Advice to the people

ADVICE

to the

PEOPLE in General,

with

Regard to their Health:

But more particularly calculated for those, who, by their Distance from regular Physicians, or other very experienced Practitioners, are the most unlikely to be seasonably provided with the best Advice and Assistance, in acute Diseases, or upon any sudden inward or outward Accident.

WITH

A Table of the most cheap, yet effectual Remedies, and the plainest Directions for preparing them readily.

Translated from the French Edition of

Dr. Tissot's Avis au Peuple, &c.

Printed at Lyons; with all his own Notes; a few of his medical Editor's at Lyons; and several occasional Notes, adapted to this English Translation,

By J. Kirkpatrick, M. D.

LONDON:

Printed for T. Becket and P. A. De Hondt, at Tully's Head, near Surry-Street, in the Strand.

M DCC LXV.

the Translator's PREFACE.

hough the great Utility of those medical Directions, with which the following Treatise is thoroughly replenished, will be sufficiently evident to every plain and sensible Peruser of it; and the extraordinary Reception of it on the Continent is recited in the very worthy Author's Preface; yet something, it should seem, may be pertinently added, with Regard to this Translation of it, by a Person who has been strictly attentive to the Original: a Work, whose Purpose was truly necessary and benevolent; as the Execution of it, altogether, is very happily accomplished.

It will be self evident, I apprehend, to every excellent Physician, that a radical Knowledge of the Principles, and much Experience in the Exercise, of their Profession, were necessary to accommodate such a Work to the Comprehension of those, for whom it was more particularly calculated. Such Gentlemen must observe, that the certain Axiom of Nature's curing Diseases, which is equally true in our Day, as it was in that of Hippocrates, so habitually animates this Treatise, as not to require the least particular Reference. This Hippocratic Truth as certain (though much less subject to general Observation) as that Disease, or Age, is finally prevalent over all sublunary Life, the most attentive Physicians discern the soonest, the most ingenuous readily confess: and hence springs that wholesome Zeal and Severity, with which Dr. Tissot encounters such Prejudices of poor illiterate Persons, as either oppose, or very ignorantly precipitate, her Operations, in her Attainment of Health. These Prejudices indeed may seem, from this Work, to be still greater, and perhaps grosser too, in Swisserland than among ourselves; though it is certain there is but too much Room for the Application of his salutary Cautions and Directions, even in this Capital; and doubtless abundantly more at great Distances from it. It may be very justly supposed, for one Instance, that in most of those Cases in the Small Pocks, in which the Mother undertakes the Cure of her Child, or confides it to a Nurse, that Saffron, in a greater or less Quantity, and Sack or Mountain Whey, are generally still used in the Sickening before Eruption; to accelerate that very Eruption, whose gradual Appearance, about the fourth Day, from that of Seizure inclusive, is so favourable and promising to the Patient; and the Precipitation of which is often so highly pernicious to them. Most of, or rather all, his other Cautions and Corrections seem equally necessary here, as often as the Sick are similarly circumstanced, under the different acute Diseases in which he enjoins them.

Without the least Detraction however from this excellent Physician, it may be admitted that a few others, in many other Countries, might have sufficient Abilities and Experience for the Production of a like Work, on the same good Plan. This, we find, Dr. Hirzel, principal Physician of Zurich, had in Meditation, when the present Treatise appeared, which he thought had so thoroughly fulfilled his own Intention, that it prevented his attempting to execute it. But the great Difficulty consisted in discovering a Physician, who, with equal Abilities, Reputation and Practice, should be qualified with that much rarer Qualification of caring so much more for the Health of those, who could never pay him for it, than for his own Profit or Ease, as to determine him to project and to accomplish so necessary, and yet so self-denying, a Work. For as the Simplicity he proposed in the Style and Manner of it, by condescending, in the plainest Terms, to the humblest Capacities, obliged him to depress himself, by writing rather beneath the former Treatises, which had acquired him the Reputation of medical Erudition, Reasoning and Elegance; we find that the Love of Fame itself, so stimulating even to many ingenuous Minds, was as impotent as that of Wealth, to seduce him from so benign, so generous a Purpose. Though, upon Reflection, it is by no Means strange to see wise Men found their Happiness, which all [however variously and even oppositely] pursue, rather in Conscience, than on Applause; and this naturally reminds us of that celebrated Expression of Cato, or some other excellent Ancient, “that he had rather be good, than be reputed so.”

However singular such a Determination may now appear, the Number of reputable medical Translators into different Languages, which this original Work has employed on the Continent, makes it evident, that real Merit will, sooner or later, have a pretty general Influence; and induce many to imitate that Example, which they either could not, or did not, propose. As the truly modest Author has professedly disclaimed all Applause on the Performance, and contented himself with hoping an Exemption from Censure, through his Readers' Reflection on the peculiar Circumstances and Address of it; well may his best, his faithfullest Translators, whose Merit and Pains must be of a very secondary Degree to his own, be satisfied with a similar Exemption: especially when joined to the Pleasure, that must result from a Consciousness of having endeavoured to extend the Benefits of their Author's Treatise, to Multitudes of their own Country and Language.

For my own Particular, when after reading the Introduction to the Work, and much of the Sequel, I had determined to translate it; to be as just as possible to the Author, and to his English Readers, I determined not to interpolate any Sentiment of my own into the Text, nor to omit one Sentence of the Original, which, besides its being Detraction in its literal Sense, I thought might imply it in its worst, its figurative one; for which there was no Room. To conform as fully as possible to the Plainness and Perspicuity he proposed, I have been pretty often obliged in the anatomical Names of some Parts, and sometimes of the Symptoms, as well as in some pretty familiar, though not entirely popular Words, to explain all such by the most common Words I have heard used for them; as after mentioning the Diaphragm, to add, or Midriff—the Trachæa—or Windpipe—acrimonious, or very sharp, and so of many others. This may a little, though but a little, have extended the Translation beyond the Original; as the great Affinity between the French and Latin, and between the former and many Latin Words borrowed from the Greek, generally makes the same anatomical or medical Term, that is technical with us, vernacular or common with them. But this unavoidable Tautology, which may be irksome to many Ears, those medical Readers, for whom it was not intended, will readily forgive, from a Consideration of the general Address of the Work: while they reflect that meer Style, if thoroughly intelligible, is least essential to those Books, which wholly consist of very useful, and generally interesting, Matter.

As many of the Notes of the Editor of Lyons, as I have retained in this Version (having translated from the Edition of Lyons) are subscribed E. L. I have dispensed with several, some, as evidently less within Dr. Tissot's Plan, from tending to theorize, however justly or practically, where he must have had his own Reasons for omitting to theorize: a few others, as manifestly needless, from what the Author had either premised, or speedily subjoined, on the very same Circumstance: besides a very few, from their local Confinement to the Practice at Lyons, which lies in a Climate somewhat more different from our own than that of Lausanne. It is probable nevertheless, I have retained a few more than were necessary in a professed Translation of the original Work: but wherever I have done this, I have generally subjoined my Motive for it; of whatever Consequence that may appear to the Reader. I have retained all the Author's own Notes, with his Name annexed to them; or if ever the Annotator was uncertain to me, I have declared whose Note I supposed it to be.

Such as I have added from my own Experience or Observation are subscribed K, to distinguish them from the others; and that the Demerit of any of them may neither be imputed to the learned Author, nor to his Editor. Their principal Recommendation, or Apology is, that whatever Facts I have mentioned are certainly true. I have endeavoured to be temperate in their Number and Length, and to imitate that strict Pertinence, which prevails throughout the Author's Work. If any may have ever condescended to consider my Way of writing, they will conceive this Restraint has cost me at least as much Pains, as a further Indulgence of my own Conceptions could have done. The few Prescriptions I have included in some of them, have been so conducted, as not to give the Reader the least Confusion with Respect to those, which the Author has given in his Table of Remedies, and which are referred to by numerical Figures, throughout the Course of his Book.

The moderate Number of Dr. Tissot's Prescriptions, in his Table of Remedies, amounting but to seventy-one, and the apparent Simplicity of many of them, may possibly disgust some Admirers of pompous and compound Prescription. But his Reserve, in this important Respect, has been thoroughly consistent with his Notion of Nature's curing Diseases; which suggested to him the first, the essential Necessity of cautioning his Readers against doing, giving, or applying any thing, that might oppose her healing Operations (a most capital Purpose of his Work) which important Point being gained, the mildest, simplest and least hazardous Remedies would often prove sufficient Assistants to her. Nevertheless, under more severe and tedious Conflicts, he is not wanting to direct the most potent and efficacious ones. The Circumstances of the poor Subjects of his medical Consideration, became also a very natural Object to him, and was in no wise unworthy the Regard of the humane Translator of Bilguer on Amputations, or rather against the crying Abuse of them; an excellent Work, that does real Honour to them both; and which can be disapproved by none, who do not prefer the frequently unnecessary Mutilation of the afflicted, to the Consumption of their own Time, or the Contraction of their Employment.

Some Persons may imagine that a Treatise of this Kind, composed for the Benefit of labouring People in Swisserland, may be little applicable to those of the British Islands: and this, in a very few Particulars, and in a small Degree, may reasonably be admitted. But as we find their common Prejudices are often the very same; as the Swiss are the Inhabitants of a colder Climate than France, and generally, as Dr. Tissot often observes, accustomed to drink (like ourselves) more strong Drink than the French Peasantry; and to indulge more in eating Flesh too, which the Religion of Berne, like our own, does not restrain; the Application of his Advice to them will pretty generally hold good here. Where he forbids them Wine and Flesh, all Butchers Meat, and in most Cases all Flesh, and all strong Drink should be prohibited here: especially when we consider, that all his Directions are confined to the Treatment of acute Diseases, of which the very young, the youthful, and frequently even the robust are more generally the Subjects. Besides, in some few of the English Translator's Notes, he has taken the Liberty of moderating the Coolers, or the Quantities of them (which may be well adapted to the great Heats and violent Swiss Summers he talks of) according to the Temperature of our own Climate, and the general Habitudes of our own People. It may be observed too, that from the same Motive, I have sometimes assumed the Liberty of dissenting from the Text in a very few Notes, as for Instance, on the Article of Pastry, which perhaps is generally better here than in Swisserland (where it may be no better than the coarse vile Trash that is hawked about and sold to meer Children) as I have frequently, in preparing for Inoculation, admitted the best Pastry (but not of Meat) into the limited Diet of the Subjects of Inoculation, and constantly without the least ill Consequence. Thus also in Note [⁷⁰] Page [287], [288], I have presumed to affirm the Fact, that a strong spirituous Infusion of the Bark has succeeded more speedily in some Intermittents, in particular Habits, than the Bark in Substance. This I humbly conceive may be owing to such a Menstruum's extracting the Resin of the Bark more effectually (and so conveying it into the Blood) than the Juices of the Stomach and of the alimentary Canal did, or could. For it is very conceivable that the Crasis, the Consistence, of the fibrous Blood may sometimes be affected with a morbid Laxity or Weakness, as well as the general System of the muscular Fibres.

These and any other like Freedoms, I am certain the Author's Candour will abundantly pardon; since I have never dissented for Dissention's Sake, to the best of my Recollection; and have the Honour of harmonizing very generally in Judgment with him. If one useful Hint or Observation occurs throughout my Notes, his Benevolence will exult in that essential Adherence to his Plan, which suggested it to me: While an invariable ecchoing Assentation throughout such Notes, when there really was any salutary Room for doubting, or for adding (with Respect to ourselves) would discover a Servility, that must have disgusted a liberal manly Writer. One common good Purpose certainly springs from the generous Source, and replenishes the many Canals into which it is derived; all the Variety and little Deviations of which may be considered as more expansive Distributions of its Benefits.

Since the natural Feelings of Humanity generally dispose us, but especially the more tender and compassionate Sex, to advise Remedies to the poor Sick; such a Knowledge of their real Disease, as would prevent their Patrons, Neighbours and Assistants from advising a wrong Regimen, or an improper or ill-timed Medicine, is truly essential to relieving them: and such we seriously think the present Work is capable of imparting, to all commonly sensible and considerate Perusers of it. A Vein of unaffected Probity, of manly Sense, and of great Philanthropy, concur to sustain the Work: And whenever the Prejudices of the Ignorant require a forcible Eradication; or the crude Temerity and Impudence of Knaves and Impostors cry out for their own Extermination, a happy Mixture of strong Argument, just Ridicule, and honest Severity, give a poignant and pleasant Seasoning to the Work, which renders it occasionally entertaining, as it is continually instructive.

A general Reader may be sometimes diverted with such Customs and Notions of the Swiss Peasants, as are occasionally mentioned here: and possibly our meerest Rustics may laugh at the brave simple Swiss, on his introducing a Sheep into the Chamber of a very sick Person, to save the Life of the Patient, by catching its own Death. But the humblest Peasantry of both Nations are agreed in such a Number of their absurd unhealthy Prejudices, in the Treatment of Diseases, that it really seemed necessary to offer our own the Cautions and Counsels of this principal Physician, in a very respectable Protestant Republick, in Order to prevent their Continuance. Nor is it unreasonable to presume, that under such a Form of Government, if honestly administered upon its justest Principles, the People may be rather more tenderly regarded, than under the Pomp and Rage of Despotism, or the Oppression of some Aristocracies.

Besides the different Conditions of [¹] Persons, to whom our Author recommends the Patronage and Execution of his Scheme, in his Introduction, it is conceived this Book must be serviceable to many young Country Practitioners, and to great Numbers of Apothecaries, by furnishing them with such exact and striking Descriptions of each acute Disease and its Symptoms, as may prevent their mistaking it for any other; a Deception which has certainly often been injurious, and sometimes even fatal: for it is dreadful but to contemplate the Destruction or Misery, with which Temerity and Ignorance, so frequently combined, overwhelm the Sick. Thus more Success and Reputation, with the Enjoyment of a better Conscience, would crown their Endeavours, by a more general Recovery of, or Relief to, their Patients. To effect this, to improve every Opportunity of eschewing medical Evil, and of doing medical Good, was the Author's avowed Intention; which he informs us in his Preface, he has heard, from some intelligent and charitable Persons, his Treatise had effected, even in some violent Diseases. That the same good Consequences may every where attend the numerous Translations of it, must be the fervent Wish of all, except the Quacks and Impostors he so justly characterizes in his thirty-third Chapter! and particularly of all, who may be distinguishably qualified, like himself, to,

—Look through Nature up to Nature's GOD!

The AUTHOR's DEDICATION.

To the most Illustrious, the most Noble and Magnificent Lords, the Lords President and Counsellors of the Chamber of Health, of the City and Republick of Berne.

Most honourable Lords,

hen I first published the following Work, my utmost Partiality to it was not sufficient to allow me the Confidence of addressing it to Your Lordships. But Your continual Attention to all the Objects, which have any Relation to that important Part of the Administration of the State, which has been so wisely committed to Your Care, has induced You to take Notice of it. You have been pleased to judge it might prove useful, and that an Attempt must be laudable, which tends to the Extermination of erroneous and inveterate Prejudices, those cruel Tyrants, that are continually opposing the Happiness of the People, even under that Form and Constitution of Government, which is the best adapted to establish and to increase it.

Your Lordships Approbation, and the splendid Marks of [²] Benevolence, with which You have honoured me, have afforded me a juster Discernment of the Importance of this Treatise, and have inclined me to hope, most Illustrious, most Noble, and Magnificent Lords, that You will permit this new Edition of it to appear under the Sanction of your Auspices; that while the Publick is assured of Your general Goodness and Beneficence, it may also be informed of my profoundly grateful Sense of them, on the same Occasion.

May the present Endeavour then, in fully corresponding to my Wishes, effectually realize Your Lordships utmost Expectations from it; while You condescend to accept this small Oblation, as a very unequal Expression of that profound Respect, with which I have the Honour to be,

Most Illustrious, Most Noble, and Magnificent Lords,

Your most humble

And most

Obedient Servant,

TISSOT.

Lausanne,

Dec. 3, 1762.

THE AUTHOR's PREFACE.

f Vanity too often disposes many to speak of themselves, there are some Occasions, on which a total Silence might be supposed to result from a still higher Degree of it: And the very general Reception of the Advice to the People has been such, that there would be Room to suspect me of that most shocking Kind of Pride, which receives Applause with Indifference (as deeming its own Merit Superior to the greatest) if I did not appear to be strongly impressed with a just Sense of that great Favour of the Publick, which has been so very obliging, and is so highly agreable, to me.

Unfeignedly affected with the unhappy Situation of the poor Sick in Country Places in Swisserland, where they are lost from a Scarcity of the best Assistance, and from a fatal Superfluity of the worst, my sole Purpose in writing this Treatise has been to serve, and to comfort them. I had intended it only for a small Extent of Country, with a moderate Number of Inhabitants; and was greatly surprized to find, that within five or six Months after its Publication, it was become one of the most extensively published Books in Europe; and one of those Treatises, on a scientific Subject, which has been perused by the greatest Number of Readers of all Ranks and Conditions. To consider such Success with Indifference, were to have been unworthy of it, which Demerit, at least on this Account, I cannot justly be charged with; since Indifference has not been my Case, who have felt, as I ought, this Gratification of Self-love; and which, under just and prudent Restrictions, may perhaps be even politically cherished; as the Delight naturally arising from having been approved, is a Source of that laudable Emulation, which has sometimes produced the most essential good Consequences to Society itself. For my own particular, I can truly aver, that my Satisfaction has been exquisitely heightened on this Occasion, as a Lover of my Species: since judging from the Success of this Work (a Success which has exceeded my utmost Expectations) of the Effects that may reasonably be expected from it, I am happily conscious of that Satisfaction, or even Joy, which every truly honest Man must receive, from rendering essential good Offices to others. Besides which, I have enjoyed, in its utmost Extent, that Satisfaction which every grateful Man must receive from the Approbation and Beneficence of his Sovereign, when I was distinguished with the precious Medal, which the illustrious Chamber of Health of the Republick of Berne honoured me with, a few Months after the Publication of this Treatise; together with a Letter still more estimable, as it assured me of the extraordinary Satisfaction the Republick had testified on the Impression of it; a Circumstance, which I could not avoid this publick Acknowledgement of, without the greatest Vanity and Ingratitude. This has also been a very influencing Motive with me, to exert my utmost Abilities in perfecting this new Edition, in which I have made many Alterations, that render it greatly preferable to the first; and of which Amendments I shall give a brief Account, after saying somewhat of the Editions, which have appeared elsewhere.

The first is that, which Messrs. Heidegger, the Booksellers published in the German Language at Zurich, about a Year since. I should have been highly delighted with the meer Approbation of M. Hirzel, first Physician of the Canton of Zurich, &c. whose superior and universal Talents; whose profound Knowledge in the Theory of Physick; and the Extent and Success of whose Practice have justly elevated him among the small Number of extraordinary Men of our own Times; he having lately obtained the Esteem and the Thanks of all Europe, for the History of one of her [³] Sages. But I little expected the Honour this Gentleman has done me, in translating the Advice to the People into his own Language. Highly sensible nevertheless as I am of this Honour, I must always reflect with Regret, that he has consumed that important Time, in rendering my Directions intelligible to his Countrymen, which he might have employed much more usefully, in obliging the World with his own.

He has enriched his Translation with an excellent Preface, which is chiefly employed in a just and beautiful Portrait and Contrast of the true, and of the false Physician; with which I should have done myself the Pleasure to have adorned the present [⁴] Edition; if the Size of this Volume, already too large, had not proved an Obstacle to so considerable an Addition; and if the Manner, in which Mr. Hirzel speaks of its Author, had permitted me with Decency to publish his Preface. I have been informed by some Letters, that there have been two other German Translation of it; but I am not informed by whom. However, M. Hirzel's Preface, his own Notes, and some Additions with which I have furnished him, renders his Edition preferable to the first in French, and to the other German Translations already made.

The Second Edition is that, which the younger Didot, the Bookseller, published towards the End of the Winter at Paris. He had requested me to furnish him with some Additions to it, which I could not readily comply with.

The Third Edition is a Dutch Translation of it, which will be very speedily published by M. Renier Aremberg, Bookseller at Rotterdam. He had begun the Translation from my first Edition; but having wrote to know whether I had not some Additions to make, I desired him to wait for the Publication of this. I have the good Fortune to be very happy in my Translators; it being M. Bikker, a celebrated Physician at Rotterdam (so very advantagiously known in other Countries, by his beautiful Dissertation on Human Nature, throughout which Genius and Knowledge proceed Hand in Hand) who will present his Countrymen with the Advice to the People, in their own Language: and who will improve it with such Notes, as are necessary for a safe and proper Application of its Contents, in a Climate, different from that in which it was wrote. I have also heard, there has been an Italian Translation of it.

After this Account of the foreign Editions, I return to the present one, which is the second of the original French Treatise. I shall not affirm it is greatly corrected, with Respect to fundamental Points: for as I had advanced nothing in the first, that was not established on Truth and Demonstration, there was no Room for Correction, with Regard to any essential Matters. Nevertheless, in this I have made, 1, a great Number of small Alterations in the Diction, and added several Words, to render the Work still more simple and perspicuous. 2, The typographical Execution of this is considerably improved in the Type, the Paper and Ink, the Spelling, Pointing, and Arrangement of the Work. 3, I have made some considerable Additions, which are of three Kinds. Not a few of them are new Articles on some of the Subjects formerly treated of; such as the Articles concerning Tarts and other Pastry Ware; the Addition concerning the Regimen for Persons, in a State of Recovery from Diseases; the Preparation for the Small Pocks; a long Note on the Jesuits Bark; another on acid Spirits; one on the Extract of Hemlock: besides some new Matter which I have inserted; such as an Article with Regard to proper Drinks; one on the Convulsions of Infants; one on Chilblains; another on Punctures from Thorns; one upon the Reason of the Confidence reposed in Quacks, and the thirty-first Chapter entirely: in which I have extended the Consideration of some former Articles, that seemed to me a little too succinct and short. There are some Alterations of this last, this additional, Kind, interspersed almost throughout the whole Substance of this Edition; but especially in the two Chapters relating to Women and Children.

The Objects of the [XXXI Chapter] are such as require immediate Assistance, viz. Swoonings, Hæmorrhages, that is, large spontaneous Bleedings; the Attacks of Convulsions, and of Suffocations; the Consequences of Fright and Terror; Disorders occasioned by unwholesome or deadly Vapours; the Effects of Poison, and the sudden Invasions of excessive Pain.

The Omission of this Chapter was a very material Defect in the original Plan of this Work. The Editor of it at Paris was very sensible of this Chasm, or Blank, as it may be called, and has filled it up very properly: and if I have not made Use of his Supplement, instead of enlarging myself upon the Articles of which he has treated, it has only been from a Purpose of rendering the whole Work more uniform; and to avoid that odd Diversity, which seems scarcely to be avoided in a Treatise composed by two Persons. Besides which, that Gentleman has said nothing of the Articles, which employ the greatest Part of that Chapter, viz. the Swoonings, the Consequences of great Fear, and the noxious Vapours.

Before I conclude, I ought to justify myself, as well as possible, to a great Number of very respectable Persons both here and abroad, (to whom I can refuse nothing without great Chagrine and Reluctance) for my not having made such Additions as they desired of me. This however was impossible, as the Objects, in which they concurred, were some chronical Distempers, that are entirely out of the Plan, to which I was strictly attached, for many Reasons. The first is, that it was my original Purpose to oppose the Errors incurred in Country Places, in the Treatment of acute Diseases; and to display the best Method of conducting such, as do not admit of waiting for the Arrival of distant Succour; or of removing the Patients to Cities, or large Towns. It is but too true indeed, that chronical Diseases are also liable to improper Treatment in small Country Places: but then there are both Time and Convenience to convey the Patients within the Reach of better Advice; or for procuring them the Attendance of the best Advisers, at their own Places of Residence. Besides which, such Distempers are considerably less common than those to which I had restrained my Views: and they will become still less frequent, whenever acute Diseases, of which they are frequently the Consequences, shall be more rationally and safely conducted.

The second Reason, which, if alone, would have been a sufficient one, is, that it is impossible to subject the Treatment of chronical Distempers to the Capacity and Conduct of Persons, who are not Physicians. Each acute Distemper generally arises from one Cause; and the Treatment of it is simple and uniform; since those Symptoms, which manifest the Malady, point out its Cause and Treatment. But the Case is very differently circumstanced in tedious and languid Diseases; each of which may depend on so many and various Causes (and it is only the real, the true Cause, which ought to determine us in selecting its proper Remedies) that though the Distemper and its Appellation are evidently known, a meer By-stander may be very remote from penetrating into its true Cause; and consequently be incapable of chusing the best Medicines for it. It is this precise and distinguishing Discernment of the real particular Cause [or of the contingent Concurrence of more than one] that necessarily requires the Presence of Persons conversant in the Study and the Practice of all the Parts of Physick; and which Knowledge it is impossible for People, who are Strangers to such Studies, to arrive at. Moreover, their frequent Complexness; the Variety of their Symptoms; the different Stages of these tedious Diseases [not exactly attended to even by many competent Physicians] the Difficulty of ascertaining the different Doses of Medicines, whose Activity may make the smallest Error highly dangerous, &c. &c. are really such trying Circumstances, as render the fittest Treatment of these Diseases sufficiently difficult and embarrassing to the most experienced Physicians, and unattainable by those who are not Physicians.

A third Reason is, that, even supposing all these Circumstances might be made so plain and easy, as to be comprehended by every Reader, they would require a Work of an excessive Length; and thence be disproportioned to the Faculties of those, for whom it was intended. One single chronical Disease might require as large a Volume as the present one.

But finally, were I to acknowledge, that this Compliance was both necessary and practicable, I declare I find it exceeds my Abilities; and that I am also far from having sufficient Leisure for the Execution of it. It is my Wish that others would attempt it, and may succeed in accomplishing it; but I hope these truly worthy Persons, who have honoured me by proposing the Achievement of it to myself, will perceive the Reasons for my not complying with it, in all their Force; and not ascribe a Refusal, which arises from the very Nature of the thing, either to Obstinacy, or to any Want of an Inclination to oblige them.

I have been informed my Citations, or rather References, have puzzled some Readers. It was difficult to foresee this, but is easy to prevent it for the future. The Work contains Citations only of two Sorts; one, that points to the Remedies prescribed; and the other, which refers to some Passage in the Book itself, that serves to illustrate those Passages in which I cite. Neither of these References could have been omitted. The first is marked thus, Nº. with the proper Figure to it, as 1, 2, &c. This signifies, that the Medicine I direct is described in the Table of Remedies, according to the Number annexed to that Character. Thus when we find directed, in any Page of the Book, the warm Infusion [Nº. 1]; in some other, the Ptisan [Nº. 2]; or in a third, the Almond Milk, or Emulsion [Nº. 4], it signifies, that such Prescriptions will be found at the Numbers 1, 2, and 4; and this Table is printed at the End of the Book.

If, instead of forming this Table, and thus referring to the Prescriptions by their Numbers, I had repeated each Prescription as often as I directed it, this Treatise must have been doubled in Bulk, and insufferably tiresome to peruse. I must repeat here, what I have already said in the former Edition, that the [⁵] Prices of the Medicines, or of a great Number of them, are those at which the Apothecaries may afford them, without any Loss, to a Peasant in humble Circumstances. But it should be remembered, they are not set down at the full Prices which they may handily demand; since that would be unjust for some to insist on them at. Besides, there is no Kind of Tax in Swisserland, and I have no Right to impose one.

The Citations of the second Kind are very plain and simple. The whole Work is divided into numbered Paragraphs distinguished by the Mark §. And not to swell it with needless Repetitions, when in one Place I might have even pertinently repeated something already observed, instead of such Repetition at Length, I have only referred to the Paragraph, where it had been observed. Thus, for Example when we read Page [81], [§ 50] —When the Disease is so circumstanced as we have described, [§ 46],— this imports that, not to repeat the Description already given, I refer the Reader to that last § for it.

The Use of these Citations is not the least Innovation, and extremely commodious and easy: but were there only a single Reader likely to be puzzled by them, I ought not to omit this Explanation of them, as I can expect to be generally useful, only in Proportion as I am clear: and it must be obvious, that a Desire of being extensively useful is the sole Motive of this Work. I have long since had the Happiness of knowing, that some charitable and intelligent Persons have applied the Directions it contains, with extraordinary Success, even in violent Diseases: And I shall arrive at the Height of my Wishes, if I continue to be informed, that it contributes to alleviate the Sufferings, and to prolong the Days, of my rational Fellow Creatures.

N. B. A Small Blank occurring conveniently here in the Impression, the Translator of this Work has employed it to insert the following proper Remark, viz.

Whenever the Tea or Infusion of the Lime-tree is directed in the Body of the Book, which it often is, the Flowers are always meant, and not the Leaves; though by an Error of the Press, or perhaps rather by an Oversight of the Transcribers of this Version, it is printed Leaves instead of Flowers P. [392], as noted and corrected in the [Errata]. These Flowers are easily procurable here, meerly for gathering, in most Country Places in July, as few Walks, Vistas, &c. are without these Trees, planted for the pleasant Shade they afford, and to keep off the Dust in Summer, though the Leaf drops rather too early for this Purpose. Their Flowers have an agreeable Flavour, which is communicated to Water by Infusion, and rises with it in Distillation. They were, to the best of my Recollection, an Ingredient in the antiepileptic Water of Langius, omitted in our late Dispensatories of the College. They are an Ingredient in the antiepileptic Powder, in the List of Medicines in the present Practice of the Hotel Dieu at Paris: and we think were in a former Prescription of our Pulvis de Gutteta, or Powder against Convulsions. Indeed they are considered, by many medical Writers, as a Specific in all Kinds of Spasms and Pains; and Hoffman affirms, he knew a very tedious Epilepsy cured by the Use of an Infusion of these Flowers.

I also take this Opportunity of adding, that as this Translation is intended for the Attention and the Benefit of the Bulk of the Inhabitants of the British Empire, I have been careful not to admit any Gallicisms into it; as such might render it either less intelligible, or less agreeable to its Readers. If but a single one occurs, I either have printed it, or did intend it should be printed, distinguishably in Italics. K.

Introduction.

he Decrease of the Number of Inhabitants, in most of the States of Europe, is a Fact, which impresses every reflecting Person, and is become such a general Complaint, as is but too well established on plain Calculations. This Decrease is most remarkable in Country Places. It is owing to many Causes; and I shall think myself happy, if I can contribute to remove one of the greatest of them, which is the pernicious Manner of treating sick People in Country Places. This is my sole Object, tho' I may be excused perhaps for pointing out the other concurring Causes, which may be all included within these two general Affirmations; That greater Numbers than usual emigrate from the Country; and that the People increase less every where.

There are many Sorts of Emigration. Some leave their Country to enlist in the Service of different States by Sea and Land; or to be differently employ'd abroad, some as Traders, others as Domestics, &c.

Military Service, by Land or Sea, prevents Population in various Respects. In the first Place, the Numbers going abroad are always less, often much less, than those who return. General Battles, with all the Hazards and Fatigues of War; detached Encounters, bad Provisions, Excess in drinking and eating, Diseases that are the Consequences of Debauches, the Disorders that are peculiar to the Country; epidemical, pestilential or contagious Distempers, caused by the unwholsome Air of Flanders, Holland, Italy and Hungary; long Cruises, Voyages to the East or West Indies, to Guinea, &c. destroy a great Number of Men. The Article of Desertion also, the Consequences of which they dread on returning home, disposes many to abandon their Country for ever. Others, on quitting the Service, take up with such Establishments, as it has occasionally thrown in their Way; and which necessarily prevent their Return. But in the second Place, supposing they were all to come back, their Country suffers equally from their Absence; as this very generally happens during that Period of Life, when they are best adapted for Propagation; since that Qualification on their Return is impaired by Age, by Infirmities and Debauches: and even when they do marry, the Children often perish as Victims to the Excesses and Irregularities of their Fathers: they are weak, languishing, distempered, and either die young, or live incapable of being useful to Society. Besides, that the prevailing Habit of Libertinage, which many have contracted, prevents several of them from marrying at all. But notwithstanding all these inconvenient Consequences are real and notorious; yet as the Number of those, who leave their Country on these Accounts, is limited, and indeed rather inconsiderable, if compared with the Number of Inhabitants which must remain at home: as it may be affirmed too, that this relinquishing of their Country, may have been even necessary at some Times, and may become so again, if the Causes of Depopulation should cease, this kind of Emigration is doubtless the least grievous of any, and the last which may require a strict Consideration.

But that abandoning of their Country, or Expatriation, as it may be termed, the Object of which is a Change of the Emigrants Condition, is more to be considered, being more numerous. It is attended with many and peculiar Inconveniencies, and is unhappily become an epidemical Evil, the Ravages of which are still increasing; and that from one simple ridiculous Source, which is this; that the Success of one Individual determines a hundred to run the same Risque, ninety and nine of whom may probably be disappointed. They are struck with the apparent Success of one, and are ignorant of the Miscarriage of others. Suppose a hundred Persons might have set out ten Years ago, to seek their Fortune, as the saying is, at the End of six Months they are all forgotten, except by their Relations; but if one should return the same Year, with more Money than his own Fortune, more than he set out with; or if one of them has got a moderate Place with little Work, the whole Country rings with it, as a Subject of general Entertainment. A Croud of young People are seduced by this and sally forth, because not one reflects, that of the ninety nine, who set out with the hundredth Person, one half has perished, many are miserable, and the Remainder come back, without having gained any thing, but an Incapacity to employ themselves usefully at home, and in their former Occupations: and having deprived their Country of a great many Cultivaters, who, from the Produce of the Lands, would have attracted considerable Sums of Money, and many comfortable Advantages to it. In short, the very small Proportion who succeed, are continually talked of; the Croud that sink are perpetually forgot. This is a very great and real Evil, and how shall it be prevented? It would be sufficient perhaps to publish the extraordinary Risque, which may be easily demonstrated: It would require nothing more than to keep an exact yearly Register of all these Adventurers, and, at the Expiration of six, eight, or ten Years, to publish the List, with the Fate, of every Emigrant. I am greatly deceived, or at the End of a certain Number of Years, we should not see such Multitudes forsake their native Soil, in which they might live comfortably by working, to go in Search of Establishments in others; the Uncertainty of which, such Lists would demonstrate to them; and also prove, how preferable their Condition in their own Country would have been, to that they have been reduced to. People would no longer set out, but on almost certain Advantages: fewer would undoubtedly emigrate, more of whom, from that very Circumstance, must succeed. Meeting with fewer of their Country-men abroad, these fortunate few would oftner return. By this Means more Inhabitants would remain in the Country, more would return again, and bring with them more Money to it. The State would be more populous, more rich and happy; as the Happiness of a People, who live on a fruitful Soil, depends essentially on a great Number of Inhabitants, with a moderate Quantity of pecuniary Riches.

But the Population of the Country is not only necessarily lessened, in Consequence of the Numbers that leave it; but even those who remain increase less, than an equal Number formerly did. Or, which amounts to the same Thing, among the same Number of Persons, there are fewer Marriages than formerly; and the same Number of Marriages produce fewer Christenings. I do not enter upon a Detail of the Proofs, since merely looking about us must furnish a sufficient Conviction of the Truth of them. What then are the Causes of this? There are two capital ones, Luxury and Debauchery, which are Enemies to Population on many Accounts.

Luxury compells the wealthy Man, who would make a Figure; and the Man of a moderate Income, but who is his equal in every other Respect, and who will imitate him, to be afraid of a numerous Family; the Education of which must greatly contract that Expence he had devoted to Parade and Ostentation: And besides, if he must divide his Estate among a great many Children, each of them would have but a little, and be unable to keep up the State and the Train of the Father's. Since Merit is unjustly estimated by exterior Shew and Expence, one must of Course endeavour to attain for himself, and to leave his Children in, a Situation capable of supporting that Expence. Hence the fewer Marriages of People who are not opulent, and the fewer Children among People who marry.

Luxury is further prejudicial to the Increase of the People, in another Respect. The irregular Manner of Life which it introduces, depresses Health; it ruins the Constitutions, and thus sensibly affects Procreation. The preceding Generation counted some Families with more than twenty Children: the living one less than twenty Cousins. Very unfortunately this Way of thinking and acting, so preventive of Increase, has extended itself even into Villages: and they are no longer convinced there, that the Number of Children makes the Riches of the Countryman. Perhaps the next Generation will scarcely be acquainted with the Relation of Brotherhood.

A third Inconvenience of Luxury is, that the Rich retreat from the Country to live in Cities; and by multiplying their Domestics there, they drain the former. This augmented Train is prejudicial to the Country, by depriving it of Cultivaters, and by diminishing Population. These Domestics, being seldom sufficiently employed, contract the Habit of Laziness; and they prove incapable of returning to that Country Labour, for which Nature intended them. Being deprived of this Resource they scarcely ever marry, either from apprehending the Charge of Children, or from their becoming Libertines; and sometimes, because many Masters will not employ married Servants. Or should any of them marry, it is often in the Decline of Life, whence the State must have the fewer Citizens.

Idleness of itself weakens them, and disposes them to those Debauches, which enfeeble them still more. They never have more than a few Children, and these sickly; such as have not Strength to cultivate the Ground; or who, being brought up in Cities, have an Aversion to the Country.

Even those among them who are more prudent, who preserve their Morals, and make some Savings, being accustomed to a City Life, and dreading the Labour of a Country one (of the Regulation of which they are also ignorant) chuse to become little Merchants, or Tradesmen; and this must be a Drawback from Population, as any Number of Labourers beget more Children than an equal Number of Citizens; and also by Reason, that out of any given Number, more Children die in Cities, than in the Country.

The same Evils also prevail, with Regard to female Servants. After ten or twelve Years Servitude, the Maid-Servants in Cities cannot acquit themselves as good Country Servants: and such of them as chuse this Condition, quickly fail under that Kind or Quantity of Work, for which they are no longer constituted. Should we see a Woman married in the Country, a Year after leaving Town, it is easy to observe, how much that Way of living in the Country has broke her. Frequently their first Child-bed, in which Term they have not all the Attendance their Delicacy demands, proves the Loss of their Health; they remain in a State of Languor, of Feebleness, and of Decay: they have no more Children; and this renders their Husbands unuseful towards the Population of the State.

Abortions, Infants carried out of their Country after a concealed Pregnancy, and the Impossibility of their getting Husbands afterwards, are frequently the Effects of their Libertinage.

It is to be apprehended too these bad Effects are rather increasing with us; since, either for want of sufficient Numbers, or from oeconomical Views, it has become a Custom, instead of Women Servants, to employ Children, whose Manners and whole Constitutions are not yet formed; and who are ruined in the same Manner, by their Residence in Town, by their Laziness, by bad Examples, and bad Company.

Doubtless much remains still unsaid on these important Heads; but besides my Intention not to swell this Treatise immoderately, and the many Avocations, which prevent me from launching too far into what may be less within the Bounds of Medicine, I should be fearful of digressing too far from my Subject. What I have hitherto said however, I think cannot be impertinent to it; since in giving Advice to the People, with Regard to their Health, it was necessary to display to them the Causes that impaired it: though what I might be able to add further on this Head, would probably be thought more remote from the Subject.

I shall add then but a single Hint on the Occasion. Is it not practicable, in Order to remedy those Evils which we cannot prevent, to select some particular Part or Canton of the Country, wherein we should endeavour by Rewards, 1st. Irremoveably to fix all the Inhabitants. 2dly. To encourage them by other Rewards to a plentiful and legitimate Increase. They should not be permitted to go out of it, which must prevent them from being exposed to the Evils I have mentioned. They should by no means intermarry with any Strangers, who might introduce such Disorders among them. Thus very probably this Canton, after a certain Time, would become even over-peopled, and might send out Colonies to the others.

One Cause, still more considerable than those we have already mention'd, has, to this very Moment, prevented the Increase of the People in France. This is the Decay of Agriculture. The Inhabitants of the Country, to avoid serving in the Militia; to elude the Days-Service impos'd by their Lords, and the Taxes; and being attracted to the City by the Hopes of Interest, by Laziness and Libertinage, have left the Country nearly deserted. Those who remain behind, either not being encouraged to work, or not being sufficient for what there is to do, content themselves with cultivating just as much as is absolutely necessary for their Subsistence. They have either lived single, or married but late; or perhaps, after the Example of the Inhabitants of the Cities, they have refused to fulfil their Duty to Nature, to the State, and to a Wife. The Country deprived of Tillers, by this Expatriation and Inactivity, has yielded nothing; and the Depopulation of the State has daily increased, from the reciprocal and necessary Proportion between Subsistence and Population, and because Agriculture alone can increase Subsistence. A single Comparison will sufficiently evince the Truth and the Importance of these Principles, to those who have not seen them already divulged and demonstrated in the Works of the [⁶] Friend of Man.

“An old Roman, who was always ready to return to the Cultivation of his Field, subsisted himself and his Family from one Acre of Land. A Savage, who neither sows nor cultivates, consumes, in his single Person, as much Game as requires fifty Acres to feed them. Consequently Tullus Hostilius, on a thousand Acres, might have five thousand Subjects: while a Savage Chief, limited to the same Extent of Territory, could scarcely have twenty: such an immense Disproportion does Agriculture furnish, in Favour of Population. Observe these two great Extremes. A State becomes dispeopled or peopled in that Proportion, by which it recedes from one of these Methods, and approaches to the other.” Indeed it is evident, that wherever there is an Augmentation of Subsistence, an Increase of Population will soon follow; which again will still further facilitate the Increase of Provisions. In a State thus circumstanced Men will abound, who, after they have furnished sufficient Numbers for the Service of War, of Commerce, of Religion, and for Arts and Professions of every kind, will further also furnish a Source for Colonies, who will extend the Name and the Prosperity of their Nation to distant Regions. There will ensue a Plenty of Commodities, the Superfluity of which will be exported to other Countries, to exchange for other Commodities, that are not produced at home; and the Balance, being received in Money, will make the Nation rich, respectable by its Neighbours, and happy. Agriculture, vigorously pursued, is equal to the Production of all these Benefits; and the present Age will enjoy the Glory of restoring it, by favouring and encouraging Cultivaters, and by forming Societies for the Promotion of Agriculture.

I proceed at length to the fourth Cause of Depopulation, which is the Manner of treating sick People in the Country. This has often affected me with the deepest Concern. I have been a Witness, that Maladies, which, in themselves, would have been gentle, have proved mortal from a pernicious Treatment: I am convinced that this Cause alone makes as great a Havock as the former; and certainly it requires the utmost Attention of Physicians, whose Duty it is to labour for the Preservation of Mankind. While we are employing our assiduous Cares on the more polished and fashionable Part of them in Cities, the larger and more useful Moiety perish in the Country; either by particular, or by highly epidemical, Diseases, which, within a few Years past, have appeared in different Villages, and made no small Ravages. This afflicting Consideration has determined me to publish this little Work, which is solely intended for those Patients, who, by their Distance from Physicians, are deprived of their Assistance. I shall not give a Detail of my Plan, which is very simple, in this Part; but content myself with affirming, I have used my utmost Care to render it the most useful I possibly could: and I dare hope, that if I have not fully displayed its utmost Advantages, I have at least sufficiently shewn those pernicious Methods of treating Diseases, that should incontestably be avoided. I am thoroughly convinced, the Design might be accomplished more compleatly than I have done it; but those who are so capable of, do not attempt, it: I happen to be less timid; and I hope that thinking Persons will rather take it in good part of me, to have published a Book, the composing of which is rather disagreeable from its very Facility; from the minute Details, which however are indispensable; and from the Impossibility of discussing any Part of it (consistently with the Plan) to the Bottom of the Subject; or of displaying any new and useful Prospect. It may be compared, in some Respects, to the Works of a spiritual Guide, who was to write a Catechism for little Children.

At the same time I am not ignorant there have already been a few Books calculated for Country Patients, who are remote from Succour: but some of these, tho' published with a very good Purpose, produce a bad Effect. Of this kind are all Collections of Receipts or Remedies, without the least Description of the Disease; and of Course without just Directions for the Exhibition, or Application, of them. Such, for Example, is the famous Collection of Madam Fouquet, and some more in the same manner. Some others approach towards my Plan; but many of them have taken in too many Distempers, whence they are become too voluminous. Besides, they have not dwelt sufficiently upon the Signs of the Diseases; upon their Causes; the general Regimen in them, and the Mismanagement of them. Their Receipts are not generally as simple, and as easy to prepare, as they ought to be. In short, the greater Part of their Writers seem, as they advanced, to have grown tired of their melancholy Task, and to have hurried them out too expeditiously. There are but two of them, which I must name with Respect, and which being proposed on a Plan very like my own, are executed in a superior Manner, that merits the highest Acknowlegements of the Publick. One of these Writers is M. Rosen, first Physician of the Kingdom of Sweden; who, some Years since, employed his just Reputation to render the best Services to his Country Men. He has made them retrench from the Almanacs those ridiculous Tales; those extraordinary Adventures; those pernicious astrological Injunctions, which there, as well as here, answer no End, but that of keeping up Ignorance, Credulity, Superstition, and the falsest Prejudices on the interesting Articles of Health, of Diseases, and of Remedies. He has also taken Care to publish simple plain Treatises on the most popular Distempers; which he has substituted in the Place of the former Heap of Absurdities. These concise Works however, which appear annually in their Almanacs, are not yet translated from the Swedish, so that I was unqualified to make any Extracts from them. The other is the Baron Van Swieten, first Physician to their Imperial Majesties, who, about two Years since, has effected for the Use of the Army, what I now attempt for sick People in the Country. Though my Work was greatly advanced, when I first saw his, I have taken some Passages from it: and had our Plans been exactly alike, I should imagine I had done the Publick more Service by endeavouring to extend the Reading of his Book, than by publishing a new one. Nevertheless, as he is silent on many Articles, of which I have treated diffusively; as he has treated of many Distempers, which did not come within my Plan; and has said nothing of some others which I could not omit; our two Works, without entering into the Particulars of the superior Merit of the Baron's, are very different, with Regard to the Subject of the Diseases; tho' in such as we have both considered, I account it an Honour to me to find, we have almost constantly proceeded upon the same Principles.

The present Work is by no means addressed to such Physicians, as are thoroughly accomplished in their Profession; yet possibly, besides my particular medical Friends, some others may read it. I beg the Favour of all such fully to consider the Intention, the Spirit, of the Author, and not to censure him, as a Physician, from the Composition of this Book. I even advise them here rather to forbear perusing it; as a Production, that can teach them nothing. Such as read, in order to criticize, will find a much greater Scope for exercising that Talent on the other Pamphlets I have published. It were certainly unjust that a Performance, whose sole abstracted Object is the Health and Service of my Countrymen, should subject me to any disagreeable Consequences: and a Writer may fairly plead an Exemption from any Severity of Censure, who has had the Courage to execute a Work, which cannot pretend to a Panegyric.

Having premised thus much in general, I must enter into some Detail of those Means, that seem the most likely to me, to facilitate the beneficial Consequences, which, I hope, may result to others, from my present Endeavours. I shall afterwards give an Explanation of some Terms which I could not avoid using, and which, perhaps, are not generally understood.

The Title of Advice to the People, was not suggested to me by an Illusion, which might persuade me, this Book would become a Piece of Furniture, as it were, in the House of every Peasant. Nineteen out of twenty will probably never know of its Existence. Many may be unable to read, and still more unable to understand, it, plain and simple as it is. I have principally calculated it for the Perusal of intelligent and charitable Persons, who live in the Country; and who seem to have, as it were, a Call from Providence, to assist their less intelligent poor Neighbours with their Advice.

It is obvious, that the first Gentlemen I have my Eye upon, are the Clergy. There is not a single Village, a Hamlet, nor even the House of an Alien in the Country, that has not a Right to the good Offices of some one of this Order; And I assure myself there are a great Number of them, who, heartily affected with the Distress of their ailing Flocks, have wished many hundred Times, that it were in their Power to give their Parishioners some bodily Help, at the very Time they were disposing them to prepare for Death; or so far to delay the Fatality of the Distemper, that the Sick might have an Opportunity of living more religiously afterwards. I shall think myself happy, if such truly respectable Ecclesiastics shall find any Resources in this Performance, that may conduce to the Accomplishment of their beneficent Intentions. Their Regard, their Love for their People; their frequent Invitations to visit their principal Neighbours; their Duty to root out all unreasonable Prejudices, and Superstition; their Charity, their Learning; the Facility, with which their general Knowlege in Physics, qualifies them to comprehend thoroughly all the medical Truths, and Contents of this Piece, are so many Arguments to convince me, that they will have the greatest Influence to procure that Reformation, in the Administration of Physick to poor Country People, which is so necessary, so desirable, an Object.

In the next Place, I dare assure myself of the Concurrence of Gentlemen of Quality and Opulence, in their different Parishes and Estates, whose Advice is highly regarded by their Inferiors; who are so powerfully adapted to discourage a wrong, and to promote a right Practice, of which they will easily discern all the Advantages. The many Instances I have seen of their entering, with great Facility, into all the Plan and Conduct of a Cure; their Readiness and even Earnestness to comfort the Sick in their Villages; and the Generosity with which they prevent their Necessities, induce me to hope, from judging of these I have not the Pleasure to know, by those whom I have, that they will eagerly embrace an Opportunity of promoting a new Method of doing good in their Neighbourhood. Real Charity will apprehend the great Probability there is of doing Mischief, tho' with the best Intention, for want of a proper Knowledge of material Circumstances; and the very Fear of that Mischief may sometimes suspend the Exercise of such Charity; notwithstanding it must seize, with the most humane Avidity, every Light that can contribute to its own beneficent Exertion.

Thirdly, Persons who are rich, or at least in easy Circumstances, whom their Disposition, their Employments, or the Nature of their Property, fixes in the Country, where they are happy in doing good, must be delighted to have some proper Directions for the Conduct and Effectuation of their charitable Intentions.

In every Village, where there are any Persons, of these three Conditions, they are always readily apprized of the Distempers in it, by their poor Neighbours coming to intreat a little Soup, Venice Treacle, Wines, Biscuits, or any thing they imagine necessary for their sick Folks. In Consequence of some Questions to the Bystanders, or of a Visit to the sick Person, they will judge at least of what kind the Disease is; and by their prudent Advice they may be able to prevent a Multitude of Evils. They will give them some Nitre instead of Venice Treacle; Barley, or sweet Whey, in lieu of Soup. They will advise them to have Recourse to Glysters, or Bathings of their Feet, rather than to Wine; and order them Gruel rather than Biscuits. A man would scarcely believe, 'till after the Expiration of a few Years, how much Good might be effected by such proper Regards, so easily comprehended, and often repeated. At first indeed there may be some Difficulty in eradicating old Prejudices, and inveterately bad Customs; but whenever these were removed, good Habits would strike forth full as strong Roots, and I hope that no Person would be inclined to destroy them.

It may be unnecessary to declare, that I have more Expectation from the Care and Goodness of the Ladies, than from those of their Spouses, their Fathers, or Brothers. A more active Charity, a more durable Patience, a more domestic Life; a Sagacity, which I have greatly admired in many Ladies both in Town and Country, that disposes them to observe, with great Exactness; and to unravel, as it were, the secret Causes of the Symptoms, with a Facility that would do Honour to very good Practioners, and with a Talent adapted to engage the Confidence of the Patient:—All these, I say, are so many characteristical Marks of their Vocation in this important and amicable Duty; nor are there a few, who fulfil it with a Zeal, that merits the highest Commendation, and renders them excellent Models for the Imitation of others.

Those who are intrusted with the Education of Youth, may also be supposed sufficiently intelligent to take some Part in this Work; and I am satisfied that much Good might result from their undertaking it. I heartily wish, they would not only study to distinguish the Distemper (in which the principal, but by no means an insuperable Difficulty consists; and to which I hope I have considerably put them in the Way) but I would have them learn also the Manner of applying Remedies. Many of them have; I have known some who bleed, and who have given Glysters very expertly. This however all may easily learn; and perhaps it would not be imprudent, if the Art of bleeding well and safely were reckoned a necessary Qualification, when they are examined for their Employment. These Faculties, that of estimating the Degree of a Fever, and how to apply and to dress Blisters, may be of great Use within the Neighbourhood of their Residence. Their Schools, which are not frequently over-crouded, employ but a few of their daily Hours; the greater part of them have no Land to cultivate; and to what better Use can they apply their Leisure, than to the Assistance and Comfort of the Sick? The moderate Price of their Service may be so ascertained, as to incommode no Person; and this little Emolument might render their own Situation the more agreeable: besides which, these little Avocations might prevent their being drawn aside sometimes, by Reason of their Facility and frequent Leisure, so as to contract a Habit of drinking too often. Another Benefit would also accrue from accustoming them to this kind of Practice, which is, that being habituated to the Care of sick People, and having frequent Occasions to write, they would be the better qualify'd, in difficult Cases, to advise with those, who were thought further necessary to be consulted.

Doubtless, even among Labourers, there may be many, for some such I have known, who being endued with good natural Sense and Judgment, and abounding with Benevolence, will read this Book with Attention, and eagerly extend the Maxims and the Methods it recommends.

And finally I hope that many Surgeons, who are spread about the Country, and who practice Physic in their Neighbourhood, will peruse it; will carefully enter into the Principles established in it, and will conform to its Directions; tho' a little different perhaps from such as they may have hitherto practiced. They will perceive a Man may learn at any Age, and of any Person; and it may be hoped they will not think it too much Trouble to reform some of their Notions in a Science, which is not properly within their Profession (and to the Study of which they were never instituted) by those of a Person, who is solely employed in it, and who has had many Assistances of which they are deprived.

Midwives may also find their Attendance more efficacious, as soon as they are thoroughly disposed to be better informed.

It were heartily to be wished, that the greater Part of them had been better instructed in the Art they profess. The Instances of Mischief that might have been avoided, by their being better qualify'd, are frequent enough to make us wish there may be no Repetition of them, which it may be possible to prevent. Nothing seems impossible, when Persons in Authority are zealously inclined to prevent every such Evil; and it is time they should be properly informed of one so essentially hurtful to Society.

The Prescriptions I have given consist of the most simple Remedies, and I have adjoined the Manner of preparing them so fully, that I hope no Person can be at any Loss in that Respect. At the same time, that no one may imagine they are the less useful and efficacious for their Simplicity, I declare, they are the same I order in the City for the most opulent Patients. This Simplicity is founded in Nature: the Mixture, or rather the Confusion, of a Multitude of Drugs is ridiculous. If they have the very same Virtues, for what Purpose are they blended? It were more judicious to confine ourselves to that, which is the most effectual. If their Virtues are different, the Effect of one destroys, or lessens, the Effect of the other; and the Medicine ceases to prove a Remedy.

I have given no Direction, which is not very practicable and easy to execute; nevertheless it will be discernible, that some few are not calculated for the Multitude, which I readily grant. However I have given them, because I did not lose Sight of some Persons; who, tho' not strictly of the Multitude, or Peasantry, do live in the Country, and cannot always procure a Physician as soon, or for as long a Time, as they gladly would.

A great Number of the Remedies are entirely of the Country Growth, and may be prepared there; but there are others, which must be had from the Apothecaries. I have set down the Price [⁷] at which I am persuaded all the Country Apothecaries will retail them to a Peasant, who is not esteemed a rich one. I have marked the Price, not from any Apprehension of their being imposed on in the Purchase, for this I do not apprehend; but, that seeing the Cheapness of the Prescription, they may not be afraid to buy it. The necessary Dose of the Medicine, for each Disease, may generally be purchased for less Money than would be expended on Meat, Wine, Biscuits, and other improper things. But should the Price of the Medicine, however moderate, exceed the Circumstances of the Sick, doubtless the Common Purse, or the Poors-Box will defray it: moreover there are in many Country Places Noblemens Houses, some of whom charitably contribute an annual Sum towards buying of Medicines for poor Patients. Without adding to which Sum, I would only intreat the Favour of each of them to alter the Objects of it, and to allow their sick Neighbours the Remedies and the Regimen directed here, instead of such as they formerly distributed among them.

It may still be objected, that many Country Places are very distant from large Towns; from which Circumstance a poor Peasant is incapable of procuring himself a seasonable and necessary Supply in his Illness. I readily admit, that, in Fact, there are many Villages very remote from such Places as Apothecaries reside in. Yet, if we except a few among the Mountains, there are but very few of them above three or four Leagues from some little Town, where there always lives some Surgeon, or some Vender of Drugs. Perhaps however, even at this Time, indeed, there may not be many thus provided; but they will take care to furnish themselves with such Materials, as soon as they have a good Prospect of selling them, which may constitute a small, but new, Branch of Commerce for them. I have carefully set down the Time, for which each Medicine will keep, without spoiling. There is a very frequent Occasion for some particular ones, and of such the School-masters may lay in a Stock. I also imagine, if they heartily enter into my Views, they will furnish themselves with such Implements, as may be necessary in the Course of their Attendance. If any of them were unable to provide themselves with a sufficient Number of good Lancets, an Apparatus for Cupping, and a Glyster Syringe (for want of which last a Pipe and Bladder may be occasionally substituted) the Parish might purchase them, and the same Instruments might do for the succeeding School-master. It is hardly to be expected, that all Persons in that Employment would be able, or even inclined, to learn the Way of using them with Address; but one Person who did, might be sufficient for whatever Occasions should occur in this Way in some contiguous Villages; with very little Neglect of their Functions among their Scholars.

Daily Instances of Persons, who come from different Parts to consult me, without being capable of answering the Questions I ask them, and the like Complaints of many other Physicians on the same Account, engaged me to write the last Chapter of this Work. I shall conclude this Introduction with some Remarks, necessary to facilitate the Knowledge of a few Terms, which were unavoidable in the Course of it.

The Pulse commonly beats in a Person in good Health, from the Age of eighteen or twenty to about sixty six Years, between sixty and seventy Times in a Minute. It sometimes comes short of this in old Persons, and in very young Children it beats quicker: until the Age of three or four Years the Difference amounts at least to a third; after which it diminishes by Degrees.

An intelligent Person, who shall often touch and attend to his own Pulse, and frequently to other Peoples, will be able to judge, with sufficient Exactness, of the Degree of a Fever in a sick Person. If the Strokes are but one third above their Number in a healthy State, the Fever is not very violent: which it is, as often as it amounts to half as many more as in Health. It is very highly dangerous, and may be generally pronounced mortal, when there are two Strokes in the Time of one. We must not however judge of the Pulse, solely by its Quickness, but by its Strength or Weakness; its Hardness or Softness; and the Regularity or Irregularity of it.

There is no Occasion to define the strong and the feeble Pulse. The Strength of it generally affords a good Prognostic, and, supposing it too strong, it may easily be lowered. The weak Pulse is often very menacing.

If the Pulse, in meeting the Touch, excites the Notion of a dry Stroke, as though the Artery consisted of Wood, or of some Metal, we term it hard; the opposite to which is called soft, and generally promises better. If it be strong and yet soft, even though it be quick, it may be considered as a very hopeful Circumstance. But if it is strong and hard, that commonly is a Token of an Inflammation, and indicates Bleeding and the cooling Regimen. Should it be, at the same time, small, quick and hard, the Danger is indeed very pressing.

We call that Pulse regular, a continued Succession of whole Strokes are made in equal Intervals of Time; and in which Intervals, not a single Stroke is wanting (since if that is its State, it is called an intermitting Pulse.) The Beats or Pulsations are also supposed to resemble each other so exactly in Quality too, that one is not strong, and the next alternately feeble.

As long as the State of the Pulse is promising; Respiration or Breathing is free; the Brain does not seem to be greatly affected; while the Patient takes his Medicines, and they are attended with the Consequence that was expected; and he both preserves his Strength pretty well, and continues sensible of his Situation, we may reasonably hope for his Cure. As often as all, or the greater Number of these characterizing Circumstances are wanting, he is in very considerable Danger.

The Stoppage of Perspiration is often mentioned in the Course of this Work. We call the Discharge of that Fluid which continually passes off through the Pores of the Skin, Transpiration; and which, though invisible, is very considerable. For if a Person in Health eats and drinks to the Weight of eight Pounds daily, he does not discharge four of them by Stool and Urine together, the Remainder passing off by insensible Transpiration. It may easily be conceived, that if so considerable a Discharge is stopt, or considerably lessened; and if this Fluid, which ought to transpire through the Skin, should be transfered to any inward Part, it must occasion some dangerous Complaint. In fact this is one of the most frequent Causes of Diseases.

To conclude very briefly—All the Directions in the following Treatise are solely designed for such Patients, as cannot have the Attendance of a Physician. I am far from supporting, they ought to do instead of one, even in those Diseases, of which I have treated in the fullest Manner; and the Moment a Physician arrives, they ought to be laid aside. The Confidence reposed in him should be entire, or there should be none. The Success of the Event is founded in that. It is his Province to judge of the Disease, to select Medicines against it; and it is easy to foresee the Inconveniences that may follow, from proposing to him to consult with any others, preferably to those he may chuse to consult with; only because they have succeeded in the Treatment of another Patient, whose Case they suppose to have been nearly the same with the present Case. This were much the same, as to order a Shoemaker to make a Shoe for one Foot by the Pattern of another Shoe, rather than by the Measure he has just taken.

N. B. Though a great Part of this judicious Introduction is less applicable to the political Circumstances of the British Empire, than to those of the Government for which it was calculated; we think the good Sense and the unaffected Patriotism which animate it, will supersede any Apology for our translating it. The serious Truth is this, that a thorough Attention to Population seems never to have been more expedient for ourselves, than after so bloody and expensive, though such a glorious and successful War: while our enterprizing Neighbours, who will never be our Friends, are so earnest to recruit their Numbers; to increase their Agriculture; and to force a Vent for their Manufactures, which cannot be considerably effected, without a sensible Detriment to our own. Besides which, the unavoidable Drain from the People here, towards an effectual Cultivation, Improvement, and Security of our Conquests, demands a further Consideration. K.

ADVICE TO THE PEOPLE,

With Respect to their HEALTH.

Chapter I.

Of the most usual Causes of popular Maladies.

Sect. 1.

he most frequent Causes of Diseases commonly incident to Country People are, 1. Excessive Labour, continued for a very considerable Time. Sometimes they sink down at once in a State of Exhaustion and Faintness, from which they seldom recover: but they are oftener attacked with some inflammatory Disease; as a Quinsey, a Pleurisy, or an Inflammation of the Breast.

There are two Methods of preventing these Evils: one is, to avoid the Cause which produces them; but this is frequently impossible. Another is, when such excessive Labour has been unavoidable, to allay their Fatigue, by a free Use of some temperate refreshing Drink; especially by sweet Whey, by Butter-milk, or by [⁸] Water, to a Quart of which a Wine-glass of Vinegar may be added; or, instead of that, the expressed Juice of Grapes not fully ripe, or even of Goosberries or Cherries: which wholesome and agreeable Liquors are refreshing and cordial. I shall treat, a little lower, of inflammatory Disorders. The Inanition or Emptiness, though accompanied with Symptoms different from the former, have yet some Affinity to them with Respect to their Cause, which is a kind of general Exsiccation or Dryness. I have known some cured from this Cause by Whey, succeeded by tepid Baths, and afterwards by Cow's Milk: for in such Cases hot Medicines and high Nourishment are fatal.

§ 2. There is another Kind of Exhaustion or Emptiness, which may be termed real Emptiness, and is the Consequence of great Poverty, the Want of sufficient Nourishment, bad Food, unwholesome Drink, and excessive Labour. In Cases thus circumstanced, good Soups and a little Wine are very proper. Such happen however very seldom in this Country: I believe they are frequent in some others, especially in many Provinces of France.

§ 3. A second and very common Source of Disorders arises, from Peoples' lying down and reposing, when very hot, in a cold Place. This at once stops Perspiration, the Matter of which being thrown upon some internal Part, proves the Cause of many violent Diseases, particularly of Quinseys, Inflammations of the Breast, Pleurisies, and inflammatory Cholics. These Evils, from this Cause, may always be avoided by avoiding the Cause, which is one of those that destroy a great Number of People. However, when it has occurred, as soon as the first Symptoms of the Malady are perceiveable, which sometimes does not happen till several Days after, the Patient should immediately be bled; his Legs should be put into Water moderately hot, and he should drink plentifully of the tepid Infusion marked No. 1. Such Assistances frequently prevent the Increase of these Disorders; which, on the contrary, are greatly aggravated, if hot Medicines are given to sweat the Patient.

§ 4. A third Cause is drinking cold Water, when a Person is extremely hot. This acts in the same Manner with the second; but its Consequences are commonly more sudden and violent. I have seen most terrible Examples of it, in Quinseys, Inflammations of the Breast, Cholics, Inflammations of the Liver, and all the Parts of the Belly, with prodigious Swellings, Vomitings, Suppressions of Urine, and inexpressible Anguish. The most available Remedies in such Cases, from this Cause, are, a plentiful Bleeding at the Onset, a very copious Drinking of warm Water, to which one fifth Part of Whey should be added; or of the Ptisan No. 2, or of an Emulsion of Almonds, all taken warm. Fomentations of warm Water should also be applied to the Throat, the Breast and Belly, with Glysters of the same, and a little Milk. In this Case, as well as in the preceding one, ([§ 3].) a Semicupium, or Half-bath of warm Water has sometimes been attended with immediate Relief. It seems really astonishing, that labouring People should so often habituate themselves to this pernicious Custom, which they know to be so very dangerous to their very Beasts. There are none of them, who will not prevent their Horses from drinking while they are hot, especially if they are just going to put them up. Each of them knows, that if he lets them drink in that State, they might possibly burst with it; nevertheless he is not afraid of incurring the like Danger himself. However, this is not the only Case, in which the Peasant seems to have more Attention to the Health of his Cattle, than to his own.

§ 5. The fourth Cause, which indeed affects every Body, but more particularly the Labourer, is, the Inconstancy of the Weather. We shift all at once, many times a Day, from Hot to Cold, and from Cold to Hot, in a more remarkable Manner, and more suddenly, than in most other Countries. This makes Distempers from Defluxion and Cold so common with us: and it should make us careful to go rather a little more warmly cloathed, than the Season may seem to require; to have Recourse to our Winter-cloathing early in Autumn, and not to part with it too early in the Spring. Prudent Labourers, who strip while they are at Work, take care to put on their Cloaths in the Evening when they return home. [⁹] Those, who from Negligence, are satisfied with hanging them upon their Country Tools, frequently experience, on their Return, the very unhappy Effects of it. There are some, tho' not many Places, where the Air itself is unwholsome, more from its particular Quality, than from its Changes of Temperature, as at Villeneuve, and still more at Noville, and in some other Villages situated among the Marshes which border on the Rhone. These Countries are particularly subject to intermitting Fevers; of which I shall treat briefly hereafter.

§ 6. Such sudden Changes are often attended with great Showers of Rain, and even cold Rain, in the Middle of a very hot Day; when the Labourer who was bathed, as it were, in a hot Sweat, is at once moistened in cold Water; which occasions the same Distempers, as the sudden Transition from Heat to Cold, and requires the same Remedies. If the Sun or a hot Air succeed immediately to such a Shower, the Evil is considerably lighter: but if the Cold continues, many are often greatly incommoded by it.

A Traveller is sometimes thoroughly and unavoidably wet with Mud; the ill Consequence of which is often inconsiderable, provided he changes his Cloaths immediately, when he sets up. I have known fatal Pleurisies ensue from omitting this Caution. Whenever the Body or the Limbs are wet, nothing can be more useful than bathing them in warm Water. If the Legs only have been wet, it may be sufficient to bath them. I have radically, thoroughly, cured Persons subject to violent Cholics, as often as their Feet were wet, by persuading them to pursue this Advice. The Bath proves still more effectual, if a little Soap be dissolved in it.

§ 7. A fifth Cause, which is seldom attended to, probably indeed because it produces less violent Consequences, and yet is certainly hurtful, is the common Custom in all Villages, of having their Ditches or Dunghills directly under their Windows. Corrupted Vapours are continually exhaling from them, which in Time cannot fail of being prejudicial, and must contribute to produce putrid diseases. Those who are accustomed to the Smell, become insensible of it: but the Cause, nevertheless, does not cease to be unwholesomly active; and such as are unused to it perceive the Impression in all its Force.

§ 8. There are some Villages, in which, after the Curtain Lines are erased, watery marshy Places remain in the Room of them. The Effect of this is still more dangerous, because that putrify'd Water, which stagnates during the hot Season, suffers its Vapours to exhale more easily, and more abundantly, than that in the Curtain Lines did. Having set out for Pully le Grand, in 1759, on Account of an epidemical putrid Fever which raged there, I was sensible, on traversing the Village, of the Infection from those Marshes; nor could I doubt of their being the Cause of this Disease, as well as of another like it, which had prevailed there five Years before. In other Respects the Village is wholesomly situated. It were to be wished such Accidents were obviated by avoiding these stagnated Places; or, at least, by removing them and the Dunghils, as far as possible from the Spot, where we live and lodge.

§ 9. To this Cause may also be added the Neglect of the Peasants to air their Lodgings. It is well known that too close an Air occasions the most perplexing malignant Fevers; and the poor Country People respire no other in their own Houses. Their Lodgings, which are very small, and which notwithstanding inclose, (both Day and Night) the Father, Mother, and seven or eight Children, besides some Animals, are never kept open during six Months in the Year, and very seldom during the other six. I have found the Air so bad in many of these Houses, that I am persuaded, if their Inhabitants did not often go out into the free open Air, they must all perish in a little Time. It is easy, however, to prevent all the Evils arising from this Source, by opening the Windows daily: so very practicable a Precaution must be followed with the happiest Consequences.

§ 10. I consider Drunkenness as a sixth Cause, not indeed as producing epidemical Diseases, but which destroys, as it were, by Retail, at all times, and every where. The poor Wretches, who abandon themselves to it, are subject to frequent Inflammations of the Breast, and to Pleurisies, which often carry them off in the Flower of their Age. If they sometimes escape through these violent Maladies, they sink, a long Time before the ordinary Approach of old Age, into all its Infirmities, and especially into an Asthma, which terminates in a Dropsy of the Breast. Their Bodies, worn out by Excess, do not comply and concur, as they ought, with the Force or Operation of Remedies; and Diseases of Weakness, resulting from this Cause, are almost always incurable. It seems happy enough, that Society loses nothing in parting with these Subjects, who are a Dishonour to it; and whose brutal Souls are, in some Measure, dead, long before their Carcases.

§ 11. The Provisions of the common People are also frequently one Cause of popular Maladies. This happens 1st, whenever the Corn, not well ripened, or not well got in, in bad [¹⁰] Harvests, has contracted an unwholesome Quality. Fortunately however this is seldom the Case; and the Danger attending the Use of it, may be lessened by some Precautions, such as those of washing and drying the Grain completely; of mixing a little Wine with the Dough, in kneading it; by allowing it a little more Time to swell or rise, and by baking it a little more. 2dly, The fairer and better saved Part of the Wheat is sometimes damaged in the Farmers House; either because he does not take due Care of it, or because he has no convenient Place to preserve it, only from one Summer to the next. It has often happened to me, on entering one of these bad Houses, to be struck with the Smell of Wheat that has been spoiled. Nevertheless, there are known and easy Methods to provide against this by a little Care; though I shall not enter into a Detail of them. It is sufficient to make the People sensible, that since their chief Sustenance consists of Corn, their Health must necessarily be impaired by what is bad. 3dly, That Wheat, which is good, is often made into bad Bread, by not letting it rise sufficiently; by baking it too little, and by keeping it too long. All these Errors have their troublesome Consequences on those who eat it; but in a greater Degree on Children and Valetudinarians, or weakly People.

Tarts or Cakes may be considered as an Abuse of Bread, and this in some Villages is increased to a very pernicious Height. The Dough is almost constantly bad, and often unleavened, ill baked, greasy, and stuffed with either fat or sour Ingredients, which compound one of the most indigestible Aliments imaginable. Women and Children consume the most of this Food, and are the very Subjects for whom it is the most improper: little Children especially, who live sometimes for many successive Days on these Tarts, are, for the greater Part, unable to digest them perfectly. Hence they receive a [¹¹] Source of Obstructions in the Bowels of the Belly, and of a slimy Viscidity or Thickishness, throughout the Mass of Humours, which throws them into various Diseases from Weakness; slow Fevers, a Hectic, the Rickets, the King's Evil, and Feebleness; for the miserable Remainder of their Days. Probably indeed there is nothing more unwholesome than Dough not sufficiently leavened, ill-baked, greasy, and soured by the Addition of Fruits. Besides, if we consider these Tarts in an oeconomical View, they must be found inconvenient also for the Peasant on that Account.

Some other Causes of Maladies may also be referred to the Article of Food, tho' less grievous and less frequent, into a full Detail of which it is very difficult to enter: I shall therefore conclude that Article with this general Remark; that it is the Care which Peasants usually take in eating slowly, and in chewing very well, that very greatly lessens the Dangers from a bad Regimen: and I am convinced they constitute one of the greatest Causes of that Health they enjoy. We may further add indeed the Exercise which the Peasant uses, his long abiding in the open Air, where he passes three fourths of his Life; besides (which are also considerable Advantages) his happy Custom of going soon to Bed, and of rising very early. It were to be wished, that in these Respects, and perhaps on many other Accounts, the Inhabitants of the Country were effectually proposed as Models for reforming the Citizens.

§ 12. We should not omit, in enumerating the Causes of Maladies among Country People, the Construction of their Houses, a great many of which either lean, as it were, close to a higher Ground, or are sunk a little in the Earth. Each of these Situations subjects them to considerable Humidity; which is certain greatly to incommode the Inhabitants, and to spoil their Provisions, if they have any Quantity in Store; which, as we have observed, is another, and not the least important, Source of their Diseases. A hardy Labourer is not immediately sensible of the bad Influence of this moist and marshy Habitation; but they operate at the long Run, and I have abundantly observed their most evident bad Effects, especially on Women in Child-bed, on Children, and in Persons recovering of a preceding Disease. It would be easy to prevent this Inconvenience, by raising the Ground on which the House stood, some, or several, Inches above the Level of the adjacent Soil, by a Bed of Gravel, of small Flints, pounded Bricks, Coals, or such other Materials; and by avoiding to build immediately close to, or, as it were, under a much higher Soil. This Object, perhaps, may well deserve the Attention of the Publick; and I earnestly advise as many as do build, to observe the necessary Precautions on this Head. Another, which would cost still less Trouble, is to give the Front of their Houses an Exposure to the South-East. This Exposure, supposing all other Circumstances of the Building and its Situation to be alike, is both the most wholesome and advantageous. I have seen it, notwithstanding, very often neglected, without the least Reason being assigned for not preferring it.

These Admonitions may possibly be thought of little Consequence by three fourths of the People. I take the Liberty of reminding them, however, that they are more important than they may be supposed; and so many Causes concur to the Destruction of Men, that none of the Means should be neglected, which may contribute to their Preservation.

§ 13. The Country People in Swisserland drink, either 1, pure Water, 2, some Wine, 3, Perry, made from wild Pears, or sometimes Cyder from Apples, and, 4, a small Liquor which they call Piquette, that is Water, which has fermented with the Cake or Husks of the Grapes, after their Juice has been expressed. Water however is their most general Drink; Wine rarely falling in their Way, but when they are employed by rich Folks; or when they can spare Money enough for a Debauch. Fruit Wines and the [¹²] Piquettes are not used in all Parts of the Country; they are not made in all Years; and keep but for some Months.

Our Waters in general, are pretty good; so that we have little Occasion to trouble ourselves about purifying them; and they are well known in those Provinces where they are chiefly and necessarily used. [¹³] The pernicious Methods taken to improve or meliorate, as it is falsely called, bad Wines, are not as yet sufficiently practiced among us, for me to treat of them here: and as our Wines are not hurtful, of themselves, they become hurtful only from their Quantity. The Consumption of made Wines and Piquettes is but inconsiderable, and I have not hitherto known of any ill Effects from them, so that our Liquors cannot be considered as Causes of Distempers in our Country; but in Proportion to our Abuse of them by Excess. The Case is differently circumstanced in some [¹⁴] other Countries; and it is the Province of Physicians who reside in them, to point out to their Country-Men the Methods of preserving their Health; as well as the proper and necessary Remedies in their Sickness.

Chapter II.

Of the Causes which aggravate the Diseases of the People. General Considerations.

Sect. 14.

he Causes already enumerated in the first Chapter occasion Diseases; and the bad Regimen, or Conduct of the People, on the Invasion of them, render them still more perplexing, and very often mortal.

There is a prevailing Prejudice among them, which is every Year attended with the Death of some Hundreds in this Country, and it is this—That all Distempers are cured by Sweat; and that to procure Sweat, they must take Abundance of hot and heating things, and keep themselves very hot. This is a Mistake in both Respects, very fatal to the Population of the State; and it cannot be too much inculcated into Country People; that by thus endeavouring to force Sweating, at the very Beginning of a Disease, they are with great Probability, taking Pains to kill themselves. I have seen some Cases, in which the continual Care to provoke this Sweating, has as manifestly killed the Patient, as if a Ball had been shot through his Brains; as such a precipitate and untimely Discharge carries off the thinner Part of the Blood, leaving the Mass more dry, more viscid and inflamed. Now as in all acute Diseases (if we except a very few, and those too much less frequent) the Blood is already too thick; such a Discharge must evidently increase the Disorder, by co-operating with its Cause. Instead of forcing out the watery, the thinner Part of the Blood, we should rather endeavour to increase it. There is not a single Peasant perhaps, who does not say, when he has a Pleurisy, or an Inflammation of his Breast, that his Blood is too thick, and that it cannot circulate. On seeing it in the Bason after Bleeding, he finds it black, dry, burnt; these are his very Words. How strange is it then, that common Sense should not assure him, that, far from forcing out the Serum, the watery Part, of such a Blood by sweating, there is a Necessity to increase it?

§ 15. But supposing it were as certain, as it is erroneous, that Sweating was beneficial at the Beginning of Diseases, the Means which they use to excite it would not prove the less fatal. The first Endeavour is, to stifle the Patient with the Heat of a close Apartment, and a Load of Covering. Extraordinary Care is taken to prevent a Breath of fresh Air's squeezing into the Room; from which Circumstance, the Air already in it is speedily and extremely corrupted: and such a Degree of Heat is procured by the Weight of the Patient's Bed-cloaths, that these two Causes alone are sufficient to excite a most ardent Fever, and an Inflammation of the Breast, even in a healthy Man. More than once have I found myself seized with a Difficulty of breathing, on entering such Chambers, from which I have been immediately relieved, on obliging them to open all the Windows. Persons of Education must find a Pleasure, I conceive, in making People understand, on these Occasions, which are so frequent, that the Air being more indispensably necessary to us, if possible, than Water is to a Fish, our Health must immediately suffer, whenever that ceases to be pure; in assuring them also, that nothing corrupts it sooner than those Vapours, which continually steam from the Bodies of many Persons inclosed within a little Chamber, from which the Air is excluded. The Absurdity of such Conduct is a self-evident Certainty. Let in a little fresh Air on these miserable Patients, and lessen the oppressing Burthen of their Coverings, and you generally see upon the Spot, their Fever and Oppression, their Anguish and Raving, to abate.

§ 16. The second Method taken to raise a Sweat in these Patients is, to give them nothing but hot things, especially Venice Treacle, Wine, or some [¹⁵] Faltranc, the greater Part of the Ingredients of which are dangerous, whenever there is an evident Fever; besides Saffron, which is still more pernicious. In all feverish Disorders we should gently cool, and keep the Belly moderately open; while the Medicines just mentioned both heat and bind; and hence we may easily judge of their inevitable ill Consequences. A healthy Person would certainly be seized with an inflammatory Fever, on taking the same Quantity of Wine, of Venice Treacle, or of Faltranc, which the Peasant takes now and then, when he is attacked by one of these Disorders. How then should a sick Person escape dying by them? Die indeed he generally does, and sometimes with astonishing Speed. I have published some dreadful Instances of such Fatality some Years since, in another Treatise. In fact they still daily occur, and unhappily every Person may observe some of them in his own Neighbourhood.

§ 17. But I shall be told perhaps, that Diseases are often carried off by Sweat, and that we ought to be guided by Experience. To this I answer, it is very true, that Sweating cures some particular Disorders, as it were, at their very Onset, for Instance, those Stitches that are called spurious or false Pleurisies, some rheumatic Pains, and some Colds or Defluxions. But this only happens when the Disorders depend solely and simply on stopt or abated Perspiration, to which such Pain instantly succeeds; where immediately, before the Fever has thickened the Blood, and inflamed the Humours; and where before any internal Infarction, any Load, is formed, some warm Drinks are given, such as Faltranc and Honey; which, by restoring Transpiration, remove the very Cause of the Disorder. Nevertheless, even in such a Case, great Care should be had not to raise too violent a Commotion in the Blood, which would rather restrain, than promote, Sweat, to effect which Elder-flowers are in my Opinion preferable to Faltranc. Sweating is also of Service in Diseases, when their Causes are extinguished, as it were, by plentiful Dilution: then indeed it relieves, by drawing off, with itself, some Part of the distempered Humours; after which their grosser Parts have passed off by Stool and by Urine: besides which, the Sweat has also served to carry off that extraordinary Quantity of Water, we were obliged to convey into the Blood, and which was become superfluous there. Under such Circumstances, and at such a Juncture, it is of the utmost Importance indeed, not to check the Sweat, whether by Choice, or for Want of Care. There might often be as much Danger in doing this, as there would have been in endeavouring to force a Sweat, immediately upon the Invasion of the Disorder; since the arresting of this Discharge, under the preceding Circumstances, might frequently occasion a more dangerous Distemper, by repelling the Humour on some inward vital Part. As much Care therefore should be taken not to check, imprudently, that Evacuation by the Skin, which naturally occurs towards the Conclusion of Diseases, as not to force it at their Beginning; the former being almost constantly beneficial, the latter as constantly pernicious. Besides, were it even necessary, it might be very dangerous to force it violently; since by heating the Patients greatly, a vehement Fever is excited; they become scorched up in a Manner, and the Skin proves extremely dry. Warm Water, in short, is the best of Sudorifics.

If the Sick are sweated very plentifully for a Day or two, which may make them easier for some Hours; these Sweats soon terminate, and cannot be excited again by the same Medicines. The Dose thence is doubled, the Inflammation is increased, and the Patient expires in terrible Anguish, with all the Marks of a general Inflammation. His Death is ascribed to his Want of Sweating; when it really was the Consequence of his Sweating too much at first; and of his taking Wine and hot Sudorifics. An able Swiss Physician had long since assured his Countrymen, that Wine was fatal to them in Fevers; I take leave to repeat it again and again, and wish it may not be with as little Success.

Our Country Folks, who in Health, naturally dislike red Wine, prefer it when Sick; which is wrong, as it binds them up more than white Wine. It does not promote Urine as well; but increases the Force of the circulating Arteries, and the Thickness of the Blood, which were already too considerable.

§ 18. Their Diseases are also further aggravated by the Food that is generally given them. They must undoubtedly prove weak, in Consequence of their being sick; and the ridiculous Fear of the Patients' dying of Weakness, disposes their Friends to force them to eat; which, increasing their Disorder, renders the Fever mortal. This Fear is absolutely chimerical; never yet did a Person in a Fever die merely from Weakness. They may be supported, even for some Weeks, by Water only; and are stronger at the End of that Time, than if they had taken more solid Nourishment; since, far from strengthening them, their Food increases their Disease, and thence increases their Weakness.

§ 19. From the first Invasion of a Fever, Digestion ceases. Whatever solid Food is taken corrupts, and proves a Source of Putridity, which adds nothing to the Strength of the Sick, but greatly to that of the Distemper. There are in fact a thousand Examples to prove, that it becomes a real Poison: and we may sensibly perceive these poor Creatures, who are thus compelled to eat, lose their Strength, and fall into Anxiety and Ravings, in Proportion as they swallow.

§ 20. They are also further injured by the Quality, as well as the Quantity, of their Food. They are forced to sup strong Gravey Soups, Eggs, Biscuits, and even Flesh, if they have but just Strength and Resolution to chew it. It seems absolutely impossible for them to survive all this Trash. Should a Man in perfect Health be compelled to eat stinking Meat, rotten Eggs, stale sour Broth, he is attacked with as violent Symptoms, as if he had taken real Poison, which, in Effect, he has. He is seized with Vomiting, Anguish, a violent Purging, and a Fever, with Raving, and eruptive Spots, which we call the Purple Fever. Now when the very same Articles of Food, in their soundest State, are given to a Person in a Fever, the Heat, and the morbid Matter already in his Stomach, quickly putrify them; and after a few Hours produce all the abovementioned Effects. Let any Man judge then, if the least Service can be expected from them.

§ 21. It is a Truth established by the first of Physicians, above two thousand Years past, and still further ratified by his Successors, that as long as a sick Person has a bad Humour or Ferment in his Stomach, his Weakness increases, in Proportion to the Food he receives. For this being corrupted by the infected Matter it meets there, proves incapable of nourishing, and becomes a conjunct or additional Cause of the Distemper.

The most observing Persons constantly remark, that whenever a feverish Patient sups, what is commonly called some good Broth, the Fever gathers Strength and the Patient Weakness. The giving such a Soup or Broth, though of the freshest soundest Meat, to a Man who has a high Fever, or putrid Humours in his Stomach, is to do him exactly the same service, as if you had given him, two or three Hours later, stale putrid Soup.

§ 22. I must also affirm, that this fatal Prejudice, of keeping up the Patients' Strength by Food, is still too much propagated, even among those very Persons, whose Talents and whose Education might be expected to exempt them from any such gross Error. It were happy for Mankind, and the Duration of their Lives would generally be more extended, if they could be thoroughly persuaded of this medical, and so very demonstrable, Truth;—That the only things which can strengthen sick Persons are those, which are able to weaken their Disease; but their Obstinacy in this Respect is inconceivable: it is another Evil superadded to that of the Disease, and sometimes the more grievous one. Out of twenty sick Persons, who are lost in the Country, more than two Thirds might often have been cured, if being only lodged in a Place defended from the Injuries of the Air, they were supplied with Abundance of good Water. But that most mistaken Care and Regimen I have been treating of, scarcely suffers one of the twenty to survive them.

§ 23. What further increases our Horror at this enormous Propensity to heat, dry up, and cram the sick is, that it is totally opposite to what Nature herself indicates in such Circumstances. The burning Heat of which they complain; the Dryness of the Lips, Tongue and Throat; the flaming high Colour of their Urine; the great Longing they have for cooling things; the Pleasure and sensible Benefit they enjoy from fresh Air, are so many Signs, or rather Proofs, which cry out with a loud Voice, that we ought to attemperate and cool them moderately, by all means. Their foul Tongues, which shew the Stomach to be in the like Condition; their Loathing, their Propensity to vomit, their utter Aversion to all solid Food, and especially to Flesh; the disagreeable Stench of their Breath; their Discharge of fetid Wind upwards and downwards, and frequently the extraordinary Offensiveness of their Excrements, demonstrate, that their Bowels are full of putrid Contents, which must corrupt all the Aliments superadded to them; and that the only thing, which can prudently be done, is to dilute and attemper them by plentiful Draughts of refreshing cooling Drinks, which may promote an easy Discharge of them. I affirm it again, and I heartily wish it may be thoroughly attended to, that as long as there is any Taste of Bitterness, or of Putrescence; as long as there is a Nausea or Loathing, a bad Breath, Heat and Feverishness with fetid Stools, and little and high-coloured Urine; so long all flesh, and Flesh-Soup, Eggs, and all kind of Food composed of them, or of any of them, and all Venice Treacle, Wine, and all heating things are so many absolute Poisons.

§ 24. I may possibly be censured as extravagant and excessive on these Heads by the Publick, and even by some Physicians: but the true and enlightened Physicians, those who attend to the Effects of every Particular, will find on the contrary, that far from exceeding in this Respect, I have rather feebly expressed their own Judgment, in which they agree with that of all the good ones, who have existed within more than two thousand Years; that very Judgment which Reason approves, and continual Experience confirms. The Prejudices I have been contending against have cost Europe some Millions of Lives.

§ 25. Neither should it be omitted, that even when a Patient has very fortunately escaped Death, notwithstanding all this Care to obtain it, the Mischief is not ended; the Consequences of the high Aliments and heating Medicines being, to leave behind the Seed, the Principle, of some low and chronical Disease; which increasing insensibly, bursts out at length, and finally procures him the Death he has even wished for, to put an End to his tedious Sufferings.

§ 26. I must also take Notice of another dangerous common Practice; which is that of purging, or vomiting a Patient, at the very Beginning of a Distemper. Infinite Mischiefs are occasioned by it. There are some Cases indeed, in which evacuating Medicines, at the Beginning of a Disease, are convenient and even necessary. Such Cases shall be particularly mentioned in some other Chapters: but as long as we are unacquainted with them, it should be considered as a general Rule, that they are hurtful at the Beginning; this being true very often; and always, when the Diseases are strictly inflammatory.

§ 27. It is hoped by their Assistance, at that Time, to remove the Load and Oppression of the Stomach, the Cause of a Disposition to vomit, of a dry Mouth, of Thirst, and of much Uneasiness; and to lessen the Leaven or Ferment of the Fever. But in this Hope they are very often deceived; since the Causes of these Symptoms are seldom of a Nature to yield to these Evacuations. By the extraordinary Viscidity or Thickness of the Humours, that foul the Tongue, we should form our Notions of those, which line the Stomach and the Bowels. It may be washed, gargled and even scraped to very little good Purpose. It does not happen, until the Patient has drank for many Days, and the Heat, the Fever and the great Siziness of the Humours are abated, that this Filth can he thoroughly removed, which by Degrees separates of itself. The State of the Stomach being conformable to that of the Tongue, no Method can effectually scour and clean it at the Beginning: but by giving refreshing and diluting Remedies plentifully, it gradually frees itself; and the Propensity to vomit, with its other Effects and Uneasinesses, go off naturally, and without Purges.

§ 28. Neither are these Evacuations only negatively wrong, merely from doing no Good; for considerable Evil positively ensues from the Application of those acrid irritating Medicines, which increase the Pain and Inflammation; drawing the Humours upon those Parts that were already overloaded with them; which by no means expel the Cause of the Disease, that not being at this time fitted for Expulsion, as not sufficiently concocted or ripe: and yet which, at the same Time, discharge the thinnest Part of the Blood, whence the Remainder becomes more thick; in short which carry off the useful, and leave the hurtful Humours behind.

§ 29. The Vomit especially, being given in an inflammatory Disease, and even without any Distinction in all acute ones, before the Humours have been diminished by Bleeding, and diluted by plentiful small Drinks, is productive of the greatest Evils; of Inflammations of the Stomach, of the Lungs and Liver, of Suffocations and Frenzies. Purges sometimes occasion a general Inflammation of the Guts, which [¹⁶] terminates in Death. Some Instances of each of these terrible Consequences have I seen, from blundering Temerity, Imprudence and Ignorance. The Effect of such Medicines, in these Circumstances, are much the same with those we might reasonably expect, from the Application of Salt and Pepper to a dry, inflamed and foul Tongue, in Order to moisten and clean it.

§ 30. Every Person of sound plain Sense is capable of perceiving the Truth of whatever I have advanced in this Chapter: and there would be some Degree of Prudence, even in those who do not perceive the real good Tendency of my Advice, not to defy nor oppose it too hardily. The Question relates to a very important Object; and in a Matter quite foreign to themselves, they undoubtedly owe some Deference to the Judgment of Persons, who have made it the Study and Business of their whole Lives. It is not to myself that I hope for their Attention, but to the greatest Physicians, whose feeble Instrument and Eccho I am. What Interest have any of us in forbidding sick People to eat, to be stifled, or to drink such heating things as heighten their Fever? What Advantage can accrue to us from opposing the fatal Torrent, which sweeps them off? What Arguments can persuade People, that some thousand Men of Genius, of Knowledge, and of Experience, who pass their Lives among a Croud and Succession of Patients; who are entirely employed to take Care of them, and to observe all that passes, have been only amusing and deceiving themselves, on the Effects of Food, of Regimen and of Remedies? Can it enter into any sensible Head, that a Nurse, who advises Soup, an Egg, or a Biscuit, deserves a Patient's Confidence, better than a Physician who forbids them? Nothing can be more disagreeable to the latter, than his being obliged to dispute continually in Behalf of the poor Patients; and to be in constant Terror, lest this mortally officious Attendance, by giving such Food as augments all the Causes of the Disease, should defeat the Efficacy of all the Remedies he administers to remove it; and should fester and aggravate the Wound, in Proportion to the Pains he takes to dress it. The more such absurd People love a Patient, the more they urge him to eat, which, in Effect, verifies the Proverb of killing one with Kindness.

Chapter III.

Of the Means that ought to be used, at the Beginning of Diseases; and of the Diet in acute Diseases.

Sect. 31.

have clearly shewn the great Dangers of the Regimen, or Diet, and of the principal Medicines too generally made Use of by the Bulk of the People, on these Occasions. I must now point out the actual Method they may pursue, without any Risque, on the Invasion of some acute Diseases, and the general Diet which agrees with them all. As many as are desirous of reaping any Benefit from this Treatise, should attend particularly to this Chapter; since, throughout the other Parts of it, in Order to avoid Repetitions, I shall say nothing of the Diet, except the particular Distemper shall require a different one, from that of which I am now to give an exact Detail. And whenever I shall say in general, that a Patient is to be put upon a Regimen, it will signify, that he is to be treated according to the Method prescribed in this Chapter; and all such Directions are to be observed, with Regard to Air, Food, Drink and Glysters; except when I expressly order something else, as different Ptisans, Glysters, &c.

§ 32. The greater Part of Diseases (by which I always understand acute and feverish ones) often give some Notice of their Approach a few Weeks, and, very commonly, some Days before their actual Invasion; such as a light Lassitude, or Weariness, Stiffness or Numbness; less Activity than usual, less Appetite, a small Load or Heaviness at Stomach; some Complaint in the Head; a profounder Degree of Sleep, yet less composed, and less refreshing than usual; less Gayety and Liveliness; sometimes a light Oppression of the Breast, a less regular Pulse; a Propensity to be Cold; an Aptness to sweat; and sometimes a Suppression of a former Disposition to sweat. At such a Term it may be practicable to prevent, or at least considerably to mitigate, the most perplexing Disorders, by carefully observing the four following Points.

1. To omit all violent Work or Labour, but yet not so, as to discontinue a gentle easy Degree of Exercise.

2. To bring the Complainant to content himself without any, or with very little, solid Food; and especially to renounce all Flesh, Flesh-broth, Eggs and Wine.

3. To drink plentifully, that is to say, at least three Pints, or even four Pints daily, by small Glasses at a Time, from half hour to half hour, of the Ptisans [Nº. 1] and [2], or even of warm Water, to each Quart of which may be added half a Glass of Vinegar. No Person can be destitute of this very attainable Assistance. But should there be a Want even of Vinegar, a few Grains of common [¹⁷] Salt may be added to a Quart of warm Water for Drink. Those who have Honey will do well to add two or three Spoonfuls of it to the Water. A light Infusion of Elder Flowers, or of those of the Linden, the Lime-tree, may also be advantageously used, and even well settled and clear sweet Whey.

4. Let the Person, affected with such previous Complaints, receive Glysters of warm Water, or the Glyster [Nº. 5]. By pursuing these Precautions some grievous Disorders have often been happily rooted out: and although they should not prove so thoroughly efficacious, as to prevent their Appearance, they may at least be rendered more gentle, and much less dangerous.

§ 33. Very unhappily People have taken the directly contrary Method. From the Moment these previous, these forerunning Complaints are perceived, they allow themselves to eat nothing but gross Meat, Eggs, or strong Meat-Soups. They leave off Garden-Stuff and Fruits, which would be so proper for them; and they drink heartily (under a Notion of strengthening the Stomach and expelling Wind) of Wine and other Liquors, which strengthen nothing but the Fever, and expel what Degree of Health might still remain. Hence all the Evacuations are restrained; the Humours causing and nourishing the Diseases are not at all attempered, diluted, nor rendered proper for Evacuation. Nay, on the very contrary, they become more sharp, and more difficult to be discharged: while a sufficient Quantity of diluting refreshing Liquor, asswages and separates all Matters foreign to the Blood, which it purifies; and, at the Expiration of some Days, all that was noxious in it is carried off by Stool, by Urine, or by Sweat.

§ 34. When the Distemper is further advanced, and the Patient is already seized with that Coldness or Shuddering, in a greater or less Degree, which ushers in all Disease; and which is commonly attended with an universal Oppression, and Pains over all the Surface of the Body; the Patient, thus circumstanced, should be put to Bed, if he cannot keep up; or should sit down as quietly as possible, with a little more Covering than usual: he should drink every Quarter of an Hour a small Glass of the Ptisan, [Nº. 1] or [2], warm; or, if that is not at Hand, of some one of those Liquids I have recommended [§ 32].

§ 35. These Patients earnestly covet a great Load of covering, during the Cold or Shivering; but we should be very careful to lighten them as soon as it abates; so that when the succeeding Heat begins, they may have no more than their usual Weight of Covering. It were to be wished perhaps, they had rather less. The Country People lie upon a Feather-bed, and under a downy Coverlet, or Quilt, that is commonly extremely heavy; and the Heat which is heightened and retained by Feathers, is particularly troublesome to Persons in a Fever. Nevertheless, as it is what they are accustomed to, this Custom may be complied with for one Season of the Year: but during our Heats, or whenever the Fever is very violent, they should lie on a Pallet (which will be infinitely better for them) and should throw away their Coverings of Down, so as to remain covered only with Sheets, or something else, less injurious than Feather-Coverings. A Person could scarcely believe, who had not been, as I have, a Witness of it, how much Comfort a Patient is sensible of, in being eased of his former Coverings. The Distemper immediately puts on a different Appearance.

§ 36. As soon as the Heat after the Rigor, or Coldness and Shuddering, approaches, and the Fever is manifestly advanced, we should provide for the Patient's Regimen. And

1, Care should be taken that the Air, in the Room where he lies, should not be too hot, the mildest Degree of Warmth being very sufficient; that there be as little Noise as possible, and that no Person speak to the Sick, without a Necessity for it. No external Circumstance heightens the Fever more, nor inclines the Patient more to a Delirium or Raving, than the Persons in the Chamber, and especially about the Bed. They lessen the Spring, the elastic and refreshing Power, of the Air; they prevent a Succession of fresh Air; and the Variety of Objects occupies the Brain too much. Whenever the Patient has been at Stool, or has made Urine, these Excrements should be removed immediately. The Windows should certainly be opened Night and Morning, at least for a Quarter of an Hour each Time; when also a Door should be opened, to promote an entire Renovation or Change of the Air in the Room. Nevertheless, as the Patient should not be exposed at any Time to a Stream or Current of Air, the Curtains of his Bed should be drawn on such Occasions; and, if he lay without any, Chairs, with Blankets or Cloaths hung upon them, should be substituted in the Place of Curtains, and surround the Bed; while the Windows continued open, in Order to defend the Patient from the Force of the rushing Air. If the Season, however, be rigidly cold, it will be sufficient to keep the Windows open, but for a few Minutes, each Time. In Summer, at least one Window should be set open Day and Night. The pouring a little Vinegar upon a red-hot Shovel also greatly conduces to restore the Spring, and correct the Putridity, of the Air. In our greatest Heats, when that in the Room seems nearly scorching, and the sick Person is sensibly and greatly incommoded by it, the Floor may be sprinkled now and then; and Branches of Willow or Ash-trees dipt a little in Pails of Water may be placed within the Room.

§ 37. 2. With Respect to the Patient's Nourishment, he must entirely abstain from all Food; but he may always be allowed, and have daily prepared, the following Sustenance, which is one of the wholesomest, and indisputably the simplest one. Take half a Pound of Bread, a Morsel of the freshest Butter about the Size only of a Hazel Nut (which may even be omitted too) three Pints and one quarter of a Pint of Water. Boil them 'till the Bread be entirely reduced to a thin Consistence. Then strain it, and give the Patient one eighth Part of it every three, or every four, Hours; but still more rarely, if the Fever be vehemently high. Those who have Groats, Barley, Oatmeal, or Rice, may boil and prepare them in the same Manner, with some Grains of Salt.

§ 38. The Sick may also be sometimes indulged, in lieu of these different Spoon-Meats, with raw Fruits in Summer, or in Winter with Apples baked or boiled, or Plumbs and Cherries dried and boiled. Persons of Knowledge and Experience will be very little, or rather not at all, surprized to see various Kinds of Fruit directed in acute Diseases; the Benefit of which they may here have frequently seen. Such Advice can only disgust those, who remain still obstinately attached to old Prejudices. But could they prevail on themselves to reflect a little, they must perceive, that these Fruits which allay Thirst; which cool and abate the Fever; which correct and attemper the putrid and heated Bile; which gently dispose the Belly to be rather open, and promote the Secretion and Discharge of the Urine, must prove the properest Nourishment for Persons in acute Fevers. Hence we see, as it were by a strong Admonition from Nature herself, they express an ardent Longing for them; and I have known several, who would not have recovered, but for their eating secretly large Quantities of those Fruits they so passionately desired, and were refused. As many however, as are not convinced by my Reasoning in this Respect, may at least make a Tryal of my Advice, on my Affirmation and Experience; when I have no doubt but their own will speedily convince them of the real Benefit received from this Sort of Nourishment. It will then be evident, that we may safely and boldly allow, in all continual Fevers, Cherries red and black, Strawberries, the best cured Raisins, Raspberries, and Mulberries; provided that all of them be perfectly ripe. Apples, Pears and Plumbs are less melting and diluting, less succulent, and rather less proper. Some kinds of Pears however are extremely juicy, and even watery almost, such as the Dean or Valentia Pear, different Kinds of the Buree Pear; the St. Germain, the Virgoleuse; the green sugary Pear, and the Summer Royal, which may all be allowed; as well as a little Juice of very ripe Plumbs, with the Addition of Water to it. This last I have known to asswage Thirst in a Fever, beyond any other Liquor. Care should be taken, at the same Time, that the Sick should never be indulged in a great Quantity of any of them at once, which would overload the Stomach, and be injurious to them; but if they are given a little at a Time and often, nothing can be more salutary. Those whose Circumstances will afford them China Oranges, or Lemons, may be regaled with the Pulp and Juice as successfully; but without eating any of their Peel, which is hot and inflaming.

§ 39. 3. Their Drink should be such as allays Thirst, and abates the Fever; such as dilutes, relaxes, and promotes the Evacuations by Stool, Urine and Perspiration. All these which I have recommended in the preceding Chapters, jointly and severally possess these Qualities. A Glass or a Glass and a half of the Juice of such Fruits as I have just mentioned, may also be added to three full Pints of Water.

§ 40. The Sick should drink at least twice or thrice that Quantity daily, often, and a little at once, between three or four Ounces, every Quarter of an Hour. The Coldness of the Drink should just be taken off.

§ 41. 4. If the Patient has not two Motions in the 24 Hours; if the Urine be in small Quantity and high coloured; if he rave, the Fever rage, the Pain of the Head and of the Loins be considerable, with a Pain in the Belly, and a Propensity to vomit, the Glyster [Nº. 5] should be given at least once a Day. The People have generally an Aversion to this kind of Remedy; notwithstanding there is not any more useful in feverish Disorders, especially in those I have just recounted; and one Glyster commonly gives more Relief, than if the Patient had drank four or five Times the Quantity of his Drinks. The Use of Glysters, in different Diseases, will be properly ascertained in the different Chapters, which treat of them. But it may be observed in this Place, that they are never to be given at the very Time the Patient is in a Sweat, which seems to relieve him.

§ 42. 5. As long as the Patient has sufficient Strength for it, he should sit up out of Bed one Hour daily, and longer if he can bear it; but at least half an Hour. It has a Tendency to lessen the Fever, the Head-ach, and a Light-headiness, or Raving. But he should not be raised, while he has a hopeful Sweating; though such Sweats hardly ever occur, but at the Conclusion of Diseases, and after the Sick has had several other Evacuations.

§ 43. 6. His Bed should be made daily while he sits up; and the Sheets of the Bed, as well as the Patient's Linen, should be changed every two Days, if it can be done with Safety. An unhappy Prejudice has established a contrary, and a really dangerous, Practice. The People about the Patient dread the very Thought of his rising out of Bed; they let him continue there in nasty Linen loaden with putrid Steams and Humours; which contribute, not only to keep up the Distemper, but even to heighten it into some Degree of Malignity. I do again repeat it here, that nothing conduces more to continue the Fever and Raving, than confining the Sick constantly to Bed, and witholding him from changing his foul Linen: by relieving him from both of which Circumstances I have, without the Assistance of any other Remedy, put a Stop to a continual Delirium of twelve Days uninterrupted Duration. It is usually said, the Patient is too weak, but this is a very weak Reason. He must be in very nearly a dying Condition, not to be able to bear these small Commotions, which, in the very Moment when he permits them, increase his Strength, and immediately after abate his Complaints. One Advantage the Sick gain by sitting up a little out of Bed, is the increased Quantity of their Urine, with greater Facility in passing it. Some have been observed to make none at all, if they did not rise out of Bed.

A very considerable Number of acute Diseases have been radically, effectually, cured by this Method, which mitigates them all. Where it is not used, as an Assistance at least, Medicines are very often of no Advantage. It were to be wished the Patient and his Friends were made to understand, that Distempers were not to be expelled at once with rough and precipitate Usage; that they must have their certain Career or Course; and that the Use of the violent Methods and Medicines they chuse to employ, might indeed abridge the Course of them, by killing the Patient; yet never otherwise shortened the Disease; but, on the contrary, rendered it more perplexing, tedious and obstinate; and often entailed such unhappy Consequences on the Sufferer, as left him feeble and languid for the rest of his Life.

§ 44. But it is not sufficient to treat, and, as it were, to conduct the Distemper properly. The Term of Recovery from a Disease requires considerable Vigilance and Attention, as it is always a State of Feebleness, and, thence, of Depression and Faintness. The same Kind of Prejudice which destroys the Sick, by compelling them to eat, during the Violence of the Disease, is extended also into the Stage of Convalescence, or Recovery; and either renders it troublesome and tedious; or produces fatal Relapses, and often chronical Distempers. In Proportion to the Abatement, and in the Decline, of the Fever, the Quantity of Nourishment may be gradually increased: but as long as there are any Remains of it, their Qualities should be those I have already recommended. Whenever the Fever is compleatly terminated, some different Foods may be entered upon; so that the Patient may venture upon a little white Meat, provided it be tender; some [¹⁸] Fish; a little Flesh-Soup, a few Eggs at times, with Wine property diluted. It must be observed at the same Time, that those very proper Aliments which restore the Strength, when taken moderately, delay the perfect Cure, if they exceed in Quantity, tho' but a little; because the Action of the Stomach being extremely weakened by the Disease and the Remedies, is capable only, as yet, of a small Degree of Digestion; and if the Quantity of its Extents exceed its Powers, they do not digest, but become putrid. Frequent Returns of the Fever supervene; a continual Faintishness; Head-achs; a heavy Drowsiness without a Power of Sleeping comfortably; flying Pains and Heats in the Arms and Legs; Inquietude; Peevishness; Propensity to Vomit; Looseness; Obstructions, and sometimes a slow Fever, with a Collection of Humours, that comes to Suppuration.

All these bad Consequences are prevented, by the recovering Sick contenting themselves, for some Time, with a very moderate Share of proper Food. We are not nourished in Proportion to the Quantity we swallow, but to that we digest. A Person on the mending Hand, who eats moderately, digests it and grows strong from it. He who swallows abundantly does not digest it, and instead of being nourished and strengthened, he withers insensibly away.

§ 45. We may reduce, within the few following Rules, all that is most especially to be observed, in Order to procure a compleat, a perfect Termination of acute Diseases; and to prevent their leaving behind them any Impediments to Health.

1. Let these who are recovering, as well as those who are actually sick, take very little Nourishment at a time, and take it often.

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

3. Let them chew whatever solid Victuals they eat, very carefully.

4. Let them diminish their Quantity of Drink. The best for them in general is Water, [¹⁹] with a fourth or third Part of white Wine. Too great a Quantity of Liquids at this time prevents the Stomach from recovering its Tone and Strength; impairs Digestion; keeps up Weakness; increases the Tendency to a Swelling of the Legs; sometimes even occasions a slow Fever; and throws back the Person recovering into a languid State.

5. Let them go abroad as often as they are able, whether on Foot, in a Carriage, or on Horseback. This last Exercise is the healthiest of all, and three fourths of the labouring People in this Country, who have it in their Power to procure it without Expense, are in the wrong to neglect it. They, who would practice it, should mount before their principal Meal, which should be about Noon, and never ride after it. Exercise taken before a Meal strengthens the Organs of Digestion, which is promoted by it. If the Exercise is taken soon after the Meal, it impairs it.

6. As People in this State are seldom quite as well towards Night, in the Evening they should take very little Food. Their Sleep will be the less disturbed for this, and repair them the more, and sooner.

7. They should not remain in Bed above seven, or eight Hours.

8. The Swelling of the Legs and Ancles, which happens to most Persons at this time, is not dangerous, and generally disappears of itself; if they live soberly and regularly, and take moderate Exercise.

9. It is not necessary, in this State, that they should go constantly every Day to Stool; though they should not be without one above two or three. If their Costiveness exceeds this Term, they should receive a Glyster the third Day, and even sooner, if they are heated by it, if they feel puffed up, are restless, and have any Pains in the Head.

10. Should they, after some time, still continue very weak; if their Stomach is disordered; if they have, from time to time, a little irregular Fever, they should take three Doses daily of the Prescription [Nº. 14]. which fortifies the Digestions, recovers the strength, and drives away the Fever.

11. They must by no means return to their Labour too soon. This erroneous Habit daily prevents many Peasants from ever getting perfectly well, and recovering their former Strength. From not having been able to confine themselves to Repose and Indolence for some Days, they never become as hearty hardy Workmen as they had been: and this premature hasty Labour makes them lose in the Consequence, every following Week of their Lives, more time than they ever gained, by their over-early resuming of their Labour. I see every Day weakly Labourers, Vineroons, and other Workmen, who date the Commencement of their Weakness from that of some acute Disease, which, for want of proper Management through the Term of their Recovery, was never perfectly cured. A Repose of seven or eight Days, more than they allowed themselves, would have prevented all these Infirmities; notwithstanding it is very difficult to make them sensible of this. The Bulk, the Body of the People, in this and in many other Cases, look no further than the present Day; and never extend their Views to the following one. They are for making no Sacrifice to Futurity; which nevertheless must be done, to render it favourable to us.

Chapter IV.

Of an Inflammation of the Breast.

Sect. 46.

he Inflammation of the Breast, or Peripneumony, or a Fluxion upon the Breast, is an Inflammation of the Lungs, and most commonly of one only, and consequently on one Side. The Signs by which it is evident, are a Shivering, of more or less Duration, during which the Person affected is sometimes very restless and in great Anguish, an essential and inseparable symptom; and which has helped me more than once to distinguish this Disease certainly, at the very Instant of its Invasion. Besides this, a considerable Degree of Heat succeeds the Shivering, which Heat, for a few ensuing Hours, is often blended as it were, with some Returns of Chilliness. The Pulse is quick, pretty strong, moderately full, hard and regular, when the Distemper is not very violent; but small, soft and irregular, when it is very dangerous. There is also a Sensation of Pain, but rather light and tolerable, in one Side of the Breast; sometimes a kind of straitning or Pressure on the Heart; at other times Pains through the whole Body, especially along the Reins; and some Degree of Oppression, at least very often; for sometimes it is but very inconsiderable. The Patient finds a Necessity of lying almost continually upon his Back, being able to lie but very rarely upon either of his Sides. Sometimes his Cough is dry, and then attended with the most Pain; at other times it is accompanied with a Spitting or Hawking up, blended with more or less Blood, and sometimes with pure sheer Blood. There is also some Pain, or at least a Sensation of Weight and Heaviness in the Head: and frequently a Propensity to rave. The Face is almost continually flushed and red: though sometimes there is a Degree of Paleness and an Air of Astonishment, at the Beginning of the Disease, which portend no little Danger. The Lips, the Tongue, the Palate, the Skin are all dry; the Breath hot; the Urine little and high coloured in the first Stage: but more plentiful, less flaming, and letting fall much Sediment afterwards. There is a frequent Thirst, and sometimes an Inclination to vomit; which imposing on the ignorant Assistants, have often inclined them to give the Patient a Vomit, which is mortal, especially at this Juncture. The Heat becomes universal. The Symptoms are heightened almost every Night, during which the Cough is more exasperated, and the Spitting or Expectoration in less Quantity. The best Expectoration is of a middling Consistence, neither too thin, nor too hard and tough, like those which are brought up at the Termination of a Cold; but rather more yellow, and mixed with a little Blood, which gradually becomes still less, and commonly disappears entirely, before the seventh Day. Sometimes the Inflammation ascends along the Wind-pipe, and in some Measure suffocates the Patient, paining him considerably in Swallowing, which makes him think he has a sore Throat.

§ 47. Whenever the Disease is very violent at first, or increases to be such, the Patient cannot draw his Breath, but when he sits up. The Pulse becomes very small and very quick; the Countenance livid, the Tongue black; the Eyes stare wildly; and he suffers inexpressible Anguish, attended with incessant Restlessness and Agitation in his Bed. One of his Arms is sometimes affected with a sort of Palsy; he raves without Intermission; can neither thoroughly wake nor sleep. The Skin of his Breast and of his Neck is covered (especially in close sultry Weather, and when the Distemper is extremely violent) with livid Spots, more or less remarkable, which should be called petechial ones, but are improperly termed the pourpre, or purple. The natural Strength becomes exhausted; the Difficulty of breathing increases every Moment; he sinks into a Lethargy, and soon dies a terrible Death in Country Places, by the very Effects of the inflaming Medicines they employ on such Occasions. It has been known in Fact, that the Use of them has raised the Distemper to such a Height, that the very Heart has been rent open, which the Dissection of the Body has demonstrated.

§ 48. If the Disease rushes on at once, with a sudden and violent Attack; if the Horror, the Cold and Shivering last many Hours, and are followed with a nearly scorching Degree of Heat; if the Brain is affected from the very Onset; if the Patient has a small Purging, attended with a Tenesinus, or straining to Stool, often termed a Needy; if he abhors the Bed; if he either sweat excessively, or if his Skin be extremely dry; if his natural Manner and Look are considerably changed; and if he spits up with much Difficulty, the Disease is extremely dangerous.

§ 49. He must directly, from the first Seizure in this State, be put upon a Regimen, and his Drink must never be given cold. It should either be the Barley Water [Nº. 2], the Almond Emulsion [Nº. 4], or that of [Nº. 7]. The Juices of the Plants, which enter into the last of these Drinks, are excellent Remedies in this Case; as they powerfully attenuate, or melt down, the viscid thick Blood, which causes the Inflammation.

The Advantage of Bleeding:

As long as the Fever keeps up extremely violent; while the Patient does not expectorate sufficiently; continues raving; has a violent Head-ach, or raises up pure Blood, the Glyster [Nº. 5] must be given thrice, or at least twice, in twenty four Hours. However the principal Remedy is Bleeding. As soon as ever the preceding cold Assault is over, twelve Ounces of Blood must be taken away at once; and, if the Patient be young and strong, fourteen or even sixteen. This plentiful Bleeding gives him more Ease, than if twenty four Ounces had been drawn, at three different Times.

§ 50. When the Disease is circumstanced as described ([§ 46]) that first Bleeding makes the Patient easy for some Hours; but the Complaint returns; and to obviate its Violence, as much as possible, we must, except things promise extremely well, repeat the Bleeding four Hours after the first, taking again twelve Ounces of Blood, which pretty often proves sufficient. But if, about the Expiration of eight or ten Hours, it appears to kindle up again, it must be repeated a third, or even a fourth Time. Yet, with the Assistance of other proper Remedies, I have seldom been obliged to bleed a fourth Time, and have sometimes found the two first Bleedings sufficient.

If the Disease has been of several Days Duration, when I have first been called; if the Fever is still very high; if there be a Difficulty of Breathing; if the Patient does not expectorate at all, or brings up too much Blood; without being too solicitous about the Day of the Disease, the Patient should be bled, though it were on the tenth. [²⁰]

§ 51. In this, and in all other inflammatory Diseases, the Blood is in a very thick viscid State: and almost immediately on its being drawn, a white tough Skin, somewhat like Leather, is formed on its Top, which most People have seen, and which is called the pleuritic Crust. It is thought a promising Appearance, when at each Bleeding it seems less hard, and less thick, than it was at the preceding ones: and this is very generally true, if the Sick feels himself, at the same Time, sensibly better: but whoever shall attend solely to the Appearance of the Blood, will find himself often deceived. It will happen, even in the most violent Inflammation of the Breast, that this Crust is not formed, which is supposed to be a very unpromising Sign. There are also, in this Respect, many odd Appearances, which arise from the smallest Circumstances; so that we must not regulate the Repetitions of our bleeding, solely by this Crust: and in general we must not be over credulous in supposing, that the Appearances in the Blood, received into the Bason, can enable us to determine, with Certainty, of its real State in the Body.

§ 52. When the sick Person is in the Condition described ([§ 47]) the Bleeding is not only unattended with Ease; but sometimes it is also pernicious, by the sudden Weakness to which it reduces him. Generally in such a Case all Medicines and Means are insignificant: and it is a very bad Sign in this Disease, when this Discharge is not attended with Ease and Benefit to the Sick; or when there are some Circumstances, which oblige us to be sparing of it.

§ 53. The Patient's Legs should every Day, for one half Hour, be put into a Bath of warm Water, wrapping him up closely; that the Cold may not check that Perspiration, which the Bath promotes.

§ 54. Every two Hours he should take two Spoonfuls of the Mixture [Nº. 8], which promotes all the Discharges, and chiefly that of Expectoration.

§ 55. When the Oppression and Straitness are considerable, and the Cough dry, the Patient may receive the Vapour of boiling Water, to which a little Vinegar has been added. There are two ways of effecting this; either by placing below his Face, after setting him up, a Vessel filled with such boiling hot Water, and covering the Patient's Head and the Vessel with a Linen Cloth, that may inclose the Steam; or else by holding before his Mouth a Spunge dipped in the same boiling Liquor. This last Method is the least effectual, but it fatigues the Patient considerably less. When this bad Symptom is extremely pressing, Vinegar alone should be used without Water; and the Vapour of it has often saved Patients, who seemed to have one Foot in the Grave: but it should be continued for several Hours.

§ 56. The outward Remedies directed in [Nº. 9.] are also applied with Success to the Breast, and to the Throat.

§ 57. When the Fever is extremely high, the Sick should take every Hour, a Spoonful of the Mixture [Nº. 10]. in a Cup of the Ptisan [²¹] but without diminishing on this Account the usual Quantity of his other Drinks, which may be taken immediately after it.

§ 58. As long as the Patient shall grow worse, or only continue equally bad, the same Medicines are to be repeated. But if on the third Day (tho' it rarely happens so soon) or fourth, or fifth, the Disease takes a more favourable Turn; if the Exasperation returns with less Violence; the Cough be less severe; the Matter coughed up less bloody: if Respiration becomes easier; the Head be less affected; the Tongue not quite so dry; if the high Colour of the Urine abates, and its Quantity be increased, it may be sufficient then to keep the Patient carefully to his Regimen, and to give him a Glyster every Evening. The Exasperation that occurs the fourth Day is often the highest.

§ 59. This Distemper is most commonly terminated and carried off by Expectoration, and often by Urine, which on the seventh, the ninth, or the eleventh Day, and sometimes on the Days between them, begins to let fall a plentiful Sediment, or Settling, of a pale red Colour, and sometimes real Pus or ripe Matter. These Discharges are succeeded by Sweats, which are as serviceable then, as they were injurious at the Beginning of the Disease.

§ 60. Some Hours before these Evacuations appear, there come on, and not seldom, some very alarming Symptoms, such as great Anguish; Palpitations, some Irregularity in the Pulse; an increased Oppression; convulsive Motions (this being what is called the Crisis, the Height, or Turn of the Distemper) but they are no ways dangerous, provided they do not occasion any improper Treatment. These Symptoms depend on the morbid and purulent Matter, which, being dislodged, circulates with the Humours, and irritates different Parts, until the Discharge of it has fairly begun; after which all such Symptoms disappear, and Sleep generally ensues. However I cannot too strongly insist on the Necessity of great Prudence in such Circumstances. Sometimes it is the Weakness of the Patient, and at other times Convulsions, or some other Symptoms, that terrify the By-standers. If, which is most generally the Case, the absurd Practice of directing particular Remedies for such Accidents takes place, such as spirituous Cordials, Venice Treacle, Confections, Castor and Rue; the Consequence is, that Nature being disturbed in her Operations, the Crisis or Turn is not effected; the Matter which should be discharged by Stool, by Urine, or by Sweat, is not discharged out of the Body; but is thrown upon some internal or external part of it. Should it be on some inward part, the Patient either dies at once; or another Distemper succeeds, more troublesome and incurable than the first. Should it be expelled to some outward part, the Danger indeed is less; and as soon as ever such a Tumour appears, ripening Pultices should be apply'd to bring it to a Head, after which it should immediately be opened.

§ 61. In order to prevent such unhappy Consequences, great Care must be taken, whenever such terrifying Symptoms come on, [about the Time of the Crisis] to make no Change in the Diet, nor in the Treatment of the Patient; except in giving him the loosening Glyster [Nº. 5]; and applying every two Hours a Flannel, squeezed out of warm Water, which may cover all the Belly, and in a Manner go round the Body behind the Reins. The Quantity of his Drink may also be increased a little; and that of his Nourishment lessened, as long as this high and violent State continues.

§ 62. I have not spoken of Vomits or Purges, as being directly contrary to the Nature of this Disease. Anodynes, or Opiates, to procure Sleep are also, in general, very improper. In a few Cases, however, they may possibly be useful; but these Cases are so very difficult to be sufficiently distinguished, that Opiates should never be admitted in this Disease, without the Presence and Advice of a Physician. I have seen many Patients, who have been thrown into an incurable Hectic, by taking them improperly. When the Disease is not received in a mortal Degree, nor has been injudiciously treated, and proceeds in a benign regular Manner, the Patient may be called very well and safe by the fourteenth Day; when he may, if he has an Appetite, be put upon the Diet of People who are recovering. But if he still retains an Aversion to Food; if his Mouth is foul and furred, and he is sensible of some Heaviness in his Head, he should take the purging Potion [Nº. 11].

§ 63. Bleedings from the Nose occur sometimes naturally in this Disease, even after repeated Bleedings by Art; these are very benign and favourable, and are commonly attended with more Ease and Relief than artificial Bleedings. Such voluntary Discharges may sometimes be expected, when the Patient is sensibly mended in many Respects after the Use of the Lancet; and yet complains of a great Pain in his Head, accompanied with quick sparkling Eyes, and a Redness of the Nose. Nothing should be done to stop these voluntary Bleedings, since it would be very dangerous: For when Nature has fulfilled her Intention by them, they cease of themselves. At other times, but more rarely, the Distemper is carried off by a natural Purging, attended with moderate Pain, and the Discharge of bilious Matter.

§ 64. If the Expectoration, or hawking up of Matter, stops very suddenly, and is not speedily attended with some other Evacuation; the Oppression and Anguish of the Patient immediately return, and the Danger is great and pressing. If the Distemper, at this Juncture, is not of many Days standing; if the Patient is a strong Person; if he has not as yet been plentifully bled; if there be still some Blood mixed with the Humour he expectorates; or if the Pulse be strong and hard, he should be bled immediately in the Arm; and constantly receive the Steam of hot Water and Vinegar by the Mouth, and drink plentifully of the Ptisan [Nº. 2], something hotter than ordinary. But if his Circumstances, after this Suppression, are different from these just mentioned; instead of bleeding him, two Blisters should be applied to the Legs; and he should drink plentifully of the Ptisan [Nº. 12].

The Causes which oftenest produce this Suppression of his Expectoration are, 1, a sharp and sudden cold Air. 2, too hot a one. 3, over hot Medicines. 4, excessive Sweating. 5, a Purge prematurely and injudiciously timed. and 6, some immoderate Passion of the Mind.

§ 65. When the Sick has not been sufficiently bled, or not soon enough; and even sometimes, which I have seen, when he has been greatly weakened by excessive Bleeding; so that the Discharges by Stool, Urine, Expectoration and Perspiration, have not been sufficiently made; when these Discharges have been confused by some other Cause; or the Disease has been injudiciously treated; then the Vessels that have been inflamed, do not unload themselves of the Humours, which stuff up and oppress them: but there happens in the Substance of the affected Lung, the same Circumstance we see daily occur on the Surface of the Body. If an inflammatory Tumour or Swelling does not disperse itself, and disappears insensibly, it forms an Imposthume or Abscess. Thus exactly also in the inflamed Lung, if the Inflammation is not dissipated, it forms an Abscess, which, in that part, is called a Vomica: and the Matter of that Abscess, like the external ones, remains often long inclosed in its Sac or Bag, without bursting open its Membrane or Case, and discharging the Matter it contains.

§ 66. If the Inflammation was not very deeply seated in the inward Substance of the diseased Lung; but was extended to its Surface, that is, very near the Ribs, the Sac will burst on the Surface of the Lung; and the Matter contained in it must be discharged into the Cavity, or Hollowness of the Breast, between the Lung, the Ribs, and the Diaphragm or Midriff, which is the Membrane that divides the Breast and the Belly. But when the Inflammation is considerably deeper, the Imposthume bursts withinside of the Lung itself. If its Orifice, or Opening is so small, that but little can get out at once; if the Quantity of all the Matter be inconsiderable, and the Patient is at the same Time pretty strong, he coughs up the Matter, and is very sensibly relieved. But if this Vomica be large, or if its Orifice is wide, and it throws out a great Quantity of Matter at once; or if the Patient is very weak, he dies the Moment it bursts, and that sometimes when it is least expected. I have seen one Patient so circumstanced expire, as he was conveying a Spoonful of Soup to his Mouth; and another, while he was wiping his Nose. There was no present Symptom in either of these Cases, whence a Physician might suppose them likelier to die at that Instant, than for some Hours before. The Pus, or Matter, is commonly discharged through the Mouth after Death, and the Bodies very soon become putrified.

§ 67. We call that Vomica which is not burst, an occult or hidden, and that which is, an evident or open one. It is of considerable Importance to treat exactly and clearly of this Topic; as a great Number of Country People die of these Imposthumes, even without a Suspicion of the Cause of their Death. I had an Instance of it some Days since, in the School-master of a Village. He had an occult and very considerable Vomica in the left Lung, which was the Consequence of an Inflammation of the Breast, that had been treated improperly at the Beginning. He seemed to me not likely to live twenty four Hours; and really died in the Night, after inexpressible Anguish.

§ 68. Whatever Distemper is included within the Breast of a living Patient, is neither an Object of the Sight or Touch whence these Vomicas, these inward Tumours, are so often unknown, and indeed unsuspected. The Evacuations that were necessary for the Cure, or sometimes for the Prevention, of them, have not taken place, during the first fourteen Days. At the End of this Term, the Patient, far from being cured, is not very considerably relieved; but, on the contrary, the Fever continues to be pretty high, with a Pulse continually quick; in general soft and weak; though sometimes pretty hard, and often fluctuating, or, as it were, waving. His Breathing is still difficult and oppressed; with small cold Shudderings from Time to Time; an Exasperation of the Fever; flushed Cheeks, dry Lips, and Thirst.

The Increase of these Symptoms declare, that Pus or Matter is thoroughly formed: the Cough then becomes more continual; being exasperated with the least Motion; or as soon as ever the Patient has taken any Nourishment. He can repose only on the Side affected. It often happens indeed, that he cannot lie down at all; but is obliged to be set up all Day; sometimes even without daring to lean a little upon his Loins, for fear of increasing the Cough and Oppression. He is unable to sleep; has a continual Fever, and his Pulse frequently intermits.

The Fever is not only heightened every Evening; but the smallest Quantity of Food, the gentlest Motion, a little Coughing, the lightest Agitation of the Mind, a little more than usual Heat in the Chamber, Soup either a little too strong, or a little too salt, increase the Quickness of his Pulse the Moment they occur, or are given. He is quite restless, has some short Attacks of the most terrible Anguish, accompanied and succeeded by Sweatings on his Breast, and from his whole Countenance. He sweats sometimes the whole Night; his Urine is reddish, now frothy, and at other times oily, as it were. Sudden Flushings, hot as Flames, rise into his whole Visage. The greater Number of the Sick are commonly sensible of a most disagreeable Taste in their Mouth; some of old strong Cheese; others of rotten Eggs; and others again of stinking Meat, and fall greatly away. The Thirst of some is unquenchable; their Mouths and Lips are parched; their Voice weak and hoarse; their Eyes hollow, with a kind of Wildness in their Looks. They have a general Disgust to all Food; and if they should ask for some particular Nourishment without seeing it, they reject it the Moment it is brought them; and their Strength at length seems wholly exhausted.

Besides these Symptoms, a little Inflation, or Bloatedness, as it were, is sometimes observed on the Breast, towards the Side affected; with an almost insensible Change of Colour. If the Vomica be situated at the Bottom of the affected Lobe of the Lungs, and in its internal Part, that is, nearly in the Middle of the Breast, some Puffiness or light Swelling may be perceived in some Bodies, by gently pressing the Pit of the Stomach; especially when the Patient coughs. In short, according to the Observations of a German Physician, if one strike the open Hand on the Breast, covered only with a Shirt, it retains in the Spot, which is directly opposite to the Vomica, a flat heavy Sound, as if one struck a Piece of Flesh; while in striking on the other Side it gives a clear loud Sound, as from a Drum. I still doubt however, whether this Observation will generally hold true; and it would be hazardous to affirm there is no Abscess in a Breast, which does not return this heavy Sound.

§ 69. When a Vomica is formed, as long as it is not emptied, all the Symptoms I have already enumerated increase, and the Vomica grows in Size: the whole Side of the Lung affected sometimes becomes a Bag or Sac of Matter. The sound Side is compressed; and the Patient dies after dreadful Anguish, with the Lung full of Pus, and without having ever brought up any.

To avoid such fatal Consequences, it is necessary to procure the Rupture and Discharge of this inward Abscess, as soon as we are certain of its Existence: And as it is safer it should break within the Lobe affected, from whence it may be discharged by hawking up; than that it should burst and void itself into the Cavity of the Breast, for Reasons I shall give hereafter, we must endeavour, that this Rupture may be effected within the internal Substance of the Lungs.

§ 70. The most effectual Methods to procure this are, 1. To make the Patient continually receive, by his Mouth, the Vapour of warm Water. 2. When by this Means that part of the Sac or Abscess is softened, where we could wish the Rupture of it to happen, the Patient is to swallow a large Quantity of the most emollient Liquid; such as Barley Water, Almond Milk, light Veal Broth, or Milk and Water. By this Means the Stomach is kept always full: so that the Resistance to the Lungs being considerable on that Side, the Abscess and its Contents will naturally be pressed towards the Side of the Wind-pipe, as it will meet with less Resistance there. This fulness of the Stomach will also incline the Patient to cough, which may concur to produce a good Event. Hence, 3, we should endeavour to make the Patient cough, by making him smell to some Vinegar, or even snuff up a little; or by injecting into his Throat, by the Means of a small Syringe or Pipe, such as Children make out of short Pieces of Elder-Boughs, a little Water or Vinegar. 4. He should be advised to bawl out aloud, to read loud, or to laugh heartily; all which Means contribute to burst open the Abscess, as well as those two following ones. 5. Let him take every two Hours a Soup-Ladle of the Potion [Nº. 8]. 6. He should be put into a Cart, or some other Carriage; but not before he has drank plentifully of such Liquors as I have just mentioned: after which the Shaking and Jolting in the Carriage have sometimes immediately procured that Rupture, or breaking of the Bag or Abscess, we wished for.

§ 71. Some Years since I saw a Country Maid Servant, who was left in a languishing Condition after an Inflammation of the Breast; without any Person's suspecting her Ailment. This Woman being put into a Cart, that was sent for a Load of Hay; one of the Wheels run violently against a Tree: she swooned away, and at the same Time brought up a great Quantity of digested Matter. She continued to bring up more; during which I was informed of her Case, and of the Accident, which effectually cured her.

A Swiss Officer, who served in Piedmont, had been in a languid State of Health for some Months; and returned home to set himself down as easily as he could, without conceiving any considerable Hopes of Recovery. Upon entering into his own Country, by the Way of Mount Bernard; and being obliged to go some Paces on Foot, he fell down; and remained in a Swoon above a Quarter of an Hour: during which Time he threw up a large Quantity of Matter, and found himself that very Moment very greatly relieved. I ordered him a proper Diet, and suitable Medicines: his Health became perfectly established; and the Preservation of his Life was principally owing to this lucky Fall.

Many Persons afflicted with a Vomica, faint away the very Instant it breaks. Some sharp Vinegar should be directly held to their Nose. This small Assistance is generally sufficient, where the bursting of it is not attended with such Appearances as shew it to be mortal, in which Case every Application is insignificant.

§ 72. If the sick Person was not extremely weak before the Bursting of the Abscess; if the Matter was white, and well conditioned; if the Fever abates after it; if the Anguish, Oppression and Sweats terminate; if the Cough is less violent; if the Patient is sensibly easier in his Situation or Posture; if he recovers his Sleep and Appetite; if his usual Strength returns; if the Quantity he expectorates, or brings up, becomes daily and gradually less; and if his Urine is apparently better, we may have Room to hope, that by the Assistance of these Remedies I shall immediately direct, he may be radically, compleatly cured.

§ 73. But if on the contrary; when his Strength is exhausted before the bursting of the Abscess; when the Matter is too thin and transparent, brown, green, yellow, bloody and of an Offensive Smell; if the Pulse continues quick and weak; if the Patient's Appetite, Strength and Sleep do not improve, there remains no hope of a Cure, and the best Medicines are ineffectual: Nevertheless we ought to make some Tryal of them.

§ 74. They consist of the following Medicines and Regulations. 1. Give every four Hours a little Barley or Rice Cream. 2. If the Matter brought up is thick and glewy, so that it is very difficult to be loosened and discharged, give every two Hours a Soup-ladle of the Potion [Nº. 8]; and between the giving these two, let the Patient take every half Hour a Cup of the Drink [Nº. 13]. 3. When the Consistence of the Matter is such, that there is no Occasion for these Medicines to promote the Discharge of it, they must be omitted; tho' the same Sort and Quantity of Food are to be continued; but with the Addition of an equal Quantity of Milk; or, which would be still more beneficial, instead of this Mixture, we should give an equal Quantity of sweet Milk, taken from a good Cow, which, in such a Case, may compose the whole Nourishment of the Patient. 4. He should take four Times a Day, beginning early in the Morning, and at the Distance of two Hours, a Dose of the Powder [Nº. 14], diluted in a little Water, or made into a Bolus, or Morsel, with a little Syrup or Honey. His common Drink should be Almond Emulsion, commonly called Almond Milk, or Barley Water, or fresh Water with a fourth part Milk. 5. He should air and exercise every Day on Horseback, or in a Carriage, according as his Strength and his Circumstances will allow him. But of all Sorts of Exercise, that upon a trotting Horse is, beyond all Comparison, the very best, and the easiest to be procured by every Body; provided the Disease be not too far advanced; since in such a Situation, any Exercise, that was only a little violent, might prove pernicious.

§ 75. The Multitude, who are generally illiterate, seldom consider any thing as a Remedy, except they swallow it. They have but little Confidence in Regimen, or any Assistance in the Way of Diet, and consider Riding on Horseback as wholly useless to them. This is a dangerous Mistake, of which I should be glad to undeceive them: since this Assistance, which appears so insignificant to them, is probably the most effectual of any: it is that in Fact, without which they can scarcely expect a Cure, in the highest Degrees of this Disease: it is that, which perhaps alone may recover them, provided they take no improper Food. In brief it is considered, and with Reason, as the real Specific for this Disease.

§ 76. The Influence of the Air is of more Importance in this Disorder, than in any others; for which Reason great Care should be taken to procure the best, in the Patient's Chamber. For this Purpose it should often be ventilated, or have an Admission of fresh Air, and be sweetened from Time to Time, tho' very lightly, with a little good Vinegar; and in the Season it should be plentifully supplied with agreeable Herbs, Flowers and Fruits. Should the Sick be unfortunately situated, and confined in an unwholsome Air, there can be but little Prospect of curing him, without altering it.

§ 77. Out of many Persons affected with these Disorders, some have been cured by taking nothing whatsoever but Butter-milk; others by Melons and Cucumbers only; and others again by Summer Fruits of every Sort. Nevertheless, as such Cases are singular, and have been but few, I advise the Patient to observe the Method I have directed here, as the surest.

§ 78. It is sufficient if he have a Stool once in two, or even in three, Days. Hence, there is no Reason for him, in this Case, to accustom himself to Glysters: they might excite a Looseness, which may be very dangerous.

§ 79. When the Discharge of the Matter from the Breast diminishes, and the Patient is perceivably mended in every Respect, it is a Proof that the Wound in the Abscess is deterged, or clean, and that it is disposed to heal up gradually. If the Suppuration, or Discharge, continues in great Quantity; if it seems but of an indifferent Consistence; if the Fever returns every Evening, it may be apprehended, that the Wound, instead of healing, may degenerate into an Ulcer, which must prove a most embarrassing Consequence. Under such a Circumstance, the Patient would fall into a confirmed Hectic, and die after some Months Sickness.

§ 80. I am not acquainted with any better Remedy, in such a dangerous Case, than a Perseverance in these already directed, and especially in moderate Exercise on Horseback. In some of them indeed Recourse may be had to the sweet Vapours of some vulnerary Herbs in hot Water, with a little Oil of Turpentine, as directed [Nº. 15]. I have seen them succeed; but the safest Way is to consult a Physician, who may examine and consider, if there is not some particular Circumstance combined with the Disease, that proves an Obstacle to the Cure of it. If the Cough prevents the Patient from Sleeping, he may take in the Evening two or three Table Spoonfuls of the Prescription [Nº. 16], in a Glass of Almond Milk or Barley Water.

§ 81. The very same Causes which suddenly suppress the Expectoration, in an Inflammation of the Breast, may also check the Expectoration from a Vomica already begun: in which Circumstance the Patient is speedily afflicted with an Oppression and Anguish, a Fever and evident Feebleness. We should immediately endeavour to remove this Stoppage, by the Vapour of hot Water; by giving a Spoonful of the Mixture [Nº. 3] every Hour; by a large Quantity of the Ptisan [Nº. 12], and by a proper Degree of Motion or Exercise. As soon as ever the Expectoration returns, the Fever and the other Symptoms disappear. I have seen this Suppression in strong Habits quickly followed with an Inflammation about the Seat of the Vomica, which has obliged me to bleed, after which the Expectoration immediately returned.

§ 82. It happens sometimes, that the Vomica is entirely cleansed; the Expectoration is entirely finished, or drained off, the Patient seems well, and thinks himself compleatly cured: but soon after, the Uneasiness, Oppression, Cough and Fever are renewed, because the Membrane or Bag of the Vomica fills again: again it empties itself, the Patient expectorates for some Days, and seems to recover. After some Time however, the same Scene is repeated; and this Vicissitude, or Succession, of moderate and of bad Health, often continues for some Months and even some Years. This happens when the Vomica is emptied, and is gradually deterged; so that its Membranes, or Sides touch or approach each other; but without cicatrizing or healing firmly; and then there drops or leaks in very gradually fresh Matter. For a few Days this seems no ways to incommode the Patient; but as soon as a certain Quantity is accumulated, he is visited again with some of the former Symptoms, 'till another Evacuation ensues. People thus circumstanced, in this Disease, sometimes appear to enjoy a tolerable Share of Health. It may be considered as a kind of internal Issue, which empties and cleanses itself from Time to Time; pretty frequently in some Constitutions, more slowly in others; and under which some may attain a good middling Age. When it arrives however at a very considerable Duration, it proves incurable. In its earliest State, it gives way sometimes to a Milk-diet, to riding on Horseback; and to the Medicine [Nº. 14].

§ 83. Some may be surprized, that in treating of an Abscess of the Lungs, and of the Hectic, which is a Consequence of it, I say nothing of those Remedies, commonly termed Balsamics, and so frequently employed in them, for Instance, Turpentines, Balsam of Peru, of Mecca, Frankincense, Mastich, Myrrh, Storax and Balsam of Sulphur. I shall however say briefly here (because it is equally my Design to destroy the Prejudice of the People, in favour of improper Medicines, and to establish the Reputation of good ones) that I never in such Cases made use of these Medicines; because I am convinced, that their Operation is generally hurtful in such Cases; because I see them daily productive of real Mischief; that they protract the Cure, and often change a slight Disorder into an incurable Disease. They are incapable of perfect Digestion, they obstruct the finest Vessels of the Lungs, whose Obstructions we should endeavour to remove; and evidently occasion, except their Dose be extremely small, Heat and Oppression. I have very often seen to a Demonstration, that Pills compounded of Myrrh, Turpentine and Balsam of Peru, have, an Hour after they were swallowed, occasioned a Tumult and Agitation in the Pulse, high Flushings, Thirst and Oppression. In short it is demonstrable to every unprejudiced Person, that these Remedies, as they have been called, are truly prejudicial in this Case; and I heartily wish People may be disabused with Respect to them, and that they may lose that Reputation so unhappily ascribed to them.

I know that many Persons, very capable in other Respects, daily make use of them in these Distempers: such however cannot fail of disusing them, as soon as they shall have observed their Effects, abstracted from the Virtues of the other Medicines to which they add them, and which mitigate the Danger of them. I saw a Patient, whom a foreign Surgeon, who lived at Orbe, attempted to cure of a Hectic with melted Bacon, which aggravated the Disease. This Advice seemed, and certainly was, absurd; nevertheless the Balsamics ordered in such Cases are probably not more digestible than fat Bacon. The Powder [Nº. 14] possesses whatever these Balsamics pretend to: it is attended with none of the Inconveniencies they produce; and has all the good Qualities ascribed to them. Notwithstanding which, it must not be given while the Inflammation exists; nor when it may revive again; and no other Aliment should be mixed with the Milk.

The famous Medicine called the Antihectic, (Antihecticum Poterii) has not, any more than these Balsamics, the Virtues ascribed to it in such Cases. I very often give it in some obstinate Coughs to Infants with their Milk, and then it is very useful: but I have seldom seen it attended with considerable Effects in grown Persons; and in the present Cases I should be fearful of its doing Mischief.

§ 84. If the Vomica, instead of breaking within the Substance of the Lungs affected, should break without it, the Pus must be received into the Cavity of the Breast. We know when that has happened, by the Sensation or Feeling of the Patient; who perceives an uncommon, a singular kind of Movement, pretty generally accompanied with a Fainting. The Oppression and Anguish cease at once; the Fever abates; the Cough however commonly continues, tho' with less Violence, and without any Expectoration. But this seeming Amendment is of a short Duration, since from the daily Augmentation of the Matter, and its becoming more acrid or sharp, the Lungs become oppressed, irritated and eroded. The Difficulty of Breathing, Heat, Thirst, Wakefulness, Distaste, and Deafness, return, with many other Symptoms unnecessary to be enumerated, and especially with frequent Sinkings and Weakness. The Patient should be confined to his Regimen, to retard the Increase of the Disease as much as possible; notwithstanding no other effectual Remedy remains, except that of opening the Breast between two of the Ribs, to discharge the Matter, and to stop the Disorder it occasions. This is called the Operation for the Empyema. I shall not describe it here, as it should not be undertaken but by Persons of Capacity and Experience, for whom this Treatise was not intended. I would only observe, it is less painful than terrifying; and that if it is delayed too long, it proves useless, and the Patient dies miserably.

§ 85. We may daily see external Inflammations turn gangrenous, or mortify. The same Thing occurs in the Lungs, when the Fever is excessive, the Inflammation either in its own Nature, extremely violent, or raised to such a Height by hot Medicines. Intolerable Anguish, extreme Weakness, frequent Faintings, Coldness of the Extremities, a livid and fœtid thin Humour brought up instead of concocted Spitting, and sometimes blackish Stripes on the Breast, sufficiently distinguish this miserable State. I have smelt in one Case of this Kind, where the Patient had been attacked with this Disease (after a forced March on Foot, having taken some Wine with Spices to force a Sweat) his Breath so horribly stinking, that his Wife had many Sinkings from attending him. When I saw him, I could discern neither Pulse nor Intellect, and ordered him nothing. He died an Hour afterwards, about the Beginning of the third Hour.

§ 86. An Inflammation may also become hard, when it forms what we call a Scirrhus, which is a very hard Tumour, indolent, or unpainful. This is known to occur, when the disease has not terminated in any of those Manners I have represented; and where, tho' the Fever and the other Symptoms disappear, the Respiration, or Breathing, remains always a little oppressed; the Patient still retains a troublesome Sensation in one Side of his Breast; and has from Time to Time a dry Cough, which increases after Exercise, and after eating. This Malady is but seldom cured; though some Persons attacked with it last many Years, without any other considerable Complaint. They should avoid all Occasions of over-heating themselves; which might readily produce a new Inflammation about this Tumour, the Consequences of which would be highly dangerous.

§ 87. The best Remedies against this Disorder, and from which I have seen some good Effects, are the medicated Whey [Nº. 17], and the Pills [Nº. 18]. The Patient may take twenty Pills, and a Pint and a half of the Whey every Morning for a long Continuance; and receive inwardly, now and then, the Vapour of hot Water.

§ 88. Each Lung, in a perfect State of Health, touches the Pleura, the Membrane, that lines the Inside of the Breast; though it is not connected to it. But it often happens, after an Inflammation of the Breast, after the Pleurisy, and in some other Cases, that these two Parts adhere closely to each other, and are never afterwards separated. However this is scarcely to be considered as a Disease; and remains commonly unknown, as the Health is not impaired by it, and nothing is ever prescribed to remove it. Nevertheless I have seen a few Cases, in which this Adhesion was manifestly prejudicial.

Chapter V.

Of the Pleurisy.

Sect. 89.

he Pleurisy, which is chiefly known by these four Symptoms, a strong Fever, a Difficulty of Breathing, a Cough, and an acute Pain about the Breast; the Pleurisy, I say, is not a different Malady from the Peripneumony, or Inflammation of the Breast, the Subject of the preceding Chapter; so that I have very little to say of it, particularly, or apart.

§ 90. The Cause of this Disease then is exactly the same with that of the former, that is, an Inflammation of the Lungs; but an Inflammation, that seems rather a little more external. The only considerable Difference in the Symptoms is, that the Pleurisy is accompanied with a most acute Pain under the Ribs, and which is commonly termed a Stitch. This Pain is felt indifferently over every Part of the Breast; though more commonly about the Sides, under the more fleshy Parts of the Breast, and oftenest on the right Side. The Pain is greatly increased whenever the Patient coughs or draws in the Air in breathing; and hence a Fear of increasing it, by making some Patients forbear to cough or respire, as much as they possibly can; and that aggravates the Disease, by stopping the Course of the Blood in the Lungs, which are soon overcharged with it. Hence the Inflammation of this Bowel becomes general; the Blood mounts up to the Head; the Countenance looks deeply red, or as it were livid; the Patient becomes nearly suffocated, and falls into the State described [§ 47].

Sometimes the Pain is so extremely violent, that if the Cough is very urgent at the same Time, and the Sick cannot suppress or restrain it, they are seized with Convulsions, of which I have seen many Instances, but these occur almost always to Women; though they are much less subject than Men to this Disease, and indeed to all inflammatory ones. It may be proper however to observe here, that if Women should be attacked with it, during their monthly Discharges, that Circumstance should not prevent the repeated and necessary Bleedings, nor occasion any Alteration in the Treatment of the Disease. And hence it appears, that the Pleurisy is really an Inflammation of the Lungs, accompanied with acute Pain.

§ 91. I am sensible that sometimes an Inflammation of the Lungs is communicated also to that Membrane, which lines the Inside of the Breast; and which is called the Pleura; and from thence to the Muscles, the fleshy Parts, over and between the Ribs. This however is not very frequently the Case.

§ 92. Spring is commonly the Season most productive of Pleurisies: in general there are few in Summer: notwithstanding that in the Year 1762, there were a great many during the hottest Season, which then was excessively so. The Disease usually begins with a violent Shivering, succeeded by considerable Heat, with a Cough, an Oppression, and sometimes with a sensible Straitning, or Contraction, as it were, all over the Breast; and also with a Head-ach, a Redness of the Cheeks, and with Reachings to vomit. The Stitch does not always happen at the very first Onset; often not 'till after several Hours from the first Complaint; sometimes not before the second, or even the third Day. Sometimes the Patient feels two Stitches, in different Parts of the Side; though it seldom happens that they are equally sharp, and the lightest soon ceases. Sometimes also the Stitch shifts its Place, which promises well, if the Part first attacked by it continues perfectly free from Pain: but it has a bad Appearance, if, while the first is present, another also supervenes, and both continue. The Pulse is usually very hard in this Distemper; but in the dreadful Cases described [§ 47] and [90], it becomes soft and small. There often occur at, or very quickly after, the Invasion, such an Expectoration, or hawking up, as happens in an Inflammation of the Breast; at other Times there is not the least Appearance of it, whence such are named dry Pleurisies, which happen pretty often. Sometimes the Sick cough but little, or not at all. They often lie more at Ease upon the Side affected, than on the sound one. The Progress of this Disease advances exactly like that described in the preceding Chapter: for how can they differ considerably? and the Treatment of both is the same. Large Hæmorrhages, or Bleedings from the Nose, frequently happen, to the great Relief of the Patient; but sometimes such Discharges consist of a kind of corrupted Blood, when the Patient is very ill, and these portend Death.

§ 93. This Distemper is often produced by drinking cold Water, while a Person is hot; from which Cause it is sometimes so violent, as to kill the Patient in three Hours. A young Man was found dead at the Side of the Spring, from which he had quenched his Thirst: neither indeed is it uncommon for Pleurisies to prove mortal within three Days.

Sometimes the Stitch disappears, whence the Patient complains less; but at the same Time his Countenance changes; he grows pale and sad; his Eyes look dull and heavy, and his Pulse grows feeble. This signifies a Translation of the Disease to the Brain, a Case which is almost constantly fatal.

There is no Disease in which the critical Symptoms are more violent, and more strongly marked, than in this. It is proper this should be known, as it may prevent or lessen our excessive Terror. A perfect Cure supervenes sometimes, at the very Moment when Death was expected.

§ 94. This Malady is one of the most common and the most destroying kind, as well from its own violent Nature, as through the pernicious Treatment of it in Country Places. That Prejudice, which insists on curing all Diseases by Sweating, entirely regulates their Conduct in treating a Pleurisy; and as soon as a Person is afflicted with a Stitch, all the hot Medicines are immediately set to Work. This mortal Error destroys more People than Gunpowder; and it is by so much the more hurtful, as the Distemper is of the most violent kind; and because, as there is commonly not a Moment to be lost, the whole depends on the Method immediately recurred to.

§ 95. The proper Manner of treating this Disease, is exactly the same in all Respects, with that of the Peripneumony; because, I again affirm, it is the very same Disease. Hence the Bleedings, the softening and diluting Drinks, the Steams, the Glysters, the Potion [Nº. 8], and the emollient Poultices are the real Remedies. These last perhaps are still more effectual in the Pleurisy; and therefore they should be continually applied over the very Stitch.

The first Bleeding, especially if there has been a considerable Discharge, almost constantly abates the Stitch, and often entirely removes it: though it more commonly returns, after an Intermission of some Hours, either in the same Spot, or sometimes in another. This shifting of it is rather favourable, especially if the Pain, that was first felt under the Breast, shifts into the Shoulders, to the Back, the Shoulder-blade, or the Nape of the Neck.

When the Stitch is not at all abated, or only a little; or if, after having abated, it returns as violently as at first, and especially if it returns in the same Spot, and the Height of the other Symptoms continue, Bleeding must be repeated. But if a sensible Abatement of the Stitch continues; and if, though it returns, it should be in a smaller Degree, and by Intervals, or in these Places I have mentioned above; if the Quickness, or the Hardness of the Pulse, and all the other Symptoms are sensibly diminished, this repeated Bleeding may sometimes be omitted. Nevertheless, in a very strong Subject, it seems rather prudent not to omit it, since in such Circumstances it can do no Mischief; and a considerable Hazard may sometimes be incurred by the Omission. In very high and dangerous Pleurisies a frequent Repetition of bleeding is necessary; except some Impediment to it should arise from the particular Constitution of the Patient, or from his Age, or some other Circumstances.

If, from the Beginning of the Disease, the Pulse is but a little quicker and harder than in a healthy State; if it is not manifestly strong; if the Head-ach and the Stitch are so moderate as to prove supportable; if the Cough is not too violent; if there is no sensible Oppression or Straitness, and the Patient expectorate, or cough up, Bleeding may be omitted.

With Respect to the administering of other Remedies, the same Directions are to be exactly followed, which have been already given in the preceding Chapter, to which the Reader is referred from [§ 53] to [66].

§ 96. When the Disease is not very acute and pressing, I have often cured it in a very few Days by a single Bleeding, and a large Quantity of a Tea or Infusion of Elder-flowers, sweetened with Honey. It is in some Cases of this kind, that we often find the Water Faltranc succeed, with the Addition of some Honey, and even of Oil: though the Drink I have just directed is considerably preferable. That Drink which is compounded of equal Quantities of Wine and Water, with the Addition of much Venice Treacle, annually destroys a great Number of People in the Country.

§ 97. In those dry Pleurisies, in which the Stitch, the Fever, and the Head-ach are strong and violent; and where the Pulse is very hard and very full, with an excessive Dryness of the Skin and of the Tongue, Bleeding should be frequently repeated, and at small Intervals from each other. This Method frequently cures the Disease effectually, without using any other Evacuation.

§ 98. The Pleurisy terminates, like any other inward Inflammation, either by some Evacuation; by an Abscess; in a Mortification; or in a Scirrhosity or hard Tumour; and it often leaves Adhesions in the Breast.

The Gangrene or Mortification sometimes appears on the third Day, without having been preceded by very vehement Pains. In such Cases the dead Body often looks very black, especially in the Parts near the Seat of the Disease: and in such the more superstitious ascribe it to some supernatural Cause; or draw some unhappy Presage from it, with Respect to those who are yet unattacked by it. This Appearance however is purely a natural Consequence, quite simple, and cannot be otherwise; and the hot Regimen and Medicines are the most prevailing Causes of it. I have seen it thus circumstanced in a Man in the Flower of his Age, who had taken Venice Treacle in Cherry Water, and the Ingredients of Faltranc infused in Wine.

§ 99. Vomicas are sometimes the Consequences of Pleurisies; but their particular Situation disposes them more to break [²²] outwardly; which is the most frequent Cause of an Empyema [§ 84]. “To prevent this, it is highly proper to apply, at the first Invasion of the Disease, to the Spot where the Pain chiefly rages, a small Plaister, which may exactly fit it; since if the Pleurisy should terminate in an Abscess or Imposthume, the purulent Matter will be determined to that Side.

“As soon then as it is foreseen that an Abscess is forming (see [§ 68]) we should erode, by a light Caustic, the Place where it is expected; and as soon as it is removed, Care should be taken to promote Suppuration there. By this Means we may entertain a reasonable Hope, that the Mass of Matter will incline its Course to that Spot, where it will meet with the least Resistance, and be discharged from thence. For this Heap of Matter is often accumulated between the Pleura, and the Parts which adhere to it.”

This is the Advice of a very [²³] great Physician; but I must inform the Reader, there are many Cases, in which it can be of no Service; neither ought it to be attempted, but by Persons of undoubted Abilities.

With Regard to the Scirrhosity, or Hardness, and to the Circumstances of Adhesions, I can add nothing to what I have said in [§ 86] and [87].

§ 100. It has been observed that some Persons, who have been once attacked by this Disease, are often liable to Relapses of it, especially such as drink hard. I knew one Man, who reckoned up his Pleurisies by Dozens. A few Bleedings, at certain proper Intervals, might prevent these frequent Returns of it; which, joined to their excessive Drinking, make them languid and stupid, in the very Flower of their Age. They generally fall into some Species of an Asthma, and from that into a Dropsy, which proves the melancholy, though not an improper, Conclusion of their Lives. Such as can confine themselves to some proper Precautions, may also prevent these frequent Returns of this Disease, even without bleeding; by a temperate Regimen; by abstaining from Time to Time, from eating Flesh and drinking Wine; at which Times they should drink Whey, or some of those Diet-Drinks [Nº. 1], [2], [4]; and by bathing their Legs sometimes in warm Water; especially in those Seasons, when this Disease is the most likely to return.

§ 101. Two Medicines greatly esteemed in this Disease among the Peasantry, and even extolled by some Physicians, are the Blood of a wild He Goat, and the [²⁴] Soot in an Egg. I do not contest the Cure or Recovery of many Persons, who have taken these Remedies; notwithstanding it is not less true, that both of them, as well as the Egg in which the Soot is taken, are dangerous: For which Reason it is prudent, at least, never to make use of them; as there is great Probability, they may do a little Mischief; and a Certainty that they can do no Good. The Genipi, or [²⁵] Wormwood of the Alps, has also acquired great Reputation in this Disease, and occasioned many Disputes between some very zealous Ecclesiastics, and a justly celebrated Physician. It seems not difficult however to ascertain the proper Use of it. This Plant is a powerful Bitter; it heats and excites Sweat: it seems clear, that, from such Consequences, it should never be employed in a Pleurisy, while the Vessels are full, the Pulse hard, the Fever high, and the Blood inflamed. In all such Circumstances it must aggravate the Disease; but towards the Conclusion of it, when the Vessels are considerably emptied, the Blood is diluted, and the Fever abated, it may then be recurred to; but with a constant Recollection that it is hot, and not to be employed without Reflection and Prudence. [²⁶]