Chapter XIV: Part II: Of Diseases (4)

Indeed, if fresh matter be applied long enough to the skin, there is no occasion for any wound at all. Let a bit of thread, about half an inch long, wet with the matter, be immediately applied to the arm, midway between the shoulder and the elbow, and covered with a piece of the common sticking-plaster, and kept on for eight or ten days. This will seldom fail to communicate the disease. We mention this method, because many people are afraid of a wound; and doubtless the more easily the operation can be performed, it has the greater chance to become general. Some people imagine, that the discharge from a wound lessens the eruption; but there is no great stress to be laid upon this notion; besides, deep wounds often ulcerate, and become troublesome.

We do not find that inoculation is at all considered as a medical operation in those countries from whence we learned it. In Turkey it is performed by the women, and in the East Indies by the Brachmins or priests. In this country the custom is still in its infancy; we make no doubt, however, but it will soon become so familiar, that parents will think no more of inoculating their children, than at present they do of giving them a purge.

No set of men have it so much in their power to render the practice of inoculation general as the clergy, the greatest opposition to it still arising from some scruples of conscience, which they alone can remove. I would recommend it to them not only to endeavour to remove the religious objections which weak minds may have to this salutary practice, but to enjoin it as a duty, and to point out the danger of neglecting to make use of a mean which Providence has put in our power for saving the lives of our offspring. Surely such parents as wilfully neglect the means of saving their children’s lives, are as guilty as those who put them to death. I wish this matter were duly weighed. No one is more ready to make allowance for human weakness and religious prejudices, yet I cannot help recommending it, in the warmest manner, to parents, to consider how great an injury they do their children, by neglecting to give them this disease in the early period of life.

The numerous advantages arising from the inoculation of the small-pox have been pretty fully pointed out by the learned Dr. M‘Kenzie, in his History of Health[95]. To those mentioned by the Doctor we shall only add, that such as have not had the small-pox in the early period of life, are not only rendered unhappy, but likewise in a great measure unfit for sustaining many of the most useful and important offices. Few people would chuse even to hire a servant who had not had the small-pox, far less to purchase a slave who had the chance of dying of this disease. How could a physician or a surgeon, who had never had the small-pox himself, attend others under that malady? How deplorable is the situation of females, who arrive at mature age without having had the small-pox! A woman with child seldom survives this disease: and if an infant happen to be seized with the small-pox upon the mother’s breast, who has not had the disease herself the scene must be distressing! If she continue to suckle the child, it is at the peril of her own life; and if she wean it, in all probability it will perish. How often is the affectionate mother forced to leave her house, and abandon her children, at the very time when her care is most necessary? Yet should parental affection get the better of her fears, the consequences would often prove fatal. I have known the tender mother and her sucking infant laid in the same grave, both untimely victims to this dreadful malady. But these are scenes too shocking even to mention. Let parents who run away with their children to avoid the small-pox, or who refuse to inoculate them in infancy, consider to what deplorable situations, they may be reduced by this mistaken tenderness!

As the small-pox is now become an epidemical disease in most parts of the known world, no other choice remains but to render the malady as mild as possible. This is the only manner of extirpation now left in our power; and though it may seem paradoxical, the artificial method of communicating the disease, could it be rendered universal, would amount to nearly the same thing as rooting it out. It is a matter of small consequence, whether a disease be entirely extirpated, or rendered so mild as neither to destroy life nor hurt the constitution; but that this may be done by inoculation, does not now admit of a doubt. The numbers who die under inoculation hardly deserve to be named. In the natural way, one in four or five generally dies; but by inoculation not one of a thousand. Nay, some can boast of having inoculated ten thousand without the loss of a single patient.

I have often wished to see some plan established for rendering this salutary practice universal; but am afraid I shall never be so happy. The difficulties indeed are many; yet the thing is by no means impracticable. The aim is great; no less than saving the lives of one-fourth part of mankind. What ought not to be attempted in order to accomplish so desirable an end?

The first step towards rendering the practice universal, must be to remove the religious prejudices against it. This, as already observed, can only be done by the clergy. They must not only recommend it as a duty to others, but likewise practise it on their own children. Example will ever have more influence than precept.

The next thing requisite is to put it in the power of all. For this purpose we would recommend it to the Faculty to inoculate the children of the poor _gratis_. It is hard that so useful a part of mankind should by their poverty be excluded from such a benefit.

Should this fail, it is surely in the power of any State to render the practice general, at least as far as their dominion extends. We do not mean that it ought to be enforced by a law. The best way to promote it would be to employ a sufficient number of operators at the public expence to inoculate the children of the poor. This would only be necessary till the practice became general; afterwards custom, the strongest of all laws, would oblige every individual to inoculate his children to prevent reflections.

It may be objected to this scheme, that the poor would refuse to employ the inoculators: this difficulty is easily removed. A small premium to enable mothers to attend their children while under the disease, would be a sufficient inducement; besides, the success attending the operation would soon banish all objections to it. Even considerations of profit would induce the poor to embrace this plan. They often bring up their children to the age of ten or twelve, and when they come to be useful, they are snatched away by this malady, to the great loss of their parents, and detriment of the public.

The British legislature has of late years shewn great attention to the preservation of infant lives, by supporting the foundling hospital, &c. But we will venture to say, if one-tenth part of the sums laid out in supporting that institution, had been bestowed towards promoting the practice of inoculation of the small-pox among the poor, that not only more useful lives had been saved, but the practice ere now rendered quite universal in this island. It is not to be imagined what effect example and a little money will have upon the poor; yet, if left to themselves, they would go on for ever in the old way, without thinking of any improvement. We only mean this as a hint to the humane and public-spirited. Should such a scheme be approved, a proper plan might easily be laid down for the execution of it.

But as public plans are very difficult to bring about, and often, by the selfish views and misconduct of those intrusted with the execution of them, fail of answering the noble purposes for which they were designed; we shall therefore point out some other method by which the benefits of inoculation may be extended to the poor.

There is no doubt but inoculators will daily become more numerous. We would therefore have every parish in Britain to allow one of them a small annual salary for inoculating all the children of the parish at a proper age. This might be done at a very trifling expence, and it would enable every one to enjoy the benefit of this salutary invention.

Two things chiefly operate to prevent the progress of inoculation. The one is a wish to put the evil day as far off as possible. This is a principle in our nature; and as inoculation seems rather to be anticipating a future evil, it is no wonder mankind are so averse to it. But this objection is sufficiently answered by the success. Who in his senses would not prefer a lesser evil to-day to a greater to-morrow, provided they were equally certain?

The other obstacle is the fear of reflections. This has very great weight with the bulk of mankind. Should the child die, they think the world would blame them. This they cannot bear. Here lies the difficulty; and till that be removed, inoculation will make but small progress. Nothing however can remove it but custom. Make the practice fashionable, and all objections will soon vanish. It is fashion alone that has led the multitude since the beginning of the world, and will lead them to the end. We must therefore call upon the more enlightened part of mankind to set a pattern to the rest. Their example, though it may for some time meet with opposition, will at length prevail.

I am aware of an objection to this practice from the expence with which it may be attended: this is easily obviated. We do not mean that every parish ought to employ a Sutton or a Dimsdale as inoculators. These have by their success already recommended themselves to crowned heads, and are beyond the vulgar reach; but have not others an equal chance to succeed? They certainly have. Let them make the same trial, and the difficulties will soon vanish. There is not a parish, and hardly a village in Britain, destitute of some person who can bleed. But this is a far more difficult operation, and requires both more skill and dexterity than inoculation.

The persons to whom we would chiefly recommend the performance of this operation are the clergy. Most of them know something of medicine. Almost all of them bleed, and can order a purge, which are all the qualifications necessary for the practice of inoculation. The priests among the less enlightened Indians perform this office, and why should a Christian teacher think himself above it? Surely the bodies of men, as well as their souls, merit a part of the pastor’s care; at lead the greatest Teacher who ever appeared among men seems to have thought so.

Should all other methods fail, we would recommend it to parents to perform the operation themselves. Let them take any method of communicating the disease they please; provided the subjects be healthy, and of a proper age, they will seldom fail to succeed to their wish. I have known many instances even of mothers performing the operation, and never so much as heard of one bad consequence. A planter in one of the West India islands is said to have inoculated, with his own hand, in one year, three hundred of his slaves, who, notwithstanding the warmth of the climate, and other unfavourable circumstances, all did well. Common mechanics have often, to my knowledge, performed the operation with as good success as physicians. We do not however mean to discourage those who have it in their power, from employing people of skill to inoculate their children, and attend them while under the disease, but only to shew, that where such cannot be had, the operation ought not upon that account to be neglected.

Instead of multiplying arguments to recommend this practice, I shall just beg leave to mention the method which I took with my own son, then an only child. After giving him two gentle purges, I ordered the nurse to take a bit of thread which had been previously wet with fresh matter from a pock, and to lay it upon his arm, covering it with a piece of sticking-plaster. This remained on six or seven days, till it was rubbed off by accident. At the usual time the small-pox made their appearance, and were exceedingly favourable. Surely this, which is all that is generally necessary, may be done without any skill in medicine.

We have been the more full upon this subject because the benefits of inoculation cannot be extended to society by any other means than making the practice general. While it is confined to a few, it must prove hurtful to the whole. By means of it the contagion is spread, and is communicated to many who might otherwise never have had the disease. Accordingly it is found that more die of the small-pox now than before inoculation was introduced; and this important discovery, by which alone more lives might be saved than by all the endeavours of the Faculty, is in a great measure lost by its benefits not being extended to the whole community[96].

The spring and autumn have been usually reckoned the most proper seasons for inoculation, on account of the weather being then most temperate; but it ought to be considered that these are generally the most unhealthy seasons of the whole year. Undoubtedly the best preparation for the disease is a previous good state of health. I have always observed that children in particular are more sickly towards the end of spring and autumn than at any other time of the year. On this account, as well as for the advantage of cool air, I would propose winter as the most proper season for inoculation; though, on every other consideration, the spring would seem to be preferable.

The most proper age for inoculation is between three and five. Many approve of inoculating on the breast, and where no circumstances forbid this practice, I have no objection to it. Children, however, are more liable to convulsions at this time than afterwards; besides, the anxiety of the mother or nurse, should the child be in danger, would not fail to heighten it by spoiling the milk.

Children who have constitutional diseases must nevertheless be inoculated. It will often mend the habit of body; but ought to be performed at a time when they are most healthy. Accidental diseases should always be removed before inoculation.

It is generally thought necessary to regulate the diet for some time before the disease be communicated. In children, however, great alteration in diet is seldom necessary, their food being commonly of the most simple and wholesome kind, as milk, water-pap, weak broths, bread, light pudding, mild roots, and white meats.

But children who have been accustomed to a hotter diet, who are of a gross habit, or abound with bad humours, ought to be put upon a spare diet before they are inoculated. Their food should be of a light cooling nature, and their drink whey, butter-milk, and such like.

We would recommend no other medicinal preparation but two or three mild purges, which ought to be suited to the age and strength of the patient. The success of inoculators does not depend on the preparation of their patients, but on their management of them while under the disease. Their constant care is to keep them cool, and their bodies gently open, by which means the fever is kept low, and the eruption greatly lessened. The danger is seldom great when the pustules are few; and their number is generally in proportion to the fever which precedes and attends the eruption. Hence the chief secret of inoculation consists in regulating the eruptive fever, which generally may be kept sufficiently low by the methods mentioned above.

The regimen during the disease is in all respects the same as under the natural small-pox. The patient must be kept cool, his diet should be light, and his drink weak and diluting, &c. Should any bad symptoms appear, which is seldom the case, they must be treated in the same way as directed in the natural small-pox. Purging is not less necessary after the small-pox by inoculation than in the natural way, and ought by no means to be neglected.

CHAP. XXIV.
OF THE MEASLES.

The measles appeared in Europe about the same time with the small-pox, and have a great affinity to that disease. They both came from the same quarter of the world, are both infectious, and seldom attack the same person more than once. The measles are most common in the spring season, and generally disappear in summer. The disease itself, when properly managed, seldom proves fatal; but its consequences are often very troublesome.

CAUSE.——This disease, like the small-pox, proceeds from infection, and is more or less dangerous according to the constitution of the patient, the season of the year, the climate, &c.

SYMPTOMS.——The measles, like other fevers, are preceded by alternate fits of heat and cold, with sickness, and loss of appetite. The tongue is white, but generally moist. There is a short cough, a heaviness of the head and eyes, drowsiness, and a running at the nose. Sometimes indeed the cough does not come before the eruption has appeared. There is an inflammation and heat in the eyes, accompanied with a defluxion of sharp rheum, and great acuteness of sensation, so that they cannot bear the light without pain. The eye-lids frequently swell so as to occasion blindness. The patient generally complains of his throat; and a vomiting or looseness often precedes the eruption. The stools in children are commonly greenish; they complain of an itching of the skin, and are remarkably peevish. Bleeding at the nose is common, both before and in the progress of the disease.

About the fourth day, small spots, resembling flea-bites, appear, first upon the face; then upon the breast, and afterwards on the extremities: these may be distinguished from the small pox by their scarcely rising above the skin. The fever, cough, and difficulty of breathing, instead of being removed by the eruption as in the small pox, are rather increased; but the vomiting generally ceases.

About the sixth or seventh day from the time of sickening, the measles begin to turn pale on the face, and afterwards upon the body; so that by the ninth day they entirely disappear. The fever; however, and difficulty of breathing, often continue, especially if the patient has been kept upon too hot a regimen. Petechiæ, or purple spots, may likewise be occasioned by this error.

A violent looseness sometimes succeeds the measles; in which case the patient’s life is in imminent danger.

Such as die of the measles generally expire about the ninth day from the invasion, and are commonly carried off by a peripneumony, or inflammation of the lungs.

The most favourable symptoms are a moderate looseness, a moist skin, and a plentiful discharge of urine.

When the eruption suddenly falls in, and the patient is seized with a delirium, he is in the greatest danger. If the measles turn too soon of a pale colour, it is an unfavourable symptom, as are also great weakness, vomiting, restlessness, and difficulty of swallowing. Purple or black spots appearing among the measles are very unfavourable. When a continual cough, with hoarseness, succeeds the disease, there is reason to suspect an approaching consumption of the lungs.

Our business in this disease is to assist Nature, by proper cordials, in throwing out the eruption, if her efforts be too languid; but when they are too violent they must be restrained by evacuations, and cool diluting liquors, &c. We ought likewise to endeavour to appease the most urgent symptoms, as the cough, restlessness, and difficulty of breathing.

REGIMEN.——The cool regimen is necessary here as well as in the small-pox. The food too must be light, and the drink diluting. Acids however do not answer so well in the measles as in the small-pox, as they tend to exasperate the cough. Small beer likewise, though a good drink in the small-pox, is here improper. The most suitable liquors are decoctions of liquorice with marsh-mallow roots and sarsaparilla, infusions of linseed, or of the flowers of elder, balm-tea, clarified whey, barley-water, and such like. These, if the patient be costive, may be sweetened with honey; or, if that should disagree with the stomach, a little manna may occasionally be added to them.

MEDICINE.——The measles being an inflammatory disease, without any critical discharge of matter, as in the small-pox, bleeding is commonly necessary, especially when the fever runs high, with difficulty of breathing, and great oppression of the breast. But if the disease be of a mild kind, bleeding may be omitted[97].

Bathing the feet and legs frequently in lukewarm water both tends to abate the violence of the fever, and to promote the eruption.

The patient is often greatly relieved by vomiting. When there is a tendency this way, it ought to be promoted by drinking lukewarm water, or weak camomile-tea.

When the cough is very troublesome, with dryness of the throat, and difficulty of breathing, the patient may hold his head over the steam of warm water, and draw the steam into his lungs.

He may likewise lick a little sperma-ceti and sugar-candy pounded together; or take now and then a spoonful of the oil of sweet almonds, with sugar-candy dissolved in it. These will soften the throat, and relieve the tickling cough.

If at the turn of the disease the fever assumes new vigour, and there appears great danger of suffocation, the patient must be bled according to his strength, and blistering-plasters applied, with a view to prevent the load from being thrown on the lungs, where if an inflammation should fix itself, the patient’s life will be in imminent danger.

In case the measles should suddenly disappear, it will be necessary to pursue the same method which we have recommended when the small-pox recede. The patient must be supported with wine and cordials. Blistering-plasters must be applied to the legs and arms, and the body rubbed all over with warm flannels. Warm poultices may likewise be applied to the feet and palms of the hands.

When purple or black spots appear, the patient’s drink should be sharpened with spirits of vitriol; and if the putrid symptoms increase, the Peruvian bark must be administered in the same manner as directed in the small-pox.

Opiates are sometimes necessary, but should never be given except in cases of extreme restlessness, a violent looseness, or when the cough is very troublesome. For children, the syrup of poppies is sufficient. A tea-spoonful or two may be occasionally given, according to the patient’s age, or the violence of the symptoms.

After the measles are gone off, the patient ought to be purged. This may be conducted in the same manner as directed in the small-pox.

If a violent looseness succeeds the measles, it may be checked by taking for some days a gentle dose of rhubarb in the morning, and an opiate over night; but if these do not remove it, bleeding will seldom fail to have that effect.

Patients recovering after the measles should be careful what they eat or drink. Their food for some time ought to be light, and in small quantities, and their drink diluting, and rather of an opening nature, as butter-milk, whey, and such like. They ought also to beware of exposing themselves too soon to the cold air, lest a suffocating catarrh, an asthma, or a consumption of the lungs, should ensue.

Should a cough, with difficulty of breathing, and other symptoms of a consumption, remain after the measles, small quantities of blood may be frequently let at proper intervals, as the patient’s strength and constitution will permit. He ought likewise to drink asses milk, to remove to a free air, if in a large town, and to ride daily on horseback. He must keep close to a diet consisting of milk and vegetables; and lastly, if these do not succeed, let him remove to a warmer climate[98].

OF THE SCARLET FEVER.

The scarlet fever is so called from the colour of the patient’s skin, which appears as if it were tinged with red wine. It happens at any season of the year, but is most common towards the end of summer; at which time it often seizes whole families; children and young persons are most subject to it.

It begins like other fevers, with coldness and shivering, without any violent sickness. Afterwards the skin is covered with red spots, which are broader, more florid, and less uniform than the measles. They continue two or three days, and then disappear; after which the cuticle, or scarf-skin, falls off.

There is seldom any occasion for medicine in this disease. The patient ought however to keep within doors, to abstain from flesh, strong liquors, and cordials, and to drink freely of cool diluting liquors. If the fever runs high, the body must be kept gently open by emollient clysters, or small doses of nitre and rhubarb. A scruple of the former, with five grains of the latter, may be taken thrice a-day, or oftener, if necessary.

Children and young persons are sometimes seized at the beginning of this disease with a kind of stupor and epileptic fits. In this case the feet and legs should be bathed in warm water, a large blistering-plaster applied to the neck, and a dose of the syrup of poppies given every night till the patient recovers[99].

The scarlet fever however is not always of so mild a nature. It is sometimes attended with putrid or malignant symptoms, in which case it is always dangerous. In the malignant scarlet fever the patient is not only affected with coldness and shivering, but with languor, sickness, and great oppression, to these succeed excessive heat, nausea and vomiting, with a soreness of the throat; the pulse is extremely quick, but small and depressed; the breathing frequent and laborious; the skin hot, but not quite dry; the tongue moist, and covered with a whitish mucus; the tonsils inflamed and ulcerated. When the eruption appears, it brings no relief: on the contrary, the symptoms generally grow worse, and fresh ones come on, as purging, delirium, &c.

When this disease is mistaken for a simple inflammation, and treated with repeated bleedings, purging and cooling medicines, it generally proves fatal. The only medicines that can be depended on in this case are cordials and antiseptics, as the Peruvian bark, wine, snake-root, and the like. The treatment must be in general similar to that of the putrid fever, or of the malignant ulcerous sore throat[100].

OF THE BILIOUS FEVER.

When a continual, remitting, or intermitting fever is accompanied with a frequent or copious evacuation of bile, either by vomit or stool, the fever is denominated bilious. In Britain the bilious fever generally makes its appearance about the end of summer, and ceases towards the approach of winter. It is most frequent and fatal in warm countries, especially where the soil is marshy, and when great rains are succeeded by sultry heats. Persons who work without doors, lie in camps, or who are exposed to the night air, are most liable to this kind of fever.

If there are symptoms of inflammation at the beginning of this fever, it will be necessary to bleed, and to put the patient upon the cool diluting regimen recommended in the inflammatory fever. The saline draught may likewise be frequently administered, and the patient’s body kept open by clysters or mild purgatives. But if the fever should remit or intermit, bleeding will seldom be necessary. In this case a vomit may be administered, and, if the body be bound, a gentle purge; after which the Peruvian bark will generally complete the cure.

In case of a violent looseness, the patient must be supported with chicken broth, jellies of hartshorn, and the like; and he may use the _white decoction_ for his ordinary drink[101]. If a bloody flux should accompany this fever, it must be treated in the manner recommended under the article _Dysentery_.

When there is a burning heat, and the patient does not sweat, that evacuation may be promoted by giving him, three or four times a day, a table-spoonful of Mindererus’s spirit[102] mixed in a cup of his ordinary drink.

If the bilious fever be attended with the nervous, malignant, or putrid symptoms, which is sometimes the case, the patient must be treated in the same manner as directed under these diseases.

After this fever, proper care is necessary to prevent a relapse. For this purpose the patient, especially towards the end of autumn, ought to continue the use of the Peruvian bark for some time after he is well. He should likewise abstain from all trashy fruits, new liquors, and every kind of flatulent aliment.

CHAP. XXV.
OF THE ERYSIPELAS, OR ST. ANTHONY’S FIRE.

This disease, which in some parts of Britain is called _the rose_, attacks persons at any period of life, but is most common between the age of thirty and forty. Persons of a sanguine or plethoric habit are most liable to it. It often attacks young people, and pregnant women; and such as have once been afflicted with it are very liable to have it again. Sometimes it is a primary disease, and at other times only a symptom of some other malady. Every part of the body is liable to be attacked by an erysipelas, but it most frequently seizes the legs or face, especially the latter. It is most common in autumn, or when hot weather is succeeded by cold and wet.

CAUSES.——The erysipelas may be occasioned by violent passions or affections of the mind; as fear, anger, &c. When the body has been heated to a great degree, and is immediately exposed to the cold air, so that the perspiration is suddenly checked, an erysipelas will often ensue[103]. It may also be occasioned by drinking to excess, by continuing too long in a warm bath, or by any thing that overheats the blood. If any of the natural evacuations be obstructed, or in too small quantity, it may cause an erysipelas. The same effect will follow from the stoppage of artificial evacuations; as issues, setons, or the like.

SYMPTOMS.——The erysipelas attacks with shivering, thirst, loss of strength, pain in the head and back, heat, restlessness, and a quick pulse; to which may be added vomiting, and sometimes a delirium. On the second, third, or fourth day, the part swells, becomes red, and small pustules appear at which time the fever generally abates.

When the erysipelas seizes the foot, the parts contiguous swell, the skin shines; and, if the pain be violent, it will ascend to the leg, and will not bear to be touched.

When it attacks the face, it swells, appears red, and the skin is covered with small pustules filled with clear water. One or both eyes are generally closed with the swelling; and there is a difficulty of breathing. If the mouth and nostrils be very dry, and the patient drowsy, there is reason to suspect an inflammation of the brain.

If the erysipelas affects the breast, it swells and becomes exceedingly hard, with great pain, and is apt to suppurate. There is a violent pain in the arm-pit on the side affected, where an abscess is often formed.

If in a day or two the swelling subsides, the heat and pain abate, the colour of the part turns yellow, and the cuticle breaks and falls off in scales, the danger is over.

When the erysipelas is large, deep, and affects a very sensible part of the body, the danger is great. If the red colour changes into a livid or black, it will end in a mortification. Sometimes the inflammation cannot be discussed, but comes to a suppuration; in which case fistulas, a gangrene, or mortification, often ensue.

Such as die of this disease are commonly carried off by the fever, which is attended with difficulty of breathing, and sometimes with a delirium and great drowsiness. They generally die about the seventh or eighth day.

REGIMEN.——In the erysipelas the patient must neither be kept too hot nor too cold, as either of these extremes will tend to make it retreat, which is always to be guarded against. When the disease is mild, it will be sufficient to keep the patient within doors, without confining him to his bed, and to promote the perspiration by diluting liquors, &c.

The diet ought to be slender, and of a moderately cooling and moistening quality, as groat-gruel, panado, chicken or barley-broth, with cooling herbs and fruits, &c. avoiding flesh, fish, strong drink, spices, pickles, and all other things that may heat and inflame the blood; the drink may be barley-water, an infusion of elder-flowers, common whey, and such like.

But if the pulse be low, and the spirits sunk, the patient must be supported with negus, and other things of a cordial nature. His food may be sago-gruel with a little wine, and nourishing broths taken in small quantities, and often repeated. Great care however must be taken not to overheat him.

MEDICINE.——In this disease much mischief is often done by medicine, especially by external applications. People, when they see an inflammation, immediately think that something ought to be applied to it. This indeed is necessary in large phlegmons; but in an erysipelas the safer course is to apply nothing. Almost all ointments, salves, and plasters, being of a greasy nature, tend rather to obstruct and repel, than promote any discharge from the part. At the beginning of this disease it is neither safe to promote a suppuration, nor to repel the matter too quickly. The erysipelas in many respects resembles the gout, and is to be treated with the greatest caution. Fine wool, or very soft flannel, are the safest applications to the part. These not only defend it from the external air, but likewise promote the perspiration, which has a great tendency to carry off the disease. In Scotland the common people generally apply a mealy cloth to the parts affected, which is far from being improper.

It is common to bleed in the erysipelas; but this likewise requires caution. If however the fever be high, the pulse hard and strong, and the patient vigorous, it will be proper to bleed; but the quantity must be regulated by these circumstances, and the operation repeated as the symptoms may require. If the patient has been accustomed to strong liquors, and the disease attacks his head, bleeding is absolutely necessary.

Bathing the feet and legs frequently in lukewarm water, when the disease attacks the face or brain, has an excellent effect. It tends to make a derivation from the head, and seldom fails to relieve the patient. When bathing proves ineffectual, poultices, or sharp sinapisms, may be applied to the soles of the feet, for the same purpose.

In cases where bleeding is requisite, it is likewise necessary to keep the body open. This may be effected by emollient clysters, or small doses of nitre and rhubarb. Some indeed recommend very large doses of nitre in the erysipelas; but nitre seldom sits easy on the stomach when taken in large doses. It is however one of the best medicines when the fever and inflammation run high. Half a drachm of it, with four or five grains of rhubarb, may be taken in the patient’s ordinary drink, four times a day.

When the erysipelas leaves the extremities, and seizes the head so as to occasion a delirium or stupor, it is absolutely necessary to open the body. If clysters and mild purgatives fail to have this effect, stronger ones must be given. Blistering plasters must likewise be applied to the neck, or behind the ears, and sharp cataplasms laid to the soles of the feet.

When the inflammation cannot be discussed, and the part has a tendency to ulcerate, it will then be proper to promote suppuration, which may be done by the application of ripening poultices with saffron, warm fomentations, and such like.

When the black, livid, or blue colour of the part shews a tendency to mortification, the Peruvian bark must be administered. It may be taken along with acids, as recommended in the small-pox, or in any other form more agreeable to the patient. It must not however be trifled with, as the patient’s life is at stake. A drachm may be given every two hours, if the symptoms be threatening, and cloths dipped in warm camphorated spirits of wine, or the tincture of myrrh and aloes, may be applied to the part, and frequently renewed. It may likewise be proper in this case to apply poultices of the bark, or to foment the part affected with a strong decoction of it.

In what is commonly called the _scorbutic erysipelas_, which continues for a considerable time, it will only be necessary to give gentle laxatives, and such things as purify the blood and promote the perspiration. Thus, after the inflammation has been checked by opening medicines, the decoction of woods[104] may be drank, after which a course of bitters will be proper.

Such as are liable to frequent attacks of the erysipelas ought carefully to guard against all violent passions; to abstain from strong liquors, and all fat, viscid, and highly nourishing food. They should likewise take sufficient exercise, carefully avoiding the extremes of heat or cold. Their food should consist chiefly of milk, and such fruits, herbs, and roots, as are of a cooling quality; and their drink ought to be small-beer, whey, butter-milk, and such like. They should never suffer themselves to be long costive. If that cannot be prevented by suitable diet, it will be proper to take frequently a gentle dose of rhubarb, cream of tartar, the lenitive electuary, or some other mild purgative.

CHAP. XXVI.
OF THE PHRENITIS, OR INFLAMMATION OF THE BRAIN.

This is sometimes a primary disease, but oftener only a symptom of some other malady; as the inflammatory, eruptive, or spotted fever, &c. It is very common however as a primary disease in warm climates, and is most incident to persons about the prime or vigour of life. The passionate, the studious, and those whose nervous system is irritable in a high degree, are most liable to it.

CAUSES.——This disease is often occasioned by night-watching, especially when joined with hard study: it may likewise proceed from hard drinking, anger, grief, or anxiety. It is often occasioned by the stoppage of usual evacuations; as the bleeding piles in men, the customary discharges of women, &c. Such as imprudently expose themselves to the heat of the sun, especially by sleeping without doors in a hot season with their heads uncovered, are often suddenly seized with an inflammation of the brain, so as to awake quite delirious. When repellents are imprudently used in an erysipelas, an inflammation of the brain is sometimes the consequence. It may likewise be occasioned by external injuries, as blows or bruises upon the head, &c.

SYMPTOMS.——The symptoms which usually precede a true inflammation of the brain are pain of the head, redness of the eyes, a violent flushing of the face, disturbed sleep, or a total want of it, great dryness of the skin, costiveness, a retention of urine, a small dropping of blood from the nose, singing of the ears, and extreme sensibility of the nervous system.

When the inflammation is formed, the symptoms in general are similar to those of the inflammatory fever. The pulse indeed is often weak, irregular, and trembling; but sometimes it is hard and contracted. When the brain itself is inflamed, the pulse is always soft and low; but when the inflammation only affects the integuments of the brain, viz. the dura and pia mater, it is hard. A remarkable quickness of hearing is a common symptom of this disease; but that seldom continues long. Another usual symptom is a great throbbing or pulsation in the arteries of the neck and temples. Though the tongue is often black and dry, yet the patient seldom complains of thirst, and even refuses drink. The mind chiefly runs upon such objects as have before made a deep impression on it; and sometimes, from a sullen silence, the patient becomes all of a sudden quite outrageous.

A constant trembling and starting of the tendons is an unfavourable symptom, as are also a suppression of urine; a total want of sleep; a constant spitting; a grinding of the teeth, which last may be considered as a kind of convulsion. When a phrenitis succeeds an inflammation of the lungs, of the intestines, or of the throat, &c. it is owing to a translation of the disease from these parts to the brain, and generally proves fatal. This shews the necessity of proper evacuations, and the danger of repellents in all inflammatory diseases.

The favourable symptoms are, a free perspiration, a copious discharge of blood from the nose, the bleeding piles, a plentiful discharge of urine, which lets fall a copious sediment. Sometimes the disease is carried off by a looseness, and in women by an excessive flow of the _menses_.

As this disease often proves fatal in a few days, it requires the most speedy applications. When it is prolonged, or improperly treated, it sometimes ends in madness, or a kind of stupidity which continues for life.

In the cure, two things are chiefly to be attended to, _viz._ to lessen the quantity of blood in the brain, and to retard the circulation towards the head.

REGIMEN.——The patient ought to be kept very quiet. Company, noise, and every thing that affects the senses, or disturbs the imagination, increases the disease. Even too much light is hurtful: for which reason the patient’s chamber ought to be a little darkened, and he should neither be kept too hot nor cold. It is not however necessary to exclude the company of an agreeable friend, as this has a tendency to sooth and quiet the mind. Neither ought the patient to be kept too much in the dark, lest it should occasion a gloomy melancholy, which is too often the consequence of this disease.

The patient must, as far as possible, be soothed and humoured in every thing. Contradiction will ruffle his mind, and increase his malady. Even when he calls for things which are not to be obtained, or which might prove hurtful, he is not to be positively denied them, but rather put off with the promise of having them as soon as they can be obtained, or by some other excuse. A little of any thing that the mind is set upon, though not quite proper, will hurt the patient less than a positive refusal. In a word, whatever he was fond of, or used to be delighted with when in health, may here be tried, as pleasing stories, soft music, or whatever has a tendency to sooth the passions and compose the mind. Boerhaave proposes several mechanical experiments for this purpose; as the soft noise of water distilling by drops into a bason, and the patient trying to reckon them, &c. Any uniform sound, if low and continued, has a tendency to procure sleep, and consequently may be of service.

The aliment ought to be light, consisting chiefly of farinaceous substances; as panado, and water-gruel sharpened with jelly of currants, or juice of lemons, ripe fruits roasted or boiled, jellies, preserves, &c. The drink small, diluting, and cooling; as whey, barley-water, or decoctions of barley and tamarinds, which latter not only render the liquor more palatable, but likewise more beneficial, as they are of an opening nature.

MEDICINE.——In an inflammation of the brain, nothing more certainly relieves the patient than a free discharge of blood from the nose. When this comes of its own accord, it is by no means to be stopped, but rather promoted, by applying cloths dipped in warm water to the part. When bleeding at the nose does not happen spontaneously, it may be provoked, by putting a straw, or any other sharp body, up the nostril.

Bleeding in the temporal arteries greatly relieves the head: but as this operation cannot always be performed, we would recommend in its stead bleeding in the jugular veins. When the patient’s pulse and spirits are so low, that he cannot bear bleeding with the lancet, leeches may be applied to the temples. These not only draw off the blood more gradually, but by being applied nearer to the part affected, generally give more immediate relief.

A discharge of blood from the hæmorrhoidal veins is likewise of great service, and ought by all means to be promoted. If the patient has been subject to the bleeding piles, and that discharge has been stopped, every method must be tried to restore it; as the application of leeches to the parts, sitting over the steams of warm water, sharp clysters, or suppositories made of honey, aloes, and rock-salt.

If the inflammation of the brain be occasioned by the stoppage of evacuations either natural or artificial, as the menses, issues, setons, or such like, all means must be used to restore them as soon as possible, or to substitute others in their stead.

The patient’s body must be kept open by stimulating clysters or smart purges; and small quantities of nitre ought frequently to be mixed with his drink. Two or three drachms, or more, if the case be dangerous, may be used in the space of twenty-four hours.

The head should be shaved and frequently rubbed with vinegar and rose-water. Cloths dipped in this mixture may likewise be applied to the temples. The feet ought frequently to be bathed in lukewarm water, and soft poultices of bread and milk may be kept constantly applied to them.

If the disease proves obstinate, and does not yield to these medicines, it will be necessary to apply a blistering-plaster to the whole head.

CHAP. XXVII.
OF THE OPHTHALMIA, OR INFLAMMATION OF THE EYES.

This disease may be occasioned by external injuries; as blows, burns, bruises, and the like. It may likewise proceed from dust, quicklime, or other substances, getting into the eyes. It is often caused by the stoppage of customary evacuations; as the healing of old sores, drying up of issues, the suppressing of gentle morning sweats, or of the sweating of the feet, &c. Long exposure to the night air, especially in cold northerly winds, or whatever suddenly checks the perspiration, especially after the body has been much heated, is very apt to cause an inflammation of the eyes. Viewing snow or other white bodies for a long time, or looking stedfastly at the sun, a clear fire, or any bright object, will likewise occasion this malady. A sudden transition from darkness to very bright light will often have the same effect.

Nothing more certainly occasions an inflammation of the eyes than night-watching, especially reading or writing by candle-light. Drinking spirituous liquors, and excess of venery, are likewise very hurtful to the eyes. The acrid fumes of metals, and of several kinds of fuel, are also pernicious. Sometimes an inflammation of the eyes proceeds from a venereal taint, and often from a scrophulous or gouty habit. It may likewise be occasioned by hairs in the eye-lids turning inwards, and hurting the eyes. Sometimes the disease is epidemic, especially after wet seasons; and I have frequently known it prove infectious, particularly to those who lived in the same house with the patient. It may be occasioned by moist air, or living in low damp houses, especially in persons who are not accustomed to such situations. In children it often proceeds from imprudently drying up of scabbed heads, a running behind the ears, or any other discharge of that kind. Inflammations of the eyes often succeed the small-pox or measles, especially in children of a scrophulous habit.

SYMPTOMS.——An inflammation of the eyes is attended with acute pain, heat, redness, and swelling. The patient is not able to bear the light, and sometimes he feels a pricking pain, as if his eyes were pierced with a thorn. Sometimes he imagines his eyes are full of motes, or thinks he sees flies dancing before him. The eyes are filled with a scalding rheum, which rushes forth in great quantities, whenever the patient attempts to look up. The pulse is generally quick and hard, with some degree of fever. When the disease is violent, the neighbouring parts swell, and there is a throbbing or pulsation in the temporal arteries, &c.

A slight inflammation of the eyes, especially from an external cause, is easily cured; but when the disease is violent, and continues long, it often leaves specks upon the eyes, or dimness of sight, and sometimes total blindness.

If the patient be seized with a looseness, it has a good effect; and when the inflammation passes from one eye to another, as it were by infection, it is no unfavourable symptom. But when the disease is accompanied with a violent pain of the head, and continues long, the patient is in danger of losing his sight.

REGIMEN.——The diet, unless in scrophulous cases, can hardly be too spare, especially at the beginning. The patient must abstain from every thing of a heating nature. His food should consist chiefly of mild vegetables, weak broths, and gruels. His drink may be barley-water, balm-tea, common whey, and such like.

The patient’s chamber must be darkened, or his eyes shaded by a cover, so as to exclude the light, but not to press upon the eyes. He should not look at a candle, the fire, or any luminous object, and ought to avoid all smoke, as the fumes of tobacco, or any thing that may cause coughing, sneezing, or vomiting. He should be kept quiet, avoiding all violent efforts, either of body or mind, and encouraging sleep as much as possible.

MEDICINE.——This is one of those diseases wherein great hurt is often done by external applications. Almost every person pretends to be possessed of a remedy for the cure of sore eyes. These remedies generally consist of eye-waters and ointments, with other external applications, which do mischief twenty times for once they do good. People ought therefore to be very cautious how they use such things, as even the pressure upon the eyes often increases the malady.

Bleeding, in a violent inflammation of the eyes, is always necessary. This should be performed as near the part affected as possible. An adult may lose ten or twelve ounces of blood from the jugular vein, and the operation may be repeated according to the urgency of the symptoms. If it should not be convenient to bleed in the neck, the same quantity may be let from the arm, or any other part of the body.

Leeches are often applied to the temples, or under the eyes, with good effect. The wounds must be suffered to bleed for some hours, and if the bleeding stop soon, it may be promoted by the application of cloths dipt in warm water. In obstinate cases, it will be necessary to repeat this operation several times.

Opening and diluting medicines are by no means to be neglected. The patient may take a small dose of Glauber’s salts, and cream of tartar, every second or third day, or a decoction of tamarinds with senna. If these be not agreeable, gentle doses of rhubarb and nitre, a little of the lenitive electuary, or any other mild purgative, will answer the same end. The patient at the same time must drink freely of water-gruel, tea, whey, or any other weak diluting liquor. He ought likewise to take, at bed-time, a large draught of very weak wine-whey, in order to promote perspiration. His feet and legs must frequently be bathed in lukewarm water, and his head shaved twice or thrice a-week, and afterwards washed in cold water. This has often a remarkably good effect.

If the inflammation does not yield to these evacuations, blistering-plasters must be applied to the temples, behind the ears, or upon the neck, and kept open for some time by the mild blistering ointment. I have seldom known these, if long enough kept open, fail to remove the most obstinate inflammation of the eyes; but for this purpose it is often necessary to continue the discharge for several weeks.

When the disease has been of long standing, I have seen very extraordinary effects from a seton in the neck, or between the shoulders, especially the latter. It should be put upwards and downwards, or in the direction of the spine, and in the middle between the shoulder-blades. It may be dressed twice a-day with yellow basilicon. I have known patients, who had been blind for a considerable time, recover sight by means of a seton placed as above. When the seton is put across the neck, it soon wears out, and is both more painful and troublesome than between the shoulders; besides, it leaves a disagreeable mark, and does not discharge so freely.