Chapter XI: Part 11

It begins with much Flatulence, or Wind, with Swelling and slight Pains in the Belly, accompanied with great Dejection; and followed with large Evacuations either by Stool or by Vomit at first, but whenever either of them has begun, the other quickly follows. The Matter evacuated is either yellowish, green, brown, whitish, or black; the Pains in the Belly violent; the Pulse, almost constantly feverish, is sometimes strong at first, but soon sinks into Weakness, in Consequence of the prodigious Discharge. Some Patients purge a hundred Times in the Compass of a few Hours: they may even be seen to fall away; and if the Disease exists in a violent Degree, they are scarcely to be known within three or four Hours from the Commencement of these Discharges. After a great Number of them they are afflicted with Spasms, or Cramps, in their Legs, Thighs, and Arms, which torment them as much as the Pains in the Belly. When the Disease rages too highly to be asswaged, Hiccups, Convulsions and a Coldness of the Extremities approach; there is a scarcely intermitting Succession of fainting, or swooning Fits, the Patient dying either in one of them, or in Convulsions.

Sec. 322. This Disease, which constantly depends on a Bile raised to the highest Acrimony, commonly prevails towards the End of July and in August: especially if the Heats have been very violent, and there have been little or no Summer Fruits, which greatly conduce to attempt: and allay the putrescent Acrimony of the Bile.

Sec. 323. Nevertheless, however violent this Distemper may be, it is less dangerous, and also less tormenting than the former, many Persons recovering from it.

1, Our first Endeavour should be to dilute, or even to drown this acrid Bile, by Draughts, by Deluges, of the most mitigating Drinks; the irritation being so very great, that every Thing having the least Sharpness is injurious. Wherefore the patient should continually take in, by Drink, and by Way of Glyster, either Barley-Water, Almond-Milk, or pure Water, with one eighth Part Milk, which has succeeded very well in my Practice. Or he may use a very light Decoction, or Ptisan, as it were, of Bread, which is made by gently boiling a Pound of toasted Bread, in three or four Pots of Water for half an Hour. In _Swisserland_ we prefer Oat bread. We also successfully use pounded Rye, making a light Ptisan of it.

A very light thin Soup made of a Pullet, a Chicken, or of one Pound of lean Veal, in three Pots of Water, is very proper too in this Disease. Whey is also employed to good Purpose; and in those Places, where it can easily be had, Butter-milk is the best Drink of any. But, whichever of these Drinks shall be thought preferable, it is a necessary Point to drink very plentifully of it; and the Glysters should be given every two Hours.

2, If the Patient is of a robust Constitution, and sanguine Complexion, with a strong Pulse at the Time of the Attack, and the Pains are very severe, a first, and in some Cases, a second Bleeding, very early in the Invasion, asswages the Violence of the Malady, and allows more Leisure for the Assistance of other Remedies. I have seen the Vomiting cease almost entirely, after the first Bleeding.

The Rage of this Disease abates a little after a Duration of five or six Hours: we must not however, during this Remission or Abatement, forbear to throw in proper Remedies; since it returns soon after with great Force, which Return however indicates no Alteration of the Method already entered upon.

3, In general the warm Bath refreshes the Patient while he continues in it; but the Pains frequently return soon after he is taken out, which, however, is no Reason for omitting it, since it has frequently been found to give a more durable Relief. The Patient should continue in it a considerable Time, and, during that Time, he should take six or seven Glasses of the Potion No. 32, which has been very efficacious in this Disease. By these Means the Vomiting has been stopt; and the Patient, upon going out of the Bath, has had several large Stools, which very considerably diminished the Violence of the Disease.

4, If the Patient's Attendants are terrified by these great Evacuations, and determine to check them (however prematurely) by Venice Treacle, Mint Water, Syrup of white Poppies, called Diacodium, by Opium or Mithridate, it either happens, that the Disease and all its Symptoms are heightened, to which I have been a Witness; or, if the Evacuations should actually be stopt, the Patient, in Consequence of it, is thrown into a more dangerous Condition. I have been obliged to give a Purge, in order to renew the Discharges, to a Man, who had been thrown into a violent Fever, attended with a raging _Delirium_, by a Medicine composed of Venice Treacle, Mithridate and Oil. Such Medicines ought not to be employed, until the Smallness of the Pulse, great Weakness, violent and almost continual Cramps, and even the Insufficience of the Patient's Efforts to vomit, make us apprehensive of his sinking irrecoverably. In such Circumstances indeed he should take, every Quarter or half Quarter of an Hour, a Spoonful of the Mixture No. 50, still continuing the diluting Drinks. After the first Hour, they should only be given every Hour, and that only to the Extent of eight Doses. But I desire to insist upon it here, that this Medicine should not be given too early in this Distemper.

Sec. 324. If the Patient is likely to recover, the Pains and the Evacuations gradually abate; the Thirst is less; the Pulse continues very quick, but it becomes regular. There have been Instances of their Propensity to a heavy kind of Drowsiness at this Time; for perfect refreshing Sleep advances but slowly after this Disease. It will still be proper to persevere in the Medicines already directed, though somewhat less frequently. And now we may begin to allow the Patient a few Soups from farinaceous mealy Substances; and as soon as the Evacuations accompanying this Disease are evidently ceased, and the Pains are vanished; though an acute Sensibility and great Weakness continues, beside such Soups, he may be allowed some new-laid Eggs, very lightly boiled, or even raw, for some Days. After this he must be referred to the Regimen so frequently recommended to Persons in a State of Recovery: when the concurring Use of the Powder No. 24, taken twice a Day, will greatly assist to hasten and to establish his Health.

__Chapter XXIII.__

_Of a Diarrhoea, or Looseness._

__Sect.__ 325.

Every one knows what is meant by a Looseness or Purging, which the Populace frequently call a Flux, and sometimes a Cholic.

There are certain very chronical, or tedious and obstinate ones, which arise from some essential Fault in the Constitution. Of such, as foreign to my Plan, I shall say nothing.

Those which come on suddenly, without any preceding Disorder, except sometimes a slight Qualm or short Loathing, and a Pain in the Loins and Knees; which are not attended with smart Pains nor a Fever (and frequently without any Pain, or any other Complaint) are oftener of Service than prejudicial. They carry off a Heap of Matter that may have been long amassed and corrupted in the Body; which, if not discharged, might have produced some Distemper; and, far from weakening the Body, such Purgings as these render it more strong, light and active.

Sec. 326. Such therefore ought by no Means to be stopped, nor even speedily checked: they generally cease of themselves, as soon as all the noxious Matter is discharged; and as they require no Medicine, it is only necessary to retrench considerably from the ordinary Quantity of Nourishment; to abstain from Flesh, Eggs and Wine or other strong Drink; to live only on some Soups, on Pulse, or on a little Fruit, whether raw or baked, and to drink rather less than usual. A simple Ptisan with a little Syrup of _Capillaire_, or Maiden-hair, is sufficient in these Purgings, which require no Venice Treacle, Confection, nor any Drug whatever.

Sec. 327. But should it continue more than five or six Days, and manifestly weaken the Patient; if the Pain attending it grows a little severe; and especially if the Irritation, the urging to Stool, proves more frequent, it becomes seasonable to check, or to stop, it. For this Purpose the Patient is to be put into a Regimen; and if the Looseness has been accompanied with a great Loathing, with Risings or Wamblings at Stomach, with a foul furred Tongue, and a bad Taste in the Mouth, he must take the Powder No. 35. But if these Symptoms do not appear, give him that of No. 51: and during the three following Hours, let him take, every half Hour, a Cup of weak light Broth, without any Fat on it.

If the Purging, after being restrained by this Medicine, should return within a few Days, it would strongly infer, there was still some tough viscid Matter within, that required Evacuation. To effect this he should take the Medicines No. 21, 25 or 27; and afterwards take fasting, for two successive Mornings, half the Powder, No. 51.

On the Evening of that Day when the Patient took No. 35, or No. 51, or any other Purge, he may take a small Dose of Venice Treacle.

Sec. 328. A Purging is often neglected for a long Time, without observing the least Regimen, from which Neglect they degenerate into tedious and as it were habitual, perpetual ones, and entirely weaken the Patient. In such Cases, the Medicine No. 35 should be given first; then, every other Day for four Times successively, he should take No. 51: during all which Time he should live on nothing but Panada (See Sec. 57) or on Rice boiled in weak Chicken-broth. A strengthing stomachic Plaister has sometimes been successfully applied, which may be often moistened in a Decoction of Herbs boiled in Wine. Cold and Moisture should be carefully avoided in these Cases, which frequently occasion immediate Relapses, even after the Looseness had ceased for many Days.

__Chapter XXIV.__

_Of the Dysentery, or Bloody-flux._

__Sect.__ 329.

The Dysentery is a Flux or Looseness of the Belly, attended with great Restlessness and Anguish, with severe Gripings, and frequent Propensities to go to Stool. There is generally a little Blood in the Stools, though this is not a constant Symptom, and is not essential to the Existence of a Dysentery; notwithstanding it may not be much less dangerous, for the Absence of this Symptom.

Sec. 330. The Dysentery is often epidemical; beginning sometimes at the End of July, though oftner in August, and going off when the Frosts set in. The great preceding Heats render the Blood and the Bile acrid or sharp; and though, during the Continuance of the Heat, Perspiration is kept up (See Introduct. P. 28) yet as soon as the Heat abates, especially in the Mornings and Evenings, that Discharge is diminished; and by how much the more Viscidity or Thickness the Humours have acquired, in Consequence of the violent Heats, the Discharge of the sharp Humour by Perspiration being now checked, it is thrown upon the Bowels which it irritates, producing Pains in, and Evacuations from them.

This Kind of Dysentery may happen at all Times, and in all Countries; but if other Causes, capable of producing a Putridity of the Humours, be complicated with it; such as the crouding up a great Number of People into very little Room, and very close Quarters, as in Hospitals, Camps, or Prisons, this introduces a malignant Principle into the Humours, which, co-operating with the simpler Cause of the Dysentery, renders it the more difficult and dangerous.

Sec. 331. This Disease begins with a general Coldness rather than a Shivering, which lasts some Hours; the Patient's Strength soon abates, and he feels sharp Pains in his Belly, which sometimes continue for several Hours, before the Flux begins. He is affected with _Vertigos_, or Swimmings in the Head, with Reachings to vomit, and grows pale; his Pulse at the same Time being very little, if at all, feverish, but commonly small, and at length the Purging begins. The first Stools are often thin, and yellowish; but in a little Time they are mixt with a viscid ropy Matter, which is often tinged with Blood. Their Colour and Consistence are various too, being either brown, greenish or black, thinner or thicker, and foetid: The Pains increase before each of the Discharges, which grow very frequent, to the Number of eight, ten, twelve or fifteen in an Hour: then the Fundament becomes considerably irritated, and the _Tenesmus_ (which is a great Urgency to go to Stool, though without any Effect) is joined to the Dysentery or Flux, and often brings on a Protrusion or falling down of the Fundament, the Patient being now most severely afflicted. Worms are sometimes voided, and glairy hairy Humours, resembling Pieces or Peelings of Guts, and sometimes Clots of Blood.

If the Distemper rises to a violent Height, the Guts become inflamed, which terminates either in Suppuration or in Mortification; the miserable Patient discharges _Pus_, or black and foetid watery Stools: the Hiccup supervenes; he grows delirious; his Pulse sinks; and he falls into cold Sweats and Faintings which terminate in Death.

A kind of Phrenzy, or raging _Delirium_, sometimes comes on before the Minute of Expiration. I have seen a very unusual Symptom accompany this Disease in two Persons, which was an Impossibility of swallowing, for three Days before Death.

But in general this Distemper is not so extremely violent; the Discharges are less frequent, being from twenty-five to forty within a Day and Night. Their Contents are less various and uncommon, and mixed with very little Blood; the Patient retains more Strength; the Number of Stools gradually decrease; the Blood disappears; the Consistence of the Discharges improves; Sleep and Appetite return, and the Sick recovers.

Many of the Sick have not the least Degree of Fever, nor of Thirst, which perhaps is less common in this Disease, than in a simple Purging or Looseness.

Their Urine sometimes is but in a small Quantity; and many Patients have ineffectual Endeavours to pass it, to their no small Affliction and Restlessness.

Sec. 332. The most efficacious Remedy for this Disease is a Vomit. That of No. 34, (when there is no present Circumstance that forbids the giving a Vomit) if taken immediately on the first Invasion of it, often removes it at once; and always shortens its Duration. That of No. 35 is not less effectual; it has been considered for a long Time, even as a certain Specific, which it is not, though a very useful Medicine. If the Stools prove less frequent after the Operation of either of them, it is a good Sign; if they are no Ways diminished, we may apprehend the Disease is like to be tedious and obstinate.

The Patient is to be ordered to a Regimen, abstaining from all Flesh-meat with the strictest Attention, until the perfect Cure of the Disease. The Ptisan No. 3 is the best Drink for him.

The Day after the Vomit, he must take the Powder No. 51 divided into two Doses: the next Day he should take no other Medicine but his Ptisan; on the fourth the Rhubarb must be repeated; after which the Violence of the Disease commonly abates: His Diet during the Disease is nevertheless to be continued exactly for some Days; after which he may be allowed to enter upon that of Persons in a State of Recovery.

Sec. 333. The Dysentery sometimes commences with an inflammatory Fever; a feverish, hard, full Pulse, with a violent Pain in the Head and Loins, and a stiff distended Belly. In such a Case the Patient must be bled once; and daily receive three or even four of the Glysters No. 6, drinking plentifully of the Drink No. 3.

When all Dread of an Inflammation is entirely over, the Patient is to be treated in the Manner just related; though often there is no Necessity for the Vomit: and if the inflammatory Symptoms have run high, his first Purge should be that of No. 11, and the Use of the Rhubarb may be postponed, till about the manifest Conclusion of the Disease.

I have cured many Dysenteries, by ordering the Sick no other Remedy, but a Cup of warm Water every Quarter of an Hour; and it were better to rely only on this simple Remedy, which must be of some Utility, than to employ those, of whose Effects Country People are ignorant, and which are often productive of very dangerous ones.

Sec. 334. It sometimes happens that the Dysentery is combined with a putrid Fever, which makes it necessary, after the Vomit, to give the Purges No. 23 or 47, and several Doses of No. 24, before the Rhubarb is given. No. 32 is excellent in this combined Case.

There was in _Swisserland_ in the Autumn of 1755, after a very numerous Prevalence of epidemical putrid Fevers had ceased, a Multitude of Dysenteries, which had no small Affinity with, or Relation to, such Fevers. I treated them first, with the Prescription No. 34, giving afterwards No. 32; and I directed the Rhubarb only to very few, and that towards the Conclusion of the Disease. By much the greater Number of them were cured at the End of four or five Days. A small Proportion of them, to whom I could not give the Vomit, or whose Cases were more complicated, remained languid a considerable Time, though without Fatality or Danger.

Sec. 335. When the Dysentery is blended with Symptoms of Malignity (See Sec. 245) after premising the Prescription No. 35, those of No. 38 and 39 may be called in successfully.

Sec. 336. When the Disease has already been of many Days standing, without the Patient's having taken any Medicines, or only such as were injurious to him, he must be treated as if the Distemper had but just commenced; unless some Symptoms, foreign to the Nature of the Dysentery, had supervened upon it.

Sec. 337. Relapses sometimes occur in Dysenteries, some few Days after the Patients appeared well; much the greater Number of which are occasioned either by some Error in Diet, by cold Air, or by being considerably over-heated. They are to be prevented by avoiding these Causes of them; and may be removed by putting the Patient on his Regimen, and giving him one Dose of the Prescription No. 51. Should it return even without any such discoverable Causes, and if it manifests itself to be the same Distemper renewed, it must be treated as such.

Sec. 338. This Disease is sometimes combined too with an intermitting Fever; in which Case the Dysentery must be removed first, and the intermittent afterwards. Nevertheless if the Access, the Fits of the Fever have been very strong, the Bark must be given as directed Sec. 259.

Sec. 339. One pernicious Prejudice, which still generally prevails is, that Fruits are noxious in a Dysentery, that they even give it, and aggravate it; and this perhaps is an extremely ill-grounded one. In truth bad Fruits, and such as have not ripened well, in unseasonable Years, may really occasion Cholics, a Looseness (though oftner a Costiveness) and Disorders of the Nerves, and of the Skin; but never can occasion an epidemical Dysentery or Flux. Ripe Fruits, of whatever Species, and especially Summer Fruits, are the real Preservatives from this Disease. The greatest Mischief they can effect, must result from their thinning and washing down the Humours, especially the thick glutinous Bile, if they are in such a State; good ripe Fruits being the true Dissolvents of such; by which indeed they may bring on a Purging, but such a one, as is rather a Guard against a Dysentery.

We had a great, an extraordinary Abundance of Fruit in 1759 and 1760, but scarcely any Dysenteries. It has been even observed to be more rare, and less dangerous than formerly; and if the Fact is certain, it cannot be attributed to any thing more probably, than to the very numerous Plantations of Trees, which have rendered Fruit very plenty, cheap and common. Whenever I have observed Dysenteries to prevail, I made it a Rule to eat less Flesh, and Plenty of Fruit; I have never had the slightest Attack of one; and several Physicians use the same Caution with the same Success.

I have seen eleven Patients in a Dysentery in one House, of whom nine were very tractable; they eat Fruit and recovered. The Grandmother and one Child, whom she loved more than the rest, were carried off. She managed the Child after her own Fashion, with burnt Wine, Oil, and some Spices, but no Fruit. She conducted herself in the very same Manner, and both died.

In a Country Seat near _Berne_, in the Year 1751, when these Fluxes made great Havock, and People were severely warned against the Use of Fruits, out of eleven Persons in the Family, ten eat plentifully of Prunes, and not one of them was seized with it: The poor Coachman alone rigidly observed that Abstinence from Fruit injoined by this Prejudice, and took a terrible Dysentery.

This same Distemper had nearly destroyed a Swiss Regiment in Garrison in the South of _France_; the Captains purchased the whole Crop of several Acres of Vineyard; there they carried the sick Soldiers, and gathered the Grapes for such as could not bear being carried into the Vineyard; those who were well eating nothing else: after this not one more died, nor were any more even attacked with the Dysentery.

A Clergyman was seized with a Dysentery, which was not in the least mitigated by any Medicines he had taken. By meer Chance he saw some red Currans; he longed for them, and eat three Pounds of them between seven and nine o'Clock in the Morning; that very Day he became better, and was entirely well on the next.

I could greatly enlarge the Number of such Instances; but these may suffice to convince the most incredulous, whom I thought it might be of some Importance to convince. Far from forbidding good Fruit, when Dysenteries rage, the Patients should be encouraged to eat them freely; and the Directors of the Police, instead of prohibiting them, ought to see the Markets well provided with them. It is a Fact of which Persons, who have carefully informed themselves, do not in the least doubt. Experience demonstrates it, and it is founded in Reason, as good Fruit counter-operates all the Causes of Dysenteries. [77]

[77] The Experience of all Countries and Times so strongly confirms
these important Truths, that they cannot be too often repeated, too
generally published, whenever and wherever this Disease rages. The
Succession of cold Showers to violent Heats; too moist a
Constitution of the Air; an Excess of animal Food; Uncleanliness
and Contagion, are the frequent Causes of epidemical Fluxes. _E.
L._

I have retained the preceding Note, abridged from this Gentleman,
as it contains the Suffrage of another experienced Physician,
against that Prejudice of ripe Fruits occasioning Fluxes, which is
too popular among ourselves, and probably more so in the Country
than in _London_. I have been also very credibly assured, that the
Son of a learned Physician was perfectly cured of a very obstinate
Purging, of a Year's Continuance (in Spite of all the usual
officinal Remedies) by his devouring large Quantities of ripe
Mulberries, for which he ardently longed, and drinking very freely
of their expressed Juice. The Fact occurred after his Father's
Decease, and was affirmed to me by a Gentleman intimately
acquainted with them both. _K._

Sec. 340. It is important and even necessary, that each Subject of this Disease should have a Close-stool or Convenience apart to himself, as the Matter discharged is extremely infectious: and if they make Use of Bed-pans, they should be carried immediately out of the Chamber, the Air of which should be continually renewed, burning Vinegar frequently in it.

It is also very necessary to change the Patient's Linen frequently; without all which Precautions the Distemper becomes more violent, and attacks others who live in the same House. Hence it is greatly to be wished the People in general were convinced of these Truths.

It was _Boerhaave's_ Opinion, that all the Water which was drank, while Dysenteries were epidemical, should be _stummed_, as we term it, or sulphurized. [78]

[78] Our learned Author, or his medical Editor at _Lyons_, observes
here, 'that in the Edition of this Treatise at _Paris_, there was
an essential Mistake, by making _Boerhaave_ recommend the Addition
of Brandy, _Eau de vie_, instead of stumming or sulphurizing it,'
for which this Note, and the Text too use the Verb _branter_, which
Word we do not find in any Dictionary. We are told however, it
means to impregnate the Casks in which the Water is reserved, with
the Vapour of Sulphur, and then stopping them; in the same Manner
that Vessels are in some Countries, for the keeping of Wine. He
observes the Purpose of this is to oppose Corruption by the acid
Steams of the Sulphur. _K._

Sec. 341. It has happened, by some unaccountable Fatality, that there is no Disease, for which a greater Number of Remedies are advised, than for the Dysentery. There is scarcely any Person but what boasts of his own Prescription, in Preference to all the rest, and who does not boldly engage to cure, and that within a few Hours, a tedious severe Disease, of which he has formed no just Notion, with some Medicine or Composition, of whose Operation he is totally ignorant: while the poor Sufferer, restless and impatient, swallows every Body's Recommendation, and gets poisoned either through Fear, downright Disgust or Weariness, or through entire Complaisance. Of these many boasted Compositions, some are only indifferent, but others pernicious. I shall not pretend to detail all I know myself, but after repeatedly affirming, that the only true Method of Cure is that I have advised here, the Purpose of which is evacuating the offending Matter; I also affirm that all those Methods, which have a different Scope or Drift, are pernicious; but shall particularly observe, that the Method most generally followed, which is that of stopping the Stools by Astringents, or by Opiates, is the worst of all, and even so mortal a one, as to destroy a Multitude of People annually, and which throws others into incurable Diseases. By preventing the Discharge of these Stools, and inclosing the Wolf in the Fold, it either follows, 1, that this [79] retained Matter irritates and inflames the Bowels from which Inflammation excruciating Pains arise, an acute inflammatory Cholic, and finally a Mortification and Death; or a _Schirrhus_, which degenerates into a _Cancer_, (of which I have seen a dreadful Instance) or else an Abscess, Suppuration and Ulcer. Or 2, this arrested Humour is repelled elsewhere, producing a _Scirrhus_ in the Liver, or Asthmas, Apoplexy, Epilepsy, or Falling Sickness; horrible rheumatic Pains, or incurable Disorders of the Eyes, or of the Teguments, the Skin and Surface.

[79] A first or second Dose of Glauber Salt has been known to succeed in
the epidemical Summer Fluxes of the hotter Climates, when repeated
Doses of Rhubarb and Opiates had failed. Such Instances seems a
collateral Confirmation of Dr. _Tissot's_ rational and successful
Use of cooling opening Fruits in them. _K._

Such are the Consequences of all the astringent Medicines, and of those which are given to procure Sleep in this Disease, as Venice Treacle, Mithridate and Diascordium, when given too early in Dysenteries.

I have been consulted on Account of a terrible Rheumatism, which ensued immediately after taking a Mixture of Venice Treacle and Plantain, on the second Day of a Dysentery.

As those who advise such Medicines, are certainly unaware of their Consequences, I hope this Account of them will be sufficient, to prevent their Repetition.

Sec. 342. Neither are Purges without their Abuse and Danger; they determine the Course of all the Humours more violently to the tender afflicted Parts; the Body becomes exhausted; the Digestions fail; the Bowels are weakened, and sometimes even lightly ulcerated, whence incurable _Diarrhoeas_ or Purgings ensue, and prove fatal after many Years Affliction.

Sec. 343. If the Evacuations prove excessive, and the Distemper tedious, the Patient is likely to fall into a Dropsy; but if this is immediately opposed, it may be removed by a regular and drying Diet, by Strengthners, by Friction and proper Exercise.

__Chapter XXV.__

_Of the Itch._

__Sect.__ 344.

The Itch is an infectious Disorder contracted by touching infected Persons or Cloaths, but not imbibed from the Air: So that by carefully avoiding the _Medium_, or Means of Contagion, the Disorder may be certainly escaped.

Though any Part of the Body may be infested with the Itch, it commonly shews itself on the Hands, and chiefly between the Fingers. At first one or two little Pimples or Pustules appear, filled with a kind of clear Water, and excite a very disagreeable Itching. If these Pustules are broke by scratching them, the Water oozing from them infects the neighbouring Parts. At the Beginning of this Infection it can scarcely be distinguished, if a Person is not well apprized of its Nature; but in the Progress of it, the little Pustules increase both in Number and Size; and when they are opened by scratching, a loathsome kind of Scab is formed, and the Malady extends over the whole Surface. Where they continue long, they produce small Ulcers, and are at that Time highly contagious.

Sec. 345. Bad Diet, particularly the Use of Salt Meat, bad unripe Fruit, and Uncleanliness occasion this Disease; though it is oftnest taken by Contagion. Some very good Physicians suppose it is never contracted otherwise; but I must take Leave to dissent, as I have certainly seen it exist without Contagion.

When it happens to a Person, who cannot suspect he has received it by Contact, his Cure should commence with a total Abstinence from all Salt, sour, fat and spicy Food. He should drink a Ptisan of wild and bitter Succory, or that of No. 26, five or six Glasses of which may be daily taken; at the End of four or five Days, he may be purged with No. 21, or with an Ounce of _Sedlitz_ [or _Epsom_] Salt. His Abstinence, his Regimen is to be continued; the Purge to be repeated after six or seven Days; and then all the Parts affected, and those very near them, are to be rubbed in the Morning fasting, with a fourth Part of the Ointment No. 52. The three following Days the same Friction is to be repeated, after which the same Quantity of Ointment is to be procured, and used in the same Proportion; but only every other Day. It happens but seldom that this Method fails to remove this disagreeable Malady; sometimes however it will return, in which Case, the Patient must be purged again, and then recur to the Ointment, whose good Effects I have experienced, and continually do.

If the Disease has been very lately contracted, and most certainly by Contact, the Ointment may be fearlessly employed, as soon as it is discovered, without taking any Purge before it. But if, on the contrary, the Disease has been long neglected, and has rose to a high Degree, it will be necessary to restrain the Patient a long Time to the Regimen I have directed; he must be repeatedly purged, and then drink plentifully of the Ptisan No. 26, before the Ointment is rubbed in. When the Malady is thus circumstanced, I have always begun with the Ointment No. 28, half a Quarter of which is to be used every Morning. I have also frequently omitted the Use of that No. 52, having always found the former as certain, but a little slower in its Effects.

Sec. 346. While these Medicines are employed, the Patient must avoid all Cold and Wet, especially if he makes Use of No. 28, [80] in which there is Quick-silver; which, if such Precautions were neglected, might bring on a Swelling of the Throat and Gums, and even rise to a Salivation. Yet this Ointment has one Advantage in its having no Smell, and being susceptible of an agreeable one; while it is very difficult to disguise the disagreeable Odour of the other.

The Linen of a Person in this Disease ought to be often changed; but his upper Cloaths must not be changed: because these having been infected, might, when worn again, communicate the Itch to the Wearer again, after he had been cured.

Shirts, Breeches and Stockings may be fumigated with Sulphur, before they are put on; and this Fumigation should be made in the open Air.

[80] I have seen a pretty singular Consequence from the Abuse of
mercurial Unction for the Itch; whether it happened from the
Strength or Quantity of the Ointment, or from taking Cold after
applying it, as this Subject, a healthy Youth of about sixteen,
probably did, by riding three or four Miles through the Rain. But
without any other previous Complaint, he awoke quite blind one
Morning, wondering, as he said, when it would be Day. His Eyes were
very clear, and free from Inflammation, but the Pupil was wholly
immoveable, as in a _Gutta serena_. I effected the Cure by some
moderate Purges repeated a few Times; by disposing him to sweat by
lying pretty much in Bed (it being towards Winter) and by promoting
his Perspiration, chiefly with Sulphur: after which the shaved
Scalp was embrocated with a warm nervous Mixture, in which Balsam
of _Peru_ was a considerable Ingredient. In something less than
three Weeks he could discern a glowing Fire, or the bright Flame of
a Candle. As his Sight increased, he discerned other Objects, which
appeared for some Days inverted to him, with their Colours
confused; but Red was most distinguishable. He discovered the Aces
sooner than other Cards; and in about six or seven Weeks recovered
his full Sight in all its natural Strength, which he now enjoys.
_K._

Sec. 347. If this Disorder becomes very inveterate and tedious, it exhausts the Patient, in Consequence of its not suffering him to sleep at Nights, as well as by his restless Irritation; and sometimes even brings on a Fever, so that he falls away in Flesh, and his Strength abates.

In such a Case he must take, 1, a gentle Purge.

2, Make Use frequently of warm Baths.

3, He must be put on the Regimen of Persons in a State of Recovery.

4, He must take Morning and Evening, fifteen Days successively, the Powder No. 53, with the Ptisan No. 26.

This Malady is often very obstinate, and then the Medicines must be varied according to the Circumstances, the Detail of which I avoid here.

Sec. 348. After giving repeated Purges in such obstinate Cases, mineral Waters abounding with Sulphur, such as [81] those of _Yverdun_, &c. often effect a Cure; and simple cold Bathings in Rivers or Lakes have sometimes succeeded in very inveterate Cases of this Disorder.

[81] Sea water, and those of _Dulwich_, _Harrigate_, _Shadwell_, &c.
will be full as effectual. _K._

Nothing conduces more to the long Continuance of this Malady, than the Abuse of hot Waters, such as infusions of Tea, &c.

Sec. 349. I shall conclude this Chapter, with a repeated Injunction not to be too free or rash in the Use of the Ointment No. 52, and other outward Remedies for extinguishing the Itch. There is hardly any Complaint, but what has been found to be the Consequence of too sudden a Removal of this Disorder by outward Applications, before due Evacuations have been made, and a moderate Abatement of the Sharpness of the Humours has been effected.

__Chapter XXVI.__

_The Treatment of Diseases peculiar to Women._

__Sect.__ 350.

Besides all the preceding Diseases, to which Women are liable in common with Men, their Sex also exposes them to others peculiar to it, and which depend upon four principal Sources; which are their monthly Discharges, their Pregnancy, their Labours in Child-birth, and the Consequences of their Labours. It is not my present Design to treat professedly on each of the Diseases arising from these Causes, which would require a larger Volume than I have proposed; but I shall confine myself to certain general Directions on these four Heads.

Sec. 351. Nature, who intended Women for the Increase, and the Nourishment of the human Race at the Breast, has subjected them to a periodical Efflux, or Discharge, of Blood: which Circumstance constitutes the Source, from whence the Infant is afterwards to receive his Nutrition and Growth.

This Discharge generally commences, with us, between the Age of sixteen and eighteen. Young Maidens, before the Appearance of this Discharge, are frequently, and many for a long Time, in a State of Weakness, attended with various Complaints, which is termed the _Chlorosis_, or Green Sickness, and Obstructions: and when their Appearance is extremely slow and backward, it occasions very grievous, and sometimes even mortal Diseases. Nevertheless it is too usual, though very improper, to ascribe all the Evils, to which they are subject at this Term of Life, solely to this Cause; while they really often result from a different Cause, of which the Obstructions themselves are sometimes only the Effect; and this is the natural, and, in some Degree, even necessary Feebleness of the Sex. The Fibres of Women which are intended to be relaxed, and to give Way, when they are unavoidably extended by the Growth of the Child, and its inclosing Membranes (which frequently arise to a very considerable Size) should necessarily be less stiff and rigid, less strong, and more lax and yielding than the Fibres of Men. Hence the Circulation of their Blood is more slow and languid than in Males; their Blood is less compact and dense, and more watery; their Fluids are more liable to stagnate in their different Bowels, and to form Infarctions and Obstructions.

Sec. 352. The Disorders to which such a Constitution subjects them might, in some Measure, be prevented, by assisting that Languor or Feebleness of their natural Movements, by such an Increase of their Force, as Exercise might contribute to: But this Assistance, which in some Manner is more necessary for Females than Males, they are partly deprived of, by the general Education and Habitude of the Sex; as they are usually employed in managing Household Business, and such light sedentary Work, as afford them less Exercise and Motion, than the more active Occupations of Men. They stir about but little, whence their natural Tendency to Weakness increases from Habit, and thence becomes morbid and sickly. Their Blood circulates imperfectly; its Qualities become impaired; the Humours tend to a pretty general Stagnation; and none of the vital Functions are completely discharged.

From such Causes and Circumstances they begin to sink into a State of Weakness, sometimes while they are very young, and many Years before this periodical Discharge could be expected. This State of Languor disposes them to be inactive; a little Exercise soon fatigues them, whence they take none at all. It might prove a Remedy, and even effect a Cure, at the Beginning of their Complaint; but as it is a Remedy, that is painful and disagreeable to them, they reject it, and thus increase their Disorders.

Their Appetite declines with the other vital Functions, and gradually becomes still less; the usual salutary Kinds of Food never exciting it; instead of which they indulge themselves in whimsical Cravings, and often of the oddest and most improper Substances for Nutrition, which entirely impair the Stomach with its digestive Functions, and consequently Health itself.

But sometimes after the Duration of this State for a few Years, the ordinary Time of their monthly Evacuations approaches, which however make not the least Appearance, for two Reasons. The first is, that their Health is too much impaired to accomplish this new Function, at a Time when all the others are so languid: and the second is, that under such Circumstances, the Evacuations themselves are unnecessary; since their final Purpose is to discharge (when the Sex are not pregnant) that superfluous Blood, which they were intended to produce, and whose Retention would be unhealthy, when not applied to the Growth of the Foetus, or Nourishment of the Child: and this Superfluity of Blood does not exist in Women, who have been long in a very low and languishing State.

Sec. 353. Their Disorder however continues to increase, as every one daily must, which does not terminate. This Increase of it is attributed to the Suppression or Non-appearance of their monthly Efflux, which is often erroneous; since the Disorder is not always owing to that Suppression, which is often the Effect of their Distemperature. This is so true, that even when the Efflux happens, if their Weakness still continues, the Patients are far from being the better for it, but the reverse. Neither is it unusual to see young Lads, who have received from Nature, and from their Parents, a sort of feminine Constitution, Education and Habitude, infested with much the same Symptoms, as obstructed young Women.

Country Girls, who are generally more accustomed to such hardy Work and Exercise as Country Men, are less subject to these Complaints, than Women who live in Cities.

Sec. 354. Let People then be careful not to deceive themselves on this important Account; since all the Complaints of young Maidens are not owing to the Want of their Customs. Nevertheless it is certain there are some of them, who are really afflicted from this Cause. For Instance, when a strong young Virgin in full Health, who is nearly arrived to her full Growth, and who manifestly abounds with Blood, does not obtain this Discharge at the usual Time of Life, then indeed this superfluous Blood is the Fountain of very many Disorders, and greatly more violent ones than those, which result from the contrary Causes already mentioned.

If the lazy inactive City Girls are more subject to the Obstructions, which either arise from the Weakness and Languor I have formerly taken Notice of, or which accompany it; Country Girls are more subject to Complaints from this latter Cause (too great a Retention of superfluous Blood) than Women who live in Cities: and it is this last Cause that excites those singular Disorders, which appear so supernatural to the common People, that they ascribe them to Sorcery.

Sec. 355. And even after these periodical Discharges have appeared, it is known that they have often been suppressed, without the least unhealthy Consequence resulting from that Suppression. They are often suppressed, in the Circumstances mentioned Sec. 351, by a Continuance of the Disease, which was first an Obstacle or Retardment to their Appearance; and in other Cases, they have been suppressed by other Causes, such as Cold, Moisture, violent Fear, any very strong Passion; by too chilly a Course of Diet, with Indigestion; or too hot and irritating Diet; by Drinks cooled with Ice, by Exercise too long continued, and by unusual Watching. The Symptoms, occasioned by such Suppressions, are sometimes more violent than those, which preceded the first Appearance of the Discharge.

Sec. 356. The great Facility with which this Evacuation may be suppressed, diminished, or disordered, by the Causes already assigned; the terrible Evils which are the Consequences of such Interruptions and Irregularities of them, seem to me very cogent Reasons to engage the Sex to use all possible Care, in every Respect, to preserve the Regularity of them; by avoiding, during their Approach and Continuance, every Cause that may prevent or lessen them. Would they be thoroughly persuaded, not solely by my Advice, but by that of their Mothers, their Relations, their Friends, and by their own Experience, of what great Importance it is to be very attentive to themselves, at those critical Times, I think there is not one Woman, who from the first, to the very last Appearance of them, would not conduct herself with the most scrupulous Regularity.

Their Demeanour, in these Circumstances, very fundamentally interests their own Health, as well as that of their Children; and consequently their own Happiness, as well as that of their Husbands and Families.

The younger and more delicate they are, Caution becomes the more necessary for them. I am very sensible a strong Country Girl is too negligent in regulating herself at those critical Seasons, and sometimes without any ill Consequence; but at another Time she may suffer severely for it: and I could produce a long List of many, who, by their Imprudence on such Occasions, have thrown themselves into the most terrible Condition.

Besides the Caution with which Females should avoid these general Causes, just mentioned in the preceding Section, every Person ought to remember what has most particularly disagreed with her during that Term, and for ever constantly to reject it.

Sec. 357. There are many Women whose Customs visit them without the slightest Impeachment of their Health: others are sensibly disordered on every Return of them; and to others again they are very tormenting, by the violent Cholics, of a longer or a shorter Duration, which precede or accompany them. I have known some of these violent Attacks last but some Minutes, and others which continued a few Hours. Nay some indeed have persisted for many Days, attended with Vomiting, Fainting, with Convulsions from excessive Pain, with Vomiting of Blood, Bleedings from the Nose, _&c._ which, in short, have brought them to the very Jaws of Death. So very dangerous a Situation requires the closest Attention; though, as it results from several and frequently very opposite Causes, it is impossible within the present Plan, to direct the Treatment that may be proper for each Individual. Some Women have the Unhappiness to be subject to these Symptoms every Month, from the first Appearance, to the final Termination, of these Discharges; except proper Remedies and Regimen, and sometimes a happy Child-birth, remove them. Others complain but now and then, every second, third, or fourth Month; and there are some again, who having suffered very severely during the first Months, or Years, after their first Eruptions, suffer no more afterwards. A fourth Number, after having had their Customs for a long Time, without the least Complaint, find themselves afflicted with cruel Pains, at every Return of them; if by Imprudence, or some inevitable Fatality, they have incurred any Cause, that has suppressed, diminished, or delayed them. This Consideration ought to suggest a proper Caution even to such, as generally undergo these Discharges, without Pain or Complaint: since all may be assured, that though they suffer no sensible Disorder at that Time, they are nevertheless more delicate, more impressible by extraneous Substances, more easily affected by the Passions of the Mind, and have also weaker Stomachs at these particular Periods.

Sec. 358. These Discharges may also be sometimes too profuse in Quantity, in which Case the Patients become obnoxious to very grievous Maladies; into the Discussion of which however I shall not enter here, as they are much less frequent than those, arising from a Suppression of them. Besides which, in such Cases, Recourse may be had to the Directions I shall give hereafter, when I treat of that Loss of Blood, which may be expedient, during the Course of Gravidation or Pregnancy. See Sec. 365.

Sec. 359. Finally, even when they are the most regular, after their Continuance for a pretty certain Number of Years (rarely exceeding thirty-five) they go off of their own Accord, and necessarily, between the Age of forty-five and fifty; sometimes even sooner, but seldom continuing longer: and this _Crisis_ of their ceasing is generally a very troublesome, and often a very dangerous, one for the Sex.

Sec. 360. The Evils mentioned Sec. 352 may be prevented, by avoiding the Causes producing them; and, 1, by obliging young Maidens to use considerable Exercise; especially as soon as there is the least Reason to suspect the Approach of this Disorder, the _Chlorosis_, or Green Sickness.

2, By watching them carefully, that they eat nothing unwholesome or improper; as there are scarcely any natural Substances, even among such as are most improper for them, and the most distasteful, which have not sometimes been the Objects of their sickly, their unaccountable Cravings. Fat Aliments, Pastry, farinaceous or mealy, and sour and watery Foods are pernicious to them. Herb-Teas, which are frequently directed as a Medicine for them, are sufficient to throw them into the Disorder, by increasing that Relaxation of their Fibres, which is a principal Cause of it. If they must drink any such Infusions, as medicated Drinks, let them be taken cold: but the best Drink for them is Water, in which red hot Iron has been extinguished.

3, They must avoid hot sharp Medicines, and such as are solely intended to force down their Terms, which are frequently attended with very pernicious Consequences, and never do any good: and they are still the more hurtful, as the Patient is the younger.

4, If the Malady increases, it will be necessary to give them some Remedies; but these should not be Purges, nor consist of Diluters, and Decoctions of Herbs, of Salts, and a Heap of other useless and noxious Ingredients; but they should take Filings of Iron, which is the most certain Remedy in such Cases. These Filings Should be of true simple Iron, and not from Steel; and Care should be taken that it be not rusty, in which State it has very little Effect.

At the Beginning of this Distemper, and to young Girls, it is sufficient to give twenty Grains daily, enjoining due Exercise and a suitable Diet. When it prevails in a severer Degree, and the Patient is not so young, a Quarter of an Ounce may be safely ventured on: Certain Bitters or Aromatics may be advantageously joined to the Filings, which are numbered in the Appendix, 54, 55, 56, and constitute the most effectual Remedies in this Distemper, to be taken in the Form of Powder, of vinous Infusion, or of Electary. [82] When there is a just Indication to bring down the Discharge, the vinous Infusion No. 55 must be given, and generally succeeds: but I must again repeat it (as it should carefully be considered) that the Stoppage or Obstruction of this Discharge is frequently the Effect, not the Cause, of this Disease; and that there should be no Attempt to force it down, which in such a Case, may sometimes prove more hurtful than beneficial; since it would naturally return of its own Accord, on the Recovery, and with the Strength, of the Patient: as their Return should follow that of perfect Health, and neither can precede Health, nor introduce it. There are some Cases particularly, in which it would be highly dangerous to use hot and active Medicines, such Cases for Instance, as are attended with some Degree of Fever, a frequent Coughing, a Haemorrhage, or Bleeding, with great Leanness and considerable Thirst: all which Complaints should be removed, before any hot Medicines are given to force this Evacuation, which many very ignorantly imagine cures all other female Disorders; an Error, that has prematurely occasioned the Loss of many Womens' Lives.

[82] The _French_ Word here, _Opiat_, is sometimes used by them for a
compound Medicine of the Consistence of an Electary; and cannot be
supposed, in this Place, to mean any Preparation, into which
_Opium_ enters. _K._

Sec. 361. While the Patient is under a Course of these Medicines, she should not take any of those I have forbidden in the preceding Sections; and the Efficacy of these should also be furthered with proper Exercise. That in a Carriage is very healthy; Dancing is so too, provided it be not extended to an Excess. In Case of a Relapse in these Disorders, the Patient is to be treated, as if it were an original Attack.

Sec. 362. The other Sort of Obstructions described Sec. 354 requires a very different Treatment. Bleeding, which is hurtful in the former Sort, and the Use, or rather Abuse, of which has thrown several young Women into irrecoverable Weaknesses, has often removed this latter Species, as it were, in a Moment. Bathing of the Feet, the Powders No. 20, and Whey have frequently succeeded: but at other Times it is necessary to accommodate the Remedies and the Method to each particular Case, and to judge of it from its own peculiar Circumstances and Appearances.

Sec. 363. When these Evacuations naturally cease through Age (See Sec. 359) if they stop suddenly and all at once, and had formerly flowed very largely, Bleeding must, 1, necessarily be directed, and repeated every six, every four, or even every three Months.

2, The usual Quantity of Food should be somewhat diminished, especially of Flesh, of Eggs and of strong Drink.

3, Exercise should be increased.

4, The Patient should frequently take, in a Morning fasting, the Powder No. 24, which is very beneficial in such Cases; as it moderately increases the natural Excretions by Stool, Urine and Perspiration; and thence lessens that Quantity of Blood, which would otherwise superabound.