. If these fail, chalybeate medicines must be used, such as the tincture of vitriol of mars, steel-filings finely powdered to 6, 8, or 10 grains, or oil of cinnamon with sugar, or bitters, or spaw-waters, with constant exercise.

Of Worms.

Worms are various with respect to their shape and magnitude, and have their seat in the stomach and intestines. The round are furnished with a proboscis, and a kind of crooked claws, wherewith they sometimes gnaw and tear the membranes. If these lodge in the stomach, their bites are attended with an inexpressible pain, anxiety, inquietude, nausea, and flux of spittle; a fetid smell exhales from the mouth; the countenance is now pale, and then red; there is an itching of the nostrils, with an inclination to vomit, and a dry and troublesome cough by fits, and sometimes fainting.

When they are contained in the intestines, especially the ilion, then they produce the following symptoms. The belly is strangely distended, especially in infants, and they seem to be afflicted with the tympany, with now and then a diarrhoea, and the faces are of an ash-colour, not unlike cow dung; the upper parts waste away, insomuch that the bones are visible; and yet the appetite is great. The face is generally pale and tumid; the excrements seem to be full of cucumber-seed, or the like.

The signs of the ascariides are as follows: Their seat is chiefly in the grofs intestines, and they are most plentiful in the rectum. They are like book-worms, and are thrown out in large quantities. They have many things in common with the other insects, and produce inflation of the belly, leanness, and a nausea; they are attended with a great itching of the anus, and cause fetid excrements.

The broad worm, called tenia, is like a narrow tape two or three ells long, or longer, divided through the whole length with crofs joints or knots. Andry affirms, that there is only one in the body at a time, and therefore is called folium.

The Greeks called the remedies against worms anthelmintics; the most approved of which are asa-foetida and sagapenum, especially if mixed with purges, such as mercurius dulcis, and extract of rhubarb in pills; with this caution, that before and after the use of them, a few spoonfuls of salad oil, or oil of sweet almonds should be taken, for all things of that kind are of great use. The seeds of cina, santonicum, and tanfey, are likewise useful, by resisting the putredinous colluvies, and restoring the tone of the intestines.

Some affirm, that bitters are good remedies, as the tops of wormwood, the lesser centaury, scordium, and flowers of tanfey; likewise Peruvian bark, and eleutheria, in beer or wine, chiefly canary, in which some spoonfuls of the infusion or decoction should be taken every day. Aloes, myrrh, and corallina, are likewise powerful medicines in a proper vehicle, or with honey, in the form of an electuary. The fresh juice of water-cresses, taken every morning for some days, is likewise proper.

The filings of steel disturb the lumbrici and ascariides; as also Spaw waters; likewise spirit of vitriol or sulphur, and the elixir of vitriol: Wine itself is not a bad thing drank at meals.

Medicines of quicksilver are likewise good, especially half an ounce of it boiled in a pint of wormwood water, in a glass vessel, for half an hour, stirring the quicksilver with a stick: the dose is a spoonful for a boy, often in a day: an adult may take three, in an ounce or two of fuscive syrup of roses; or it may be boiled in milk, if the children prefer it.

If these fail, a purge should be given every third or fourth day; such as mercurius dulcis, with aloes, diagridium, resin of jalap, or troches of alhandal.

When internal things are rejected, the belly may be anointed with oxen gall made hot, two or three times a day, or with oil of coloquintida, or of wormwood, with distilled oils of wormwood and tanfey, to which the decoction of quicksilver with milk may be added.

To kill the ascariides, chalybeates are good, and mercurial purges, with clysters of a decoction of wormwood, seeds of cina, myrrh, and quicksilver, to which may be added an ounce and a half or two ounces of oil of wormwood made by decoction. Or the clyster may be of salad oil, or oil of sweet almonds, or linseed alone, and injected often.

The powder of tin has been used many years as a remedy against worms, and particularly the flat kind which often elude the force of other medicines; but the success of this depends upon the proper dose, and then it will have remarkable effects.

Take an ounce and an half of pewter, and grind it to a fine powder, and mix it with half a pint of treacle.

To adults give two ounces of the powder of pure tin, sifted through the finest hair sieve, mixt with eight ounces of treacle, after the patient has been purged with an infusion of senna and manna.

Of Difficulty or Suppression of Urine.

Difficulty of urine arises generally from a stone, or from an inflammation of the kidneys or the neck of the bladder. In sanguine persons, it may proceed from the suppression of some usual hemorrhage, or from the blind piles; or there may be a congestion of blood in the spongey or cavernous part of the urethra, which may be so distended and inflated, as not to transmit the urine, or at least with great difficulty. In some it may be owing to a spasm of the neck of the bladder, or to sharp urine; in others to a palsy of the bladder, or a carbuncle of the urethra; or from a tumour, abscess, or ulcer, in the prostrate gland; or from its being too large, or indurated, as often happens. Likewise in bloody urine it is not seldom suppressed; at least it is expelled with great pain and trouble, which proceeds from a concretion of blood. Etmuller affirms, that a dysuria is generally occasioned from the want of mucus of the urinary passage, or its being worn off.

As the causes of an itchury are various, they ought to be carefully distinguished from each other. When it proceeds from an inflammation of the kidneys, the pain and heat are principally in that region, attended with a fever; if from a stone in the kidneys, it is accompanied with vomiting; if from a stone in the bladder, there is a violent pain pain in the bladder, which is extended to the very extremity of the urethra; a mucus or pus is excreted with pale urine; and, upon proper examination, the stone may be felt; but the most certain sign is searching the bladder with a catheter. When this disorder arises from a stone in the urethra, it may be easily felt. If from an inflammation of the neck of the bladder, there is a tumour and pain in the perineum; but it may be felt perceived by thrusting the finger into the anus, and turning it up towards the bladder; for a tumour will be perceived by the physician, and by the patient a burning and pressing pain; and when a catheter is introduced into the urethra, an impediment will be felt near the neck of the bladder, which will hinder it from proceeding further. To these signs may be added, when the disorder is great, a tenesmus, a contraction of the anus, an anxiety of the praecordia, coldness of the extreme parts, vomiting, and a febrile pulse. When the cavernous substance of the urethra is too much distended with blood, and the urine is suppressed, a silver pipe cannot be admitted into the urethra, especially if the patient abounds with blood. When there is a spasm in the neck of the bladder, it appears from the causes aforesaid; and likewise the patient perceives a spasmodic constriction about the neck of the bladder, and a catheter will pass thereto, but no farther; and there are no signs of a stone in the urethra or bladder.

If the urine is sharp, and produces a spasm, we may discover it from its being very flanking, especially if the patient is old or scrofulous; and there are many saline particles in the urine like lime. When there is a caruncle in the neck of the bladder, it may be known from the signs mentioned in the lues venerea, where the cure is treated of. An abscess in the prostrate gland often is mistaken for a caruncle. When a scirrhus of the prostrate gland is the cause of a supposition, there is a hard or indolent tumour in the perineum, or at least the pain is not great.

When the urinary passages are obstructed by solid bodies, that is, the pelvis of the kidneys, the ureters, or the neck of the bladder, or the urethra, from a stone contained therein; if it be small, diuretics will be proper, which are mentioned in a fit of the gravel or stone; to which may be added a decoction of eringo-root and Epsom salt or Selters waters taken often therewith. But if the stone is large, and cannot be excreted by these means, strong diuretics are highly hurtful, and it must be cured by section; (see Surgery.) But if the patient is too weak, or too old, and cannot undergo the operation, the stone, if possible, must be driven back; and the pains must be appeased with antispasmodics internally, and with lenients, lubricant and oily medicines, as well as gentle analgesics: Externally, with emollient clysters, ointments, liniments, and baths. If the pains are violent, lenient injections may be thrown up into the bladder, of salad, linseed, and white poppy oil, or oil of sweet almonds, or a decoction of linseed or roots of mallows in milk, with the addition of a little fresh butter. This done, the patient must have recourse to lime-water.

If the urine is suppressed from an inflammation of the kidneys or bladder, diuretics are pernicious, and mineral waters not safe; but rather refrigerating nitrous remedies, neutral salts, crabs-eyes, tartar-vitriolate, may be given, with a grain of camphor in every dose. To render them more efficacious, they may be joined to a decoction or infusion of parsley-roots, eringo-tea, ground-ivy, or the like; likewise emulsions of the four colds seeds, with crabs-eyes, calx of antimony, and nitre, or seeds of violets, which are laxative and gently diuretic: to these may be added fomentations, and a bladder filled with hot milk or water, or emollient and resolvent cataplasm, applied to the region of the kidneys or bladder, or perineum, according to the place of the inflammation, as well as baths of the same kind; but above all, bleeding is necessary, especially in the plethoric, and the promoting of usual hemorrhages. In the mean while aperients and resolvents must be given, such as powders of crabs-eyes, arcum duplicatum, tartar-vitriolate, and nitre; or medicinal waters, with bitter cathartic salts given now and then.

When the spungy substance of the urethra is swelled with blood, and as it were inflated, a copious bleeding is the principal remedy.

When a spasm affects the neck of the bladder, it must be treated with temperating and antispasmodic powders, diuretic waters, and infusions, with emulsions, or lenient oils now and then, such as salad-oil, oils of sweet almonds, poppy or linseed: externally, cataplasm, ointments, clysters, and baths, of the emollient and demulcent kind; with gentle opiates, if the disease requires them.

If the spasm proceeds from a sharp urine, from the surly, or otherwise, it must be treated with gentle purges and diaphoretics, and absorbents, such as crabs-eyes, mother of pearl, prepared chalk, calx of antimony, and amber; with lenient decoctions of china root, farfara-pilla, or mallows, with emulsions and demulcent oils; to which may be added syrup of marsh-mallows; when the pains are violent, they must be appeased with moderate opiates.

If the difficulty proceeds from blood remaining in the bladder, or its neck, the concretion is to be resolved and expelled with warm infusions of digestive herbs drank like tea, such as ground-ivy, arnica, chervil, or veronica; with tincture of tartar, or liquor of the terra foliata of tartar, with digestive powders of crabs eyes, saturated with the juice of oranges or lemons, sperma ceti, tartar-vitriolate, nitre, and cinnabar: to which may be added the water of chervil or parsley; with roasted onions applied hot to the region of the pubes, perineum; or cataplasm of wheat-flour boiled in milk, with butter and a little saffron, or with white lily roots, mallows, marsh-mallows, or camomile flowers applied to relax the spasm of the neck of the bladder; or with a bladder of hot milk, in which camomile flowers have been boiled; with emollient and resolvent clysters of camomile-flowers boiled in milk, with oil or fresh butter: but, if all these fail, a catheter is to be introduced into the neck of the bladder, to break the concretion, and evacuate the urine.

When there is an ulcer in the bladder, which will appear from purulent and fetid urine, with a most violent pain in the bladder, as if a stone was contained therein; all sharp and stimulating things must be avoided, and the infusions of vulnerary absorbent roots and herbs must be given with mucilages and soft balsamics, especially balsam of Mecca, Tolu, &c., with a moderate use of quicksilver, especially especially if the case is venereal. Then mineral waters may be drank, either alone or with warm milk, for several weeks, or the hot bath waters: to these may be added injections of a decoction of the traumatic herbs, such as agrimony, St John's wort, plantain, or yarrow; or, in their stead, milk with syrup of marsh-mallows, or fresh butter, or oil of St John's wort.

If there is a difficulty of urine in pregnant women towards the last months, diuretics must be shunned. The best remedy in this case is to ease the pressure upon the part; but, if that will not do, to use a catheter.

Lastly, if it proceeds from a swelling of the prostate gland, or if it is become scirrhouss, it must be treated as such, as will be hereafter taught.

But, if these remedies will not do, the bladder must be pierced with a trochar, which is called the puncture of the perineum; and, when the perforation is made, the water must be evacuated, as in the dropy: The instrument must be left in the wound, and be fastened in such a manner that it does not fall out, so that the urine may be made as often as there is occasion: It is a troublesome operation, but the only one left.

Of the Diabetes.

A Diabetes happens when the urine comes away crude, exceeding the quantity of liquids drank, attended with weakness, which generally proceeds from the kidneys, which are too weak and lax, especially in those who have been accustomed to drink too much. Heist.

Lister observes, that a diabetes comes slowly on, and is a long while in breeding. In the beginning, the mouth is dry, and the spittle a little white and frothy; the urine being somewhat more than usual, with a small thirst. A heat begins to be perceived in the bowels, which is a little pungent; the patient falls away, and the mind is anxious and unstable. In time the thirst greatly increases, the urine is plentiful, and the body wastes. When they make water without intermission, the thirst becomes intolerable; and, though much is drank, it is not proportionable to the water. When the urine is retained a little while, there is a swelling of the loins, ilia, and testes, and it comes away with pain. Now death is at hand. The urine is pale, not sweet, but it is more sweetish at last than at first.

Strengtheners, moderate astringents, and species of hyacinth, with crocus martis, are good in this disease, especially with anodynes: or Japan earth, or the tincture of vitriol of mars, red wine with water in a small quantity: the drink should be sparing, and all excesses avoided. Exercise and frictions of the body are likewise profitable, because they strengthen the parts, and increase perspiration.

Lister says, almonds and a milk diet are proper in this distemper; as also wine with ginger; allowing in the mean time a draught of milk and water to allay the thirst.

Willis declares, he has often prescribed tincture of antimony with good success; and lime-water with sassafras, aniseeds, railins, or liquorice.

Of WOMENS DISEASES.

Of the Chlorosis, or Green-Sickness.

Sydenham looks upon this to be a species of the hysterical affection, and is known by a paleness and discolouration of the face and the whole body. The complexion appears a little sublivid or greenish, with a red or dark circle under the eyes; the face is bloated, the eyelids and ankles are apt to fweel; the whole body is heavy and dull; there is a tensive latitude of the legs and feet, difficulty of breathing, palpitation of the heart, pain of the head, a feverish pulse, a drowsiness; a pica, or desire of eating unfit things, such as coals, chalk, &c. and a suppression of the menses. The clavus hystericus often attacks patients in the height of this disorder.

The cure is to be attempted with chalybeate medicines, such as are prescribed in the hysterical disorder, given according to the patient's age, drinking wine after them; or the corroborating infusion with angelica root. If the patient is not very weak, she may be purged once or twice before the course is entered upon.

Heister recommends attenuants, evacuants, and strengtheners, with a good diet and exercise; particularly from v to viij grains of powder of steel, with half a scruple of a proper efosaccharum, or with bitter extracts given in the evening; as also emmenagogues at due times, with pendulvia and bleeding in the foot about the time of menstruation. If these will not suffice, he thinks matrimony a certain cure.

Of the Suppression of the Menses.

As soon as a healthy female arrives at her full growth, she generates more blood than can be conveniently contained in the vessels; wherefore the superfluity is evacuated by the uterine arteries, and is called the Menstrual.

Boerhaave observes, that in a suppression of the menses there is a plethora, with a little effluvium to motion; a heaviness, a paleness, a pain of the loins and of the groin; all the functions, whether natural, vital, or animal, are depraved. Sometimes the menses will force a way thro' the eyes, ears, nostrils, gums, the salival ducts, bladder, breasts, skin, wounds, or ulcers.

Hence often arises a depravation of all the viscera, as also diseases without number, partly from a putrefaction already begun, and partly from the hurt which the vessels have received.

From this disorder proceed want of appetite; the pica and malacia, or a depraved appetite. If it is habitual and obstinate, a scirrhus or dropy of the womb are to be feared, or a rupture of some blood-vessel, especially of the lungs. It is not so dangerous when the uterus is not infarcted, or when there is no other symptom of the menses. If this disease is attended with the florid albus, it may become habitual, and from yellow become green and acrid, corroding the uterus, and laying a foundation of a dropy therein.

Things which retard the menses are, immoderate cold, sorrow, a sudden fright, too great evacuations, incrassating ting diet, a crudity of the humours, acids, and astringent medicines.

This disorder is to be cured in the same manner as the hysterical affection; but, if the remedies for that fail, the patient must take every morning five spoonfuls of an hysterical julep, with twelve drops of spirit of hartshorn; and every night a scruple of compound powder of myrrh made into a bolus, or pills with syrup of lemons. Allen recommends cantharides and camphor; the dose is from two grains to six.

Hoffman directs chalybeates, or pills made of aloes, myrrh, saffron, amber, caftor, and round birthwort. Pitcairn thinks mercury more efficacious than steel.

If the fluids are inclined to stagnate, their fluidity may be preserved by fomentations and frictions of the feet; by opening a vein in the foot, and bleeding elsewhere; by giving uterine purges; by emmenagogues; by plasters, fomentations, liniments, vapours and heat; by strengthening the vessels debilitated with a plethora, by chalybeates and astringents.

Uterine cathartics are aloes, myrrh, bryony, colocynthus, gum-ammoniac, bdellium, sagapenum, opopanax, afa fetida, galbanum, and elixir proprietas.

Emmenagogues, besides the former, are, aristolochia, mugwort, motherwort, camomile, juniper, marjoram, marum, feverfew, pennyroyal, rue, savine, sage, elder, wild-thyme, tanfly, thyme. To which may be added balm, roemary, well-flowers, saffron, bay and juniper berries, amber, rhubarb, and aromatics. As also borax, alkaline and volatile salts; warm, stimulating, acid, and aromatic oils; the barks of guaiacum, sassafras, cinnamon, and juniper; the rinds of oranges, citrons, and lemons.

Resolving plasters are those of cumin, melilot, galbanum, bayberries, labdanum, oxycroceum, which must be applied to the soles of the feet, navel and groin. The fomentations may be made of Venice soap, and some of the above mentioned herbs.

Of the Immoderate Flux of the Menses, or Uterine Hemorrhage.

Every large flux of blood from the uterus is not to be esteemed noxious, but such only as is attended with loss of strength, which brings on other symptoms, such as want of appetite, crudities from indigestion, a sensation of weight near the regimen of the stomach, an ill colour in the face, a languid pulse, often with a gentle heat, an oedematous swelling of the feet, and a disturbed sleep without refreshment.

Sometimes the menses flow in too great plenty and with impertinency at the usual period; sometimes twice or oftener in a month; sometimes again they continue several days longer than ordinary.

This flux sometimes consists of thin florid blood, which happens chiefly in abortions; and from a retention of pieces of the secundines, which keep the mouths of the vessels open. Sometimes there are coagulated and clotted masses like flesh come away with the blood, of the size of an egg, which is occasioned by a stoppage of the menses for two or three months. At other times the blood is grumous, coagulated, and black; generally on the first days of child-bed, in slender and plethoric subjects. When the patient is cachectic, and the flux continues long, it is thin, watery, and mucid. In the scorbutic, it is corrupt and fetid, with acrimony and pain. In the younger sort, before child-bearing, if the evacuation be immoderate, it is commonly followed by a fluor albus, or the dripping of a white, impure, mucid matter.

The cause may be referred to a copious and impetuous afflux of blood to the uterus, and an unequal and impeded reflux by the veins; which distending and relaxing the uterine vessels, make the orifices too wide, or rend and corrode them, by which the blood flows too freely. This may happen from a plethora, or when there has been a long suppression, or an abortion, or a difficult labour. It generally happens to women about the fifteenth year, when the menses are going to leave them; and not always without danger. It sometimes happens to women upwards of sixty, which, if attended with a slow fever, halts death.

The concomitant signs are generally these: A tension and inflation of the hypochondria, a heavy pressing pain about the loins, sometimes with a chillness; a coldness of the extremities, a sinking of the vessels, a paleness of the face, a quick pulse, with an internal heat, a costiveness, and little urine; all which shew there is not only a debility and laxity of the uterus, but spasmodic strictures of the vasaous and nervous parts, which force the blood to the uterus.

If the body is cacochymic or scorbutic, or full of bad humours, or afflicted with the venereal disease; when the viscera are unfound, and the liver, spleen, and mesenteric veins, are stuffed with thick blood, the case is dangerous and troublesome; for the fault of the fluids and cachexy continually increase: Besides, the more the strength is weakened, the more the stomach and digestion are hurt; the blood is depraved, and the excretions disturbed and lessened. When this happens to women when the child is dead, their lives are in great danger, and nothing but speedy assistance from a man-midwife can save them. The case is also dangerous when the secundines are violently extracted, or parts of them are retained, and which sometimes degenerates into moles.

Immoderate evacuations are produced by a sedentary life, which gives room for abundance of thick chyle and milk. It is caused likewise by too frequent use of salt, acid, and seasoned meats; by spirituous liquors, &c. by violent agitations and passions of the mind, from losses, gaming, love, anger, &c. It may be observed likewise, that violent exercise does as much harm as the moderate is serviceable, especially if the patient is subject to this flux from other causes; such as immoderate repetitions of the venereal act, especially in women of a delicate constitution; too frequent child-bearing.

The cure should respect the restraining a present flux, and the keeping within bounds a future one.

It should be begun with rest, if convenient, in bed; the patient lying on her back, and silent as much as possible. Bleed in the arm, according as the constitution and strength of the patient, as well as the urgency of the symptoms, will admit or require. Avoid ligatures of the limbs. Let the patient fare slenderly on veal and chicken broths; broths, fish soups; and drink a pifan of nettle-tops, yarrow, and plantane, with orange-peel, or of the greater comfrey; if she be hot and bilious, with linseed.

If these fail, have recourse to all remedies.

Of the Fluor Albus, or Whites.

The fluor albus consists in the efflux of a whitish, lymphatic, serous, or aqueous humour, from the matrix. It is sometimes white, sometimes pale, yellow, green, or blackish; sometimes it is sharp and corrosive, sometimes foul and fetid: the face is discoloured, there is a pain in the spine of the back, the appetite is lost, and the eyes and feet swell. Some women have a periodical flux of the whites instead of the menses.

The symptoms are, a pain and weight in the loins, which is worst in the lymphatic flux, as being attended with a swelling of the uterus, turbid urine, barrenness, a propensity to abortion; a loathing of some things, and longing for others; indigestion; thickness and crudity of the blood; whence proceed oedematous swellings of the feet by day, and of the face by night; difficult breathing, palpitation of the heart, syncope, relaxation of the ligaments of the uterus, a total or partial procidentia uteri; if the flux is acid and corrosive, it ulcerates the vulva; creates phlyctena; which last generally proceed from a scirrhus or cancer in the uterus; a slow fever; dropsies of different parts; of which, or a consumption, the patient generally dies.

It may be known from a virulent gonorrhoea; because this is attended with pain and an inflammation of the external parts of the pudenda, chiefly about the clitoris; heat, sharpness and difficulty of urine, pain in coition; it makes its progress sooner. If the gonorrhoea is inveterate, it is very like a fluor albus.

Besides arterial blood, the menses consist of redundant lymph or serum, chiefly from the membranous cells, and ventricles of the glands of those parts of the membrana cellulosae which are more immediately connected with the kidneys, uterus, and ovarium. When this lymphatic secretion becomes morbid, it is called the fluor albus. At first the parts of the membrana adiposa of the loins, kidneys, and uterine appendages, are wasted by it; but at length the flux becomes acrimonious, and may melt and carry off all the fat of the body.

The fluor albus sometimes is discharged from the uterine vessels, and sometimes from the glands of the vagina: in the first case it stops when the menses begin to flow; in the latter it continues with them, and pregnant women are not exempted from it.

When this flux is unseasonably stopped, it causes the belly to swell, with pains of the loins, slow fevers, numbness of the joints, and great languor of the body.

When the flux is lacteous, it may be cured in fifteen days. The patient must feed sparingly, use frequent exercise, and sleep little. If this is not complied with, she must bleed in the arm once or twice a month, and take purges and emetics, or at least frequent clysters. The efficacy must be assisted with diaphoretics, decoction of the woods, and diuretics.

In the semiflaccous flux, infilling and nourishing diet will be best, such as creams, soaps, boiled milk, roast meat, jellies, &c., milk, or milk turned with a decoction of china, is very good.

Narcotics are highly useful, especially if the patient is restless, or delirious. In the beginning the dose must be small, which may be gradually increased.

When the vesiculae lacteae are relaxed, the tone must be restored with hot mineral baths, fomentations and injections of and bathing in the same. The stream may also be conveyed into the vagina with a funnel.

Decoctions of the woods are also good as diaphoretics; and diuretics of a decoction of roots of eringo and rest-harrow, with powder of millepedes, or glaucer's salt.

If the lymphatic flux is attended with a scrophulous, scrofulous, or venereal taint, these disorders must be first removed. If the uterine lymphatics are compressed by scirrhosities, cancers, ganglions, or the like, regard must be had to the causes.

In obstructions of the glands of the uterus, begin with bleeding; then a gentle purge, or an emetic of 12 grains of tartar emetic or ipecacuanha. Afterwards, if the patient's constitution is cold, attenuating aperients. If the hot and bilious, with a sensible pain in the uterus, cooling broths and apozems, with the addition of crayfish; asses milk, with a decoction of barley; chalybeate whey, with chervil boiled therein. Gently purging mineral waters, baths, and half baths, are convenient in the summer.

Of the Furor Uterinus.

Salacity in women, attended with impudence, restlessness, and a delirium, is called the furor uterinus.

It arises from a too great sensibility or inflammation of the pudenda, or parts wherein the venereal stimulus resides, which are chiefly the clitoris and vagina; or the too great abundance and acrimony of the fluids of those parts; or both these causes may exist together.

In the delirium maniacum, the patient is entirely shameless; in the melancholic more reserved, and her folly is confined to fewer objects.

It may proceed from the abuse of hot aperitives; thus sal ammoniac, borax, and cantharides, have produced it: from powerful emenagogues in hot and bilious constitutions; sometimes from difficult and suppressed menses; from remedies given against sterility. Musk dissolved in oleum aromaticum, and rubbed on the membrum virile, has raised a phlogosis in the vagina, whence a furor uterinus ensued.

It is difficult to cure in those whose menses are difficult at first; in inveterate cases; in old subjects. It is easier cured, when the furor uterinus is essential, and the delirium symptomatic, than when the delirium is essential, and the furor symptomatic. The maniacal delirium is harder to manage than the melancholic. If it continues a month or two, the fault of the brain becomes obliterate, for it degenerates into real madness.

The indications of cure, are to diminish the heat and sensibility of the affected parts; to cool, sweeten, and dilute the blood, and to render it balsamic; or to pursue both intentions at once.

The first indication is answered by frequent and copious bleedings, as in an incipient madness; even to eight times in two days, if nothing forbids; if she faints, there is no danger. She must likewise be purged, as mad folks are, with jalap, scammony, diagrid. The dose must be increased one third, as being hard to purge. Emetics are also good; for they evacuate the bile, which abates the acrimony of the humours. In the intervals, order frequent emollient clysters; to which add half a dram of sal prunella, or a little vinegar morning and night, baths and semicupia; moderate the heat, irritation, and sensibility of the parts affected: as also emollient injections into the vagina, and somnations, or pessaries of cotton may be steeped therein; sal prunella may also be mixed therein.

Of an Inflammation of the Womb.

An inflammation of the uterus appears from extraordinary heat, and a fixed pain in the groin, with an acute fever, a pain in the loins and belly, an inflation of the abdomen, a stimulus to make water and go to stool; heat, and difficulty of urine; tumour, pain, heat, and tension of the hypogastric region; redness of the os uteri, and great heat of the vagina. If the fore-part of the uterus is affected, there is a dysuria or heat of urine; if the back part, a tenesmus, frequent faintings and cardialgia, a burning fever; or, if the inflammation is violent, a lypiria, in which the external parts or extremities are cold, and the internal burn, and the pulse is imperceptible; a delirium and phrenzy: the breasts swell in proportion as the inflamed uterus.

This disease may be said to be superficial or more grievous and profound. It is easy formed in child-bed women, and frequently accompanies the milk fever; and may be cured in a few days, if rightly managed: But when it is very intense, and attended with grievous symptoms without remission, it kills on the seventh, ninth, or eleventh day; and a white miliary fever generally supervenes, which is the worst omen, for it shews a mortification of the uterus. When this fever happens, there are spasmodic and painful strictures in the abdomen, the flux of the uterus is stopped, the body is coltive, the feet are cold; there is an urging to make water, which is painful; the head looks red, and swells; the eyes shine; drops of blood fall from the nose; the mind is disturbed; the sleep is little, with terrifying dreams: there is likewise most difficult breathing, faintings, convulsions, a phrenetic delirium, which commonly have a fatal tendency.

This disease should be distinguished from an inflammation of the bladder or rectum; which may be done from the place of the pain: in that of the bladder it is superficial, as if it were in the integuments; in that of the rectum it is very deep, as if about the os sacrum; in that of the uterus it is in the middle, with a violent heat in the vagina, if the finger is introduced. If the bladder is affected, there is an extraordinary heat and retention of urine; and a tenesmus, if in the rectum: In the bladder; the pain is precisely on the os pubis; in the rectum, the anus is affected. If these symptoms happen in an inflammation of the uterus, they are more slight.

If the inflammation is not resolved, it generally ends in a mortification, ulcer, or cancer. A mortification soon kills, and the womb and vagina after a distention appear to be of a blackish brown. If it ends in a suppuration, the disease is of longer date, which generally happens to women not in child-bed: It begins to discover itself about the ninth or tenth day, by the cessation of most of the inflammatory symptoms, which will return about the twelfth with a shooting pain in the affected part.

A gangrene or mortification happens on the fourth or fifth day, and is known by a weak, languishing, and intermittent pulse, and by a sudden cessation of all the symptoms.

If the disease exceeds the time of the former terminations, and the inflammation is superficial, it is apt to turn to an induration or scirrhus; which ulcerating, becomes a cancer, and is incurable. If, about the twenty-second day, there is a tenacity or hardness, and a dull heavy pain in the region of the uterus, there is a scirrhus formed.

Women in child-bed sometimes have the womb inflamed from the fault of unskillful midwives, or hard labour; or the lochia are stopped by pains, or hysterical spasms, dread, or cold; wherefore proper precautions should be used to prevent it; which may done by keeping them under a gentle diaphoretic regimen, and by allaying the almost febrile heat. Oil of almonds is proper alone, or with a fourth part of sperma ceti, given daily to half an ounce in chicken-broth; externally the whole abdomen should be anointed with oil of dill, camomile and white lilies, of each an ounce, oil of caraways a dram, or a dram of camphor; laying a warm napkin doubled over the same.

The tumult being thus appeased, the lochia are to be promoted with pills of bitter extracts, temperate resinous gums, and aloes well corrected, of which xv gr. is a dose morning and evening, to be continued from five to eight days. These are also good when the after-birth or part of it is retained.

If there is a fever, the belly is distended with wind, the lochia are retained, and the spasms tend to the upper parts, you must bleed in the foot.

The drink may be chicken-broth, with scorzonera-root, succory, and thavings of hartshorn boiled therein. As also tempering and resolving powders made of crabs-eyes, and their solution, nitre, and sal polychrest. To which may be added clysters of whey, camomile-flowers, mug-wort, fage, &c., with honey, nitre, and fat of hens.

In women out of child-bed the inflammation generally happens in the neck of the uterus and the vagina; and then, besides the foregoing things, you must apply epithems to the pubes, uterine injections, pessaries, and suppositories. The epithem may be of arquebusade water four ounces, essence of saffron, camphorated spirit of wine, of each two ounces, nitre a dram, dissolved in elder-flower water; and, as circumstances require, mixed with vinegar, or rue, or scordium, and applied with a double cloth. The injection may consist of asses milk, with flowers of elder, myrrh, and saffron; and a little nitre may be added to the decoction. The tenesmus may be appeased with emollient half baths, or with an ounce of oil of sweet almonds, and xij grains of saffron, injected into the anus. These remedies are useful in case of a suppuration. Of the Abscess of the Womb.

Abscesses of the womb are either inflammatory, tuberculous, or steatomatous.

The symptoms of an incipient abscess are much the same as the inflammation, such as pain, heat, tension, &c., which intermit for some time, and appear again, when the suppuration begins; of which the inflammatory is most sensible, the steatomatous the least. When the abscess is formed, all the symptoms of inflammation vanish: but coldness of the extremities, a slow fever, and marasmus, gradually increase from the absorption of the pus into the blood.

If no inflammation has preceded, and the patient was subject to obstructions, especially of the glands of the uterus, and had a lymphatic fluor albus, it may be tuberculous; if the tumour is soft and indolent, it may be steatomatous; but these are rare. The place may be partly discovered by the touch, but more especially by the complaints of the patient.

If it breaks into the bladder, and passes off by urine, or into the rectum, and is discharged by stool, or into the groin, it is dangerous; if into the abdomen, incurable: If it breaks into the vagina, it may become an ulcer, which is commonly mortal; or the patient may perish by a hectic fever before the eruption. The tuberculous and steatomatous are much the slowest.

The work in this case must be left to nature, in a confirmed abscess; unless it can be come at through the vagina, and opened with a lancet, and then detersive injections may perform a cure.

Of the Ulcer of the Uterus.

An ulcer may have its issue and seat in the concave surface of the uterus; or may be lodged more deep, and have issues into the rectum, bladder, groin, or cavity of the abdomen.

The causes of an erosion may be the fluor albus, or rather lymphatics; the corruption of the fetus, or placenta, in the womb; acrid or caustic injections; the frequent use of cantharides, the lues venerea, or acrimonious medicines.

If the ulcer proceeds from an abscess, it may be inflammatory, tuberculous, or steatomatous; if from an erosion, it may be venereal, scorbutic, scrophulous, or simple: It may be also simple, scirrhus, or cancerous.

The chief sign of an ulcer is the efflux of purulent matter; and the greater the quantity, the profounder the ulcer. If the flux is fuscous, or mixed with blood, the blood-vessels are eroded. Mortal hemorrhages sometimes supervene. Sometimes they may proceed from a fever, and rarefaction of the blood.

An ulcer is hard to be distinguished from a fluor albus; however pus is always more compact and fetid, unless it is lymphatic; and there is always a fixed pain from an ulcer.

All ulcers of the uterus are dangerous; when they are fistulous, or scirrhus, or both, they portend death: the same may be said of the cancerous; or when they are attended with a slow hectic fever, swellings of the feet, a marasmus, &c.

In order to the cure, it is necessary to know whether the ulcer is seated in the body of the uterus, or near the os uteri, in the vagina; or whether it be venereal, for the last must be treated as that distemper requires.

To correct the vicious acrimony of the blood, use broths, or decoctions of lettuce, succory, borage, with sal prunella; sometimes with veal or a pullet; also chalybeated whey, sweetened with syrup of violets. But the best thing is a milk-diet; to which, for variety's sake, may be added rice, eggs, a decoction of china, barley, &c., or cervil, agrimony, fumitory, or the second lime-water, or steel-waters alone. Likewise emollient baths or semicupia.

Injections of whey and brown sugar are good.

To consolidate the ulcer, use injections of agrimony, with the second lime water; or warm sulphureous bath-waters, and the fumigations of the gums.

To ease the pain, give gentle narcotics.

Of the Scirrhus of the Uterus.

Sometimes an inflammation of the uterus ends in a scirrhus, which is a hard, tenient, and indolent tumour, without heat and pain.

It is a very troublesome disorder, and often incurable, and the attempt to remove it is dangerous, though it is apt to bring on dropsies, a cancer, a marasmus, &c. Its seat is in the glands, lymphatic vessels, or lacteals of the uterus.

The symptoms are, a weight in the hypogastrium, when the patient stands or walks; difficulty of lying on the well side; if the tumour is painful, she is obliged to lie on her back; the menstres are suppressed; sometimes there are violent and dangerous hemorrhages; a dropsy of the abdomen or uterus: If it suppurates, there are signs of an abscess. It may be partly discovered by pressing the hand on the region of the os pubis.

If the tumour be small, recent, and void of pain, you may give broths of eringo, reft-harrow, and alparagus roots, of each half an ounce. Whey, with vitriolate tartar, or chalybeated whey, are very gentle. Or give a pint every day of vitriolic waters, for two or three months.

If these heat too much, she must drink asses or goats milk. This is a palliative cure. But, to dissolve the scirrhus matter, the patient must use baths, and half baths, of emollient decoctions. Emollient injections and moderate clysters are very beneficial.

When heat, pain, and tension of the uterus are perceived, forbear deobftruents, and bleed. Use no aperitives at the time of purging. At other times use diuretics and narcotics. If the tumour does not diminish, leave these medicines off, and have recourse to the palliative cure.

Of the Cancer of the Uterus.

A Cancer is a scirrhus become exquisitely painful. When there is a darting or lancinating pain in the scirrhus, and in fifteen days or a month it becomes much larger than it was before, and scabrous; that is, angular and rugged; and the skin that covers it is smoother, till a fissure appears; the lips of which are retorted, and an ichor or acrimonious ferocity proceeds therefrom, with a soft fungous flesh about the fissure; you have the progress to a confirmed cancer. The matter never becomes pus.

An ulcer of the uterus resembles a cancer, when a putrid fumes issues from the corrupted substance of the womb, with great stench, exquisite pain, and grievous symptoms. This disease is almost incurable.

The principal symptom of a cancer is pain, which is attended with restlessness, watching, indigestion; which produce a slow fever, consumption, marasmus, and the like.

A hard, tenacious, painful tumour, preceded by an indolent scirrhus, plainly evinces the existence of a cancer. If nothing is discharged by the uterus, but a limpid, pellucid lymph, it is an occult cancer; if acrid serum, or ichor, it is open.

There is nothing to be done in this case, but by demulcents and leniency. If there is any hope of cure, it must be placed in afflatus milk, the Selters waters, and in bathing in soft water wherein wheat-bran has been boiled; in which the patient must sit for an hour, or longer. She must abstain from all sharp, acrid, stimulating, and heating things.

Of the Procidentia Uteri.

It is a common disorder; and the uterus presents itself in the vagina between the labia, or is quite visible. Sometimes it is only the internal membrane of the vagina, sometimes the body of the womb.

This disorder is rarely dangerous, for women bear it a long time.

The cure consists in reducing the uterus, and retaining it in its place. To reduce it, order a simple clyster to evacuate the rectum; the patient should also bleed three or four times: Then emollient cataplasm should be used of white bread and milk, or of emollient plants; emollient baths are also to be employed. The parts being thus relaxed, the patient must lie on her back, with her hips higher than her head, and her legs quite asunder; then put back the uterus by degrees, where you find the least resistance, and without any violence. This done, the patient must be confined to her bed for about fifteen days, with her thighs closed, or her legs across, and her hips raised.

The cure must be completed with astringent injections, baths, and pessaries; with fumigations of frankincense, red roses, and mastic.

For Abortions,

For Childbirth, see Midwifery.

Of Children's Diseases.

Of Disorders from a Retention of the Meconium.

Infants newly born, from a retention of the meconium and other foetal matter in the prænate visæ, are subject to gripings or pains in the belly, which produce constant crying, hiccups, the jaundice, wakefulness, restlessness, startings, frights, convulsions, and epilepsy; which, unless timely prevented, are fatal.

To carry this off, infants should suck the first milk of their mother, if they give suck; otherwise they should fast ten or twelve hours; or take the following mixture, which will soften it:

Take 6 drams of fresh milk whey, and one dram of honey; make them into a draught.

Heister advises a grain or two of the powder of jalap, or two or three of rhubarb in syrup of roses solutive, or a solution of manna; some give half an ounce of oil of sweet almonds, with a little barley-fugar. A grain of aurum fulminans is the surest remedy.

Of Disorders from Costiveness and Wind.

If after some time the excrements become hard, with costiveness and a retention of wind, they will cause the symptoms abovementioned. In this the same remedies may be used, till the child's belly is open, and the acid or corrupted milk should be corrected with absorbent and telfaceous powders; whereof half a scruple is a dose. Harris believes an acid to be so predominant in infants, as to cause all their diseases. Boerhaave affirms, if absorbents are useful at any time, they must be in these cases, and orders viij grains of the telfaceous powders three times a day.

The nurse must forbear to feed upon anything that is sour or acid.

Of Watching, or Want of Sleep.

Want of sleep proceeds from the gripes, or costiveness, and wind and pain occasioned thereby: we judge of the health of children by their sleeping quietly, and of their illness by their watching, crying, and screaming. Watching may proceed from the milk being corrupted in the stomach, or from costiveness, or from wind.

In this disorder the body should be always kept open, first by a clyster, and then a purge; and the absorbents are to be given, and carminatives, particularly powder of aniseed; and the belly is to be anointed with carminative oil. Soon after the purge, give two drams of oil of almonds. The nurses should avoid acid and flatulent things, and catching cold. Opiates, diascordium, and theriacs, must never be used, unless in cases of extreme necessity.

Of the Aphthæ, or Thrush.

The aphthæ are little whitish ulcers affecting the whole surfaces of the mouth, that is, the lips, gums, cheeks, tongue, palate, and fauces; nay, they even descend through the oesophagus to the stomach and intestines, and to the anus; but then they are very dangerous, and commonly put a period to the infant's life.

Boerhaave says, if the aphthæ are of a pearl-colour, pellucid, white, few in number, superficial, soft, and fall off easily, apt to return in part, they are of the best sort; but if they are white or opake, like bacon, yellow, brown, black, thick, dense, running together, hard, tenacious, constantly restored, corrosive, they are bad.

Harris believes gargles to be of little service, because infants cannot use them, insomuch as they swallow everything that is put into their mouths. He therefore relies for a cure on the telfaceous powders, and the most gentle cathartics, and believes them sufficient.

Allen says the decoction of elm-bark is the best gargarism for the cure of the aphthæ. This disease often attacks Adults in acute diseases and inflammation of the viscera, Boerhaave observes they are most common among the northern people, that inhabit low marshy places, and often attend a continual putrid fever, or an intermittent becoming continual; and that they are ushered in with a diarrhoea, or a dysentery, a nausea, vomiting, loss of appetite, great anxiety about the praecordia often returning, some great evacuation of the fluids, a stupor and dulness, sleepiness, a perpetual complaint of weight about the stomach.

To cure this distemper, hot, diluting, resolvent, and detergent medicines must be given, that the crust may be disposed to fall off easily.

Huxham advises, when the aphtha supervene in fevers, to use gargles frequently of emollients and detergents, made with figs, hydromel, decoction of turnips, &c. To give rhubarb inwardly, chiefly if the patient is griped and looed, adding an aromatic astringent with absorbents.

Of Galling and Excoriation.

There is often an excoriation of the parts near the pudenda, chiefly of the groin and scrotum; in the wrinkles of the neck, under the arms, and in other places, proceeding from the acrimony of the urine and sweat. From this proceed itching pains, crying, watching, and restlessness.

To remedy this, the parts affected may be washed often with warm water, and sprinkled with drying powders, such as chalk, burnt hartshorn; but especially tarry, and ceruls, which may be tied closely in a rag, and the powders shook out on the disordered places.

If the parts affected are more sore, and tend to a real ulceration, it will be proper to add a little saccharum tartare to the powders. Likewise a little white vitriol dissolved in spring water, and daubed upon the part, will dry and heal it very powerfully.

Of the Stoppage of the Nose.

The nostrils of infants are often plugged up with a gross mucus, insomuch that they can scarce breathe, or suck, or swallow; which renders them very uneasy and uneasy. To cure it, after a suitable purge, dissolve two or three grains of white vitriol in half an ounce of marjoram water; then filter it, and apply it now and then to the nostrils with a linen rag.

Or you may apply oil of sweet almonds, impregnated with the oil of marjoram, to the bottom and sides of the nostrils, which will resolve the filth, and render the respiration free.

Of the Scabby Eruptions and Crusta Lactea

The heads of children are often troubled with aches or scabby eruptions; and if the face is affected with them, they are called crusta lactea. These are expelled by the benefit of nature; and, before the eruption, the infant is often troubled with epileptic fits from the irritation of the morbid matter.

If the humours strike in, either spontaneously or by improper applications, or if the exanthemata are of a blackish colour, they are very dangerous, and the infant generally falls into an asthma or a fatal epilepsy.

In the cure, externals, and especially such as are repellent, should be avoided; and things should be given inwardly which correct and temperate the blood, and expel the noxious matter by a diaphoresis. After the prime vis are purged, both the nurse and child should take alexipharmics in the morning, and the reticulate powders with calx of antimony, amber, and cinnabar, in the afternoon.

Externally, nothing of sulphur or mercury should be applied, or repellent lotions, or anything cold. To mollify the sores, fresh butter, or calves marrow, or cream, are sufficient. This case often proves obstinate; and then the nurse should observe a strict regimen, use good diet, take sweeteners of the blood, and purgatives now and then.

Of a Diarrhoea and Vomiting.

The diarrhoea of infants is not to be stopped, either with astringents or narcotics: For astringents turn the flux of sharp humours towards the noble parts, and endanger the life of the child; and, though narcotics appease the ferocity of the turgescence humour for a time, yet they afterwards break out with greater force. Besides, opiates are too powerful for the tender constitution of infants, and must not be given at all, or with the utmost caution. In slight cases, diacordium maybe ventured upon, to five or six grains; but, if there is a fever, it cannot be given without danger.

Therefore the best way is to give chalk, coral, pearls, and the like, of which about half a scruple is a dose; which will abate the orgasm of the humours, without kindling any new heat; after which the cure may be completed with rhubarb, from six grains to half a scruple, in solute syrup of roses.

With regard to Vomiting, if there is great plenty of ferous and noxious humours in the stomack, insomuch that the stomack can retain nothing, if the child is a year or two old, he may safely take some grains of ipecacuanha; Harris says xv: but surely a third part of that quantity, nay, one or two grains, may be sufficient; for this does not require the swallowing so much liquor after it as some others; and yet clears the stomack of crudities, viscidities, and other bad humours.

Of Difficult Breeding the Teeth.

Among all the disorders which afflict children, there are none that generate such grievous symptoms as difficult dentition. About five or six months after birth, the teeth generally begin to make their appearance; first the incisors, or fore-teeth; next the canini, or dog-teeth; and lastly, the molares, or grinders. About the seventh year there comes a new set; and at twenty-one the two inner grinders, called dentes sapientiae.

At the time of cutting their teeth, they slaver very much, and have a diarrhoea, which is no bad sign; but when it is difficult, especially when the canine teeth begin to be in motion, and to make their out-way out through the gums, the child has startings in his sleep, tumours of the gums, gripes, inquietude, watchings, a looseness or coltiveness, greenish stools, the thrush, fevers, difficult breathing, infecting catarrhs, convulsions, epilepsies, which often end in death. It chews dentition is like to be bad, if the child is perpetually crying, thrusts his fingers into his mouth, and bites the nurse's nipples; if unequal tubercles are perceived in the gums, both by the sight and touch, where the teeth are expected to appear; if there is heat in the mouth and the whole body; if they start without a cause, especially in sleep. These do not come on without great flaring, and sometimes a diarrhoea, as was mentioned above.

Harris observes, that, when an inflammation appears, the physician will labour in vain, if the cure is not begun with applying a leech under each ear. When the swelling of the gums chews it is time to cut it, to make way for the tooth, he would have it done with a penknife, not with a fine lancet, lest the wound should heal, and form a cicatrix. The food he directs to be no more than luke warm.

Heister internally advises aqueous mixtures, temperating powders; externally, oil of sweet almonds, with syrup of violets, or syrup of wild poppies, lightly acidulated with spirit of vitriol, wherewith often to rub the gums; as also with the coral or other smooth things, which will have the same effect.

Morgan affirms in this case, it will be best to abate the effervescence of the blood with diluters; to appease the pain with gentle opiates; to open the body with purges and clysters; to draw off the fermented serum by blisters; to promote the cutting of the teeth by cooling, relaxing, and opening the gums; for this purpose diacodium is good; or a strong decoction of marsh-mallows and poppy-heads, in thick milk, cream, or neats-foot oil. These take off the heat, and allay the pain.

Of the Rickets.

Children are seldom attacked with rickets before they are nine months, and after they are two years old; but it frequently happens in the intermediate space between these two periods. It may proceed originally from the disorders of the parents, and may be increased by those of the nurse.

It is likewise promoted by feeding the child with aqueous and mucous substances, crude summer-fruits, fish; by unleavened farinaceous aliment, and too great a quantity of sweet things; by an intermittent autumnal ague, or other chronic or acute disorders; by a striking in of the itch or herpes; by the suppression or injudicious care of ulcers; by being enervated with baths, fomentations, ointments, or moist vapours; by continual rest in a perforated chair, with his coats up.

This disorder is known, in those who cannot walk, from the causes preceding; from his brothers or sisters having the same disease; from a flaccid tumour of the head and face; from a flabby loose skin; from a swelling of the abdomen; from a falling away of the rest of the parts, especially of the muscles; from protuberances of the epiphyses of the joints, such as the wrists, ankles, knees, elbows, &c.; from the magnitude of the jugular veins and arteries, while the rest decrease. The legs grow crooked.

In those that have begun to walk, besides the former signs, there is a flowness, debility, and tottering in his motion; which soon proceeds to a constant desire of fitting, and afterwards changes to lying down; inasmuch that nothing at last is moveable, but the neck and head. Add to these, an early wit, an understanding which exceeds his age, while the appetite and digestion continue unhurt.

As he grows older, his head is enlarged, with ample sutures; his thorax is compressed on the sides; and his sternum rises up sharp, while the extremities of the ribs are knotty. The abdomen is protuberant, and the teeth black and carious. These disorders tenibly increasing, are the cause ever after of pernicious diseases of the same kind; principally a spina ventosa, and a caries of the bones.

In the mean while a slow feverish disorder preys upon the whole body, till the time of death; and then all the fibres, vessels, and viscera appear to be soft, flaccid, and the fluids dissolved and mucous.

The cure is to be attempted with light, nourishing, dry aliment, not fat, but seasoned, and taken often; With a little sound drink, such as beer, not stale, but well boiled and fine; With a dry warm air, and dry warm woolen clothing; With being carried about in the arms, and often shook, swung, and put in motion; With being drawn in a vehicle over the stones; With repeated frictions with warm dry flannel, sprinkled with aromatics; especially the abdomen and spine of the back; With prudently repeated blisters, with strengthening purges, for several days successively; As also by the continued use of strengthening, drying, antiscorbutic remedies, and such as raise the spirits.

Particularly for food, the bread should be biscuit, with a little saffron and spices. The flesh should be pigeons, pullets, veal, rabbits, mutton, gently roasted, minced, and mixed with biscuit, salt, a little parsley, thyme, nutmeg, or the like.

Likewise rice, millet, pearl barley, boiled with raisins; to which add a little wine and spice. The drink may be generous French red wine, of which give an ounce three or four times a-day.

Medicines, whatever substances serve to restore health.

Medicines are either simple or compound: the former being formed by nature alone; and the latter owing to the industry of men, by variously mixing the simple ones together.

Medicines are likewise distinguished, from the manner of using them into internal or external; and with regard to their effects, they are said to be astringent, cathartic, emetic, &c.

Vol. III. No. 76.

Pocket-Medicines, in surgery, those which a surgeon ought to carry always about him, in a box or convenient case.

Those, according to Heister, are the common digestive ointment, and the brown or Egyptian ointment, for cleansing and digesting foul ulcers, and some vulnerary balsams, as the linimentum arcesi, or the balsam of Peru, of Gilead or Capivi, or the Samaritan balsam: to these must also be added a plaster or two, as the U u diachylon, diachylon, or stypticum Crollii, since one or other of these is almost constantly wanted. Neither should there be wanting a piece of blue vitriol for the taking down luxuriant flesh, and to stop hemorrhages; but if vitriol is wanting, burnt alum, red precipitate, the infernal stone, or any other corrosive medicine, will supply its place in corrosive intentions, and the last will also serve to open abscesses, to make fistulas, and perform many other operations of that kind.

With these there should always be kept in readiness also a quantity of scraped lint, that the surgeon may be able to give immediate assistance to wounded persons; since, if he is unprepared for this, they may easily be taken off by an hemorrhage; a circumstance which ought also to prevail with him to be always provided with suitable bandages.