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Domestic Medicine:
OR, A
TREATISE
ON THE
PREVENTION AND CURE
OF
DISEASES
BY
REGIMEN AND SIMPLE MEDICINES.
WITH
An APPENDIX, containing a DISPENSATORY for the Use of Private Practitioners.

By WILLIAM BUCHAN, M. D.

Fellow of the Royal College of Physicians, Edinburgh.

THE TWELFTH EDITION.

LONDON:

Printed for A. Strahan; T. Cadell in the Strand; and J. Balfour, and W. Creech, at Edinburgh.

M DCC XCI.

Omnes homines artem medicam nôsse oportet.——Sapientiæ cognitionem medicinæ sororem ac contubernalem esse puto.

Hippocrates.

Primoque medendi scientia, sapientiæ pars habebatur.——Rationalem quidem puto medicinam esse debere.

Celsus.

Quemadmodum sanitas omnium rerum pretium excedit, omnisque felicitas fundamentum est, ita scientia vitæ ac sanitatis tuendæ omnium nobilissima, omnibusque hominibus commendatissima esse debet.

Hoffman.

TO
Sir JOSEPH BANKS, Bart.
PRESIDENT OF THE ROYAL SOCIETY.

SIR,

The Domestic Medicine having been honoured, on its first appearance, with the patronage of your learned and worthy Predecessor, the late Sir John Pringle, I beg leave, in a more improved state, to dedicate it to you, as a small, but sincere, testimony of that veneration and esteem with which I have long beheld the Man who, born to ease and affluence, had resolution to encounter the dangers of unknown seas and distant climes, in pursuit of useful Science; and whose constant object has been to render that Science subservient to the happiness and civilization of Society,

I have the honour to be, with great respect,

SIR,

Your most obedient servant,

London,

Nov. 10, 1783.

W. BUCHAN.

ADVERTISEMENT.

Twenty years have now elapsed since the first Edition of this Book made its appearance. During this period, the Author, having been in constant practice, has taken occasion to improve several articles, which were with less accuracy inserted in the more early impressions. For this he has been censured by some, but the more candid and discerning must approve his conduct. It would be unpardonable in an Author to suffer an error in a book, on which health and life may depend, to stand uncorrected; nor would it be much less so to perceive an omission, and leave it unsupplied. His improvements, however, are not the result of mercenary views. The same principle which prompted the Author to write the Book, will ever induce him to improve it to the utmost of his power.

The Author has indeed to regret, that the limits of one volume preclude many interesting observations, and likewise deprive him of the pleasure of inserting a number of very useful remarks made by his learned and ingenious friend Doctor Duplanil, of Paris, who has done him the honour of publishing an elegant translation of this Work, in five volumes octavo, accompanied with an excellent commentary.

The improvements of the later editions are chiefly inserted in the form of notes. These are intended either to illustrate the text, or to put people on their guard in dangerous situations, and prevent fatal mistakes in the practice of medicine, which it is to be regretted are but too common.

Some attention has likewise been paid to the language. Where that was either inaccurate or obscure, as far as was practicable, it has been corrected. Indeed, the Author has all along endeavoured to observe such simplicity and perspicuity in his style as might enable the reader clearly to understand it: a circumstance of the utmost importance in a performance of this nature.

Although the Domestic Medicine was never intended to supercede the use of a physician, but to supply his place in situations where medical assistance could not easily be obtained; yet the Author is sorry to observe, that the jealousies and fears of the Faculty have prompted many of them to treat this Work in a manner altogether unbecoming the professors of a liberal science: notwithstanding their injurious treatment, he is determined to persist in his plan, being fully convinced of its utility; nor shall interest or prejudice ever deter him from exerting his best endeavours to render the Medical Art more extensively beneficial to Mankind.

But this illiberal treatment of the Faculty is not the only thing of which the Author has cause to complain. By some of them his Book has been served up mangled and mutilated, and its title, type, size, &c. so closely imitated, that purchasers are misled, and frequently buy these spurious productions instead of the real one. That a needy Author, incapable himself of producing an original work, should prey upon another, and that a mercenary Bookseller should vend such productions, knowing them to be stolen, are things not at all to be wondered at: but that all this can be done with impunity, shews that the laws of this country respecting literary property, are still in a very imperfect state, and stand much in need of amendment.

London,

Dec. 10, 1789.

PREFACE.

When I first signified my intention of publishing the following sheets, I was told by my friends it would draw on me the resentment of the whole Faculty. As I never could entertain such an unfavourable idea, I was resolved to make the experiment, which indeed came out pretty much as might have been expected. Many whose learning and liberality of sentiments do honour to medicine received the book in a manner which at once shewed their indulgence, and the falsity of the opinion that every physician wishes to conceal his art; while the more selfish and narrow-minded, generally the most numerous in every profession, have not failed to persecute both the book and its author.

The reception, however, which this work has met with from the Public merits my most grateful acknowledgments. As the best way of expressing these, I have endeavoured to render it more generally useful, by enlarging the prophylaxis, or that part which treats of preventing diseases; and by adding many articles which had been entirely omitted in the former impressions. It is needless to enumerate these additions; I shall only say, that I hope they will be found real improvements.

The observations relative to Nursing and the Management of Children, were chiefly suggested by an extensive practice among infants, in a large branch of the Foundling Hospital, where I had an opportunity not only of treating the diseases incident to childhood, but likewise of trying different plans of nursing, and observing their effects. Whenever I had it in my power to place the children under the care of proper nurses, to instruct these nurses in their duty, and to be satisfied that they performed it, very few of them died; but when, from distance of place, and other unavoidable circumstances, the children were left to the sole care of mercenary nurses, without any person to instruct or superintend them, scarce any of them lived.

This was so apparent, as with me to amount to a proof of the following melancholy fact: That almost one half of the human species perish in infancy, by improper management or neglect. This reflection has made me often wish to be the happy instrument of alleviating the miseries of those suffering innocents, or of rescuing them from an untimely grave. No one, who has not had an opportunity of observing them, can imagine what absurd and ridiculous practices still prevail in the nursing and management of infants, and what numbers of lives are by that means lost to society. As these practices are chiefly owing to ignorance, it is to be hoped, that when nurses are better informed, their conduct will be more proper.

The application of medicine to the various occupations of life has been in general the result of observation. An extensive practice for several years, in one of the largest manufacturing towns in England, afforded me sufficient opportunities of observing the injuries which those useful people sustain from their particular employments, and likewise of trying various methods of obviating such injuries. The success which attended these trials was sufficient to encourage this attempt, which I hope will be of use to those who are under the necessity of earning their bread by such employments as are unfavourable to health.

I do not mean to intimidate men, far less to insinuate that even those arts, the practice of which is attended with some degree of danger, should not be carried on; but to guard the less cautious and unwary against those dangers which they have it in their power to avoid, and which they often, through mere ignorance, incur. As every occupation in life disposes those who follow it to some particular diseases more than to others, it is certainly of importance to know these, in order that people may be upon their guard against them. It is always better to be warned of the approach of an enemy, than to be surprised by him, especially where there is a possibility of avoiding the danger.

The observations concerning Diet, Air, Exercise, &c. are of a more general nature, and have not escaped the attention of physicians in any age. They are subjects of too great importance, however, to be passed over in an attempt of this kind, and can never be sufficiently recommended. The man who pays a proper attention to these, will seldom need the physician; and he who does not, will seldom enjoy health, let him employ as many physicians as he pleases.

Though we have endeavoured to point out the causes of diseases, and to put people upon their guard against them, yet it must be acknowledged that they are often of such a nature as to admit of being removed only by the diligence and activity of the public magistrate. We are sorry, indeed, to observe, that the power of the magistrate is seldom exerted in this country for the preservation of health. The importance of a proper medical police is either not understood, or little regarded. Many things highly injurious to the public health are daily practiced with impunity, while others, absolutely necessary for its preservation, are entirely neglected.

Some of the public means of preserving health are mentioned in the general prophylaxis, as the inspection of provisions, widening the streets of great towns, keeping them clean, supplying the inhabitants with wholesome water, &c.; but they are passed over in a very cursory manner. A proper attention to these would have swelled this volume to too large a size; I have therefore reserved them for the subject of a future publication.

In the treatment of diseases, I have been peculiarly attentive to regimen. The generality of people lay too much stress upon Medicine, and trust too little to their own endeavours. It is always in the power of the patient, or of those about him, to do as much towards his recovery as can be effected by the physician. By not attending to this, the designs of Medicine are often frustrated; and the patient, by pursuing a wrong plan of regimen, not only defeats the Doctor’s endeavours, but renders them dangerous. I have often known patients killed by an error in regimen, when they were using very proper medicines. It will be said, the physician always orders the regimen when he prescribes a medicine. I wish it were so, both for the honour of the Faculty and the safety of their patients: but physicians, as well as other people, are too little attentive to this matter.

Though many reckon it doubtful whether physic is more beneficial or hurtful to mankind, yet all allow the necessity and importance of a proper regimen in diseases. Indeed the very appetites of the sick prove its propriety. No man in his senses ever imagined that a person in a fever, for example, could eat, drink, or conduct himself in the same manner as one in perfect health. This part of medicine, therefore, is evidently founded in Nature, and is every way consistent with reason and common sense. Had men been more attentive to it, and less solicitous in hunting after secret remedies, Medicine had never become an object of ridicule.

This seems to have been the first idea of Medicine. The ancient physicians acted chiefly in the capacity of nurses. They went very little beyond aliment in their prescriptions; and even this they generally administered themselves, attending the sick for that purpose through the whole course of the disease; which gave them an opportunity not only of marking the changes of diseases with great accuracy, but likewise of observing the effects of their different applications, and adapting them to the symptoms.

The learned Dr. Arbuthnot asserts, that by a proper attention to those things which are almost within the reach of every body, more good and less mischief will be done in acute diseases, than by medicines improperly and unseasonably administered; and that great cures may be effected in chronical distempers, by a proper regimen of the diet only. So entirely do the Doctor’s sentiments and mine agree, that I would advise every person, ignorant of physic, to confine his practice solely to diet, and the other parts of regimen; by which means he may often do much good, and can seldom do any hurt.

This seems also to have been the opinion of the ingenious Dr. Huxham, who observes, that we often seek from Art what all-bountiful Nature most readily, and as effectually, offers us, had we diligence and sagacity enough to observe and make use of them; that the dietetic part of Medicine is not so much studied as it ought to be; and that, though less pompous, yet it is the most natural method of curing diseases.

To render the book more generally useful, however, as well as more acceptable to the intelligent part of mankind, I have in most diseases, besides regimen, recommended some of the most simple and approved forms of medicine, and added such cautions and directions as seemed necessary for their safe administration, it would no doubt have been more acceptable to many, had it abounded with pompous prescriptions, and promised great cures in consequence of their use; but this was not my plan: I think the administration of medicines always doubtful, and often dangerous, and would much rather teach men how to avoid the necessity of using them, than how they should be used.

Several medicines, and those of considerable efficacy, may be administered with great freedom and safety. Physicians generally trifle a long time with medicines before they learn their proper use. Many peasants at present know better how to use some of the most important articles in the materia medica, than physicians did a century ago; and doubtless the same observation will hold with regard to others some time hence. Wherever I was convinced that medicine might be used with safety, or where the cure depended chiefly upon it, I have taken care to recommend it; but where it was either highly dangerous, or not very necessary, it is omitted.

I have not troubled the reader with an useless parade of quotations from different authors, but have in general adopted their observations where my own were either defective, or totally wanting. Those to whom I am most obliged are, Ramazini, Arbuthnot, and Tissot; the last of which, in his Avis au Peuple, comes the nearest to my views of any author which I have seen. Had the Doctor’s plan been as complete as the execution is masterly, we should have had no occasion for any new treatise of this kind soon; but by confining himself to the acute diseases, he has in my opinion omitted the most useful part of his subject. People in acute diseases may sometimes be their own physicians; but in the chronic, the cure must ever depend chiefly upon the patient’s own endeavours. The Doctor has also passed over the Prophylaxis, or preventive part of Medicine, very slightly, though it is certainly of the greatest importance in such a work. He had no doubt his reasons for so doing, and I am so far from finding fault with him, that I think his performance does great honour both to his head and to his heart.

Several other foreign physicians of eminence have written on nearly the same plan with Tissot, as the Baron Van Swieten, physician to their Imperial Majesties, M. Rosen, first physician of the kingdom of Sweden, &c.; but these gentlemen’s productions have never come to my hand. I cannot help wishing, however, that some of our distinguished countrymen would follow their example. There still remains much to be done on this subject, and it does not appear to me how any man could better employ his time or talents, than in eradicating hurtful prejudices, and diffusing useful knowledge among the people.

I know some of the Faculty disapprove of every attempt of this nature, imagining that it must totally destroy their influence. But this notion appears to me to be as absurd as it is illiberal. People in distress will always apply for relief to men of superior abilities, when they have it in their power; and they will do this with far greater confidence and readiness when they believe that Medicine is a rational science, than when they take it to be only a matter of mere conjecture.

Though I have endeavoured to render this Treatise plain and useful, yet I found it impossible to avoid some terms of art; but those are in general either explained, or are such as most people understand. In short, I have endeavoured to conform my style to the capacities of mankind in general; and, if my Readers do not flatter either themselves or me, with some degree of success. On a medical subject, this is not so easy a matter as some may imagine. To make a shew of learning is easier than to write plain sense, especially in a science which has been kept at such a distance from common observation. It would however be no difficult matter to prove, that every thing valuable in the practical part of Medicine is within the reach of common abilities.

It would be ungenerous not to express my warmest acknowledgments to those Gentlemen who have endeavoured to extend the usefulness of this Performance, by translating it into the language of their respective countries. Most of them have not only given elegant translations of the Book, but have also enriched it with many useful observations; by which it is rendered more complete, and better adapted to the climate and the constitutions of their countrymen. To the learned Dr. Duplanil of Paris, physician to the Count d’Artois, I lie under particular obligations; as this Gentleman has not only considerably enlarged my Treatise, but, by his very ingenious and useful notes, has rendered it so popular on the Continent, as to occasion its being translated into all the languages of modern Europe.

I have only to add, that the book has not more exceeded my expectations in its success, than in the effects it has produced. Some of the most pernicious practices, with regard to the treatment of the sick, have already given place to a more rational conduct; and many of the most hurtful prejudices, which seemed to be quite insurmountable, have in a great measure yielded to better information. Of this a stronger instance cannot be given than the inoculation of the small-pox. Few mothers, some years ago, would submit to have their children inoculated even by the hand of a Physician; yet nothing is more certain, than that of late many of them have performed this operation with their own hands; and as their success has been equal to that of the most dignified inoculators, there is little reason to doubt that the practice will become general. Whenever this shall be the case, more lives will be saved by inoculation alone, than are at present by all the endeavours of the Faculty.

INTRODUCTION.

The improvements in Medicine, since the revival of learning, have by no means kept pace with those of the other arts. The reason is obvious. Medicine has been studied by few, except those who intended to live by it as a trade. Such, either from a mistaken zeal for the honour of Medicine, or to raise their own importance, have endeavoured to disguise and conceal the art. Medical authors have generally written in a foreign language; and those who were unequal to this talk, have even valued themselves upon couching, at least, their prescriptions, in terms and characters unintelligible to the rest of mankind.

The contentions of the clergy, which happened soon after the restoration of learning, engaged the attention of mankind, and paved the way for that freedom of thought and inquiry, which has since prevailed in most parts of Europe with regard to religious matters. Every man took a side in those bloody disputes; and every gentleman, that he might distinguish himself on one side or other, was instructed in Divinity. This taught people to think and reason for themselves in matters of religion, and at last totally destroyed that complete and absolute dominion which the clergy had obtained over the minds of men.

The study of Law has likewise, in most civilized nations, been justly deemed a necessary part of the education of a gentleman. Every gentleman ought certainly to know at least the laws of his own country: and, if he were also acquainted with those of others, it might be more than barely an ornament to him.

The different branches of Philosophy have also of late been very universally studied by all who pretended to a liberal education. The advantages of this are manifest. It frees the mind from prejudice and superstition; fits it for the investigation of truth; induces habits of reasoning and judging properly; opens an inexhaustible source of entertainment; paves the way to the improvement of arts and agriculture; and qualifies men for acting with propriety in the most important stations of life.

Natural History is likewise become an object of general attention; and it well deserves to be so. It leads to discoveries of the greatest importance. Indeed agriculture, the most useful of all arts, is only a branch of Natural History, and can never arrive at a high degree of improvement where the study of that science is neglected.

Medicine however has not, as far as I know, in any country, been reckoned a necessary part of the education of a gentleman. But surely no sufficient reason can be assigned for this omission. No science lays open a more extensive field of useful knowledge, or affords more ample entertainment to an inquisitive mind. Anatomy, Botany, Chymistry, and the Materia Medica, are all branches of Natural History, and are fraught with such amusement and utility, that the man who entirely neglects them has but a sorry claim either to taste or learning. If a gentleman has a turn for observation, says an excellent and sensible writer[^[1]], surely the natural history of his own species is a more interesting subject, and presents a more ample field for the exertion of genius, than the natural history of spiders and cockle-shells.

We do not mean that every man should become a physician. This would be an attempt as ridiculous as it is impossible. All we plead for is, that men of sense and learning should be so far acquainted with the general principles of Medicine, as to be in a condition to derive from it some of those advantages with which it is fraught; and at the same time to guard themselves against the destructive influences of Ignorance, Superstition, and Quackery.

As matters stand at present, it is easier to cheat a man out of his life than of a shilling, and almost impossible either to detect or punish the offender. Notwithstanding this, people still shut their eyes, and take every thing upon trust that is administered by any Pretender to Medicine, without daring to ask him a reason for any part of his conduct. Implicit faith, every where else the object of ridicule, is still sacred here. Many of the faculty are no doubt worthy of all the confidence that can be reposed in them; but as this can never be the character of every individual in any profession, it would certainly be for the safety, as well as the honour, of mankind, to have some check upon the conduct of those to whom they entrust so valuable a treasure as health.

The veil of mystery, which still hangs over medicine, renders it not only a conjectural, but even a suspicious art. This has been long ago removed from the other sciences, which induces many to believe that Medicine is a mere trick, and that it will not bear a fair and candid examination. Medicine, however, needs only to be better known, in order to secure the general esteem of mankind. Its precepts are such as every wise man would chuse to observe, and it forbids nothing but what is incompatible with true happiness.

Disguising Medicine not only retards its improvement as a science, but exposes the profession to ridicule, and is injurious to the true interests of society. An art founded on observation never can arrive at any high degree of improvement, while it is confined to a few who make a trade of it. The united observations of all the ingenious and sensible part of mankind, would do more in a few years towards the improvement of Medicine, than those of the Faculty alone in a great many. Any man can tell when a medicine gives him ease as well as a physician; and if he only knows the name and dose of the medicine, and the name of the disease, it is sufficient to perpetuate the fact. Yet the man who adds one single fact to the stock of medical observations, does more real service to the art, than he who writes a volume in support of some favourable hypothesis.

Very few of the valuable discoveries in Medicine have been made by physicians. They have in general either been the effect of chance or of necessity, and have been usually opposed by the Faculty, till every one else was convinced of their importance. An implicit faith in the opinions of teachers, an attachment to systems and established forms, and the dread of reflections, will always operate upon those who follow Medicine as a trade. Few improvements are to be expected from a man who might ruin his character and family by even the smallest deviation from an established rule.

If men of letters, says the author of the performance quoted above, were to claim their right of inquiry into a matter that so nearly concerns them, the good effects on Medicine would soon appear. Such men would have no separate interest from that of the art. They would detect and expose assuming Ignorance under the mask of Gravity and Importance, and would be the judges and patrons of modest merit. Not having their understandings perverted in their youth by false theories, unawed by authority, and unbiassed by interest, they would canvass with freedom the most universally received principles in Medicine, and expose the uncertainty of many of those doctrines, of which a physician dares not so much as seem to doubt.

No argument, continues he, can be brought against laying open Medicine, which does not apply with equal, if not greater force, to religion; yet experience has shewn, that since the laity have asserted their right of inquiry into these subjects, Theology, considered as a science, has been improved, the interests of real religion have been promoted, and the clergy have become a more learned, a more useful, and a more respectable body of men, than they ever were in the days of their greatest power and splendour.

Had other medical writers been as honest as this gentleman, the art had been upon a very different footing at this day. Most of them extol the merit of those men who brought Philosophy out of the schools, and subjected it to the rules of common sense. But they never consider that Medicine, at present, is in nearly the same situation as Philosophy was at that time, and that it might be as much improved by being treated in the same manner. Indeed, no science can either be rendered rational or useful, without being submitted to the common sense and reason of mankind. These alone stamp a value upon science; and what will not bear the test of these ought to be rejected.

I know it will be said, that diffusing medical knowledge among the people might induce them to tamper with Medicine, and to trust to their own skill instead of calling a physician. The reverse of this however is true. Persons who have most knowledge in these matters, are commonly most ready both to ask and to follow advice, when it is necessary. The ignorant are always most apt to tamper with Medicine, and have the least confidence in physicians. Instances of this are daily to be met with among the ignorant peasants, who, while they absolutely refuse to take a medicine which has been prescribed by a physician, will swallow with greediness any thing that is recommended to them by their credulous neighbours. Where men will act even without knowledge, it is certainly more rational to afford them all the light we can, than to leave them entirely in the dark.

It may also be alleged, that laying Medicine more open to mankind would lessen their faith in it. This would indeed be the case with regard to some; but it would have a quite contrary effect upon others. I know many people who have the utmost dread and horror of every thing prescribed by a physician, but who will nevertheless very readily take a medicine which they know, and whose qualities they are in some measure acquainted with. Hence it is evident, that the dread arises from the doctor, not from the drug. Nothing ever can or will inspire mankind with an absolute confidence in physicians, but an open, frank, and undisguised behaviour. While the least shadow of mystery remains in the conduct of the Faculty, doubts, jealousies, and suspicions, will arise in the minds of men.

No doubt cases will sometimes occur, where a prudent physician may find it expedient to disguise a medicine. The whims and humours of men must be regarded by those who mean to do them service; but this can never affect the general argument in favour of candour and openness. A man might as well allege, because there are knaves and fools in the world, that he ought to take every one he meets for such, and to treat him accordingly. A sensible physician will always know where disguise is necessary; but it ought never to appear on the face of his general conduct.

The appearance of mystery in the conduct of physicians not only renders their art suspicious, but lays the foundations of Quackery, which is the disgrace of Medicine. No two characters can be more different than that of the honest physician and the quack; yet they have generally been very much confounded. The line between them is not sufficiently apparent; at least it is too fine for the general eye. Few persons are able to distinguish sufficiently between the conduct of that man who administers a secret medicine, and him who writes a prescription in mystical characters and an unknown tongue. Thus the conduct of the honest physician, which needs no disguise, gives a sanction to that of the villain, whose sole consequence depends upon secrecy.

No laws will ever be able to prevent quackery, while people believe that the quack is as honest a man, and as well qualified, as the physician. A very small degree of medical knowledge, however, would be sufficient to break this spell; and nothing else can effectually undeceive them. It is the ignorance and credulity of the multitude, with regard to medicine, which renders them such an easy prey to every one who has the hardiness to attack them on this quarter. Nor can the evil be remedied by any other means but by making them wiser.

The most effectual way to destroy quackery in any art or science, is to diffuse the knowledge of it among mankind. Did physicians write their prescriptions in the common language of the country, and explain their intentions to the patient, as far as he could understand them, it would enable him to know when the medicine had the desired effect; would inspire him with absolute confidence in the physician; and would make him dread and detest every man who pretended to cram a secret medicine down his throat.

Men in the different states of society, have very different views of the same object. Some time ago it was the practice of this country for every person to say his prayers in Latin, whether he knew any thing of that language or not. This conduct, though sacred in the eyes of our ancestors, appears ridiculous enough to us; and doubtless some parts of ours will seem as strange to posterity. Among these we may reckon the present mode of medical prescription, which, we venture to affirm, will sometime hence appear to have been completely ridiculous, and a very high burlesque upon the common sense of mankind.

But this practice is not only ridiculous, it is likewise dangerous. However capable physicians may be of writing Latin, I am certain apothecaries are not always in a condition to read it, and that dangerous mistakes, in consequence of this, often happen. But suppose the apothecary ever so able to read the physician’s prescription, he is generally otherwise employed, and the business of making up prescriptions is left entirely to the apprentice. By this means the greatest man in the kingdom, even when he employs a first-rate physician, in reality trusts his life in the hands of an idle boy, who has not only the chance of being very ignorant, but likewise giddy and careless. Mistakes will sometimes happen in spite of the greatest care; but, where human lives are concerned, all possible methods ought certainly to be taken to prevent them. For this reason, the prescriptions of physicians, instead of being couched in mystical characters and a foreign language, ought, in my humble opinion, to be conceived in the most plain and obvious terms imaginable.

Diffusing medical knowledge among the people would not only tend to improve the art, and to banish quackery, but likewise to render Medicine more universally useful, by extending its benefits to society. However long Medicine may have been known as a science, we will venture to say, that many of its most important purposes to society have either been overlooked, or very little attended to. The cure of diseases is doubtless a matter of great importance; but the preservation of health is of still greater. This is the concern of every man, and surely what relates to it ought to be rendered as plain and obvious to all as possible. It is not to be supposed, that men can be sufficiently upon their guard against diseases, who are totally ignorant of their causes. Neither can the legislature, in whose power it is to do much more for preserving the public health than can ever be done by the Faculty, exert that power with propriety, and to the greatest advantage, without some degree of medical knowledge.

Men of every occupation and condition in life might avail themselves of a degree of medical knowledge; as it would teach them to avoid the dangers peculiar to their respective stations; which is always easier than to remove their effects. Medical knowledge, instead of being a check upon the enjoyments of life, only teaches men how to make the most of them. It has indeed been said, that to live medically is to live miserably: but it might with equal propriety be said, that to live rationally is to live miserably. If physicians obtrude their own ridiculous whims upon mankind, or lay down rules inconsistent with reason or common sense, no doubt they will be despised. But this is not the fault of Medicine. It proposes no rules that I know, but such as are perfectly consistent with the true enjoyment of life, and every way conducive to the real happiness of mankind.

We are sorry indeed to observe, that Medicine has hitherto hardly been considered as a popular science, but as a branch of knowledge solely confined to a particular set of men, while all the rest have been taught not only to neglect, but even to dread and despise it. It will however appear, upon a more strict examination, that no science better deserves their attention, or is more capable of being rendered generally useful.

People are told, that if they dip the least into medical knowledge, it will render them fanciful, and make them believe they have every disease of which they read. This I am satisfied will seldom be the case with sensible people; and, suppose it were, they must soon be undeceived. A short time will shew them their error, and a little more reading will infallibly correct it. A single instance will shew the absurdity of this notion. A sensible lady, rather than read a medical performance, which would instruct her in the management of her children, must leave them entirely to the care and conduct of the most ignorant, credulous, and superstitious part of the human species.

No part of Medicine is of more general importance than that which relates to the nursing and management of children. Yet few parents pay a proper attention to it. They leave the sole care of their tender offspring, at the very time when care and attention are most necessary, to hirelings, who are either too careless to do their duty, or too ignorant to know it. We will venture to affirm, that more human lives are lost by the carelessness and inattention of parents and nurses, than are saved by the Faculty; and that the joint and well-conducted endeavours, both of private persons and the public, for the preservation of infant lives, would be of more advantage to society, than the whole art of Medicine, upon its present footing.

The benefits of Medicine, as a trade, will ever be confined to those who are able to pay for them; and of course, the far greater part of mankind will be every where deprived of them. Physicians, like other people, must live by their employment, and the poor must either want advice altogether, or take up with that which is worse than none. There are not however any where wanting well-disposed people, of better sense, who are willing to supply the defect of medical advice to the poor, did not their fear of doing ill often suppress their inclination to do good. Such people are often deterred from the most noble and praise-worthy actions, by the foolish alarms sounded in their ears by a set of men who, to raise their own importance, magnify the difficulties of doing good, find fault with what is truly commendable, and fleer at every attempt to relieve the sick which is not conducted by the precise rules of Medicine. These gentlemen must however excuse me for saying, that I have often known such well-disposed persons do much good; and that their practice, which is generally the result of good sense and observation, assisted by a little medical reading, is frequently more rational than that of the ignorant retainer to physic, who despises both reason and observation, that he may go wrong by rule; and who, while he is dosing his patient with medicines, often neglects other things of far greater importance.

Many things are necessary for the sick besides medicine. Nor is the person who takes care to procure those for them, of less importance than a physician. The poor oftener perish in diseases for want of proper nursing than of medicine. They are frequently in want of even the necessaries of life, and still more so of what is proper for a sickbed. No one can imagine, who has not been a witness of these situations, how much good a well-disposed person may do, by only taking care to have such wants supplied. There certainly cannot be a more necessary, a more noble, or a more godlike action, than to administer to the wants of our fellow-creatures in distress. While virtue or religion are known among mankind, this conduct will be approved; and while Heaven is just, it must be rewarded!

Persons who do not chuse to administer medicine to the sick, may nevertheless direct their regimen. An eminent medical author has said, That by diet alone all the intentions of Medicine may be answered[^[2]]. No doubt a great many of them may; but there are other things beside diet, which ought by no means to be neglected. Many hurtful and destructive prejudices, with regard to the treatment of the sick, still prevail among the people, which persons of better sense and learning alone can eradicate. To guard the poor against the influence of these prejudices, and to instil into their minds some just ideas of the importance of proper food, fresh air, cleanliness, and other pieces of regimen necessary in diseases, would be a work of great merit, and productive of many happy consequences. A proper regimen, in most diseases, is at least equal to medicine, and in many of them it is greatly superior.

To assist the well-meant endeavours of the humane and benevolent in relieving distress; to eradicate dangerous and hurtful prejudices; to guard the ignorant and credulous against the frauds and impositions of quacks and impostors; and to shew men what is in their own power, both with regard to the prevention and cure of diseases, are certainly objects worthy of the physician’s attention. These were the leading views in composing and publishing the following sheets. They were suggested by an attention to the conduct of mankind, with regard to Medicine, in the course of a pretty long practice in different parts of this island, during which the author has often had occasion to wish that his patients, or those about them, had been possessed of some such plain directory for regulating their conduct. How far he has succeeded in his endeavours to supply this deficiency, must be left for others to determine; but if they be found to contribute in any measure towards alleviating the calamities of mankind, he will think his labour very well bestowed.

CONTENTS.

CONTENTS of the APPENDIX.

PART I.
OF THE
GENERAL CAUSES OF DISEASES.

CHAP. I.
OF CHILDREN.

The better to trace diseases from their original causes, we shall take a view of the common treatment of mankind in the state of infancy. In this period of our lives, the foundations of a good or bad constitution are generally laid; it is therefore of importance, that parents be well acquainted with the various causes which may injure the health of their offspring.

It appears from the annual registers of the dead, that almost one half of the children born in Great Britain die under twelve years of age. To many, indeed, this may appear a natural evil; but, on due examination, it will be found to be one of our own creating. Were the death of infants a natural evil, other animals would be as liable to die young as man; but this we find is by no means the case.

It may seem strange that man, notwithstanding his superior reason, should fall so far short of other animals in the management of his young: But our surprise will soon cease, if we consider that brutes, guided by instinct, never err in this respect; while man, trusting solely to art, is seldom right. Were a catalogue of those infants who perish annually by art alone exhibited to public view, it would astonish most people.

If parents are above taking care of their children, others must be employed for that purpose: these will always endeavour to recommend themselves by the appearance of extraordinary skill and address. By this means such a number of unnecessary and destructive articles have been introduced into the diet, clothing, &c. of infants, that it is no wonder so many of them perish.

Nothing can be more preposterous than a mother who thinks it below her to take care of her own child, or who is so ignorant as not to know what is proper to be done for it. If we search Nature throughout, we cannot find a parallel to this. Every other animal is the nurse of its own offspring, and they thrive accordingly. Were the brutes to bring up their young by proxy, they would share the same fate with those of the human species.

We mean not, however, to impose it as a task upon every mother to suckle her own child. This, whatever speculative writers may allege, is in some cases impracticable, and would inevitably prove destructive both to the mother and child. Women of delicate constitutions, subject to hysteric fits, or other nervous affections, make very bad nurses: and these complaints are now so common, that it is rare to find a woman of fashion free from them; such women, therefore, supposing them willing, are often unable to suckle their own children.

Almost every mother would be in a condition to give suck, did mankind live agreeably to Nature: but whoever considers how far many mothers deviate from her dictates, will not be surprised to find some of them unable to perform that necessary office. Mothers who do not eat a sufficient quantity of solid food, nor enjoy the benefit of free air and exercise, can neither have wholesome juices themselves, nor afford proper nourishment to an infant. Hence children who are suckled by delicate women, either die young, or continue weak and sickly all their lives.

When we say that mothers are not always in a condition to suckle their own children, we would not be understood as discouraging that practice. Every mother who can, ought certainly to perform so tender and agreeable an office[^[3]]. But, suppose it to be out of her power, she may, nevertheless, be of great service to her child. The business of nursing is by no means confined to giving suck. To a woman who abounds with milk, this is the easiest part of it. Numberless other offices are necessary for a child, which the mother ought at least to see done.

A mother who abandons the fruit of her womb, as soon as it is born, to the sole care of an hireling, hardly deserves that name. A child, by being brought up under the mother’s eye, not only secures her affection, but may reap all the advantages of a parent’s care, though it be suckled by another. How can a mother be better employed than in superintending the nursery? This is at once the most delightful and important office; yet the most trivial business or insipid amusements are often preferred to it! A strong proof both of the bad taste and wrong education of modern females.

It is indeed to be regretted, that more care is not bestowed in teaching the proper management of children to those whom Nature has designed for mothers. This, instead of being made the principal, is seldom considered as any part of female education. Is it any wonder, when females so educated come to be mothers, that they should be quite ignorant of the duties belonging to that character? However strange it may appear, it is certainly true, that many mothers, and those of fashion too, are as ignorant, when they have brought a child into the world, of what is to be done for it, as the infant itself. Indeed, the most ignorant of the sex are generally reckoned most knowing in the business of nursing. Hence, sensible people become the dupes of ignorance and superstition; and the nursing of children, instead of being conducted by reason, is the result of whim and caprice[^[4]].

Were the time that is generally spent by females in the acquisition of trifling accomplishments, employed in learning how to bring up their children; how to dress them so as not to hurt, cramp, or confine their motions; how to feed them with wholesome and nourishing food; how to exercise their tender bodies, so as best to promote their growth and strength: were these made the objects of female instruction, mankind would derive the greatest advantages from it. But while the education of females implies little more than what relates to dress and public shew, we have nothing to expect from them but ignorance even in the most important concerns.

Did mothers reflect on their own importance, and lay it to heart, they would embrace every opportunity of informing themselves of the duties which they owe to their infant offspring. It is their province, not only to form the body, but also to give the mind its most early bias. They have it very much in their power to make men healthy or valetudinary, useful in life, or the pests of society.

But the mother is not the only person concerned in the management of children. The father has an equal interest in their welfare, and ought to assist in every thing that respects either the improvement of the body or mind.

It is pity that the men should be so inattentive to this matter. Their negligence is one reason why females know so little of it. Women will ever be desirous to excel in such accomplishments as recommend them to the other sex. But men generally keep at such a distance from even the smallest acquaintance with the affairs of the nursery, that many would reckon it an affront, were they supposed to know any thing of them. Not so, however, with the kennel or the stables: a gentleman of the first rank is not ashamed to give directions concerning the management of his dogs or horses, yet would blush were he surprised in performing the same office for that being who derived its exigence from himself, who is the heir of his fortunes, and the future hope of his country.

Nor have physicians themselves been sufficiently attentive to the management of children: this has been generally considered as the sole province of old women, while men of the first character in physic have refused to visit infants even when sick. Such conduct in the faculty has not only caused this branch of medicine to be neglected, but has also encouraged the other sex to assume an absolute title to prescribe for children in the most dangerous diseases. The consequence is, that a physician is seldom called till the good women have exhausted all their skill; when his attendance can only serve to divide the blame, and appease the disconsolate parents.

Nurses should do all in their power to prevent diseases; but when a child is taken ill, some person of skill ought immediately to be consulted. The diseases of children are generally acute, and the least delay is dangerous.

Were physicians more attentive to the diseases of infants, they would not only be better qualified to treat them properly when sick, but likewise to give useful directions for their management when well. The diseases of children are by no means so difficult to be understood as many imagine. It is true, children cannot tell their complaints; but the causes of them may be pretty certainly discovered by observing the symptoms, and putting proper questions to the nurses. Besides, the diseases of infants being less complicated, are easier cured than those of adults[^[5]].

It is really astonishing, that so little attention should in general be paid to the preservation of infants. What labour and expence are daily bestowed to prop an old tottering carcase for a few years, while thousands of those who might be useful in life, perish without being regarded! Mankind are too apt to value things according to their present, not their future, usefulness. Though this is of all others the most erroneous method of estimation; yet upon no other principle is it possible to account for the general indifference with respect to the death of infants.

Of Diseased Parents.

One great source of the diseases of children is, the unhealthiness of Parents. It would be as reasonable to expect a rich crop from a barren soil, as that strong and healthy children should be born of parents whose constitutions have been worn out with intemperance or disease.

An ingenious writer[^[6]] observes, that on the constitution of mothers depends originally that of their offspring. No one who believes this, will be surprised, on a view of the female world, to find diseases and death so frequent among children. A delicate female, brought up within doors, an utter stranger to exercise and open air, who lives on tea and other slops, may bring a child into the world, but it will hardly be fit to live. The first blast of disease will nip the tender plant in the bud: or, should it struggle through a few years existence, its feeble frame, shaken with convulsions from every trivial cause, will be unable to perform the common functions of life, and prove a burden to society.

If to the delicacy of mothers, we add the irregular lives of fathers, we shall see further cause to believe that children are often hurt by the constitution of their parents. A sickly frame may be originally induced by hardships or intemperance, but chiefly by the latter. It is impossible that a course of vice should not spoil the best constitution: and, did the evil terminate here, it would be a just punishment for the folly of the sufferer; but when once a disease is contracted and riveted in the habit, it is entailed on posterity. What a dreadful inheritance is the gout, the scurvy, or the King’s evil, to transmit to our offspring! how happy had it been for the heir of many a great estate, had he been born a beggar, rather than to inherit his father’s fortunes at the expence of inheriting his diseases!

A person labouring under any incurable malady ought not to marry. He thereby not only shortens his own life, but transmits misery to others: but when both parties are deeply tainted with the scrophula, the scurvy, or the like, the effects must be still worse. If such have any issue, they must be miserable indeed. Want of attention to these things, in forming connexions for life, has rooted out more families than plague, famine, or the sword; and as long as these connexions are formed from mercenary views, the evil will be continued[^[7]].

In our matrimonial contracts, it is amazing so little regard is had to the health and form of the object. Our sportsmen know, that the generous courser cannot be bred out of the foundered jade, nor the sagacious spaniel out of the snarling cur. This is settled upon immutable laws. The man who marries a woman of a sickly constitution, and descended of unhealthy parents, whatever his views may be, cannot be said to act a prudent part. A diseased woman may prove fertile; should this be the case, the family must become an infirmary: what prospect of happiness the father of such a family has, we shall leave any one to judge[^[8]].

Such children as have the misfortune to be born of diseased parents, will require to be nursed with greater care than others. This is the only way to make amends for the defects of constitution; and it will often go a great length. A healthy nurse, wholesome air, and sufficient exercise, will do wonders. But when these are neglected, little is to be expected from any other quarter. The defects of constitution cannot be supplied by medicine.

Those who inherit any family disease ought to be very circumspect in their manner of living. They should consider well the nature of such disease, and guard against it by a proper regimen. It is certain, that family diseases have often, by proper care, been kept off for one generation; and there is reason to believe, that, by persisting in the same course, such diseases might at length be wholly eradicated. This is a subject very little regarded, though of the greatest importance. Family constitutions are as capable of improvement as family estates; and the libertine, who impairs the one, does greater injury to his posterity, than the prodigal who squanders away the other.

Of the Clothing of Children.

The clothing of an infant is so simple a matter, that it is surprising how any person should err in it; yet many children lose their lives, and others are deformed, by inattention to this article.

Nature knows no use of clothes to an infant, but to keep it warm. All that is necessary for this purpose, is to wrap it in a soft loose covering. Were a mother left to the dictates of Nature alone, she would certainly pursue this course. But the business of dressing an infant has long been out of the hands of mothers, and has at last become a secret which none but adepts pretend to understand.

From the most early ages it has been thought necessary, that a woman in labour should have some person to attend her. This in time became a business; and, as in all others, those who were employed in it strove to outdo one another in the different branches of their profession. The dressing of a child came of course to be considered as the midwife’s province, who no doubt imagined, that the more dexterity she could shew in this article, the more her skill would be admired. Her attempts were seconded by the vanity of parents, who, too often desirous of making a shew of the infant as soon as it was born, were ambitious to have as much finery heaped upon it as possible. Thus it came to be thought as necessary for a midwife to excel in bracing and dressing an infant, as for a surgeon to be expert in applying bandages to a broken limb; and the poor child, as soon as it came into the world, had as many rollers and wrappers applied to its body, as if every bone had been fractured in the birth; while these were often so tight, as not only to gall and wound its tender frame, but even to obstruct the motion of the heart, lungs, and other organs necessary for life.

In most parts of Britain, the practice of rolling children with so many bandages is now, in some measure, laid aside; but it would still be a difficult task to persuade the generality of mankind, that the shape of an infant does not entirely depend on the care of the midwife. So far, however, are all her endeavours to mend the shape from being successful, that they constantly operate the contrary way, and mankind become deformed in proportion to the means used to prevent it. How little deformity of body is to be found among uncivilized nations? So little indeed, that it is vulgarly believed they put all their deformed children to death. The truth is, they hardly know such a thing as a deformed child. Neither should we, if we followed their example. Savage nations never think of manacling their children. They allow them the full use of every organ, carry them abroad in the open air, wash their bodies daily in cold water, &c. By this management, their children become so strong and hardy, that, by the time our puny infants get out of the nurse’s arms, theirs are able to shift for themselves[^[9]].

Among brute animals, no art is necessary to procure a fine shape. Though many of them are extremely delicate when they come into the world, yet we never find them grow crooked for want of swaddling bands. Is nature less generous to the human kind? No: but we take the business out of Nature’s hands.

Not only the analogy of other animals, but the very feelings of infants tell us, they ought to be kept easy and free from all pressure. They cannot indeed tell their complaints; but they can shew signs of pain; and this they never fail to do, by crying when hurt by their clothes. No sooner are they freed from their bracings, than they seem pleased and happy; yet, strange infatuation! the moment they hold their peace, they are again committed to their chains.

If we consider the body of an infant as a bundle of soft pipes, replenished with fluids in continual motion, the danger of pressure will appear in the strongest light. Nature, in order to make way for the growth of children, has formed their bodies soft and flexible; and lest they should receive any injury from pressure in the womb, has surrounded the fœtus every where with fluids. This shews the care which Nature takes to prevent all unequal pressure on the bodies of infants, and to defend them against every thing that might in the least cramp or confine their motions.

Even the bones of an infant are so soft and cartilaginous, that they readily yield to the slightest pressure, and easily assume a bad shape, which can never after be remedied. Hence it is, that so many people appear with high shoulders, crooked spines, and flat breasts, who were as well proportioned at their birth as others, but had the misfortune to be squeezed out of shape by the application of stays and bandages.

Pressure, by obstructing the circulation, likewise prevents the equal distribution of nourishment to the different parts of the body, by which means the growth becomes unequal. One part grows too large, while another remains too small; and thus in time the whole frame becomes disproportioned and misshapen. To this we must add, that when a child is cramped in its clothes, it naturally shrinks from the part that is hurt; and, by putting its body into unnatural postures it becomes deformed by habit.

Deformity of body may indeed proceed from weakness or disease; but, in general, it is the effect of improper clothing. Nine-tenths, at least, of the deformity among mankind, must be imputed to this cause. A deformed body is not only disagreeable to the eye, but by a bad figure both the animal and vital functions must be impeded, and of course health impaired. Hence few people remarkably mishapen are strong or healthy.

The new motions which commence at the birth, as the circulation of the whole mass of blood through the lungs, respiration, the peristaltic motion, &c. afford another strong argument for keeping the body of an infant free from all pressure. These organs, not having been accustomed to move, are easily stopped; but when this happens, death must ensue. Hardly any method could be devised more effectually to stop these motions, than bracing the body too tight with rollers[^[10]] and bandages. Were these to be applied in the same manner to the body of an adult for an equal length of time, they would hardly fail to hurt the digestion and make him sick. How much more hurtful they must prove to the tender bodies of infants, we shall leave any one to judge.

Whoever considers these things will not be surprised, that so many children die of convulsions soon after the birth. These fits are generally attributed to some inward cause; but in fact, they oftener proceed from our own imprudent conduct. I have known a child seized with convulsion-fits soon after the midwife had done swaddling it, who, upon taking off the rollers and bandages, was immediately relieved, and never had the disease afterwards. Numerous examples of this might be given, were they necessary.

It would be safer to fasten the cloths of an infant with strings than pins, as these often gall and irritate their tender skins, and occasion disorders. Pins have been found sticking above half an inch into the body of a child, after it had died of convulsion fits, which, in all probability, proceeded from that cause.

Children are not only hurt by the tightness of their clothes, but also by the quantity. Every child has some degree of fever after the birth; and if it be loaded with too many clothes, the fever must be increased. But this is not all; the child is generally laid in bed with the mother, who is often likewise feverish; to which we may add the heat of the bed-chamber, the wines, and other heating things, too frequently given to children immediately after the birth. When all these are combined, which does not seldom happen, they must increase the fever to such a degree as will endanger the life of the infant.

The danger of keeping infants too hot will further appear, if we consider that, after they have been for some time in the situation mentioned above, they are often sent into the country to be nursed in a cold house. Is it any wonder, if a child, from such a transition, catches a mortal cold, or contracts some other fatal disease? When an infant is kept too hot, its lungs, not being sufficiently expanded, are apt to remain weak and flaccid for life; hence proceed coughs, consumptions, and other diseases of the breast.

It would answer little purpose to specify the particular species of dress proper for an infant. These will always vary in different countries, according to custom and the humour of parents. The great rule to be observed is, That a child have no more clothes than are necessary to keep it warm, and that they be quite easy for its body.

Stays are the very bane of infants. A volume would not suffice to point out all the bad effects of this ridiculous piece of dress both on children and adults. The madness in favour of stays seems, however, to be somewhat abated; and it is to be hoped the world will, in time, become wise enough to know, that the human shape does not solely depend upon whale-bone and bend-leather[^[11]].

I shall only add with respect to the clothes of children, that they ought to be kept thoroughly clean. Children perspire more than adults; and if their clothes be not frequently changed, they become very hurtful. Dirty clothes not only gall and fret the tender skins of infants, but likewise occasion ill smells; and, what is worse, tend to produce vermin and cutaneous diseases.

Cleanliness is not only agreeable to the eye, but tends greatly to preserve the health of children. It promotes the perspiration, and, by that means, frees the body from superfluous humours, which, if retained, could not fail to occasion diseases. No mother or nurse can have any excuse for allowing a child to be dirty. Poverty may oblige her to give it coarse clothes; but if she does not keep them clean, it must be her own fault.

Of the Food of Children.

Nature not only points out the food proper for an infant, but actually prepares it. This, however, is not sufficient to prevent some who think themselves wiser than Nature, from attempting to bring up their children without her provision. Nothing can shew the disposition which mankind have to depart from Nature, more than their endeavouring to bring up children without the breast. The mother’s milk, or that of a healthy nurse, is unquestionably the best food for an infant. Neither art nor nature can afford a proper substitute for it. Children may seem to thrive for a few months without the breast; but, when teething, the small-pox, and other diseases incident to childhood, come on, they generally perish.

A child, soon after the birth, shews an inclination to suck; and there is no reason why it should not be gratified. It is true, the mother’s milk does not always come immediately after the birth; but this is the way to bring it: besides, the first milk that the child can squeeze out of the breast answers the purpose of cleansing, better than all the drugs in the apothecary’s shop, and at the same time prevents inflammations of the breast, fevers, and other diseases incident to mothers.

It is strange how people came to think that the first thing given to a child should be drugs. This is beginning with medicine by times, and no wonder if they generally ended with it. It sometimes happens, indeed, that a child does not discharge the meconium so soon as could be wished; this has induced physicians, in such cases, to give something of an opening nature to cleanse the first passages. Midwives have improved upon this hint, and never fail to give syrups, oils, &c. whether they be necessary or not. Cramming an infant with such indigestible stuff as soon as it is born, can hardly fail to make it sick, and is more likely to occasion diseases, than to prevent them. Children are seldom long after the birth without having passage both by stool and urine; though these evacuations may be wanting for some time without any danger. But if children must have something before they be allowed the breast, let it be a little thin water-pap, to which may be added an equal quantity of new milk; or rather water alone, with the addition of a little raw sugar. If this be given without any wines or spiceries, it will neither heat the blood, load the stomach, nor occasion gripes.

Upon the first sight of an infant, almost every person is struck with the idea of its being weak, feeble, and wanting support. This naturally suggests the need of cordials. Accordingly wines are universally mixed with the first food of children. Nothing can be more fallacious than this way of reasoning, or more hurtful to infants than the conduct founded upon it. Children require very little food for some time after the birth; and what they receive should be thin, weak, light, and of a cooling quality. A very small quantity of wine is sufficient to heat and inflame the blood of an infant; but every person conversant in these matters must know, that most of the diseases of infants proceed from the heat of their humours.

If the mother or nurse has enough of milk, the child will need little or no other food before the third or four month. It will then be proper to give it, once or twice a day, a little of some food that is easy of digestion, as water-pap, milk-pottage, weak broth with bread in it, and such like. This will ease the mother, will accustom the child by degrees to take food, and will render the weaning both less difficult and less dangerous. All great and sudden transitions are to be avoided in nursing. For this purpose, the food of children ought not only to be simple, but to resemble, as nearly as possible, the properties of milk. Indeed milk itself should make a principal part of their food, not only before they are weaned, but for some time after.

Next to milk, we would recommend good light bread. Bread may be given to a child as soon as it shews an inclination to chew; and it may at all times be allowed as much plain bread as it will eat. The very chewing of bread will promote the cutting of the teeth, and the discharge of saliva, while, by mixing with the nurse’s milk in the stomach, it will afford an excellent nourishment. Children discover an early inclination to chew whatever is put into their hands. Parents observe the inclination, but generally mistake the object. Instead of giving the child something which may at once exercise its gums and afford it nourishment, they commonly put into its hands a piece of hard metal, or impenetrable coral. A crust of bread is the best gum-stick. It not only answers the purpose better than any thing else, but has the additional properties of nourishing the child and carrying the saliva down to the stomach, which is too valuable a liquor to be lost.

Bread, besides being used dry, may be many ways prepared into food for children. One of the best methods is to boil it in water, afterwards pouring the water off, and mixing with the bread a proper quantity of new milk unboiled. Milk is both more wholesome and nourishing this way than boiled, and is less apt to occasion costiveness. For a child farther advanced, bread may be mixed in veal or chicken broth, made into puddings, or the like. Bread is a proper food for children at all times, provided it be plain, made of wholesome grain, and well fermented; but when enriched with fruits, sugars, or such things, it becomes very unwholesome.

It is soon enough to allow children animal food when they have got teeth to eat it. They should never taste it till after they are weaned, and even then they ought to use it sparingly. Indeed, when children live wholly on vegetable food, it is apt to sour on their stomachs; but, on the other hand, too much flesh heats the body, and occasions fevers and other inflammatory diseases. This plainly points out a due mixture of animal and vegetable food as most proper for children.

Few things prove more hurtful to infants, than the common method of sweetening their food. It entices them to take more than they ought to do, which makes them grow fat and bloated. It is pretty certain, if the food of children were quite plain, that they would never take more than enough. Their excesses are entirely owing to nurses. If a child be gorged with food at all hours, and enticed to take it, by making it sweet and agreeable to the palate, is it any wonder that such a child should in time be induced to crave more food than it ought to have?

Children may be hurt by too little as well as too much food. After a child is weaned, it ought to be fed four or five times a day; but should never be accustomed to eat in the night; neither should it have too much at a time. Children thrive best with small quantities of food frequently given. This neither overloads the stomach nor hurts the digestion, and is certainly most agreeable to Nature.

Writers on nursing have inveighed with such vehemence against giving children too much food, that many parents, by endeavouring to shun that error, have run into the opposite extreme, and ruined the constitutions of their children. But the error of pinching children in their food is more hurtful than the other extreme. Nature has many ways of relieving herself when overcharged; but a child, who is pinched with hunger, will never become a strong or healthy man. That errors are frequently committed on both sides, we are ready to acknowledge; but where one child is hurt by the quantity of its food, ten suffer from the quality. This is the principal evil, and claims our strictest attention.

Many people imagine, that the food which they themselves love cannot be bad for their children: but this notion is very absurd. In the more advanced periods of life we often acquire an inclination for food, which when children we could not endure. Besides, there are many things that by habit may agree very well with the stomach of a grown person, which would be hurtful to a child; as high-seasoned, salted, and smoke-dried provisions, &c. It would also be improper to feed children with fat meat, strong broths, rich soups, or the like.

All strong liquors are hurtful to children. Some parents teach their children to guzzle ale, and other fermented liquors, at every meal. Such a practice cannot fail to do mischief. These children seldom escape the violence of the small-pox, measles, hooping cough, or some inflammatory disorder. Milk, water, butter-milk, or whey, are the most proper for children to drink. If they have any thing stronger, it may be fine small beer, or a little wine mixed with water. The stomachs of children can digest well enough without the assistance of warm stimulants: besides, being naturally hot, they are easily hurt by every thing of a heating quality.

Few things are more hurtful to children than unripe fruits. They weaken the powers of digestion, and sour and relax the stomach, by which means it becomes a proper nest for insects. Children indeed shew a great inclination for fruit, and I am apt to believe, that if good ripe fruit were allowed them in proper quantity, it would have no bad effects. We never find a natural inclination wrong, if properly regulated. Fruits are generally of a cooling nature, and correct the heat and acrimony of the humours. This is what most children require; only care should be taken lest they exceed. Indeed the best way to prevent children from going to excess in the use of fruit, or eating that which is bad, is to allow them a proper quantity of what is good[^[12]].

Roots which contain a crude viscid juice should be sparingly given to children. They fill the body with gross humours, and tend to produce eruptive diseases. This caution is peculiarly necessary for the poor; glad to obtain at a small price what will fill the bellies of their children, they stuff them two or three times a day with greasy potatoes, or other crude vegetables. Children had better eat a smaller quantity of food which yields a wholesome nourishment, than be crammed with what their digestive powers are unable properly to assimilate.

Butter ought likewise to be sparingly given to children. It both relaxes the stomach, and produces gross humours. Indeed, most things that are fat or oily, have this effect. Butter, when salted, becomes still more hurtful. Instead of butter, so liberally given to children in most parts of Britain, we would recommend honey. Honey is not only wholesome, but cooling, cleansing, and tends to sweeten the humours. Children who eat honey are seldom troubled with worms: they are also less subject to cutaneous diseases, as itch, scabbed head, &c.

Many people err in thinking that the diet of children ought to be altogether moist. When children live entirely upon slops, it relaxes their solids, renders them weak, and disposes them to the rickets, the scrophula, and other glandular disorders. Relaxation is one of the most general causes of the diseases of children. Every thing therefore which tends to unbrace their solids, ought to be carefully avoided.

We would not be understood by these observations as confining children to any particular kind of food. Their diet may be frequently varied, provided always that sufficient regard be had to simplicity.

Of the Exercise of Children.

Of all the causes which conspire to render the life of man short and miserable, none has greater influence than the want of proper EXERCISE: healthy parents, wholesome food, and proper clothing, will avail little, where exercise is neglected. Sufficient exercise will make up for several defects in nursing; but nothing can supply the want of it. It is absolutely necessary to the health, the growth, and the strength of children.

The desire of exercise is coëval with life itself. Were this principle attended to, many diseases might be prevented. But, while indolence and sedentary employments prevent two-thirds of mankind from either taking sufficient exercise themselves, or giving it to their children, what have we to expect but diseases and deformity among their offspring? The rickets, so destructive to children, never appeared in Britain till manufactures began to flourish, and people, attracted by the love of gain, left the country to follow sedentary employments in great towns. It is amongst these people that this disease chiefly prevails, and not only deforms, but kills many of their offspring.

The conduct of other young animals shews the propriety of giving exercise to children. Every other animal makes use of its organs of motion as soon as it can, and many of them, even when under no necessity of moving in quest of food, cannot be restrained without force. This is evidently the case with the calf, the lamb, and most other young animals. If these creatures were not permitted to frisk about and take exercise, they would soon die or become diseased. The same inclination appears very early in the human species; but as they are not able to take exercise themselves, it is the business of their parents and nurses to assist them.

Children may be exercised various ways. The best method, while they are light, is to carry them about in the nurse’s arms[^[13]]. This gives the nurse an opportunity of talking to the child, and of pointing out every thing that may please and delight its fancy. Besides, it is much safer than swinging an infant in a machine, or leaving it to the care of such as are not fit to take care of themselves. Nothing can be more absurd than to set one child to keep another: this conduct has proved fatal to many infants, and has rendered others miserable for life.

When children begin to walk, the safest and best method of leading them about, is by the hands. The common way, of swinging them in leading-strings fixed to their backs, has several bad consequences. It makes them throw their bodies forward, and press with their whole weight upon the stomach and breast; by this means the breathing is obstructed, the breast flattened, and the bowels compressed; which must hurt the digestion, and occasion consumptions of the lungs, and other diseases.

It is a common notion, that if children are set upon their feet too soon, their legs will become crooked. There is reason to believe, that the very reverse of this is true. Every member acquires strength in proportion as it is exercised. The limbs of children are weak indeed, but their bodies are proportionally light; and had they skill to direct themselves, they would soon be able to support their own weight. Who ever heard of any other animal that became crooked by using its legs too soon? Indeed, if a child is not permitted to make any use of its legs till a considerable time after the birth, and be then set upon them with its whole weight at once, there may be some danger; but this proceeds entirely from the child’s not having been accustomed to use its legs from the beginning.

Mothers of the poorer sort think they are great gainers by making their children lie or sit while they themselves work. In this they are greatly mistaken. By neglecting to give their children exercise, they are obliged to keep them a long time before they can do any thing for themselves, and to spend more on medicine than would have paid for proper care.

To take care of their children, is the most useful business in which even the poor can be employed: but, alas! it is not always in their power. Poverty often obliges them to neglect their offspring, in order to procure the necessaries of life. When this is the case, it becomes the interest as well as the duty of the public to assist them. Ten thousand times more benefit would accrue to the State, by enabling the poor to bring up their own children, than from all the hospitals[^[14]] that ever can be erected for that purpose.

Whoever considers the structure of the human body will soon be convinced of the necessity of exercise for the health of children. The body is composed of an infinite number of tubes, whose fluids cannot be pushed on without the action and pressure of the muscles. But, if the fluids remain inactive, obstructions must happen, and the humours will of course be vitiated, which cannot fail to occasion diseases. Nature has furnished both the vessels which carry the blood and lymph with numerous valves, in order that the action of every muscle might push forward their contents; but without action, this admirable contrivance can have no effect. This part of the animal œconomy proves to a demonstration the necessity of exercise for the preservation of health.

Arguments to shew the importance of exercise might be drawn from every part of the animal œconomy; without exercise, the circulation of the blood cannot be properly carried on, nor the different secretions duly performed; without exercise, the fluids cannot be properly prepared, nor the solids rendered strong or firm. The action of the heart, the motion of the lungs, and all the vital functions, are greatly assisted by exercise. But to point out the manner in which these effects are produced, would lead us farther into the œconomy of the human body, than most of those for whom this treatise is intended would be able to follow. We shall therefore only add, that, where exercise is neglected, none of the animal functions can be duly performed; and when that is the case, the whole constitution must go to wreck.

A good constitution ought certainly to be our first object in the management of children. It lays a foundation for their being useful and happy in life; and whoever neglects it, not only fails in his duty to his offspring, but to society.

One very common error of parents, by which they hurt the constitutions of their children, is the sending them too young to school. This is often done solely to prevent trouble. When the child is at school, he needs no keeper. Thus the schoolmaster is made the nurse; and the poor child is fixed to a seat seven or eight hours a day, which time ought to be spent in exercise and diversions. Sitting so long cannot fail to produce the worst effects upon the body; nor is the mind less injured. Early application weakens the faculties, and often fixes in the mind an aversion to books, which continues for life[^[15]].

But, suppose this were the way to make children scholars, it certainly ought not to be done at the expence of their constitutions. Our ancestors, who seldom went to school very young, were not less learned than we. But we imagine the boy’s education will be quite marred, unless he be carried to school in his nurse’s arms. No wonder if such hotbed plants seldom become either scholars or men!

Not only the confinement of children in public schools, but their number, often proves hurtful. Children are much injured by being kept in crowds within doors; their breathing not only renders the place unwholesome, but if any one of them happens to be diseased, the rest catch the infection. A single child has been often known to communicate the bloody flux, the hooping-cough, the itch, or other diseases, to almost every individual in a numerous school.

But, if fashion must prevail, and infants are to be sent to school, we would recommend it to teachers, as they value the interests of society, not to confine them too long at a time, but allow them to run about and play at such active diversions as may promote their growth, and strengthen their constitutions. Were boys, instead of being whipped for stealing an hour to run, ride, swim, or the like, encouraged to employ a proper part of their time in these manly and useful exercises, it would have many excellent effects.

It would be of great service to boys, if, at a proper age, they were taught the military exercise. This would increase their strength, inspire them with courage, and when their country called for their assistance, would enable them to act in her defence, without being obliged to undergo a tedious and troublesome course of instructions, at a time when they are less fit to learn new motions, gestures, &c.[^[16]]

An effeminate education will infallibly spoil the best natural constitution; and if boys are brought up in a more delicate manner than even girls ought to be, they never will be men.

Nor is the common education of girls less hurtful to the constitution than that of boys. Miss is set down to her frame before she can put on her clothes; and is taught to believe, that to excel at the needle is the only thing that can entitle her to general esteem. It is unnecessary here to insist upon the dangerous consequences of obliging girls to sit too much. They are pretty well known, and are too often felt at a certain time of life. But supposing this critical period to be got over, greater dangers still await them when they come to be mothers. Women who have been early accustomed to a sedentary life, generally run great hazard in child-bed; while those who have been used to romp about, and take sufficient exercise, are seldom in any danger.

One hardly meets with a girl who can at the same time boast of early performances by the needle, and a good constitution. Close and early confinement generally occasions indigestions, head-achs, pale complexions, pain of the stomach, loss of appetite, coughs, consumptions of the lungs, and deformity of body. The last of these indeed is not to be wondered at, considering the awkward postures in which girls sit at many kinds of needle-work, and the delicate flexible state of their bodies in the early periods of life.

Would mothers, instead of having their daughters instructed in many trifling accomplishments, employ them in plain work and housewifery, and allow them sufficient exercise in the open air, they would both make them more healthy mothers, and more useful members of society. I am no enemy to genteel accomplishments, but would have them only considered as secondary, and always disregarded when they impair health.

Many people imagine it a great advantage for children to be early taught to earn their bread. This opinion is certainly right, provided they were so employed as not to hurt their health or growth; but, when these suffer, society, instead of being benefited, is a real loser by their labour. There are few employments, except sedentary ones, by which children can earn a livelihood; and if they be set to these too soon, it ruins their constitutions. Thus, by gaining a few years from childhood, we generally lose twice as many in the latter period of life, and even render the person less useful while he does live.

In order to be satisfied of the truth of this observation, we need only look into the great manufacturing towns, where we shall find a puny degenerate race of people, weak and sickly all their lives, seldom exceeding the middle period of life; or if they do, being unfit for business, they become a burden to society. Thus arts and manufactures, though they may increase the riches of a country, are by no means favourable to the health of its inhabitants. Good policy would therefore require, that such people as labour during life, should not be set too early to work. Every person conversant in the breed of horses, or other working animals, knows, that if they be set to hard labour too soon, they never will turn out to advantage. This is equally true with respect to the human species.

There are nevertheless various ways of employing young people without hurting their health. The easier parts of gardening, husbandry, or any business carried on without doors, are most proper. These are employments which most young people are fond of, and some parts of them may always be adapted to their age, taste, and strength[^[17]].

Such parents, however, as are under the necessity of employing their children within doors, ought to allow them sufficient time for active diversions without. This would both encourage them to do more work, and prevent their constitutions from being hurt.

Some imagine, that exercise within doors is sufficient; but they are greatly mistaken. One hour spent in running, or any other exercise without doors, is worth ten within. When children cannot go abroad, they may indeed be exercised at home. The best method of doing this, is to make them run about in a long room, or dance. This last kind of exercise, if not carried to excess, is of excellent service to young people. It cheers the spirits, promotes perspiration, strengthens the limbs, &c. I know an eminent physician who used to say, that he made his children dance, instead of giving them physic. It were well if more people followed his example.

The COLD BATH may be considered as an aid to exercise. By it the body is braced and strengthened, the circulation and secretions promoted, and, were it conducted with prudence, many diseases, as the rickets, scrophula, &c. might thereby be prevented. The ancients, who took every method to render children hardy and robust, were no strangers to the use of the cold bath; and, if we may credit report, the practice of immersing children daily in cold water must have been very common among our ancestors.

The greatest objection to the use of the cold bath arises from the superstitious prejudices of nurses. These are often so strong, that it is impossible to bring them to make a proper use of it. I have known some of them who would not dry a child’s skin after bathing it, lest it should destroy the effect of the water. Others will even put cloths dipt in the water upon the child, and either put it to bed, or suffer it to go about in that condition. Some believe, that the whole virtue of the water depends upon its being dedicated to a particular saint: while others place their confidence in a certain number of dips, as three, seven, nine, or the like; and the world could not persuade them, if these do not succeed, to try it a little longer. Thus, by the whims of nurses, children lose the benefit of the cold bath, and the hopes of the physician from that medicine are often frustrated.

We ought not, however, entirely to set aside the cold bath, because some nurses make a wrong use of it. Every child, when in health, should at least have its extremities daily washed in cold water. This is a partial use of the cold bath, and is better than none. In winter this may suffice; but, in the warm season, if a child be relaxed, or seem to have a tendency to the rickets or scrophula, its whole body ought to be frequently immersed in cold water. Care however must be taken not to do this when the body is hot, or the stomach full. The child should be dipt only once at a time, should be taken out immediately, and have its skin well rubbed with a dry cloth.

The bad Effects of unwholesome Air upon Children.

Few things prove more destructive to children than confined or unwholesome air. This is one reason why so few of those infants, who are put into hospitals, or parish workhouses, live. These places are generally crowded with old, sickly, and infirm people; by which means the air is rendered so extremely pernicious, that it becomes a poison to infants.

Want of wholesome air is likewise destructive to many of the children born in great towns. There the poorer sort of inhabitants live in low, dirty, confined houses, to which the fresh air has hardly any access. Though grown people, who are hardy and robust, may live in such situations, yet they generally prove fatal to their offspring, few of whom arrive at maturity, and those who do are weak and deformed. As such people are not in a condition to carry their children abroad into the open air, we must lay our account with losing the greater part of them. But the rich have not this excuse. It is their business to see that their children be daily carried abroad, and that they be kept in the open air for a sufficient time. This will always succeed better if the mother goes along with them. Servants are often negligent in these matters, and allow a child to sit or lie on the damp ground, instead of leading or carrying it about. The mother surely needs air as well as her children; and how can she be better employed than in attending them?

A very bad custom prevails, of making children sleep in small apartments, or crowding two or three beds into one chamber. Instead of this, the nursery ought always to be the largest and best aired room in the house. When children are confined in small apartments, the air not only becomes unwholesome, but the heat relaxes their solids, renders them delicate, and disposes them to colds and many other disorders. Nor is the custom of wrapping them up too close in cradles less pernicious. One would think that nurses were afraid lest children should suffer by breathing free air, as many of them actually cover the child’s face while asleep, and others wrap a covering over the whole cradle, by which means the child is forced to breathe the same air over and over all the time it sleeps. Cradles indeed are on many accounts hurtful to children, and it would be better if the use of them were totally laid aside[^[18]].

A child is generally laid to sleep with all its clothes on; and if a number of others are heaped above them, it must be overheated; by which means it cannot fail to catch cold on being taken out of the cradle, and exposed to the open air with only its usual clothing, which is too frequently the case.

Children who are kept within doors all day, and sleep all night in warm close apartments, may, with great propriety, be compared to plants, nursed in a hot-house, instead of the open air. Though such plants may by this means be kept alive for some time, they will never arrive at that degree of strength, vigour, and magnitude, which they would have acquired in the open air, nor would they be able to bear it afterwards, should they be exposed to it.

Children brought up in the country, who have been accustomed to open air, should not be too early sent to great towns, where it is confined and unwholesome. This is frequently done with a view to forward their education, but proves very hurtful to their health. All schools and seminaries of learning ought, if possible, to be so situated as to have fresh, dry, wholesome air, and should never be too much crowded.

Without entering into a detail of the particular advantages of wholesome air to children, or of the bad consequences which proceed from the want of it, I shall only observe, that, of several thousands of children which have been under my care, I do not remember one instance of a single child who continued healthy in a close confined situation; but have often known the most obstinate diseases cured by removing them from such a situation to an open free air.

Of Nurses.

It is not here intended to lay down rules for the choice of nurses. This would be wasting time. Common sense will direct every one to chuse a woman who is healthy, and has plenty of milk[^[19]]. If she be at the same time cleanly, careful, and goodnatured, she can hardly fail to make a proper nurse. After all, however, the only certain proof of a good nurse, is a healthy child upon her breast. But, as the misconduct of nurses often proves fatal to children, it will be of importance to point out a few of their most baneful errors, in order to rouse the attention of parents, and to make them look more strictly into the conduct of those to whom they commit the care of their infant offspring.

Though it admits of some exceptions, yet we may lay it down as a general rule, that every woman who nurses for hire should be carefully looked after, otherwise she will not do her duty. For this reason parents ought always to have their children nursed under their own eye, if possible; and where this cannot be done, they should be extremely circumspect in the choice of those persons to whom they entrust them. It is folly to imagine that any woman, who abandons her own child to suckle another for the sake of gain, should feel all the affections of a parent towards her nursing; yet so necessary are these affections in a nurse, that, but for them, the human race would soon be extinct.

One of the most common faults of those who nurse for hire, is to dose children with stupefactives, or such things as lull them asleep. An indolent nurse, who does not give a child sufficient exercise in the open air to make it sleep, and does not chuse to be disturbed by it in the night, will seldom fail to procure for it a dose of laudanum, diacodium, saffron, or what answers the same purpose, a dose of spirits, or other strong liquors. These, though they be certain poison to infants, are every day administered by many who bear the character of very good nurses[^[20]].

A nurse who has not milk enough is apt to imagine that this defect may be supplied by giving the child wines, cordial waters, or other strong liquors. This is an egregious mistake. The only thing that has any chance to supply the place of the nurse’s milk, must be somewhat nearly of the same quality, as cow’s milk, ass’s milk, or beef tea, with good bread. It never can be done by the help of strong liquors. These, instead of nourishing an infant, never fail to produce the contrary effect.

Children are often hurt by nurses suffering them to cry long and vehemently. This strains their tender bodies, and frequently occasions ruptures, inflammations of the throat, lungs, &c. A child never continues to cry long without some cause, which might always be discovered by proper attention; and the nurse who can hear an infant cry till it has almost spent itself, without endeavouring to please it, must be cruel indeed, and is unworthy to be intrusted with the care of an human creature.

Nurses who deal much in medicine are always to be suspected. They trust to it, and neglect their duty. I never knew a good nurse who had her Godfrey’s cordials, Daffy’s elixirs, &c. at hand. Such generally imagine, that a dose of medicine will make up for all defects in food, air, exercise, and cleanliness. By errors of this kind, I will venture to say, that one half the children who die annually in London lose their lives.

Allowing children to continue long wet, is another very pernicious custom of indolent nurses. This is not only disagreeable, but it galls and frets the infant, and by relaxing the solids, occasions scrophulas, rickets, and other diseases. A dirty nurse is always to be suspected.

Nature often attempts to free the bodies of children from bad humours, by throwing them upon the skin: by this means fevers and other diseases are prevented. Nurses are apt to mistake such critical eruptions for an itch, or some other infectious disorder. Accordingly they take every method to drive them in. In this way many children lose their lives; and no wonder, as Nature is opposed in the very method she takes to relieve them. It ought to be a rule, which every nurse should observe, never to stop any eruption without proper advice, or being well assured that it is not of a critical nature. At any rate, it is never to be done without previous evacuations.

Loose stools is another method by which Nature often prevents or carries off the diseases of infants. If these proceed too far, no doubt they ought to be checked; but this is never to be done without the greatest caution. Nurses, upon the first appearance of loose stools, frequently fly to the use of astringents, or such things as bind the body. Hence inflammatory fevers, and other fatal diseases, are occasioned. A dose of rhubarb, a gentle vomit, or some other evacuation, should always precede the use of astringent medicines.

One of the greatest faults of nurses is, concealing the diseases of children from their parents. This they are extremely ready to do, especially when the disease is the effect of their own negligence. Many instances might be given of persons who have been rendered lame for life by a fall from their nurse’s arms, which she, through fear, concealed till the misfortune was past cure. Every parent who intrusts a nurse with the care of a child, ought to give her the strictest charge not to conceal the most trifling disorder or misfortune that may befal it.

We can see no reason why a nurse, who conceals any misfortune which happens to a child under her care, till it loses its life or limbs, should not be punished. A few examples of this would save the lives of many infants; but as there is little reason to expect that it ever will be the case, we would earnestly recommend it to all parents to look carefully after their children, and not to trust so valuable a treasure entirely in the hands of an hireling.

No person ought to imagine these things unworthy of his attention. On the proper management of children depend not only their health and usefulness in life, but likewise the safety and prosperity of the state to which they belong. Effeminacy ever will prove the ruin of any state where it prevails; and, when its foundations are laid in infancy, it can never afterwards be wholly eradicated. Parents who love their offspring, and wish well to their country, ought therefore, in the management of their children, to avoid every thing that may have a tendency to make them weak or effeminate, and to take every method in their power to render their constitutions strong and hardy.

——By arts like these

Laconia nurs’d of old her hardy sons;

And Rome’s unconquer’d legions urg’d their way,

Unhurt, thro’ every toil in every clime[^[21]].

CHAP. II.
OF THE LABORIOUS, THE SEDENTARY, AND THE STUDIOUS.

That men are exposed to particular diseases from the occupations which they follow, is a fact well known; but to remedy this evil is a matter of some difficulty. Most people are under the necessity of following those employments to which they have been bred, whether they be favourable to health or not. For this reason, instead of inveighing, in a general way, as some authors have done, against those occupations which are hurtful to health, we shall endeavour to point out the circumstances in each of them from which the danger chiefly arises, and to propose the most rational methods of preventing it.

Chymists, founders, forgers, glass-makers, and several other artists, are hurt by the unwholesome air which they are obliged to breathe. This air is not only loaded with the noxious exhalations arising from metals and minerals, but is so charged with phlogiston as to be rendered unfit for expanding the lungs sufficiently, and answering the other important purposes of respiration. Hence proceed asthmas, coughs, and consumptions of the lungs, so incident to persons who follow these employments.

To prevent such consequences, as far as possible, the places where these occupations are carried on, ought to be constructed in such a manner as to discharge the smoke and other exhalations, and admit a free current of fresh air. Such artists ought never to continue too long at work; and when they give over, they should suffer themselves to cool gradually, and put on their clothes before they go into the open air. They ought never to drink large quantities of cold, weak, or watery liquors, while their bodies are hot, nor to indulge in raw fruits, sallads, or any thing that is cold on the stomach[^[22]].

Miners, and all who work under ground, are likewise hurt by unwholesome air. The air, by its stagnation in deep mines, not only loses its proper spring and other qualities necessary for respiration, but is often loaded with such noxious exhalations as to become a most deadly poison.

The two kinds of air which prove most destructive to miners, are what they call the fire damp, and the choke damp. In both cases the air becomes a poison, by its being loaded with phlogiston. The danger from the former may be obviated by making it explode before it accumulates in too great quantities; and the latter may be generally carried off by promoting a free circulation of air in the mine.

Miners are not only hurt by unwholesome air, but likewise by the particles of metal which adhere to their skin, clothes, &c. These are absorbed, or taken up into the body, and occasion palsies, vertigoes, and other nervous affections, which often prove fatal. Fallopius observes, that those who work in mines of mercury seldom live above three or four years. Lead, and several other metals, are likewise very pernicious to the health.

Miners ought never to go to work fasting, nor to continue too long at work. Their food ought to be nourishing, and their liquor generous: nothing more certainly hurts them than living too low. They should by all means avoid costiveness. This may either be done by chewing a little rhubarb, or taking a sufficient quantity of sallad oil. Oil not only opens the body, but sheaths and defends the intestines from the ill effects of the metals. All who work in mines or metals ought to wash carefully, and to change their clothes as soon as they give over working. Nothing would tend more to preserve the health of such people than a strict, and almost religious regard to cleanliness.

Plumbers, painters, gilders, smelters, makers of white lead, and many others who work in metals, are liable to the same diseases as miners, and ought to observe the same directions for avoiding them.

Tallow-chandlers, boilers of oil, and all who work in putrid animal substances, are likewise liable to suffer from the unwholesome smells or effluvia of these bodies. They ought to pay the same regard to cleanliness as miners; and when they are affected with nausea, sickness, or indigestion, we would advise them to take a vomit or a gentle purge. Such substances ought always to be manufactured as soon as possible. When long kept, they not only become unwholesome to those who manufacture them, but likewise to people who live in the neighbourhood.

It would greatly exceed the limits of this part of our subject, to specify the diseases peculiar to persons of every occupation; we shall therefore consider mankind under the general classes of Laborious, Sedentary, and Studious.

THE LABORIOUS.

Though those who follow laborious employments are in general the most healthy of mankind, yet the nature of their occupations, and the places where they are carried on, expose them more particularly to some diseases. Husbandmen, for example, are exposed to all the vicissitudes of the weather, which, in this country, are often very great and sudden, and occasion colds, coughs, quinsies, rheumatisms, fevers, and other acute disorders. They are likewise forced to work hard, and often to carry burdens above their strength, which, by overstraining the vessels, occasion asthmas, ruptures, pleurisies, &c.

Those who labour without doors are often afflicted with intermitting fevers or agues, occasioned by the frequent vicissitudes of heat and cold, poor living, bad water, sitting or lying on the damp ground, evening dews, night air, &c. to which they are frequently exposed.

Such as bear heavy burdens, as porters, labourers, &c. are obliged to draw in the air with much greater force, and also to keep their lungs distended with more violence than is necessary for common respiration: by this means the tender vessels of the lungs are overstretched, and often burst, insomuch that a spitting of blood or fever ensues. Hippocrates mentions an instance to this purpose, of a man, who, upon a wager, carried an ass; but was soon after seized with a fever, a vomiting of blood, and a rupture.

Carrying heavy burdens is generally the effect of mere laziness, which prompts people to do at once what should be done at twice. Sometimes it proceeds from vanity or emulation. Hence it is, that the strongest men are most commonly hurt by heavy burdens, hard labour, or feats of activity. It is rare to find one who boasts of his strength without a rupture, a spitting of blood, or some other disease, which he reaps as the fruit of his folly. One would imagine, the daily instances we have, of the fatal effects of carrying great weights, running, wrestling, and the like, would be sufficient to prevent such practices.

There are indeed some employments which necessarily require a great exertion of strength, as porters, blacksmiths, carpenters, &c. None ought to follow these but men of strong body; and they should never exert their strength to the utmost, nor work too long. When the muscles are violently strained, frequent rest is necessary, in order that they may recover their tone; without this, the strength and constitution will soon be worn out, and a premature old age be induced.

The erysipelas, or St. Anthony’s fire, is a disease very incident to the laborious. It is occasioned by whatever gives a sudden check to the perspiration, as drinking cold water when the body is warm, wet feet, keeping on wet clothes, sitting or lying on the damp ground, &c. It is impossible for those who labour without doors always to guard against these inconveniences; but it is known from experience, that their ill consequences might often be prevented by proper care.

The iliac passion, the cholic, and other complaints of the bowels, are often occasioned by the same causes as the erysipelas; but they may likewise proceed from flatulent and indigestible food. Labourers generally eat unfermented bread, made of peas, beans, rye, and other windy ingredients. They also devour great quantities of unripe fruits, baked, stewed, or raw, with various kinds of roots and herbs, upon which they often drink sour milk, stale small beer, or the like. Such a mixture cannot fail to fill the bowels with wind, and occasion diseases of those parts.

Inflammations, whitloes, and other diseases of the extremities, are likewise common among those who labour without doors. These diseases are often attributed to venom, or some kind of poison; but they generally proceed either from sudden heat after cold, or the contrary. When labourers, milk-maids, &c. come from the field, cold or wet, they run to the fire, and often plunge their hands in warm water, by which means the blood and other humours in those parts are suddenly expanded, and, the vessels not yielding so quickly, a strangulation happens, and an inflammation or a mortification ensues.

When such persons come home cold, they ought to keep at a distance from the fire for some time, to wash their hands in cold water, and to rub them well with a dry cloth. It sometimes happens, that people are so benumbed with cold, as to be quite deprived of the use of their limbs. In this case, the only remedy is to rub the parts affected with snow, or, where it cannot be had, with cold water. If they be held near the fire, or plunged into warm water, a mortification will generally ensue.

Labourers in the hot season are apt to lie down, and sleep in the sun. This practice is so dangerous, that they often wake in a burning fever. These ardent fevers, which prove so fatal about the end of summer and beginning of autumn, are frequently occasioned by this means. When labourers leave off work, which they ought always to do during the heat of the day, they should go home, or, at least, get under some cover, where they may repose themselves in safety.

Many people follow their employments in the fields from morning till night, without eating any thing. This cannot fail to hurt their health. However homely their fare be, they ought to have it at regular times; and the harder they work, the more frequently they should eat. If the humours be not frequently replenished with fresh nourishment, they soon become putrid, and produce fevers of the very worst kind.

Many peasants are extremely careless with respect to what they eat or drink, and often, through mere indolence, use unwholesome food, when they might for the same expence have that which is wholesome. In some parts of Britain, the peasants are too careless even to take the trouble of dressing their own victuals. Such people would live upon one meal a day in indolence, rather than labour, though it were to procure them the greatest affluence.

Fevers of a very bad kind are often occasioned among labourers by poor living. When the body is not sufficiently nourished, the humours become vitiated, and the solids weak; from whence the most fatal consequences ensue. Poor living is likewise productive of many of those cutaneous diseases so frequent among the lower class of people. It is remarkable that cattle, when pinched in their food, are generally affected with diseases of the skin, which seldom fail to disappear, when they are put upon a good pasture. This shews how much a good state of the humours depends upon a sufficient quantity of proper nourishment.

Poverty not only occasions, but aggravates, many of the diseases of the laborious. Few of them have much foresight; and, if they had, it is seldom in their power to save any thing. They are glad to make a shift to live from day to day; and, when any disease overtakes them, they are miserable indeed. Here the godlike virtue of charity ought always to exert itself. To relieve the industrious poor in distress, is surely the most exalted act of religion and humanity. They alone, who are witnesses of those scenes of calamity, can form a notion of what numbers perish in diseases, for want of proper assistance, and even for want of the necessaries of life.

Labourers are often hurt by a foolish emulation, which prompts them to vie with one another, till they overheat themselves to such a degree as to occasion a fever, or even to drop down dead. Such as wantonly throw away their lives in this manner, deserve to be looked upon in no better light than self-murderers.

The office of a soldier, in time of war, may be ranked among the laborious employments. Soldiers suffer many hardships from the inclemency of seasons, long marches, bad provisions, hunger, watching, unwholesome climates, bad water, &c. These occasion fevers, fluxes, rheumatisms, and other fatal diseases, which generally do greater execution than the sword, especially when campaigns are continued too late in the season. A few weeks of cold rainy weather will often prove more fatal than an engagement.

Those who have the command of armies should take care that their soldiers be well clothed and well fed. They ought also to finish their campaigns in due season, and to provide their men with dry and well-aired winter quarters. These rules, taking care, at the same time, to keep the sick at a proper distance from those in health, would tend greatly to preserve the lives of the soldiery[^[23]].

Sailors may also be numbered among the laborious. They undergo great hardships from change of climate, the violence of weather, hard labour, bad provisions, &c. Sailors are of so great importance both to the trade and safety of this kingdom, that too much pains can never be bestowed in pointing out the means of preserving their lives.

One great source of the diseases of sea-faring people is excess. When they get on shore, after having been long at sea, without regard to the climate, or their own constitutions, they plunge headlong into all manner of riot, and often persist till a fever puts an end to their lives. Thus intemperance, and not the climate, is often the cause why so many of our brave sailors die on foreign coasts. Such people ought not to live too low; but they will find moderation the best defence against fevers, and many other maladies.

Sailors, when on duty, cannot avoid sometimes getting wet. When this happens, they should change their clothes as soon as they are relieved, and take every method to restore the perspiration. They should not, in this case, make too free with spirits or other strong liquors, but should rather drink them diluted with warm water, and go immediately to bed, where a sound sleep and a gentle sweat would set all to rights.

But the health of sailors suffers most from unwholesome food. The constant use of salted provisions vitiates their humours, and occasions the scurvy, and other obstinate maladies. It is no easy matter to prevent this disease in long voyages; yet we cannot help thinking, that much might be done towards effecting so desirable an end, were due pains bestowed for that purpose. For example, various roots, greens, and fruits, might be kept a long time at sea, as onions, potatoes, cabbages, lemons, oranges, tamarinds, apples, &c. When fruits cannot be kept, the juices of them, either fresh or fermented, may. With these all the drink, and even the food of the ship’s company, ought to be acidulated in long voyages.

Stale bread and beer likewise contribute to vitiate the humours. Flour will keep for a long time on board, of which fresh bread might frequently be made. Malt too might be kept, and infused with boiling water at any time. This liquor, when drank even in form of wort, is very wholesome, and is found to be an antidote against the scurvy. Small wines and cyder might likewise be plentifully laid in; and should they turn sour, they would still be useful as vinegar. Vinegar is a great antidote against diseases, and should be used by all travellers, especially at sea. It may either be mixed with the water they drink, or taken in their food.

Such animals as can be kept alive, ought likewise to be carried on board, as hens, ducks, pigs, &c. Fresh broths made of portable soup, and puddings made of peas, or other vegetables, ought to be used plentifully. Many other things will readily occur to people conversant in these matters, which would tend to preserve the health of that brave and useful set of men[^[24]].

We have reason to believe, if due attention were paid to the diet, air, clothing, and above all things to the cleanliness of sea-faring people, they would be the most healthy set of men in the world; but when these are neglected, the very reverse will happen.

The best medical antidote that we can recommend to sailors or soldiers, on foreign coasts, especially where dampness prevails, is the Peruvian bark. This will often prevent fevers, and other fatal diseases. About a drachm of it may be chewed every day; or if this should prove disagreeable, an ounce of bark, with half an ounce of orange peel, and two drachms of snake-root coarsely powdered, may be infused for two or three days in an English quart of brandy, and half a wine glass of it taken twice or thrice a-day, when the stomach is empty. This has been found to be an excellent antidote against fluxes, putrid, intermitting, and other fevers, in unhealthy climates. It is not material in what form this medicine is taken. It may either be infused in water, wine, or spirits, as recommended above, or made into an electuary with syrup of lemons, oranges, or the like.

THE SEDENTARY.

Though nothing can be more contrary to the nature of man than a sedentary life, yet this class comprehends by far the greater part of the species. Almost the whole female world, and in manufacturing countries, the major part of the males, may be reckoned sedentary[^[25]].

Agriculture, the first and most healthful of all employments, is now followed by few who are able to carry on any other business. But those who imagine that the culture of the earth is not sufficient to employ all its inhabitants are greatly mistaken. An ancient Roman, we are told, could maintain his family from the produce of one acre of ground. So might a modern Briton, if he would be contented to live like a Roman. This shews what an immense increase of inhabitants Britain might admit of, and all of them live by the culture of the ground.

Agriculture is the great source of domestic riches. Where it is neglected, whatever wealth may be imported from abroad, poverty and misery will abound at home. Such is, and ever will be, the fluctuating state of trade and manufactures, that thousands of people may be in full employment to-day, and in beggary to-morrow. This can never happen to those who cultivate the ground. They can eat the fruit of their labour, and can always by industry obtain, at least, the necessaries of life.

Though sedentary employments are necessary, yet there seems to be no reason why any person should be confined for life to these alone. Were such employments intermixed with the more active and laborious, they would never do hurt. It is constant confinement that ruins the health. A man may not be hurt by sitting five or six hours a-day; but if he is obliged to sit ten or twelve, he will soon become diseased.

But it is not want of exercise alone which hurts sedentary people; they likewise suffer from the confined air which they breathe. It is very common to see ten or a dozen taylors[^[26]], or staymakers, for example, crowded into one small apartment, where there is hardly room for one person to breathe freely. In this situation they generally continue for many hours at a time, often with the addition of several candles, which tend likewise to waste the air, and render it less fit for respiration. Air that is breathed repeatedly becomes unfit for expanding the lungs. This is one cause of the phthisical coughs, and other complaints of the breath, so incident to sedentary artificers.

Even the perspiration from a great number of persons pent up together, renders the air unwholesome. The danger from this quarter will be greatly increased, if any one of them happens to have bad lungs, or to be otherwise diseased. Those who sit near him, being forced to breathe the same air, can hardly fail to be infected. It would be a rare thing, however, to find a dozen of sedentary people all in good health. The danger of crowding them together must therefore be evident to every one.

Many of those who follow sedentary employments are constantly in a bending posture, as shoemakers, taylors, cutlers, &c. Such a situation is extremely hurtful. A bending posture obstructs all the vital motions, and of course must destroy the health. Accordingly we find such artificers generally complaining of indigestions, flatulencies, head-achs, pains of the breast, &c.

The aliment in sedentary people, instead of being pushed forwards by an erect posture, and the action of the muscles, is in a manner confined in the bowels. Hence indigestions, costiveness, wind, and other hypochondriacal affections, the constant companions of the sedentary. Indeed none of the excretions can be duly performed where exercise is wanting; and when the matter which ought to be discharged in this way is retained too long in the body, it must have bad effects, as it is again taken up into the mass of humours.

A bending posture is likewise hurtful to the lungs. When this organ is compressed, the air cannot have free access into all its parts, so as to expand them properly. Hence tubercles, adhesions, &c. are formed, which often end in consumptions. Besides, the proper action of the lungs being absolutely necessary for making good blood, when that organ fails, the humours soon become universally depraved, and the whole constitution goes to wreck.

Sedentary artificers are not only hurt by pressure on the bowels, but also on the inferior extremities, which obstructs the circulation in these parts, and renders them weak and feeble. Thus taylors, shoemakers, &c. frequently lose the use of their legs altogether: besides, the blood and humours are, by stagnation, vitiated, and the perspiration is obstructed: from whence proceed the scab, ulcerous sores, foul blotches, and other cutaneous diseases, so common among sedentary artificers.

A bad figure of body is a very common consequence of close application to sedentary employments. The spine, for example, by being continually bent, puts on a crooked shape, and generally remains so ever after. But a bad figure of body has already been observed to be hurtful to health, as the vital functions are thereby impeded.

A sedentary life seldom fails to occasion an universal relaxation of the solids. This is the great source from whence most of the diseases of sedentary people flow. The scrophula, consumption, hysterics, and nervous diseases, now so common, were very little known in this country before sedentary artificers became so numerous: and they are very little known still among such of our people as follow active employments without doors, though in great towns at least two-thirds of the inhabitants are afflicted with them.

It is very difficult to remedy those evils, because many who have been accustomed to a sedentary life, like rickety children, lose all inclination for exercise; we shall, however, throw out a few hints with respect to the most likely means for preserving the health of this useful set of people, which some of them, we hope, will be wise enough to take.

It has been already observed, that sedentary artificers are often hurt by their bending posture. They ought therefore to stand or sit as erect as the nature of their employments will permit. They should likewise change their posture frequently, and should never sit too long at a time, but leave off work, and walk, ride, run, or do any thing that will promote the vital functions.

Sedentary artificers are generally allowed too little time for exercise; yet, short as it is, they seldom employ it properly. A journeyman taylor or weaver, for example, instead of walking abroad for exercise and fresh air, at his hours of leisure, chuses often to spend them in a public-house, or in playing at some sedentary game, by which he generally loses both his time and his money.

The awkward postures in which many sedentary artificers work, seem rather to be the effect of custom than necessity. For example, a table might surely be contrived for ten or a dozen taylors to sit round, with liberty for their legs either to hang down, or rest upon a foot-board, as they should chuse. A place might likewise be cut out for each person, in such a manner that he might sit as conveniently for working as in the present mode of sitting cross-legged.

All sedentary artificers ought to pay the most religious regard to cleanliness. Both their situation and occupations render this highly necessary. Nothing would contribute more to preserve their health, than a strict attention to it; and such of them as neglect it, not only run the hazard of losing health, but of becoming a nuisance to their neighbours.

Sedentary people ought to avoid food that is windy, or hard of digestion, and should pay the strictest regard to sobriety. A person who works hard without doors will soon throw off a debauch; but one who sits has by no means an equal chance. Hence it often happens, that sedentary people are seized with fevers after hard drinking. When such persons feel their spirits low, instead of running to the tavern for relief, they should ride, or walk in the fields. This would remove the complaint more effectually than strong liquor, and would never hurt the constitution.

Instead of multiplying rules for preserving the health of the sedentary, we shall recommend to them the following general plan, viz. That every person who follows a sedentary employment should cultivate a piece of ground with his own hands. This he might dig, plant, sow, and weed at leisure hours, so as to make it both an exercise and amusement, while it produced many of the necessaries of life. After working an hour in a garden, a man will return with more keenness to his employment within doors, than if he had been all the while idle.

Labouring the ground is every way conducive to health. It not only gives exercise to every part of the body, but the very smell of the earth and fresh herbs revives and cheers the spirits, whilst the perpetual prospect of something coming to maturity, delights and entertains the mind. We are so formed as to be always pleased with somewhat in prospect, however distant or however trivial. Hence the happiness that most men feel in planting, sowing, building, &c. These seem to have been the chief employments of the more early ages: and, when kings and conquerors cultivated the ground, there is reason to believe that they knew as well wherein true happiness consisted as we do.

It may seem romantic to recommend gardening to manufacturers in great towns; but observation proves that the plan is very practicable. In the town of Sheffield, in Yorkshire, where the great iron manufacture is carried on, there is hardly a journeyman cutler who does not possess a piece of ground, which he cultivates as a garden. This practice has many salutary effects. It not only induces these people to take exercise without doors, but also to eat many greens, roots, &c. of their own growth, which they would never think of purchasing. There can be no reason why manufacturers in any other town in Great Britain should not follow the same plan. It is indeed to be regretted, that in such a place as London a plan of this kind is not practicable; yet even there sedentary artificers may find opportunities of taking air and exercise, if they chuse to embrace them.

Mechanics are too much inclined to crowd into great towns. The situation may have some advantages; but it has likewise many disadvantages. All mechanics who live in the country have it in their power to cultivate a piece of ground; which indeed most of them do. This not only gives them exercise, but enables them to live more comfortably. So far at least as my observation extends, mechanics who live in the country are far more happy than those in great towns. They enjoy better health, live in greater affluence, and seldom fail to rear a healthy and numerous offspring.

In a word, exercise without doors, in one shape or another, is absolutely necessary to health. Those who neglect it, though they may for a while drag out life, can hardly be said to enjoy it. Weak and effeminate, they languish for a few years, and soon drop into an untimely grave.

THE STUDIOUS.

Intense thinking is so destructive to health, that few instances can be produced of studious persons who are strong and healthy. Hard study always implies a sedentary life; and when intense thinking is joined to the want of exercise, the consequences must be bad. We have frequently known even a few months of close application to study ruin an excellent constitution, by inducing a train of nervous complaints which could never be removed. Man is evidently not formed for continual thought more than for perpetual action, and would be as soon worn out by the one as by the other.

So great is the power of the mind over the body, that, by its influence, the whole vital motions may be accelerated or retarded, to almost any degree. Thus cheerfulness and mirth quicken the circulation, and promote all the secretions; whereas sadness and profound thought never fail to retard them. Hence it would appear, that even a degree of thoughtlessness is necessary to health. Indeed, the perpetual thinker seldom enjoys either health or spirits; while the person, who can hardly be said to think at all, generally enjoys both.

Perpetual thinkers, as they are called, seldom think long. In a few years they generally become quite stupid, and exhibit a melancholy proof how readily the greatest blessings may be abused. Thinking, like every thing else, when carried to extreme, becomes a vice: nor can any thing afford a greater proof of wisdom, than for a man frequently and reasonably to unbend his mind. This may generally be done by mixing in cheerful company, active diversions, or the like.

Instead of attempting to investigate the nature of that connection which subsists between the mind and body, or to inquire into the manner in which they mutually affect each other, we shall only mention those diseases to which the learned are more peculiarly liable, and endeavour to point out the means of avoiding them.

Studious persons are very subject to the gout. This painful disease in a great measure proceeds from indigestion, and an obstructed perspiration. It is impossible that the man who sits from morning till night should either digest his food, or have any of the secretions in due quantity. But when that matter, which should be thrown off by the skin, is retained in the body, and the humours are not duly prepared, diseases must ensue.

The studious are likewise very liable to the stone and gravel. Exercise greatly promotes both the secretion and discharge of urine; consequently a sedentary life must have the contrary effect. Any one may be satisfied of this by observing, that he passes much more urine by day than in the night, and also when he walks or rides, than when he sits.

The circulation in the liver being flow, obstructions in that organ can hardly fail to be the consequence of inactivity. Hence sedentary people are frequently afflicted with schirrous livers. But the proper secretion and discharge of the bile is so necessary a part of the animal œconomy, that where these are not duly performed, the health must soon be impaired. Jaundice, indigestion, loss of appetite, and a wasting of the whole body, seldom fail to be the consequences of a vitiated state of the liver, or obstructions of the bile.

Few diseases prove more fatal to the studious than consumptions of the lungs. It has already been observed, that this organ cannot be duly expanded in those who do not take proper exercise; and where that is the case, obstructions and adhesions will ensue. Not only want of exercise, but the posture in which studious persons generally sit, is very hurtful to the lungs. Those who read or write much are ready to contract a habit of bending forwards, and often press with their breast upon a table or bench. This posture cannot fail to hurt the lungs.

The functions of the heart may likewise by this means be injured. I remember to have seen a man opened, whose pericardium adhered to the breast-bone in such a manner as to obstruct the motion of the heart, and occasion his death. The only probable cause that could be assigned for this singular symptom was, that the man, whose business was writing, used constantly to sit in a bending posture, with his breast pressing upon the edge of a plain table.

No person can enjoy health who does not properly digest his food. But intense thinking and inactivity never fail to weaken the powers of digestion. Hence the humours become crude and vitiated, the solids weak and relaxed, and the whole constitution goes to ruin.

Long and intense thinking often occasions grievous head-achs, which bring on vertigoes, apoplexies, palsies, and other fatal disorders. The best way to prevent these is, never to study too long at one time, and to keep the body regular, either by proper food, or taking frequently a little of some opening medicine.

Those who read or write much are often afflicted with sore eyes. Studying by candle-light is peculiarly hurtful to the sight. This ought to be practised as seldom as possible. When it is unavoidable, the eyes should be shaded, and the head should not be held too low. When the eyes are weak or painful, they should be bathed every night and morning in cold water, to which a little brandy may be added.

It has already been observed, that the excretions are very defective in the studious. The dropsy is often occasioned by the retention of those humours which ought to be carried off in this way. Any person may observe, that sitting makes his legs swell, and that this goes off by exercise; which clearly points out the method of prevention.

Fevers, especially of the nervous kind, are often the effect of study. Nothing affects the nerves so much as intense thought. It in a manner unhinges the whole human frame, and not only hurts the vital motions, but disorders the mind itself. Hence a delirium, melancholy, and even madness, are often the effect of close application to study. In fine, there is no disease which can proceed either from a bad state of the humours, a defect of the usual secretions, or a debility of the nervous system, which may not be induced by intense thinking.

But the most afflicting of all the diseases which attack the studious is the hypochondriac. This disease seldom fails to be the companion of deep thought. It may rather be called a complication of maladies than a single one. To what a wretched condition are the best of men often reduced by it! Their strength and appetite fail; a perpetual gloom hangs over their minds; they live in the constant dread of death, and are continually in search of relief from medicine, where, alas! it is not to be found. Those who labour under this disorder, though they are often made the subject of ridicule, justly claim our highest sympathy and compassion.

Hardly any thing can be more preposterous than for a person to make study his sole business. A mere student is seldom an useful member of society. He often neglects the most important duties of life, in order to pursue studies of a very trifling nature. Indeed it rarely happens, that any useful invention is the effect of mere study. The farther men dive into profound researches, they generally deviate the more from common sense, and too often lose sight of it altogether. Profound speculations, instead of making men wiser or better, generally render them absolute sceptics, and overwhelm them with doubt and uncertainty. All that is necessary for man to know, in order to be happy, is easily obtained; and the rest, like the forbidden fruit, serves only to increase his misery.

Studious persons, in order to relieve their minds, must not only discontinue to read and write, but engage in some employment or diversion, that will so far occupy the thought as to make them forget the business of the closet. A solitary ride or walk are so far from relaxing the mind, that they rather encourage thought. Nothing can divert the mind, when it gets into a train of serious thinking, but attention to subjects of a more trivial nature. These prove a kind of play to the mind, and consequently relieve it.

Learned men often contract a contempt for what they call trifling company. They are ashamed to be seen with any but philosophers. This however is no proof of their being philosophers themselves. No man deserves that name who is ashamed to unbend his mind, by associating with the cheerful and gay. Even the society of children will relieve the mind, and expel the gloom which application to study is too apt to occasion.

As studious people are necessarily much within doors, they should make choice of a large and well-aired place for study. This would not only prevent the bad effects which attend confined air, but would cheer the spirits, and have a most happy influence both on the body and mind. It is said of Euripides the tragedian, that he used to retire to a dark cave to compose his tragedies, and of Demosthenes the Grecian orator, that he chose a place for study where nothing could be either heard or seen. With all deference to such venerable names, we cannot help condemning their taste. A man may surely think to as good purpose in an elegant apartment as in a cave; and may have as happy conceptions where the all-cheering rays of the sun render the air wholesome, as in places where they never enter.

Those who read or write much should be very attentive to their posture. They ought to sit and stand by turns, always keeping as nearly in an erect posture as possible. Those who dictate, may do it walking. It has an excellent effect frequently to read or speak aloud. This not only exercises the lungs, but almost the whole body. Hence studious people are greatly benefited by delivering discourses in public. Public speakers, indeed, sometimes hurt themselves by overacting their part; but this is their own fault. The martyr to mere vociferation merits not our sympathy.

The morning has, by all medical writers, been reckoned the best time for study. It is so. But it is also the most proper season for exercise, while the stomach is empty, and the spirits refreshed with sleep. Studious people should therefore sometimes spend the morning in walking, riding, or some manly diversions without doors. This would make them return to study with greater alacrity, and would be of more service than twice the time after their spirits are worn out with fatigue. It is not sufficient to take diversion only when we can think no longer. Every studious person should make it a part of his business, and should let nothing interrupt his hours of recreation more than those of study.

Music has a very happy effect in relieving the mind when fatigued with study. It would be well if every studious person were so far acquainted with that science as to amuse himself after severe thought, by playing such airs as have a tendency to raise the spirits, and inspire cheerfulness and good humour.

It is a reproach to Learning, that any of her votaries, to relieve the mind after study, should betake themselves to the use of strong liquors. This indeed is a remedy; but it is a desperate one, and always proves destructive. Would such persons, when their spirits are low, get on horseback, and ride ten or a dozen miles, they would find it a more effectual remedy than any cordial medicine in the apothecary’s shop, or all the strong liquors in the world.

The following is my plan, and I cannot recommend a better to others. When my mind is fatigued with study, or other serious business, I mount my horse, and ride ten or twelve miles into the country, where I spend a day, and sometimes two, with a cheerful friend; after which I never fail to return to town with new vigour, and to pursue my studies or business with fresh alacrity.

It is much to be regretted, that learned men, while in health, pay so little regard to these things! There is not any thing more common than to see a miserable object over-run with nervous diseases, bathing, walking, riding, and, in a word, doing every thing for health after it is gone; yet, if any one had recommended these things to him by way of prevention, the advice would, in all probability, have been treated with contempt, or, at least, with neglect. Such is the weakness and folly of mankind, and such the want of foresight, even in those who ought to be wiser than others!

With regard to the diet of the studious, we see no reason why they should abstain from any kind of food that is wholesome, provided they use it in moderation. They ought, however, to be sparing in the use of every thing that is windy, rancid, or hard of digestion. Their suppers should always be light, or taken soon in the evening. Their drink may be water, fine malt liquor, not too strong, good cyder, wine and water, or, if troubled with acidities, water mixed with a little brandy, rum, or any other genuine spirit.

We shall only observe, with regard to those kinds of exercise which are most proper for the studious, that they should not be too violent, nor ever carried to the degree of excessive fatigue. They ought likewise to be frequently varied so as to give action to all the different parts of the body; and should, as often as possible, be taken in the open air. In general, riding on horseback, walking, working in a garden, or playing at some active diversions, are the best.

We would likewise recommend the use of the cold bath to the studious. It will, in some measure, supply the place of exercise, and should not be neglected by persons of a relaxed habit, especially in the warm season.

No person ought either to take violent exercise, or to study immediately after a full meal.

CHAP. III.
OF ALIMENT.

Unwholesome food, and irregularities in diet, occasion many diseases. There is no doubt but the whole constitution of body may be changed by diet alone. The fluids may be thereby attenuated or condensed, rendered mild or acrimonious, coagulated or diluted, to almost any degree. Nor are its effects upon the solids less considerable. They may be braced or relaxed, have their sensibility, motions, &c. greatly increased or diminished, by different kinds of aliment. A very small attention to these things will be sufficient to shew, how much the preservation of health depends upon a proper regimen of the diet.

Nor is an attention to diet necessary for the preservation of health only: it is likewise of importance in the cure of diseases. Every intention in the cure of many diseases, may be answered by diet alone. Its effects, indeed, are not always so quick as those of medicine, but they are generally more lasting: besides, it is neither so disagreeable to the patient, nor so dangerous as medicine, and is always more easily obtained.

Our intention here is not to inquire minutely into the nature and properties of the various kinds of aliment in use among mankind; nor to shew their effects upon the different constitutions of the human body; but to mark some of the most pernicious errors which people are apt to fall into, with respect both to the quantity and qualities of their food, and to point out their influence upon health.

It is not indeed an easy matter to ascertain the exact quantity of food proper for every age, sex, and constitution: but a scrupulous nicety here is by no means necessary. The best rule is to avoid all extremes. Mankind were never intended to weigh and measure their food. Nature teaches every creature when it has enough; and the calls of thirst and hunger are sufficient to inform them when more is necessary.

Though moderation is the chief rule with regard to the quantity, yet the quality of food merits a farther consideration. There are many ways by which provisions may be rendered unwholesome. Bad seasons may either prevent the ripening of grain, or damage it afterwards. These, indeed, are acts of Providence, and we must submit to them; but surely no punishment can be too severe for those who suffer provisions to spoil by hoarding them, on purpose to raise the price, or who promote their own interest by adulterating the necessaries of life[^[27]].

Animal, as well as vegetable food, may be rendered unwholesome, by being kept too long. All animal substances have a constant tendency to putrefaction; and, when that has proceeded too far, they not only become offensive to the senses, but hurtful to health. Diseased animals, and such as die of themselves, ought never to be eaten. It is a common practice, however, in some grazing countries, for servants and poor people to eat such animals as die of any disease, or are killed by accident. Poverty, indeed, may oblige people to do this; but they had better eat a smaller quantity of what is sound and wholesome: it would both afford a better nourishment, and be attended with less danger.

The injunctions given to the Jews, not to eat any creature which died of itself, seem to have a strict regard to health; and ought to be observed by Christians as well as Jews. Animals never die themselves without some previous disease; but how a diseased animal should be wholesome food, is inconceivable: even those which die by accident must be hurtful, as their blood is mixed with the flesh, and soon turns putrid.

Animals which feed grossly, as tame ducks, hogs, &c. are neither so easily digested, nor afford such wholesome nourishment as others. No animal can be wholesome which does not take sufficient exercise. Most of our stalled cattle are crammed with gross food, but not allowed exercise nor free air; by which means they indeed grow fat, but their juices not being properly prepared or assimilated, remain crude, and occasion indigestions, gross humours, and oppression of the spirits, in those who feed upon them.

Animals are often rendered unwholesome by being overheated. Excessive heat causes a fever, exalts the animal salts, and mixes the blood so intimately with the flesh, that it cannot be separated. For this reason, butchers should be severely punished who over-drive their cattle. No person would chuse to eat the flesh of an animal which had died in a high fever; yet that is the case with all over-drove cattle; and the fever is often raised even to the degree of madness.

But this is not the only way by which butchers render meat unwholesome. The abominable custom of filling the cellular membrane of animals with air, in order to make them appear fat, is every day practised. This not only spoils the meat, and renders it unfit for keeping, but is such a dirty trick, that the very idea of it is sufficient to disgust a person of any delicacy at every thing which comes from the shambles. Who can bear the thought of eating meat which has been blown up with air from the lungs of a dirty fellow, perhaps labouring under the very worst of diseases?

Butchers have likewise a method of filling the cellular membranes of animals with blood. This makes the meat seem fatter, and likewise weigh more, but is notwithstanding a very pernicious custom, as it both renders the meat unwholesome and unfit for keeping. I seldom see a piece of meat from the shambles, where the blood is not diffused through the cellular texture. I shall not say that this is always the effect of design; but I am certain it is not the case with animals that are killed for domestic use, and properly blooded. Veal seems to be most frequently spoilt in this way. Perhaps that may in some measure be owing to the practice of carrying calves from a great distance to market, by which means their tender flesh is bruised, and many of their vessels burst.

No people in the world eat such quantities of animal food as the English, which is one reason why they are so generally tainted with the scurvy and its numerous train of consequences, indigestion, low spirits, hypochondriacism, &c. Animal food was surely designed for man, and, with a proper mixture of vegetables, it will be found the most wholesome; but to gorge beef, mutton, pork, fish, and fowl, twice or thrice a day, is certainly too much. All who value health ought to be contented with making one meal of flesh in the twenty-four hours, and this ought to consist of one kind only.

The most obstinate scurvy has often been cured by a vegetable diet; nay, milk alone will frequently do more in that disease than any medicine. Hence it is evident, that if vegetables and milk were more used in diet, we should have less scurvy, and likewise fewer putrid and inflammatory fevers. Fresh vegetables, indeed, come to be daily more used in diet; this laudable practice we hope will continue to gain ground.

Our aliment ought neither to be too moist nor too dry. Moist aliment relaxes the solids, and renders the body feeble. Thus we see females, who live much on tea and other watery diet, generally become weak, and unable to digest solid food: hence proceed hysterics, and all their dreadful consequences. On the other hand, food that is too dry, renders the solids in a manner rigid, and the humours viscid, which disposes the body to inflammatory fevers, scurvies, and the like.

Much has been said on the ill effects of tea in diet. They are, no doubt, numerous; but they proceed rather from the imprudent use of it, than from any bad qualities in the tea itself. Tea is now the universal breakfast in this part of the world; but the morning is surely the most improper time of the day for drinking it. Most delicate persons, who, by the bye, are the greatest tea-drinkers, cannot eat any thing in the morning. If such persons, after fasting ten or twelve hours, drink four or five cups of tea without eating almost any bread, it must hurt them. Good tea, taken in moderate quantity, not too strong, nor too hot, nor drank upon an empty stomach, will seldom do harm; but if it be bad, which is often the case, or substituted in the room of solid food, it must have many ill effects.

The arts of cookery render many things unwholesome, which are not so in their own nature. By jumbling together a number of different ingredients, in order to make a poignant sauce or rich soup, the composition proves almost a poison. All high seasoning, pickles, &c. are only incentives to luxury, and never fail to hurt the stomach. It were well for mankind, if cookery, as an art, were entirely prohibited. Plain roasting or boiling is all that the stomach requires. These alone are sufficient for people in health, and the sick have still less need of a cook.

The liquid part of our aliment likewise claims our attention. Water is not only the basis of most liquors, but also composes a great part of our solid food. Good water must therefore be of the greatest importance in diet. The best water is that which is most pure, and free from any mixture of foreign bodies. Water takes up parts of most bodies with which it comes into contact; by this means it is often impregnated with metals or minerals of a hurtful or poisonous nature. Hence the inhabitants of some hilly countries have peculiar diseases, which in all probability proceed from the water. Thus the people who live near the Alps in Switzerland, and the inhabitants of the Peak of Derby in England, have large tumours or wens on their necks. This disease is generally imputed to the snow water; but there is more reason to believe it is owing to the minerals in the mountains through which the waters pass.

When water is impregnated with foreign bodies, it generally appears by its weight, colour, taste, smell, heat, or some other sensible quality. Our business therefore is to chuse such water, for common use, as is lightest, and without any particular colour, taste, or smell. In most places of Britain the inhabitants have it in their power to make choice of their water; and few things would contribute more to health than a due attention to this article. But mere indolence often induces people to make use of the water that is nearest to them, without considering its qualities.

Before water is brought into great towns, the strictest attention ought to be paid to its qualities, as many diseases may be occasioned or aggravated by bad water; and when once it has been procured at a great expence, people are unwilling to give it up.

The common methods of rendering water clear by filtration, or soft, by exposing it to the sun and air, &c. are so generally known, that it is unnecessary to spend time in explaining them. We shall only, in general, advise all to avoid waters which stagnate long in small lakes, ponds, or the like, as such waters often become putrid, by the corruption of animal and vegetable bodies with which they abound. Even cattle frequently suffer by drinking, in dry seasons, water which has stood long in small reservoirs, without being supplied by springs, or freshened with showers. All wells ought to be kept clean, and to have a free communication with the air.

As fermented liquors, notwithstanding they have been exclaimed against by many writers, still continue to be the common drink of almost every person who can afford them; we shall rather endeavour to assist people in the choice of these liquors, than pretend to condemn what custom has so firmly established. It is not the moderate use of sound fermented liquors which hurts mankind: it is excess, and using such as are ill prepared or vitiated.

Fermented liquors, which are too strong, hurt digestion; and the body is so far from being strengthened by them, that it is weakened and relaxed. Many imagine that hard labour could not be supported without drinking strong liquors: this is a very erroneous notion. Men who never taste strong liquors are not only able to endure more fatigue, but also live much longer, than those who use them daily. But, suppose strong liquors did enable a man to do more work, they must nevertheless waste the powers of life, and occasion premature old age. They keep up a constant fever, which exhausts the spirits, inflames the blood, and disposes the body to numberless diseases.

But fermented liquors may be too weak as well as too strong: when that is the case, they must either be drank new, or they become sour and dead: when such liquors are drank new, the fermentation not being over, they generate air in the bowels, and occasion flatulencies; and, when kept till stale, they turn sour on the stomach, and hurt digestion. For this reason all malt liquors, cider, &c. ought to be of such strength as to keep till they be ripe, and then they should be used. When such liquors are kept too long, though they should not become sour, yet they generally contract a hardness, which renders them unwholesome.

All families, who can, ought to prepare their own liquors. Since preparing and vending of liquors became one of the most general branches of business, every method has been tried to adulterate them. The great object both to the makers and venders of liquor is, to render it intoxicating, and give it the appearance of age. But it is well known that this may be done by other ingredients than those which ought to be used for making it strong. It would be imprudent even to name those things which are daily made use of to render liquors heady. Suffice it to say, that the practice is very common, and that all the ingredients used for this purpose are of a narcotic or stupefactive quality. But as all opiates are poisonous, it is easy to see what must be the consequence of their general use. Though they do not kill suddenly, yet they hurt the nerves, relax and weaken the stomach, and spoil the digestion.

Were fermented liquors faithfully prepared, kept to a proper age, and used in moderation, they would prove real blessings to mankind. But, while they are ill prepared, various ways adulterated, and taken to excess, they must have many pernicious effects.

We would recommend it to families, not only to prepare their own liquors, but likewise their bread. Bread is so necessary a part of diet, that too much care cannot be bestowed in order to have it sound and wholesome. For this purpose, it is not only necessary that it be made of good grain, but likewise properly prepared, and kept free from all unwholesome ingredients. This, however, we have reason to believe is not always the case with bread prepared by those who make a trade of vending it. Their object is rather to please the eye, than to consult the health. The best bread is that which is neither too coarse nor too fine; well fermented and made of wheat flour, or rather of wheat and rye mixed together.

To specify the different kinds of aliment, to explain their nature and properties, and to point out their effects in different constitutions, would far exceed the limits of our design. Instead of a detail of this kind, which would not be generally understood, and of course little attended to, we shall only mention the following easy rules with respect to the choice of aliment.

Persons, whose solids are weak and relaxed, ought to avoid all viscid food, or such things as are hard of digestion. Their diet, however, ought to be nourishing; and they should take sufficient exercise in the open air.

Such as abound with blood should be sparing in the use of every thing that is highly nourishing, as fat meat, rich wines, strong ale, and such like. Their food should consist chiefly of bread and other vegetable substances; and their drink ought to be water, whey, or small beer.

Fat people should not eat freely of oily nourishing diet. They ought frequently to use raddish, garlic, spices, or such things as are heating and promote perspiration and urine. Their drink should be water, coffee, tea, or the like; and they ought to take much exercise and little sleep.

Those who are too lean must follow an opposite course.

Such as are troubled with acidities, or whose food is apt to sour on the stomach, should live much on animal food; and those who are afflicted with hot alkaline eructations, ought to use a diet consisting chiefly of acid vegetables.

People who are affected with the gout, low spirits, hypochondriac or hysteric disorders, ought to avoid all flatulent food, every thing that is viscid, or hard of digestion, all salted or smoke-dried provisions, and whatever is austere, acid, or apt to turn sour on the stomach. Their food should be light, spare, cool, and of an opening nature.

The diet ought not only to be suited to the age and constitution, but also to the manner of life: a sedentary or studious person should live more sparingly than one who labours hard without doors. Many kinds of food will nourish a peasant very well which would be almost indigestible to a citizen; and the latter will live upon a diet on which the former would starve.

Diet ought not to be too uniform. The constant use of one kind of food might have some bad effects. Nature teaches us this, by the great variety of aliment which she has provided for man, and likewise by giving him an appetite for different kinds of food.

Those who labour under any particular disease, ought to avoid such aliments as have a tendency to increase it: for example, a gouty person should not indulge in rich wines, strong soups, or gravies, and should avoid all acids. One who is troubled with the gravel ought to shun all austere and astringent aliments; and those who are scorbutic should be sparing in the use of salted provisions, &c.

In the first period of life, our food ought to be light, but nourishing, and frequently taken. Food that is solid, with a sufficient degree of tenacity, is most proper for the state of manhood. The diet suited to the last period of life, when nature is upon the decline, approaches nearly to that of the first. It should be lighter and more succulent than that of vigorous age, and likewise more frequently taken.

It is not only necessary for health that our diet be wholesome, but also that it be taken at regular periods. Some imagine long fasting will atone for excess; but this, instead of mending the matter, generally makes it worse. When the stomach and intestines are over-distended with food, they lose their proper tone, and, by long fasting, they become weak, and inflated with wind. Thus, either gluttony or fasting destroys the powers of digestion.

The frequent repetition of aliment is not only necessary for repairing the continual waste of our bodies, but likewise to keep the fluids sound and sweet. Our humours, even in the most healthy state, have a constant tendency to putrefaction, which can only be prevented by frequent supplies of fresh nourishment: when that is wanting too long, the putrefaction often proceeds so far as to occasion very dangerous fevers. From hence we may learn the necessity of regular meals. No person can enjoy a good state of health, whose vessels are either frequently overcharged, or the humours long deprived of fresh supplies of chyle.

Long fasting is extremely hurtful to young people; it not only vitiates their humours, but prevents their growth. Nor is it less injurious to the aged. Most persons, in the decline of life, are afflicted with wind: this complaint is not only increased, but even rendered dangerous, and often fatal, by long fasting. Old people, when their stomachs are empty, are frequently seized with giddiness, head-achs, and faintness. These complaints may generally be removed by a piece of bread and a glass of wine, or taking any other solid food; which plainly points out the method of preventing them.

It is more than probable, that many of the sudden deaths, which happen in the advanced periods of life, are occasioned by fasting too long, as it exhausts the spirits, and fills the bowels with wind; we would therefore advise people, in the decline of life, never to allow their stomachs to be too long empty. Many people take nothing but a few cups of tea and a little bread, from nine o’clock at night till two or three next afternoon. Such may be said to fast almost three-fourths of their time. This can hardly fail to ruin the appetite, vitiate the humours, and fill the bowels with wind; all which might be prevented by a solid breakfast.

It is a very common practice to eat a light breakfast and a heavy supper. This custom ought to be reversed. When people sup late, their supper should be very light; but the breakfast ought always to be solid. If any one eats a light supper, goes soon to bed, and rises betimes in the morning, he will be sure to find an appetite for his breakfast, and he may freely indulge it.

The strong and healthy do not indeed suffer so much from fasting as the weak and delicate; but they run great hazard from its opposite, viz. repletion. Many diseases, especially fevers, are the effect of a plethora, or too great fulness of the vessels. Strong people, in high health, have generally a great quantity of blood and other humours. When these are suddenly increased, by an overcharge of rich and nourishing diet, the vessels become too much distended, and obstructions and inflammations ensue. Hence so many people are seized with inflammatory and eruptive fevers after a feast or debauch.

All great and sudden changes in diet are dangerous. What the stomach has been long accustomed to digest, though less wholesome, will agree better with it than food of a more salutary nature which it has not been used to. When therefore a change becomes necessary, it ought always to be made gradually; a sudden transition from a poor and low, to a rich and luxurious diet, or the contrary, might so disturb the functions of the body as to endanger health, or even to occasion death itself.

When we recommend regularity in diet, we would not be understood as condemning every small deviation from it. It is next to impossible for people at all times to avoid some degree of excess, and living too much by rule might make even the smallest deviation dangerous. It may therefore be prudent to vary a little, sometimes taking more, sometimes less, than the usual quantity of meat and drink, provided always that a due regard be had to moderation.

CHAP. IV.
OF AIR.

Unwholesome air is a very common cause of diseases. Few are aware of the danger arising from it. People generally pay some attention to what they eat and drink, but seldom regard what goes into the lungs, though the latter proves often more suddenly fatal than the former.

Air, as well as water, takes up parts of most bodies with which it comes in contact, and is often so replenished with those of a noxious quality, as to occasion immediate death. But such violent effects seldom happen, as people are generally on their guard against them. The less perceptible influences of bad air prove more generally hurtful to mankind; we shall therefore endeavour to point out some of these, and to shew from whence the danger chiefly arises.

Air may become noxious many ways. Whatever greatly alters its degree of heat, cold, moisture, &c. renders it unwholesome: for example, that which is too hot dissipates the watry parts of the blood, exalts the bile, and renders the whole humour adust and thick. Hence proceed bilious and inflammatory fevers, cholera morbus, &c. Very cold air obstructs the perspiration, constringes the solids, and condenses the fluids. It occasions rheumatisms, coughs, and catarrhs, with other diseases of the throat and breast. Air that is too moist destroys the elasticity or spring of the solids, induces phlegmatic or lax constitutions, and disposes the body to agues, or intermitting fevers, dropsies, &c.

Wherever great numbers of people are crowded into one place, if the air has not a free circulation, it soon becomes unwholesome. Hence it is that delicate persons are so apt to turn sick or faint in crowded churches, assemblies, or any place where the air is injured by breathing, fires, candles, or the like.

In great cities so many things tend to contaminate the air, that it is no wonder it proves so fatal to the inhabitants. The air in cities is not only breathed repeatedly over, but is likewise loaded with sulphur, smoke, and other exhalations, besides the vapours continually arising from innumerable putrid substances, as dunghills, slaughterhouses, &c. All possible care should be taken to keep the streets of large towns open and wide, that the air may have a free current through them. They ought likewise to be kept very clean. Nothing tends more to pollute and contaminate the air of a city than dirty streets.

It is very common in this country to have church-yards in the middle of populous cities. Whether this be the effect of ancient superstition, or owing to the increase of such towns, is a matter of no consequence. Whatever gave rise to the custom, it is a bad one. It is habit alone which reconciles us to these things; by means of which the most ridiculous, nay pernicious customs, often become sacred. Certain it is, that thousands of putrid carcasses, so near the surface of the earth, in a place where the air is confined, cannot fail to taint it; and that such air, when breathed into the lungs, must occasion diseases[^[28]].

Burying within churches is a practice still more detestable. The air in churches is seldom good, and the effluvia from putrid carcasses must render it still worse. Churches are commonly old buildings with arched roofs. They are seldom open above once a week, are never ventilated by fires nor open windows, and rarely kept clean. This occasions that damp, musty, unwholesome smell which one feels upon entering a church, and renders it a very unsafe place for the weak and valetudinary. These inconveniences might, in a great measure, be obviated, by prohibiting all persons from burying within churches, by keeping them clean, and permitting a stream of fresh air to pass frequently through them, by opening opposite doors and windows[^[29]].

Wherever air stagnates long, it becomes unwholesome. Hence the unhappy persons confined in jails not only contract malignant fevers themselves, but often communicate them to others. Nor are many of the holes, for we cannot call them houses, possessed by the poor in great towns, much better than jails. These low dirty habitations are the very lurking-places of bad air and contagious diseases. Such as live in them seldom enjoy good health; and their children commonly die young. In the choice of a house, those who have it in their power ought always to pay the greatest attention to open free air.

The various methods which luxury has invented to make houses close and warm, contribute not a little to render them unwholesome. No house can be wholesome unless the air has a free passage through it. For which reason houses ought daily to be ventilated, by opening opposite windows, and admitting a current of fresh air into every room. Beds, instead of being made up as soon as people rise out of them, ought to be turned down, and exposed to the fresh air from the open windows through the day. This would expel any noxious vapour, and could not fail to promote the health of the inhabitants.

In hospitals, jails, ships, &c. where that cannot be conveniently done, ventilators should be used. The method of expelling foul, and introducing fresh air, by means of ventilators, is a most salutary invention, and is indeed the most useful of all our modern medical improvements. It is capable of universal application, and is fraught with numerous advantages, both to those in health and sickness. In all places, where numbers of people are crowded together, ventilation becomes absolutely necessary.

Air which stagnates in mines, wells, cellars, &c. is extremely noxious. That kind of air is to be avoided as the most deadly poison. It often kills almost as quickly as lightning. For this reason, people should be very cautious in opening cellars that have been long shut, or going down into deep wells or pits, especially if they have been kept close covered[^[30]].

Many people who have splendid houses, chuse to sleep in small apartments. This conduct is very imprudent. A bed-chamber ought always to be well-aired; as it is generally occupied in the night only, when all doors and windows are shut. If a fire be kept in it, the danger from a small room becomes still greater. Numbers have been stifled when asleep by a fire in a small apartment, which is always hurtful.

Those who are obliged, on account of business, to spend the day in close towns, ought, if possible, to sleep in the country. Breathing free air in the night will, in some measure, make up for the want of it through the day. This practice would have a greater effect in preserving the health of citizens than is commonly imagined.

Delicate persons ought, as much as possible, to avoid the air of great towns. It is peculiarly hurtful to the asthmatic and consumptive. Such persons should avoid cities as they would the plague. The hypochondriac are likewise much hurt by it. I have often seen persons so much afflicted with this malady while in town, that it seemed impossible for them to live, who, upon being removed to the country, were immediately relieved. The same observation holds with regard to nervous and hysteric women. Many people, indeed, have it not in their power to change their situation in quest of better air. All we can say to such persons is, that they should go as often abroad into the open air as they can, that they should admit fresh air frequently into their houses, and take care to keep them very clean.

It was necessary in former times, for safety, to surround cities, colleges, and even single houses, with high walls. These, by obstructing the free current of air, never fail to render such places damp and unwholesome. As such walls are now, in most parts of this country, become useless, they ought to be pulled down, and every method taken to admit a free passage to the air. Proper attention to Air and Cleanliness would tend more to preserve the health of mankind, than all the endeavours of the faculty.

Surrounding houses too closely with planting, or thick woods, likewise tends to render the air unwholesome. Wood not only obstructs the free current of the air, but sends forth great quantities of moist exhalations, which render it constantly damp. Wood is very agreeable at a proper distance from a house, but should never be planted too near it, especially in a flat country. Many of the gentlemen’s seats in England are rendered very unwholesome from the great quantity of wood which surrounds them.

Houses situated in low marshy countries, or near large lakes of stagnating water, are likewise unwholesome. Waters which stagnate not only render the air damp, but load it with putrid exhalations, which produce the most dangerous and fatal diseases. Those who are obliged to inhabit marshy countries, ought to make choice of the dryest situations they can find, to live generously, and to pay the strictest regard to cleanliness.

If fresh air be necessary for those in health, it is still more so for the sick, who often lose their lives for want of it. The notion that sick people must be kept very hot, is so common, that one can hardly enter the chamber where a patient lies, without being ready to faint, by reason of the hot suffocating smell. How this must affect the sick any one may judge. No medicine is so beneficial to the sick as fresh air. It is the most reviving of all cordials, if it be administered with prudence. We are not, however, to throw open doors and windows at random upon the sick. Fresh air is to be let into the chamber gradually, and, if possible, by opening the windows of some other apartment.

The air of a sick person’s chamber may be greatly freshened, and the patient much revived, by sprinkling the floor, bed, &c. frequently with vinegar, juice of lemon, or any other strong vegetable acid.

In places where numbers of sick are crowded into the same house, or, which is often the case, into the same apartment, the frequent admission of fresh air becomes absolutely necessary. Infirmaries, hospitals, &c. are often rendered so noxious, for want of proper ventilation, that the sick run more hazard from them than from the disease. This is particularly the case when putrid fevers, dysenteries, and other infectious diseases prevail.

Physicians, surgeons, and others who attend hospitals, ought, for their own safety, to take care that they be properly ventilated. Such persons as are obliged to spend most of their time amongst the sick, run great hazard of being themselves infected when the air is bad. All hospitals, and places of reception for the sick, ought to have an open situation, at some distance from any great town, and such patients as labour under any infectious disease ought never to be suffered to come near the rest[^[31]].

CHAP. V.
OF EXERCISE.

Many people look upon the necessity man is under of earning his bread by labour, as a curse. Be this as it may, it is evident from the structure of the body, that exercise is not less necessary than food for the preservation of health: those whom poverty obliges to labour for daily bread, are not only the most healthy, but generally the most happy part of mankind. Industry seldom fails to place them above want, and activity serves them instead of physic. This is peculiarly the case with those who live by the culture of the ground. The great increase of inhabitants in infant colonies, and the longevity of such as follow agriculture every where, evidently prove it to be the most healthful as well as the most useful employment.

The love of activity shews itself very early in man. So strong is this principle, that a healthy youth cannot be restrained from exercise, even by the fear of punishment. Our love of motion is surely a strong proof of its utility. Nature implants no disposition in vain. It seems to be a catholic law throughout the whole animal creation, that no creature, without exercise, should enjoy health, or be able to find subsistence. Every creature, except man, takes as much of it as is necessary. He alone, and such animals as are under his direction, deviate from this original law, and they suffer accordingly.

Inactivity never fails to induce an universal relaxation of the solids, which disposes the body to innumerable diseases. When the solids are relaxed, neither the digestion, nor any of the secretions, can be duly performed. In this case, the worst consequences must ensue. How can persons who loll all day in easy chairs, and sleep all night on beds of down, fail to be relaxed? Nor do such greatly mend the matter, who never stir abroad but in a coach, sedan, or such like. These elegant pieces of luxury are become so common, that the inhabitants of great towns seem to be in some danger of losing the use of their limbs altogether. It is now below any one to walk, who can afford to be carried. How ridiculous would it seem, to a person unacquainted with modern luxury, to behold the young and healthy swinging along on the shoulders of their fellow-creatures! or to see a fat carcase, over-run with diseases occasioned by inactivity, dragged through the streets by half a dozen horses[^[32]]!

Glandular obstructions, now so common, generally proceed from inactivity. These are the most obstinate of maladies. So long as the liver, kidnies, and other glands, duly perform their functions, health is seldom impaired; but, when they fail, nothing can restore it. Exercise is almost the only cure we know for glandular obstructions; indeed, it does not always succeed as a remedy; but there is reason to believe that it would seldom fail to prevent these complaints, were it used in due time. One thing is certain, that, amongst those who take sufficient exercise, glandular diseases are very little known; whereas the indolent and inactive are seldom free from them.

Weak nerves are the constant companions of inactivity. Nothing but exercise and open air can brace and strengthen the nerves, or prevent the endless train of diseases which proceed from a relaxed state of these organs. We seldom hear the active or laborious complain of nervous diseases; these are reserved for the sons of ease and affluence. Many have been completely cured of these disorders by being reduced, from a stare of opulence, to labour for their daily bread. This plainly points out the sources from whence nervous diseases flow, and the means by which they may be prevented.

It is absolutely impossible to enjoy health, where the perspiration is not duly carried on; but that can never be the case where exercise is neglected. When the matter which ought to be thrown off by perspiration is retained in the body, it vitiates the humours, and occasions the gout, fevers, rheumatism, &c. Exercise alone would prevent many of those diseases which cannot be cured, and would remove others where medicine proves ineffectual.

A late author[^[33]], in his excellent treatise on health, says, that the weak and valetudinary ought to make exercise a part of their religion. We would recommend this, not only to the weak and valetudinary, but to all whose business does not oblige them to take sufficient exercise, as sedentary artificers[^[34]], shop-keepers, studious persons, &c. Such ought to use exercise as regularly as they take food. This might generally be done without any interruption to business or real loss of time.

No piece of indolence hurts the health more than the modern custom of lying a-bed too long in a morning. This is the general practice in great towns. The inhabitants of cities seldom rise before eight or nine o’clock; but the morning is undoubtedly the best time for exercise, while the stomach is empty, and the body refreshed with sleep. Besides, the morning air braces and strengthens the nerves, and, in some measure, answers the purpose of a cold bath. Let any one who has been accustomed to lie a-bed till eight or nine o’clock, rise by six or seven, spend a couple of hours in walking, riding, or any active diversion without doors, and he will find his spirits cheerful and serene through the day, his appetite keen, and his body braced and strengthened. Custom soon renders early rising agreeable, and nothing contributes more to the preservation of health.

The inactive are continually complaining of pains of the stomach, flatulencies, indigestions, &c. These complaints, which pave the way to many others, are not to be removed by medicines. They can only be cured by a vigorous course of exercise, to which indeed they seldom fail to yield.

Exercise, if possible, ought always to be taken in the open air. When that cannot be done, various methods may be contrived for exercising the body within doors, as the dumb bell, dancing, fencing, &c. It is not necessary to adhere strictly to any particular kind of exercise. The best way is to take them by turns, and to use that longest which is most suitable to the strength and constitution. Those kinds of exercise which give action to most of the bodily organs, are always to be preferred, as walking, running, riding, digging, swimming, and such like.

It is much to be regretted, that active and manly diversions are now so little practised. Diversions make people take more exercise than they otherwise would do, and are of the greatest service to such as are not under the necessity of labouring for their bread. As active diversions lose ground, those of a sedentary kind seem to prevail. Sedentary diversions are of no other use but to consume time. Instead of relieving the mind, they often require more thought than either study or business. Every thing that induces people to sit still, unless it be some necessary employment, ought to be avoided.

The diversions which afford the best exercise are, hunting, shooting, playing at cricket, handball, golf[^[35]], &c. These exercise the limbs, promote perspiration, and the other secretions. They likewise strengthen the lungs, and give firmness and agility to the whole body.

Such as can, ought to spend two or three hours a-day on horseback; those who cannot ride, should employ the same time in walking. Exercise should never be continued too long. Over-fatigue prevents the benefit of exercise, and instead of strengthening the body tends to weaken it.

Every man should lay himself under some sort of necessity to take exercise. Indolence, like other vices when indulged, gains ground, and at length becomes agreeable. Hence many who were fond of exercise in the early part of life, become quite averse from it afterwards. This is the case of most hypochondriac and gouty people, which renders their diseases in a great measure incurable.

In some countries laws have been made, obliging every man, of whatever rank, to learn some mechanical employment. Whether such laws were designed for the preservation of health, or the encouragement of manufacture, is a question of no importance, Certain it is, that if gentlemen were frequently to amuse and exercise themselves in this way, it might have many good effects. They would at least derive as much honour from a few masterly specimens of their own workmanship, as from the character of having ruined most of their companions by gaming or drinking. Besides, men of leisure, by applying themselves to the mechanical arts, might improve them, to the great benefit of society.

Indolence not only occasions diseases, and renders men useless to society, but promotes all manner of vice. To say a man is idle, is little better than to call him vicious. The mind, if not engaged in some useful pursuit, is constantly in quest of ideal pleasures, or impressed with the apprehension of some imaginary evil. From these sources proceed most of the miseries of mankind. Certainly man was never intended to be idle. Inactivity frustrates the very design of his creation; whereas an active life is the best guardian of virtue, and the greatest preservative of health.

CHAP. VI.
OF SLEEP AND CLOTHING.

Sleep, as well as diet, ought to be duly regulated. Too little sleep weakens the nerves, exhausts the spirits, and occasions diseases; and too much renders the mind dull, the body gross, and disposes to apoplexies, lethargies, and other complaints of a similar nature. A medium ought therefore to be observed; but this is not easy to fix. Children require more sleep than grown persons, the laborious than the idle, and such as eat and drink freely, than those who live abstemiously. Besides, the real quantity of sleep cannot be measured by time; as one person will be more refreshed by five or six hours sleep, than another by eight or ten.

Children may always be allowed to take as much sleep as they please; but, for adults, six or seven hours is certainly sufficient, and no one ought to exceed eight. Those who lie a-bed more than eight hours may slumber, but they can hardly be said to sleep; such generally toss and dream away the fore-part of the night, sink to rest towards morning, and dose till noon. The best way to make sleep sound and refreshing is to rise betimes. The custom of lying a-bed for nine or ten hours, not only makes the sleep less refreshing, but relaxes the solids, and greatly weakens the constitution.

Nature points out night as the proper season for sleep. Nothing more certainly destroys the constitution than night-watching. It is great pity that a practice so destructive to health should be so much in fashion. How quickly the want of rest in due season will blast the most blooming complexion, or ruin the best constitution, is evident from the ghastly countenances of those who, as the phrase is, turn day into night, and night into day.

To make sleep refreshing, the following things are requisite: First, to take sufficient exercise in the open air; to avoid strong tea or coffee; next, to eat a light supper; and lastly, to lie down with a mind as cheerful and serene as possible.

It is certain that too much exercise will prevent sleep, as well as too little. We seldom however hear the active and laborious complain of restless nights. It is the indolent and slothful who generally have these complaints. Is it any wonder that a bed of down should not be refreshing to a person who sits all day in an easy chair? A great part of the pleasure of life consists in alternate rest and motion; but they who neglect the latter can never relish the former. The labourer enjoys more true luxury in plain food and sound sleep, than is to be found in sumptuous tables and downy pillows, where exercise is wanting.

That light suppers cause sound sleep, is true even to a proverb. Many persons, if they exceed the least at that meal, are sure to have uneasy nights; and, if they fall asleep, the load and oppression on their stomach and spirits occasion frightful dreams, broken and disturbed repose, the night-mare, &c. Were the same persons to go to bed with a light supper, or sit up till that meal was pretty well digested, they would enjoy sound sleep, and rise refreshed and cheerful. There are indeed some people who cannot sleep unless they have eat some solid food at night, but this does not imply the necessity of a heavy supper; besides, these are generally persons who have accustomed themselves to this method, and who do not take a sufficient quantity of solid food and exercise.

Nothing more certainly disturbs our repose than anxiety. When the mind is not at ease, one seldom enjoys sound sleep. The greatest of human blessings flies the wretched, and visits the happy, the cheerful, and the gay. This is a sufficient reason why every man should endeavour to be as easy in his mind as possible when he goes to rest. Many, by indulging grief and anxious thought, have banished sound sleep so long, that they could never afterwards enjoy it.

Sleep, when taken in the fore-part of the night, is generally reckoned most refreshing. Whether this be the effect of habit or not, is hard to say; but as most people are accustomed to go early to bed when young, it may be presumed that sleep, at this season, will prove most refreshing to them ever after. Whether the fore-part of the night be best for sleep or not, surely the fore-part of the day is fitted both for business and amusement. I hardly ever knew an early riser who did not enjoy a good state of health[^[36]].

Of Clothing.

The clothing ought to be suited to the climate. Custom has no doubt a very great influence in this article; but no custom can ever change the nature of things so far, as to render the same clothing fit for an inhabitant of Nova Zembla and the island of Jamaica. It is not indeed necessary to observe an exact proportion between the quantity of clothes we wear, and the degree of latitude which we inhabit; but, at the same time, proper attention ought to be paid to it, as well as to the openness of the country, the frequency and violence of storms, &c.

In youth, while the blood is hot and the perspiration free, it is less necessary to cover the body with a great quantity of clothes; but, in the decline of life, when the skin becomes rigid and the humours more cool, the clothing should be increased. Many diseases in the latter period of life proceed from a defect of perspiration: these may, in some measure, be prevented by a suitable addition to the clothing, or by wearing such as are better calculated for promoting the discharge from the skin, as clothes made of cotton, flannel, &c.

The clothing ought likewise to be suited to the season of the year. Clothing may be warm enough for summer, which is by no means sufficient for winter. The greatest caution, however, is necessary in making these changes. We ought neither to put off our winter clothes too soon, nor to wear our summer ones too long. In this country, the winter often sets in very early with great rigour, and we have frequently cold weather even after the commencement of the summer months. It would likewise be prudent not to make the change all at once, but to do it gradually; and indeed the changes of apparel in this climate ought to be very inconsiderable, especially among those who have passed the meridian of life[^[37]].

Clothes often become hurtful by their being made subservient to the purposes of pride or vanity. Mankind in all ages seem to have considered clothes in this view; accordingly their fashion and figure have been continually varying, with very little regard either to health, the climate, or conveniency: a farthingale, for example, may be very necessary in hot southern climates, but surely nothing can be more ridiculous in the cold regions of the north.

Even the human shape is often attempted to be mended by dress, and those who know no better believe that mankind would be monsters without its assistance. All attempts of this nature are highly pernicious. The most destructive of them in this country is that of squeezing the stomach and bowels into as narrow a compass as possible, to procure, what is falsely called, a fine shape[^[38]]. By this practice the action of the stomach and bowels, the motion of the heart and lungs, and almost all the vital functions, are obstructed. Hence proceed indigestions, syncopes, or fainting fits, coughs, consumptions of the lungs, and other complaints so common among females.

The feet likewise often suffer by pressure. How a small foot came to be reckoned genteel, I will not pretend to say; but certain it is, that this notion has made many persons lame. Almost nine-tenths of mankind are troubled with corns: a disease that is seldom or never occasioned but by strait shoes. Corns are not only very troublesome, but by rendering people unable to walk, they may likewise be considered as the remote cause of other diseases[^[39]].

The size and figure of the shoe ought certainly to be adapted to the foot. In children the feet are as well shaped as the hands, and the motion of the toes as free and easy as that of the fingers; yet few persons in the advanced periods of life are able to make any use of their toes. They are generally, by narrow shoes, squeezed all of a heap, and often laid over one another in such a manner as to be rendered altogether incapable of motion. Nor is the high heel less hurtful than the narrow toe. A lady may seem taller for walking on her tiptoes, but she will never walk well in this manner. It strains her joints, distorts her limbs, makes her stoop, and utterly destroys all her ease and gracefulness of motion: it is entirely owing to shoes with high heels and narrow toes, that not one female in ten can be said to walk well.

In fixing on the clothes, due care should be taken to avoid all tight bandages. Garters, buckles, &c. when drawn too tight, not only prevent the free motion and use of the parts about which they are bound, but likewise obstruct the circulation of the blood, which prevents the equal nourishment and growth of these parts, and occasions various diseases. Tight bandages about the neck, as stocks, cravats, necklaces, &c. are extremely dangerous. They obstruct the blood in its course from the brain, by which means head-achs, vertigoes, apoplexies, and other fatal diseases are often occasioned.

The perfection of dress is to be easy and clean. Nothing can be more ridiculous, than for any one to make himself a slave to fine clothes. Such a one, and many such there are, would rather remain as fixt as a statue from morning till night, than discompose a single hair or alter the position of a pin. Were we to recommend any particular pattern for dress, it would be that which is worn by the people called Quakers. They are always neat, clean, and often elegant, without any thing superfluous. What others lay out upon tawdry laces, ruffles, and ribands, they bestow upon superior cleanliness. Finery is only the affectation of dress, and very often covers a great deal of dirt.

We shall only add, with regard to clothing, that it ought not only to be suited to the climate, the season of the year, and the period of life; but likewise to the temperature and constitution. Robust persons are able to endure either cold or heat better than the delicate; consequently may be less attentive to their clothing. But the precise quantity of clothes necessary for any person cannot be determined by reasoning. It is entirely a matter of experience, and every man is the best judge for himself what quantity of clothes is necessary to keep him warm[^[40]].

CHAP. VII.
OF INTEMPERANCE.

A modern author[^[41]] observes, that temperance and exercise are the two best physicians in the world. He might have added, that if these were duly regarded, there would be little occasion for any other. Temperance may justly be called the parent of health; yet numbers of mankind act as if they thought diseases and death too slow in their progress, and by intemperance and debauch seem as it were to solicit their approach.

The danger of intemperance appears from the very construction of the human body. Health depends on that state of the solids and fluids which fits them for the due performance of the vital functions; and, while these go regularly on, we are sound and well; but whatever disturbs them necessarily impairs health. Intemperance never fails to disorder the whole animal œconomy; it hurts the digestion, relaxes the nerves, renders the different secretions irregular, vitiates the humours, and occasions numberless diseases.

The analogy between the nourishment of plants and animals affords a striking proof of the danger of intemperance. Moisture and manure greatly promote vegetation; yet an over-quantity of either will entirely destroy it. The best things become hurtful, nay destructive, when carried to excess. Hence we learn, that the highest degree of human wisdom consists in regulating our appetites and passions so as to avoid all extremes. It is that chiefly which entitles us to the character of rational beings. The slave of appetite will ever be the disgrace of human nature.

The Author of Nature hath endued us with various passions, for the propagation of the species, the preservation of the individual, &c. Intemperance is the abuse of these passions; and moderation consists in the proper regulation of them. Men, not contented with satisfying the simple calls of Nature, create artificial wants, and are perpetually in search of something that may gratify them; but imaginary wants can never be gratified. Nature is content with little; but luxury knows no bounds. Hence the epicure, the drunkard, and the debauchee, seldom stop in their career, till their money or their constitution fails: then indeed they generally see their error when too late.

It is impossible to lay down fixt rules with regard to diet, on account of the different constitutions of mankind. The most ignorant person, however, certainly knows what is meant by excess; and it is in the power of every man, if he chuses, to avoid it.

The great rule of diet is to study simplicity. Nature delights in the most plain and simple food, and every animal, except man, follows her dictates. Man alone riots at large, and ransacks the whole creation in quest of luxuries, to his own destruction. An elegant writer[^[42]] of the last age speaks thus of intemperance in diet: “For my part, when I behold a fashionable table set out in all its magnificence, I fancy that I see gouts and dropsies, fevers and lethargies, with other innumerable distempers, lying in ambuscade among the dishes.”

Nor is intemperance in other things less destructive than in diet. How quickly does the immoderate pursuit of carnal pleasures, or the abuse of intoxicating liquors, ruin the best constitution! Indeed these vices generally go hand in hand. Hence it is that we so often behold the votaries of Bacchus and Venus, even before they have arrived at the prime of life, worn out with diseases, and hasting with swift pace to an untimely grave. Did men reflect on the painful diseases, and premature deaths, which are daily occasioned by intemperance, it would be sufficient to make them shrink back with horror from the indulgence even of their darling pleasures.

Intemperance does not hurt its votaries alone; the innocent too often feel the direful effects of it. How many wretched orphans are to be seen embracing dunghills, whose parents, regardless of the future, spent in riot and debauch what might have served to bring up their offspring in a decent manner? How often do we behold the miserable mother, with her helpless infants, pining in want, while the cruel father is indulging his insatiate appetites?

Families are not only reduced to misery, but even extirpated, by intemperance. Nothing tends so much to prevent propagation, and to shorten the lives of children, as the intemperance of parents. The poor man who labours all day, and at night lies down contented with his humble fare, can boast a numerous offspring, while his pampered lord, sunk in ease and luxury, often languishes without an heir to his ample fortunes. Even states and empires feel the influence of intemperance, and rise or fall as it prevails.

Instead of mentioning the different kinds of intemperance, and pointing out their influence upon health, we shall only, by way of example, make a few observations on one particular species of that vice, viz. the abuse of intoxicating liquors.

Every act of intoxication puts Nature to the expence of a fever, in order to discharge the poisonous draught. When this is repeated almost every day, it is easy to foresee the consequences. That constitution must be strong indeed, which is able long to hold out under a daily fever! but fevers occasioned by drinking do not always go off in a day; they frequently end in an inflammation of the breast, liver, or brain, and produce fatal effects.

Though the drunkard should not fall by an acute disease, he seldom escapes those of a chronic kind. Intoxicating liquors, when used to excess, weaken the bowels and spoil the digestion; they destroy the power of the nerves, and occasion paralytic and convulsive disorders; they likewise heat and inflame the blood, destroy its balsamic quality, render it unfit for circulation, and the nourishment of the body. Hence obstructions, atrophies, dropsies, and consumptions of the lungs. These are the common ways in which drunkards make their exit. Diseases of this kind, when brought on by hard drinking, seldom admit of a cure.

Many people injure their health by drinking, who seldom get drunk. The continual habit of soaking, as it is called, though its effects be not so violent, is not less pernicious. When the vessels are kept constantly full and upon the stretch, the different digestions can neither be duly performed, nor the humours properly prepared. Hence most people of this character are afflicted with the gout, the gravel, ulcerous sores in the legs, &c. If these disorders do not appear, they are seized with low spirits, hypochondriacal affections, and other symptoms of indigestion.

Consumptions are now so common, that it is thought one-tenth of the inhabitants of great towns die of that disease. Hard drinking is no doubt one of the causes to which we must impute the increase of consumptions. The great quantities of viscid malt liquor drank by the common people of England, cannot fail to render the blood sizy and unfit for circulation; from whence proceed obstructions, and inflammations of the lungs. There are few great ale-drinkers who are not phthisical: nor is that to be wondered at, considering the glutinous and almost indigestible nature of strong ale.

Those who drink ardent spirits or strong wines run still greater hazard; these liquors heat and inflame the blood, and tear the tender vessels of the lungs to pieces; yet so great is the consumption of them in this country, that one would almost be induced to think that the inhabitants lived upon them[^[43]].

The habit of drinking proceeds frequently from misfortunes in life. The miserable fly to it for relief. It affords them indeed a temporary ease. But, alas! this solace is short-lived; and when it is over, the spirits sink as much below their usual tone as they had before been raised above it. Hence a repetition of the dose becomes necessary, and every fresh dose makes way for another, till the unhappy wretch becomes a slave to the bottle, and at length falls a sacrifice to what at first perhaps was taken only as a medicine. No man is so dejected as the drunkard when his debauch is gone off. Hence it is, that those who have the greatest flow of spirits while the glass circulates freely, are of all others the most melancholy when sober, and often put an end to their own miserable existence in a fit of spleen or ill humour.

Drunkenness not only proves destructive to health, but likewise to the faculties of the mind. It is strange that creatures who value themselves on account of a superior degree of reason to that of brutes, should take pleasure in sinking so far below them. Were such as voluntarily deprive themselves of the use of reason, to continue ever after in that condition, it would seem but a just punishment. Though this be not the consequence of one act of intoxication, it seldom fails to succeed a course of it. By a habit of drinking, the greatest genius is often reduced to a mere idiot[^[44]].

Intoxication is peculiarly hurtful to young persons. It heats their blood, impairs their strength, and obstructs their growth; besides, the frequent use of strong liquors in the early part of life destroys any benefit that might arise from them afterwards. Those who make a practice of drinking generous liquors when young, cannot expert to reap any benefit from them as a cordial in the decline of life.

Drunkenness is not only in itself a most abominable vice, but is an inducement to many others. There is hardly any crime so horrid that the drunkard will not perpetrate for the love of liquor. We have known mothers sell their children’s clothes, the food that they should have eat, and afterwards even the infants themselves, in order to purchase the accursed draught.

CHAP. VIII.
OF CLEANLINESS.

The want of cleanliness is a fault which admits of no excuse. Where water can be had for nothing, it is surely in the power of every person to be clean. The continual discharge from our bodies by perspiration, renders frequent change of apparel necessary. Changing apparel greatly promotes the secretion from the skin, so necessary for health. When that matter which ought to be carried off by perspiration, is either retained in the body, or resorbed from dirty clothes, it must occasion diseases.

Diseases of the skin are chiefly owing to want of cleanliness[^[45]]. They may indeed be caught by infection, or brought on by poor living, unwholesome food, &c. but they will seldom continue long where cleanliness prevails. To the same cause must we impute the various kinds of vermin which infest the human body, houses, &c. These may always be banished by cleanliness alone, and wherever they abound, we have reason to believe it is neglected.

One common cause of putrid and malignant fevers, is the want of cleanliness. These fevers commonly begin among the inhabitants of close dirty houses, who breathe unwholesome air, take little exercise, and wear dirty clothes. There the infection is generally hatched, which often spreads far and wide, to the destruction of many. Hence cleanliness may be considered as an object of public attention. It is not sufficient that I be clean myself, while the want of it in my neighbour affects my health as well as his own. If dirty people cannot be removed as a common nuisance, they ought at least to be avoided as infectious. All who regard their health should keep at a distance even from their habitations.

In places where great numbers of people are collected, cleanliness becomes of the utmost importance. It is well known that infectious diseases are communicated by tainted air. Every thing, therefore, which tends to pollute the air, or spread the infection, ought with the utmost care to be guarded against. For this reason, in great towns, no filth, of any kind, should be permitted to lie upon the streets. Nothing is more apt to convey infection than the excrements of the diseased.

In many great towns the streets are little better than dunghills, being frequently covered with ashes, dung, and nastiness of every kind. Even slaughterhouses, or killing shambles, are often to be seen in the very centre of great towns. The putrid blood, excrements, &c. with which these places are generally covered, cannot fail to taint the air, and render it unwholesome. How easily might this be prevented by active magistrates, who have it always in their power to make proper laws relative to things of this nature, and to enforce the observance of them!

We are sorry to say, that the importance of general cleanliness does not seem to be sufficiently understood by the magistrates of most great towns in Britain; though health, pleasure, and delicacy, all conspire to recommend an attention to it. Nothing can be more agreeable to the senses, more to the honour of the inhabitants, or more conducive to their health, than a clean town; nor can any thing impress a stranger with a more disrespectful idea of any people than its opposite. Whatever pretensions people may make to learning, politeness, or civilization, we will venture to affirm, that while they neglect cleanliness, they are in a state of barbarity[^[46]].

The peasants in most countries seem to hold cleanliness in a sort of contempt. Were it not for the open situation of their houses, they would often feel the bad effects of this disposition. One seldom sees a farm-house without a dunghill before the door, and frequently the cattle and their masters lodge under the same roof. Peasants are likewise extremely careless with respect to change of apparel, keeping their houses, &c. clean. This is merely the effect of indolence and a dirty disposition. Habit may indeed render it less disagreeable to them, but no habit can ever make it salutary to wear dirty clothes or breathe unwholesome air.

As many articles of diet come through the hands of peasants, every method should be taken to encourage and promote habits of cleanliness among them. This, for example, might be done by giving a small premium to the person who brings the cleanest and best article of any kind to market, as butter, cheese, &c. and by punishing severely those who bring it dirty. The same method should be taken with butchers, bakers, brewers, and all who are employed in preparing the necessaries of life.

In camps the strictest regard should be paid to cleanliness. By negligence in this matter, infectious diseases are often spread amongst a whole army; and frequently more die of these than by the sword. The Jews during their encampments in the wilderness, received particular instructions with respect to cleanliness[^[47]]. The rules enjoined them ought to be observed by all in the like situation. Indeed the whole system of laws delivered to that people has a manifest tendency to promote cleanliness. Whoever considers the nature of their climate, the diseases to which they were liable, and their dirty disposition, will see the propriety of such laws.

It is remarkable that, in most eastern countries, cleanliness makes a great part of their religion. The Mahometan, as well as the Jewish religion, enjoins various bathings, washings, and purifications. No doubt these might be designed to represent inward purity; but they were at the same time calculated for the preservation of health. However whimsical these washings may appear to some, few things would tend more to prevent diseases than a proper attention to many of them. Were every person, for example, after visiting the sick, handling a dead body, or touching any thing that might convey infection, to wash before he went into company, or sat down to meat, he would run less hazard either of catching the infection himself, or of communicating it to others.

Frequent washing not only removes the filth and sordes which adhere to the skin, but likewise promotes the perspiration, braces the body, and enlivens the spirits. How refreshed, how cheerful, and agreeable does one feel on being shaved, washed, and shifted; especially when these offices have been neglected longer than usual!

The eastern custom of washing the feet, though less necessary in this country, is nevertheless a very agreeable piece of cleanliness, and contributes greatly to the preservation of health. The sweat and dirt with which these parts are frequently covered, cannot fail to obstruct the perspiration. This piece of cleanliness would often prevent colds and fevers. Were people careful to bathe their feet and legs in lukewarm water at night, after being exposed to cold or wet through the day, they would seldom experience the ill effects which often proceed from these causes.

A proper attention to cleanliness is no where more necessary than on shipboard. If epidemical distempers break out there, no one can be safe. The best way to prevent them, is to take care that the whole company be cleanly in their clothes, bedding, &c. When infectious diseases do break out, cleanliness is the most likely means to prevent their spreading; it is likewise necessary to prevent their returning afterwards, or being conveyed to other places. For this purpose, the clothes, bedding, &c. of the sick ought to be carefully washed, and fumigated with brimstone. Infection will lodge a long time in dirty clothes, and afterwards break out in the most terrible manner.

In places where great numbers of sick people are collected together, cleanliness ought to be most religiously observed. The very smell in such places is often sufficient to make one sick. It is easy to imagine what effect that is likely to have upon the diseased. In an hospital or infirmary, where cleanliness is neglected, a person in perfect health has a greater chance to become sick, than a sick person has to get well.

Few things are more unaccountable than that neglect, or rather dread of cleanliness, which appears among those who have the care of the sick; they think it almost criminal to suffer any thing that is clean to come near a person in a fever, for example, and would rather allow him to wallow in all manner of filth, than change the least bit of his linen. If cleanliness be necessary for persons in health, it is certainly more so for the sick. Many diseases may be cured by cleanliness alone; most of them might be mitigated by it; and, where it is neglected, the slightest disorders are often changed into the most malignant. The same mistaken care which prompted people to prevent the least admission of fresh air to the sick, seems to have induced them to keep them dirty. Both these destructive prejudices will, we hope, be soon entirely eradicated.

Cleanliness is certainly agreeable to our nature. We cannot help approving it in others, even though we should not practice it ourselves. It sooner attracts our regard than even finery itself, and often gains esteem where that fails. It is an ornament to the highest as well as the lowest station, and cannot be dispensed with in either. Few virtues are of more importance to society than general cleanliness. It ought to be carefully cultivated every where; but in populous cities it should be almost revered[^[48]].

CHAP. IX.
OF INFECTION.

Many diseases are infectious. Every person ought therefore, as far as he can, to avoid all communication with the diseased. The common practice of visiting the sick, though often well meant, has many ill consequences. Far be it from us to discourage any act of charity or benevolence, especially towards those in distress; but we cannot help blaming such as endanger their own or their neighbours lives by a mistaken friendship or an impertinent curiosity.

The houses of the sick, especially in the country, are generally crowded from morning till night with idle visitors. It is customary, in such places, for servants and young people to wait upon the sick by turns, and even to sit up with them all night. It would be a miracle indeed should such always escape. Experience teaches us the danger of this conduct. People often catch fevers in this way, and communicate them to others, till at length they become epidemic.

It would be thought highly improper, for one who had not had the small-pox, to wait upon a patient in that disease; yet many other fevers are almost as infectious as the small-pox, and not less fatal. Some imagine that fevers prove more fatal in villages than in great towns, for want of proper medical assistance. This may sometimes be the case; but we are inclined to think it oftener proceeds from the cause above mentioned.

Were a plan to be laid down for communicating infection, it could not be done more effectually than by the common method of visiting the sick. Such visitors not only endanger themselves and their connections, but likewise hurt the sick. By crowding the house, they render the air unwholesome, and by their private whispers and dismal countenances disturb the imagination of the patient, and depress his spirits. Persons who are ill, especially in fevers, ought to be kept as quiet as possible. The sight of strange faces, and every thing that disturbs the mind, hurts them.

The common practice in country-places of inviting great numbers of people to funerals, and crowding them into the same apartment where the corpse lies, is another way of spreading infection. The infection does not always die with the patient. Every thing that comes into contact with his body while alive, receives the contagion, and some of them, as clothes, blankets, &c. will retain it for a long time. Persons who die of infectious disorders ought not to lie long unburied; and people should keep as much as possible at a distance from them.

It would tend greatly to prevent the spreading of infectious diseases, if those in health were kept at a proper distance from the sick. The Jewish Legislator, among many other wise institutions for preserving health, has been peculiarly attentive to the means of preventing infection, or defilement as it is called, either from a diseased person or a dead body. In many cases the diseased were to be separated from those in health; and it was deemed a crime even to approach their habitations. If a person only touched a diseased or dead body, he was appointed to wash himself in water, and to keep for some time at a distance from society.

Infectious diseases are often communicated by clothes. It is extremely dangerous to wear apparel which has been worn by the deceased, unless it has been well washed and fumigated, as infection may lodge a long time in it, and afterwards produce very tragical effects. This shews the danger of buying at random the clothes which have been worn by other people.

Infectious disorders are frequently imported. Commerce, together with the riches of foreign climes, brings us also their diseases. These do often more than counterbalance all the advantages of that trade by means of which they are introduced. It is to be regretted, that so little care is commonly bestowed, either to prevent the introduction or spreading of infectious maladies. Some attention indeed is generally paid to the plague; but other diseases pass unregarded[^[49]].

Infection is often spread through cities, by jails, hospitals, &c. These are frequently situated in the very middle of populous towns; and when infectious diseases break out in them, it is impossible for the inhabitants to escape. Did magistrates pay any regard to the health of the people, this evil might be easily remedied.

Many are the causes which tend to diffuse infection through populous cities. The whole atmosphere of a large town is one contaminated mass, abounding with various kinds of infection, and must be pernicious to health. The best advice that we can give to such as are obliged to live in large cities is, to chuse an open situation; to avoid narrow, dirty, crowded streets; to keep their own house and offices clean; and to be as much abroad in the open air as their time will permit.

It would tend greatly to prevent the spreading of infectious diseases, were proper nurses every where employed to take care of the sick. This might often save a family, or even a whole town, from being infected by one person. We do not mean that people should abandon their friends or relations in distress, but only to put them on their guard against being too much in company with those who are afflicted with diseases of an infectious nature.

Such as wait upon the sick in infectious diseases run very great hazard. They should stuff their noses with tobacco, or some other strong smelling herb, as rue, tansy, or the like. They ought likewise to keep the patient very clean, to sprinkle the room where he lies with vinegar, or other strong acids, frequently to admit a stream of fresh air into it, and to avoid the smell of his breath as much as they can. They ought never to go into company without having changed their clothes and washed their hands; otherwise, if the disease be infectious, they will in all probability carry the contagion along with them[^[50]].

However trifling it may appear to inconsiderate persons, we will venture to affirm, that a due attention to those things which tend to diffuse infection would be of great importance in preventing diseases. As most diseases are in some degree infectious, no one should continue long with the sick, except the necessary attendants. I mean not, however, by this caution, to deter those whose duty or office leads them to wait upon the sick, from such a laudable and necessary employment.

Many things are in the power of the magistrate which would tend to prevent the spreading of infection; as the promoting of public cleanliness; removing jails, hospitals, burying grounds, and other places where infection may be generated, at a proper distance from great towns[^[51]]; widening the streets; pulling down useless walls, and taking all methods to promote a free circulation of air through every part of the town, &c. Public hospitals, or proper places of reception for the sick, provided they were kept clean, well ventilated, and placed in an open situation, would likewise tend to prevent the spreading of infection. Such places of reception would prevent the poor, when sick, from being visited by their idle or officious neighbours. They would likewise render it unnecessary for sick servants to be kept in their master’s houses. Masters had better pay for having their servants taken care of in an hospital, than run the hazard of having an infectious disease diffused among a numerous family. Sick servants and poor people, when placed in hospitals, are not only less apt to diffuse infection among their neighbours, but have likewise the advantage of being well attended.

We are not, however, to learn that hospitals, instead of preventing infection, may become the means of diffusing it. When they are placed in the middle of great towns; when numbers of patients are crowded together in small apartments; when there is a constant communication kept up between the citizens and the patients; and when cleanliness and ventilation are neglected, they become nests for hatching diseases, and every one who goes into them not only runs a risk of receiving infection himself, but likewise of communicating it to others. This however is not the fault of the hospitals, but of those who have the management of them. It were to be wished, that they were both more numerous, and upon a more respectable footing, as that would induce people to go into them with less reluctance. This is the more to be desired, because most of the putrid fevers and other infectious disorders break out among the poor, and are by them communicated to the better sort. Were proper attention paid to the first appearances of such disorders, and the patients early conveyed to an hospital, we should seldom see a putrid fever, which is almost as infectious as the plague, become epidemic.

CHAP. X.
OF THE PASSIONS.

The passions have great influence both in the cause and cure of diseases. How the mind affects the body, will in all probability ever remain a secret. It is sufficient for us to know, that there is established a reciprocal influence between the mental and corporeal parts; and that whatever injures the one disorders the other.

Of Anger.

The passion of anger ruffles the mind, distorts the countenance, hurries on the circulation of the blood, and disorders the whole vital and animal functions. It often occasions fevers, and other acute diseases; and sometimes even sudden death. This passion is peculiarly hurtful to the delicate, and those of weak nerves. I have known such persons frequently lose their lives by a violent fit of anger, and would advise them to guard against the excess of this passion with the utmost care.

It is not indeed always in our power to prevent being angry; but we may surely avoid harbouring resentment in our breast. Resentment preys upon the mind, and occasions the most obstinate chronical disorders, which gradually waste the constitution. Nothing shews true greatness of mind more than to forgive injuries; it promotes the peace of society, and greatly conduces to our own ease, health, and felicity.

Such as value health should avoid violent gusts of anger, as they would the most deadly poison. Neither ought they to indulge resentment, but to endeavour at all times to keep their minds calm and serene. Nothing tends so much to the health of the body as a constant tranquillity of mind.

Of Fear.

The influence of fear, both in occasioning and aggravating diseases, is very great. No man ought to be blamed for a decent concern about life; but too great a desire to preserve it is often the cause of losing it. Fear and anxiety, by depressing the spirits, not only dispose us to diseases, but often render those diseases fatal which an undaunted mind would overcome.

Sudden fear has generally violent effects. Epileptic fits, and other convulsive disorders, are often occasioned by it. Hence the danger of that practice, so common among young people, of frightening one another. Many have lost their lives, and others have been rendered miserable, by frolics of this kind. It is dangerous to tamper with the human passions. The mind may easily be thrown into such disorder as never again to act with regularity.

But the gradual effects of fear prove most hurtful. The constant dread of some future evil, by dwelling upon the mind, often occasions the very evil itself. Hence it comes to pass, that so many die of those very diseases of which they long had a dread, or which had been impressed on their minds by some accident, or foolish prediction. This, for example, is often the case with women in child-bed. Many of those who die in that situation are impressed with the notion of their death a long time before it happens; and there is reason to believe that this impression is often the cause of it.

The methods taken to impress the minds of women with the apprehensions of the great pain and peril of child-birth, are very hurtful. Few women die in labour, though many lose their lives after it; which may be thus accounted for. A woman after delivery, finding herself weak and exhausted, immediately apprehends she is in danger; but this fear seldom fails to obstruct the necessary evacuations, upon which her recovery depends. Thus the sex often fall a sacrifice to their own imaginations, when there would be no danger, did they apprehend none.

It seldom happens that two or three women in a great town die in child-bed, but their death is followed by many others. Every woman of their acquaintance who is with child dreads the same fate, and the disease becomes epidemical by the mere force of imagination. This should induce pregnant women to despise fear, and by all means to avoid those tattling gossips who are continually buzzing in their ears the misfortunes of others. Every thing that may in the least alarm a pregnant or child-bed woman, ought with the greatest care to be guarded against.

Many women have lost their lives in child-bed by the old superstitious custom, still kept up in most parts of Britain, of tolling the parish bell for every person who dies. People who think themselves in danger are very inquisitive; and if they come to know that the bell tolls for one who died in the same situation with themselves, what must be the consequence? At any rate they are apt to suppose that this is the case, and it will often be found a very difficult matter to persuade them of the contrary.

But this custom is not pernicious to child-bed women only. It is hurtful in many other cases. When low fevers, in which it is difficult to support the patient’s spirits, prevail, what must be the effect of a funeral peal sounding five or six times a day in his ears? No doubt his imagination will suggest that others died of the same disease under which he labours. This apprehension will have a greater tendency to depress his spirits, than all the cordials of which medicine can boast will have to raise them.

If this useless piece of ceremony cannot be abolished, we ought to keep the sick as much from hearing it as possible, and from every other thing that may tend to alarm them. So far however is this from being generally attended to, that many make it their business to visit the sick, on purpose to whisper dismal stories in their ears. Such may pass for sympathizing friends, but they ought rather to be considered as enemies. All who wish well to the sick ought to keep such persons at the greatest distance from them.

A custom has long prevailed among physicians, of prognosticating, as they call it, the patient’s fate, or foretelling the issue of the disease. Vanity no doubt introduced this practice, and still supports it, in spite of common sense and the safety of mankind. I have known a physician barbarous enough to boast, that he pronounced more sentences than all his Majesty’s judges. Would to God that such sentences were not often equally fatal! It may indeed be alleged, that the doctor does not declare his opinion before the patient. So much the worse. A sensible patient had better hear what the doctor says, than learn it from the disconsolate looks, the watery eyes, and the broken whispers of those about him. It seldom happens, when the doctor gives an unfavourable opinion, that it can be concealed from the patient. The very embarrassment which the friends and attendants shew in disguising what he has said, is generally sufficient to discover the truth.

Kind Heaven has, for the wisest ends, concealed from mortals their fate; and we do not see what right any man has to announce the death of another, especially if such a declaration has a chance to kill him. Mankind are indeed very fond of prying into future events, and seldom fail to solicit the physician for his opinion. A doubtful answer, however, or one that may tend rather to encourage the hopes of the sick, is surely the most safe. This conduct could neither hurt the patient nor the physician. Nothing tends more to destroy the credit of physic than those bold prognosticators, who, by the bye, are generally the most ignorant of the faculty. The mistakes which daily happen in this way are so many standing proofs of human vanity, and the weakness of science.

We readily admit, that there are cases where the physician ought to give intimation of the patient’s danger to some of his near connexions; though even this ought always to be done with the greatest caution: but it never can be necessary in any case that the whole town and country should know, immediately after the doctor has made his first visit, that he has no hopes of his patient’s recovery. Persons whose impertinent curiosity leads them to question the physician, with regard to the fate of his patient, certainly deserve no other than an evasive answer.

The vanity of foretelling the fate of the sick is not peculiar to the faculty. Others follow their example, and those who think themselves wiser than their neighbours often do much hurt in this way. Humanity surely calls upon every one to comfort the sick, and not to add to their affliction by alarming their fears. A friend, or even a physician, may often do more good by a mild and sympathizing behaviour than by medicine, and should never neglect to administer that greatest of all cordials, Hope.

Of Grief.

Grief is the most destructive of all the passions. Its effects are permanent, and when it sinks deep into the mind, it generally proves fatal. Anger and fear, being of a more violent nature, seldom last long; but grief often changes into a fixed melancholy, which preys upon the spirits, and wastes the constitution. This passion ought not to be indulged. It may generally be conquered at the beginning; but when it has gained strength, all attempts to remove it are vain.

No person can prevent misfortunes in life; but it shews true greatness of mind to bear them with serenity. Many persons make a merit of indulging grief, and when misfortunes happen, they obstinately refuse all consolation, till the mind, overwhelmed with melancholy, sinks under the load. Such conduct is not only destructive to health, but inconsistent with reason, religion, and common sense.

Change of ideas is as necessary for health as change of posture. When the mind dwells long upon one subject, especially of a disagreeable nature, it hurts the whole functions of the body. Hence grief indulged spoils the digestion and destroys the appetite; by which means the spirits are depressed, the nerves relaxed, the bowels inflated with wind, and the humours, for want of fresh supplies of chyle, vitiated. Thus many an excellent constitution has been ruined by a family misfortune, or any thing that occasions excessive grief.

It is utterly impossible, that any person of a dejected mind should enjoy health. Life may indeed be dragged out for a few years; but whoever would live to a good old age, must be good-humoured and cheerful. This indeed is not altogether in our own power; yet our temper of mind, as well as our actions, depend greatly upon ourselves. We can either associate with cheerful or melancholy companions, mingle in the amusements and offices of life, or sit still and brood over our calamities as we choose. These, and many such things, are certainly in our power, and from these the mind generally takes its cast.

The variety of scenes which present themselves to the senses, were certainly designed to prevent our attention from being too long fixed upon any one object. Nature abounds with variety, and the mind, unless fixed down by habit, delights in contemplating new objects. This at once points out the method of relieving the mind in distress. Turn the attention frequently to new objects. Examine them for some time. When the mind begins to recoil, shift the scene. By this means a constant succession of new ideas may be kept up, till the disagreeable ones entirely disappear. Thus travelling, the study of any art or science, reading or writing on such subjects as deeply engage the attention, will sooner expel grief than the most sprightly amusements.

It has already been observed, that the body cannot be healthy unless it be exercised; neither can the mind. Indolence nourishes grief. When the mind has nothing else to think of but calamities, no wonder that it dwells there. Few people who pursue business with attention are hurt by grief. Instead therefore of abstracting ourselves from the world or business, when misfortunes happen, we ought to engage in it with more than usual attention, to discharge with double diligence the functions of our station, and to mix with friends of a cheerful and social temper.

Innocent amusements are by no means to be neglected. These, by leading the mind insensibly to the contemplation of agreeable objects, help to dispel the gloom which misfortunes cast over it. They make time seem less tedious, and have many other happy effects.

Some persons, when overwhelmed with grief, betake themselves to drinking. This is making the cure worse than the disease. It seldom fails to end in the ruin of fortune, character, and constitution.

Of Love.

Love is perhaps the strongest of all the passions; at least, when it becomes violent, it is less subject to the control either of the understanding or will, than any of the rest. Fear, anger, and several other passions, are necessary for the preservation of the individual, but love is necessary for the continuation of the species itself; it was therefore proper that this passion should be deeply rooted in the human breast.

Though love be a strong passion, it is seldom so rapid in its progress as several of the others. Few persons fall desperately in love all at once. We would therefore advise every one, before he tampers with this passion, to consider well the probability of his being able to obtain the object of his love. When that is not likely, he should avoid every occasion of increasing it. He ought immediately to fly the company of the beloved object; to apply his mind attentively to business or study; to take every kind of amusement; and above all, to endeavour, if possible, to find another object which may engage his affections, and which it may be in his power to obtain.

There is no passion with which people are so ready to tamper as love, although none is more dangerous. Some men make love for amusement, others from mere vanity, or on purpose to shew their consequence with the fair. This is perhaps the greatest piece of cruelty which any one can be guilty of. What we eagerly wish for we easily credit. Hence the too credulous fair are often betrayed into a situation which is truly deplorable, before they are able to discover that the pretended lover was only in jest. But there is no jesting with this passion. When love is got to a certain height, it admits of no other cure but the possession of its object, which in this case ought always if possible to be obtained[^[52]].

Of Religious Melancholy.

Many persons of a religious turn of mind behave as if they thought it a crime to be cheerful. They imagine the whole of religion consists in certain mortifications, or denying themselves the smallest indulgence, even of the most innocent amusements. A perpetual gloom hangs over their countenances, while the deepest melancholy preys upon their minds. At length the fairest prospects vanish, every thing puts on a dismal appearance, and those very objects which ought to give delight afford nothing but disgust. Life itself becomes a burden, and the unhappy wretch, persuaded that no evil can equal what he feels, often puts an end to his own miserable existence.

It is great pity that ever religion should be so far perverted, as to become the cause of those very evils which it was designed to cure. Nothing can be better calculated than True Religion, to raise and support the mind of its votaries under every affliction that can befal them. It teaches them that even the sufferings of this life are preparatory to the happiness of the next; and that all who persist in a course of virtue shall at length arrive at complete felicity.

Persons whose business it is to recommend religion to others, should beware of dwelling too much on gloomy subjects. That peace and tranquillity of mind, which true religion is calculated to inspire, is a more powerful argument in its favour than all the terrors that can be uttered. Terror may indeed deter men from outward acts of wickedness, but can never inspire them with that love of God, and real goodness of heart, in which alone true religion consists.

To conclude; the best way to counteract the violence of any passion, is to keep the mind closely engaged in some useful pursuit.

CHAP. XI.
OF THE COMMON EVACUATIONS.

The principal evacuations from the human body are those by stool, urine, and insensible perspiration. None of these can be long obstructed without impairing the health. When that which ought to be thrown out of the body is too long retained, it not only occasions a plethora, or too great fulness of the vessels, but acquires qualities which are hurtful to the health, as acrimony, putrescence, &c.

Of the Evacuation by Stool.

Few things conduce more to health than keeping the body regular. When the fæces lie too long in the bowels, they vitiate the humours; and when they are too soon discharged, the body is not sufficiently nourished. A medium is therefore to be desired, which can only be obtained by regularity in diet, sleep, and exercise. Whenever the body is not regular, there is reason to suspect a fault in one or other of these.

Persons who eat and drink at irregular hours, and who eat various kinds of food, and drink of several different liquors at every meal, have no reason to expect either that their digestion will be good, or their discharges regular. Irregularity in eating and drinking disturbs every part of the animal œconomy, and never fails to occasion diseases. Either too much or too little food will have this effect. The former indeed generally occasions looseness, and the latter costiveness; but both have a tendency to hurt the health.

It would be difficult to ascertain the exact number of stools which may be consistent with health, as these differ in the different periods of life, in different constitutions, and even in the same constitution under a different regimen of diet, exercise, &c. It is however generally allowed, that one stool a-day is sufficient for an adult, and that less is hurtful. But this, like most general rules, admits of many exceptions. I have known persons in perfect health who did not go to stool above once a-week. Such a degree of costiveness however is not safe; though the person who labours under it may for some time enjoy tolerable health, yet at length it may occasion diseases.

One method of procuring a stool every day is to rise betimes, and go abroad in the open air. Not only the posture in bed is unfavourable to regular stools, but also the warmth. This, by promoting the perspiration, lessens all the other discharges.

The method recommended for this purpose by Mr. Locke is likewise very proper, viz. to solicit nature, by going regularly to stool every morning whether one has a call or not. Habits of this kind may be acquired, which will in time become natural.

Persons who have frequent recourse to medicines for preventing costiveness seldom fail to ruin their constitution. Purging medicines frequently repeated weaken the bowels, hurt the digestion, and every dose makes way for another, till at length they become as necessary as daily bread. Those who are troubled with costiveness ought rather, if possible, to remove it by diet than drugs. They should likewise go thinly clothed, and avoid every thing of an astringent or of an heating nature. The diet and other regimen necessary in this case will be found under the article Costiveness, where this state of the bowels is treated as a disease.

Such persons as are troubled with a habitual looseness ought likewise to suit their diet to the nature of their complaint. They should use food which braces and strengthens the bowels, and which is rather of an astringent quality, as wheat-bread made of the finest flour, cheese, eggs, rice boiled in milk, &c. Their drink should be red port, claret, brandy and water in which toasted bread has been boiled, and such like.

As a habitual looseness is often owing to an obstructed perspiration, persons affected with it ought to keep their feet warm, to wear flannel next their skin, and take every other method to promote the perspiration. Further directions with regard to the treatment of this complaint will be found under the article Looseness.

Of Urine.

So many things tend to change both the quantity and appearances of the urine, that it is very difficult to lay down any determined rules for judging of either[^[53]]. Dr. Cheyne says, the urine ought to be equal to three-fourths of the liquid part of our aliment. But suppose any one were to take the trouble of measuring both, he would find that every thing which altered the degree of perspiration, would alter this proportion, and likewise that different kinds of aliment would afford very different quantities of urine. Though for these, and other reasons, no rule can be given for judging of the precise quantity of urine which ought to be discharged, yet a person of common sense will seldom be at a loss to know when it is in either extreme.

As a free discharge of urine not only prevents but actually cures many diseases, it ought by all means to be promoted; and every thing that may obstruct it should be carefully avoided. Both the secretion and discharge of urine are lessened by a sedentary life, sleeping on beds that are too soft and warm, food of a dry and heating quality, liquors which are astringent and heating, as red port, claret, and such like. Those who have reason to suspect that their urine is in too small quantity, or who have any symptoms of the gravel, ought not only to avoid these things, but whatever else they find has a tendency to lessen the quantity of their urine.

When the urine is too long retained, it is not only resorbed, or taken up again into the mass of fluids, but by stagnating in the bladder it becomes thicker, the more watery parts flying off first, and the more gross and earthy remaining behind. By the constant tendency which these have to concrete, the formation of stones and gravel in the bladder is promoted. Hence it comes to pass, that indolent and sedentary people are much more liable to these diseases, than persons of a more active life.

Many persons have lost their lives, and others have brought on very tedious, and even incurable disorders, by retaining their urine too long, from a false delicacy. When the bladder has been over-distended, it often loses its power of action altogether, or becomes paralytic, by which means it is rendered unable either to retain the urine, or expel it properly. The calls of Nature ought never to be postponed. Delicacy is doubtless a virtue, but that can never be reckoned true delicacy, which induces any one to risk his health or hazard his life.

But the urine may be in too great as well as too small a quantity. This may be occasioned by drinking large quantities of weak watery liquors, by the excessive use of alkaline salts, or any thing that stimulates the kidnies, dilutes the blood, &c. This disorder very soon weakens the body, and induces a consumption. It is difficult to cure, but may be mitigated by strengthening diet and astringent medicines, such as are recommended under the article Diabetes, or excessive discharge of urine.

Of the Perspiration.

Insensible perspiration is generally reckoned the greatest of all the discharges from the human body. It is of so great importance to health, that few diseases attack us while it goes properly on; but when it is obstructed, the whole frame is soon disordered. This discharge however, being less perceptible than any of the rest, is consequently less attended to. Hence it is, that acute fevers, rheumatisms, agues, &c. often proceed from obstructed perspiration before we are aware of its having taken place.

On examining patients, we find most of them impute their diseases either to violent colds which they had caught, or to slight ones which had been neglected. For this reason, instead of a critical inquiry into the nature of the perspiration, its difference in different seasons, climates, constitutions, &c. we shall endeavour to point out the causes which most commonly obstruct it, and to shew how far they may be either avoided, or have their influence counteracted by timely care. The want of a due attention to these, costs Britain annually some thousands of useful lives.

Changes in the Atmosphere.

One of the most common causes of obstructed perspiration, or catching cold, in this country, is the changeableness of the weather, or state of the atmosphere. There is no place where such changes happen more frequently than in Great Britain. With us the degrees of heat and cold are not only very different in the different seasons of the year, but often change almost from one extreme to another in a few days, and sometimes even in the course of one day. That such changes must affect the state of the perspiration is obvious to every one[^[54]].

The best method of fortifying the body against the changes of the weather, is to be abroad every day. Those who keep most within doors are most liable to catch cold. Such persons generally render themselves so delicate as to feel even the slightest changes in the atmosphere, and by their pains, coughs, and oppressions of the breast, &c. they become a kind of living barometers.

Wet Clothes.

Wet clothes not only by their coldness obstruct the perspiration, but their moisture, by being absorbed, or taken up into the body, greatly increases the danger. The most robust constitution is not proof against the danger arising from wet clothes; they daily occasion fevers, rheumatisms, and other fatal disorders, even in the young and healthy.

It is impossible for people who go frequently abroad to avoid sometimes being wet. But the danger might generally be lessened, if not wholly prevented, by changing their clothes soon; when this cannot be done, they should keep in motion till they be dry. So far are many from taking this precaution, that they often sit or lie down in the fields with their clothes wet, and frequently sleep even whole nights in this condition. The frequent instances which we have of the fatal effects of this conduct, ought certainly to deter others from being guilty of it.

Wet Feet.

Even wet feet often occasion fatal diseases. The colic, inflammations of the breast and of the bowels, the iliac passion, cholera morbus, &c. are often occasioned by wet feet. Habit will, no doubt, render this less dangerous; but it ought, as far as possible, to be avoided. The delicate, and those who are not accustomed to have their clothes or feet wet should be peculiarly careful in this respect.

Night Air.

The perspiration is often obstructed by night air; even in summer, this ought to be avoided. The dews which fall plentifully after the hottest day, make the night more dangerous than when the weather is cool. Hence, in warm countries, the evening dews are more hurtful than where the climate is more temperate.

It is very agreeable after a warm day to be abroad in the cool evening; but this is a pleasure to be avoided by all who value their health. The effects of evening dews are gradual indeed, and almost imperceptible; but they are not the less to be dreaded: we would therefore advise travellers, labourers, and all who are much heated by day, carefully to avoid them. When the perspiration has been great, these become dangerous in proportion. By not attending to this, in flat marshy countries, where the exhalations and dews are copious, labourers are often seized with intermitting fevers, quinseys, and other dangerous diseases.

Damp Beds.

Beds become damp, either from their not being used, standing in damp houses, or in rooms without fire. Nothing is more to be dreaded by travellers than damp beds, which are very common in all places where fuel is scarce. When a traveller, cold and wet, arrives at an inn, he may by means of a good fire, warm diluting liquor, and a dry bed, have the perspiration restored; but if he be put into a cold room, and laid on a damp bed, it will be more obstructed, and the worst consequences will ensue. Travellers should avoid inns which are noted for damp beds, as they would a house infected with the plague, as no man, however robust, is proof against the danger arising from them.

But inns are not the only places where damp beds are to be met with. Beds kept in private families for the reception of strangers are often equally dangerous. All kinds of linen and bedding, when not frequently used, become damp. How then is it possible that beds, which are not slept in above two or three times a year, should be safe? Nothing is more common than to hear people complain of having caught cold by changing their bed. The reason is obvious: were they careful never to sleep in a bed but what was frequently used, they would seldom find any ill consequences from a change.

Nothing is more to be dreaded by a delicate person when on a visit, than being laid in a bed which is kept on purpose for strangers. That ill-judged piece of complaisance becomes a real injury. All the bad consequences from this quarter might easily be prevented in private families, by causing their servants to sleep in the spare beds, and resign them to strangers when they come. In inns where the beds are used almost every night, nothing else is necessary than to keep the rooms well seasoned by frequent fires, and the linen dry.

That baneful custom said to be practised in many inns, of damping sheets, and pressing them in order to save washing, and afterwards laying them on the beds, ought, when discovered; to be punished with the utmost severity. It is really a species of murder, and will often prove as fatal as poison or gunshot. Indeed no linen, especially if it has been washed in winter, ought to be used till it has been exposed for some time to the fire; nor is this operation less necessary for linen washed in summer, provided it has lain by for any length of time. This caution is the more needful, as gentlemen are often exceedingly attentive to what they eat or drink at an inn, yet pay no regard to a circumstance of much more importance[^[55]].

Damp Houses.

Damp houses frequently produce the like ill consequences; for this reason those who build should be careful to chuse a dry situation. A house which stands on a damp marshy soil or deep clay, will never be thoroughly dry. All houses, unless where the ground is exceeding dry, should have the first door a little raised. Servants and others, who are obliged to live in cellars and sunk stories, seldom continue long in health: masters ought surely to pay some regard to the health of their servants, as well as to their own.

Nothing is more common than for people, merely to avoid some trifling inconveniency, to hazard their lives, by inhabiting a house almost as soon as the masons, plasterers, &c. have done with it: such houses are not only dangerous from their dampness, but likewise from the smell of lime, paint, &c. The asthmas, consumptions, and other diseases of the lungs, so incident to people who work in these articles, are sufficient proofs of their being unwholesome.

Rooms are often rendered damp by an unseasonable piece of cleanliness; I mean the pernicious custom of washing them immediately before company is put into them. Most people catch cold, if they sit but a very short time in a room that has been lately washed; the delicate ought carefully to avoid such a situation, and even the robust are not always proof against its influence[^[56]].

Sudden Transitions from Heat to Cold.

The perspiration is commonly obstructed by SUDDEN TRANSITIONS from heat to cold. Colds are seldom caught, unless when people have been too much heated. Heat rarifies the blood, quickens the circulation, and increases the perspiration; but when these are suddenly checked, the consequences must be bad. It is indeed impossible for labourers not to be too hot upon some occasions; but it is generally in their power to let themselves cool gradually, to put on their clothes when they leave off work, to make choice of a dry place to rest themselves in, and to avoid sleeping in the open fields. These easy rules, if observed, would often prevent fevers and other fatal disorders.

It is very common for people, when hot, to drink freely of cold water, or small liquors. This conduct is extremely dangerous. Thirst indeed is hard to bear, and the inclination to gratify that appetite frequently gets the better of reason, and makes us do what our judgment disapproves. Every peasant, however, knows, if his horse be permitted to drink his bellyful of cold water after violent exercise, and be immediately put into the stable, or suffered to remain at rest, that it will kill him. This they take the utmost care to prevent. It were well if they were equally attentive to their own safety.

Thirst may be quenched many ways without swallowing large quantities of cold liquor. The fields afford variety of acid fruits and plants, the very chewing of which would abate thirst. Water kept in the mouth for some time, and spit out again, if frequently repeated, will have the same effect. If a bit of bread be eaten along with a few mouthfuls of water, it will both quench thirst more effectually, and make the danger less. When a person is extremely hot, a mouthful of brandy, or other spirits, if it can be obtained, ought to be preferred to any thing else. But if any one has been so foolish, when hot, as to drink freely of cold liquor, he ought to continue his exercise at least till what he drank be thoroughly warmed upon his stomach.

It would be tedious to enumerate all the bad effects which flow from drinking cold liquors when the body is hot. Sometimes this has occasioned immediate death. Hoarseness, quinseys, and fevers of various kinds, are its common consequences. Neither is it safe when warm to eat freely of raw fruits, sallads, or the like. These indeed have not so sudden an effect on the body as cold liquors, but they are notwithstanding dangerous, and ought to be avoided.

Sitting in a warm room, and drinking hot liquors till the pores are quite open, and immediately going into the cold air, is extremely dangerous. Colds, coughs, and inflammations of the breast, are the usual effects of this conduct: yet nothing is more common than for people, after they have drank warm liquors for several hours, to walk or ride a number of miles in the coldest night, or to ramble about in the streets[^[57]].

People are very apt, when a room is hot, to throw open a window, and to sit near it. This is a most dangerous practice. Any person had better sit without doors than in such a situation, as the current of air is directed against one particular part of the body. Inflammatory fevers and consumptions have often been occasioned by sitting or standing thinly clothed near an open window. Nor is sleeping with open windows less to be dreaded. That ought never to be done, even in the hottest season, unless the window is at a distance. I have known mechanics frequently contract fatal diseases, by working stript at an open window, and would advise all of them to beware of such a practice.

Few things expose people more to catch cold than keeping their own houses too warm; such persons may be said to live in a sort of hot-houses; they can hardly stir abroad to visit a neighbour, but at the hazard of their lives. Were there no other reason for keeping houses moderately cool, that alone is sufficient: but no house that is too hot can be wholesome; heat destroys the spring and elasticity of the air, and renders it less fit for expanding the lungs, and the other purposes of respiration. Hence it is, that consumptions and other diseases of the lungs prove so fatal to people who work in forges, glasshouses, and the like.

Some are even so fool-hardy, as to plunge themselves when hot in cold water. Not only fevers, but madness itself, has frequently been the effect of this conduct. Indeed it looks too like the action of a madman to deserve a serious consideration.

The result of all these observations is, that every one ought to avoid, with the utmost attention, all sudden transitions from heat to cold, and to keep the body in as uniform a temperature as possible; or, where that cannot be done, to take care to let it cool gradually.

People may imagine that too strict an attention to these things would tend to render them delicate. So far however is this from being my design, that the very first rule proposed for preventing colds, is to harden the body, by enuring it daily to the open air.

I shall put an end to what relates to this part of my subject, by giving an abstract of the justly celebrated advice of Celsus, with respect to the preservation of health. “A man,” says he, “who is blessed with good health, should confine himself to no particular rules, either with respect to regimen or medicine. He ought frequently to diversify his manner of living; to be sometimes in town, sometimes in the country; to hunt, sail, indulge himself in rest, but more frequently to use exercise. He ought to refuse no kind of food that is commonly used, but sometimes to eat more and sometimes less; sometimes to make one at an entertainment, and sometimes to forbear it; to make rather two meals a-day than one, and always to eat heartily, provided he can digest it. He ought neither too eagerly to pursue, nor too scrupulously to avoid, intercourse with the fair sex: pleasures of this kind, rarely indulged, render the body alert and active; but, when too frequently repeated, weak and languid. He should be careful in time of health not to destroy, by excesses of any kind, that vigour of constitution which should support him under sickness.”

PART II.
OF DISEASES.

CHAP. XII.
OF THE KNOWLEDGE AND CURE OF DISEASES.

The knowledge of diseases does not depend so much upon scientific principles as many imagine. It is chiefly the result of experience and observation. By attending the sick, and carefully observing the various occurrences in diseases, a great degree of accuracy may be acquired, both in distinguishing their symptoms, and in the application of medicines. Hence sensible nurses, and other persons who wait upon the sick, often discover a disease sooner than those who have been bred to physic. We do not however mean to insinuate that a medical education is of no use: it is doubtless of the greatest importance; but it never can supply the place of observation and experience.

Every disease may be considered as an assemblage of symptoms, and must be distinguished by those which are most obvious and permanent. Instead therefore of giving a classical arrangement of diseases, according to the systematic method, it will be more suitable, in a performance of this nature, to give a full and accurate description of each particular disease as it occurs; and, where any of the symptoms of one disease have a near resemblance to those of another, to take notice of that circumstance, and at the same time to point out the peculiar or characteristic symptoms by which it may be distinguished. By a due attention to these, the investigation of diseases will be found to be a less difficult matter than most people would at first be ready to imagine.

A proper attention to the patient’s age, sex, temper of mind, constitution, and manner of life, will likewise greatly assist, both in the investigation and treatment of diseases.

In childhood the fibres are lax and soft, the nerves extremely irritable, and the fluids thin; whereas in old age the fibres are rigid, the nerves become almost insensible, and many of the vessels imperviable. These and other peculiarities render the diseases of the young and aged very different, and of course they must require a different method of treatment.

Females are liable to many diseases which do not afflict the other sex: besides, the nervous system being more irritable in them than in men, their diseases require to be treated with greater caution. They are less able to bear large evacuations; and all stimulating medicines ought to be administered to them with a sparing hand.

Particular constitutions not only dispose persons to peculiar diseases, but likewise render it necessary to treat these diseases in a peculiar manner. A delicate person, for example, with weak nerves, who lives mostly within doors, must not be treated, under any disease, precisely in the same manner as one who is hardy and robust, and who is much exposed to the open air.

The temper of mind ought to be carefully attended to in diseases. Fear, anxiety, and a fretful temper, both occasion and aggravate diseases. In vain do we apply medicines to the body to remove maladies which proceed from the mind. When it is affected, the best medicine is to sooth the passions, to divert the mind from anxious thought, and to keep the patient as easy and cheerful as possible.

Attention ought likewise to be paid to the climate, or place where the patient lives, the air he breathes, his diet, &c. Such as live in low marshy situations are subject to many diseases which are unknown to the inhabitants of high countries. Those who breathe the impure air of cities, have many maladies to which the more happy rustics are entire strangers. Persons who feed grossly, and indulge in strong liquors, are liable to diseases which do not affect the temperate and abstemious, &c.

It has already been observed, that the different occupations and situations in life dispose men to peculiar diseases. It is therefore necessary to inquire into the patient’s occupation, manner of life, &c. This will not only assist us in finding out the disease, but will likewise direct us in the treatment of it. It would be very imprudent to treat the laborious and the sedentary precisely in the same manner, even supposing them to labour under the same disease.

It will likewise be proper to inquire, whether the disease be constitutional or accidental; whether it has been of long or short duration; whether it proceeds from any great and sudden alteration in the diet, manner of life, &c. The state of the patient’s body, and of the other evacuations, ought also to be inquired into; and likewise whether he can with ease perform all the vital and animal functions, as breathing, digestion, &c.

Lastly, it will be proper to inquire what diseases the patient has formerly been liable to, and what medicines were most beneficial to him; if he has a strong aversion to any particular drug, &c.

As many of the indications of cure may be answered by diet alone, it is always the first thing to be attended to in the treatment of diseases. Those who know no better, imagine that every thing which goes by the name of a medicine possesses some wonderful power or secret charm, and think, if the patient swallows enough of drugs, that he must do well. This mistake has many ill consequences; it makes people trust to drugs, and neglect their own endeavours; besides, it discourages all attempts to relieve the sick where medicines cannot be obtained.

Medicines are no doubt useful in their place; and, when administered with prudence, they may do much good; but when they are put in place of every thing else, or administered at random, which is not seldom the case, they must do mischief. We would therefore wish to call the attention of mankind from the pursuit of secret medicines, to such things as they are acquainted with. The proper regulation of these may often do much good, and there is little danger of their ever doing hurt.

Every disease weakens the digestive powers. The diet ought therefore, in all diseases, to be light and of easy digestion. It would be as prudent for a person with a broken leg to attempt to walk, as for one in a fever to eat the same kind of food, and in the same quantity, as when he was in perfect health. Even abstinence alone will often cure a fever, especially when it has been occasioned by excess in eating or drinking.

In all fevers attended with inflammation, as pleurisies, peripneumonies, &c. thin gruels, wheys, watery infusions of mucilaginous plants, roots, &c. are not only proper for the patients food, but they are likewise the best medicines which can be administered.

In fevers of a slow, nervous, or putrid kind, where there are no symptoms of inflammation, and where the patient must be supported with cordials, that intention can always be more effectually answered by nourishing diet and generous wines, than by any medicines yet known.

Nor is a proper attention to diet of less importance in chronic than in acute diseases. Persons afflicted with low spirits, wind, weak nerves, and other hypochondriacal affections, generally find more benefit from the use of solid food and generous liquors, than from all the cordial and carminitive medicines which can be administered to them.

The scurvy, that most obstinate malady, will sooner yield to a proper vegetable diet, than to all the boasted antiscorbutic remedies of the shops.

In consumptions, when the humours are vitiated, and the stomach so much weakened as to be unable to digest the solid fibres of animals, or even to assimilate the juices of vegetables, a diet consisting chiefly of milk will not only support the patient, but will often cure the disease after every other medicine has failed.

Nor is an attention to other things of less importance than to diet. The strange infatuation which has long induced people to shut up the sick from all communication with the external air, has done great mischief. Not only in fevers, but in many other diseases, the patient will receive more benefit from having the fresh air prudently admitted into his chamber, than from all the medicines which can be given him.

Exercise may likewise in many cases be considered as a medicine. Sailing, or riding on horseback, for example, will be of more service in the cure of consumptions, glandular obstructions, &c. than any medicine yet known. In diseases which proceed from a relaxed state of the solids, the cold bath, and other parts of the gymnastic regimen, will be found equally beneficial.

Few things are of greater importance in the cure of diseases than cleanliness. When a patient is suffered to lie in dirty clothes, whatever perspires from his body is again resorbed, or taken up into it, which serves to nourish the disease and increase the danger. Many diseases may be cured by cleanliness alone; most of them may be mitigated by it, and in all of them it is highly necessary both for the patient and those who attend him.

Many other observations, were it necessary, might be adduced to prove the importance of a proper regimen in diseases. Regimen will often cure diseases without medicine, but medicine will seldom succeed where a proper regimen is neglected. For this reason, in the treatment of diseases, we have always given the first place to regimen. Those who are ignorant of medicine may confine themselves to it only. For others who have more knowledge, we have recommended some of the most simple but approved forms of medicine in every disease. These however are never to be administered but by people of better understanding; nor even by them without the greatest precaution.

CHAP. XIII.
OF FEVERS IN GENERAL.

As more than one half of mankind is said to perish by fevers, it is of importance to be acquainted with their causes. The most general causes of fevers are, infection, errors in diet, unwholesome air, violent emotions of the mind, excess or suppression of usual evacuations, external or internal injuries, and extreme degrees of heat or cold. As most of these have already been treated of at considerable length, and their effects shewn, we shall not now resume the consideration of them, but shall only recommend it to all, as they would wish to avoid fevers and other fatal diseases, to pay the most punctual attention to these articles.

Fevers are not only the most frequent of all diseases, but they are likewise the most complex. In the most simple species of fever there is always a combination of several different symptoms. The distinguishing symptoms of fever are, increased heat, frequency of pulse, loss of appetite, general debility, pain in the head, and a difficulty in performing some of the vital or animal functions. The other symptoms usually attendant on fevers are, nausea, thirst, anxiety, delirium, weariness, wasting of the flesh, want of sleep, or the sleep disturbed and not refreshing.

When the fever comes on gradually, the patient generally complains first of languor or listlessness, soreness of the flesh, or the bones, as the country people express it, heaviness of the head, loss of appetite, sickness, with clamminess of the mouth; after some time come on excessive heat, violent thirst, restlessness, &c.

When the fever attacks suddenly, it always begins with an uneasy sensation of excessive cold, accompanied with debility and loss of appetite; frequently the cold is attended with shivering, oppression about the heart, and sickness at stomach, or vomiting.

Fevers are divided into continual, remitting, intermitting, and such as are attended with cutaneous eruption or topical inflammation, as the small-pox, erysipelas, &c. By a continual fever is meant that which never leaves the patient during the whole course of the disease, or which shews no remarkable increase or abatement in the symptoms. This kind of fever is likewise divided into acute, slow, and malignant. The fever is called acute when its progress is quick, and the symptoms violent; but when these are more gentle, it is generally denominated slow. When livid or petechial spots shew a putrid state of the humours, the fever is called malignant, putrid, or petechial.

A remitting fever differs from a continual only in a degree. It has frequent increases and decreases, or exacerbations and remissions, but never wholly leaves the patient during the course of the disease. Intermitting fevers or agues are those which, during the time that the patient may be said to be ill, have evident intervals or remissions of the symptoms.

As a fever is only an effort of Nature to free herself from an offending cause, it is the business of those who have the care of the sick to observe with diligence which way Nature points, and to endeavour to assist her operations. Our bodies are so framed, as to have a constant tendency to expel or throw off whatever is injurious to health. This is generally done by urine, sweat, stool, expectoration, vomit, or some other evacuation.

There is reason to believe, if the efforts of Nature, at the beginning of a fever, were duly attended to and promoted, it would seldom continue long; but when her attempts are either neglected or counteracted, it is no wonder if the disease proves fatal. There are daily instances of persons who, after catching cold, have all the symptoms of a beginning fever; but by keeping warm, drinking diluting liquors, bathing their feet in warm water, &c. the symptoms in a few hours disappear, and the danger is prevented.

When fevers of a putrid kind threaten, the best method of obviating their effects is by repeated vomits.

Our design is not to enter into a critical inquiry into the nature and immediate causes of fevers, but to mark their most obvious symptoms, and to point out the proper treatment of the patient with respect to his diet, drink, air, &c. in the different stages of the disease. In these articles the inclinations of the patient will in a great measure direct our conduct.

Almost every person in a fever complains of great thirst, and calls out for drink, especially of a cooling nature. This at once points out the use of water, and other cooling liquors. What is so likely to abate the heat, attenuate the humours, remove spasms and obstructions, promote perspiration, increase the quantity of urine, and in short produce every salutary effect in an ardent or inflammatory fever, as drinking plentifully of water, thin gruel, or any other weak liquor, of which water is the basis? The necessity of diluting liquors is pointed out by the dry tongue, the parched skin, and the burning heat, as well as by the unquenchable thirst of the patient.

Many cooling liquors, which are extremely grateful to patients in a fever, may be prepared from fruits, as decoctions of tamarinds, apple-tea, orange-whey, and the like. Mucilaginous liquors might also be prepared from marsh-mallow roots, linseed, lime-tree buds, and other mild vegetables. These liquors, especially when acidulated, are highly agreeable to the patient, and should never be denied him.

At the beginning of a fever the patient generally complains of great lassitude or weariness, and has no inclination to move. This evidently shews the propriety of keeping him easy, and if possible in bed. Lying in bed relaxes the spasms, abates the violence of the circulation, and gives Nature an opportunity of exerting all her force to overcome the disease. The bed alone would often remove a fever at the beginning; but when the patient struggles with the disease, instead of driving it off, he only fixes it the deeper, and renders it more dangerous. This observation is too often verified in travellers, who happen when on a journey to be seized with a fever. Their anxiety to get home induces them to travel with the fever upon them, which conduct seldom fails to render it fatal.

In fevers the mind as well as the body should be kept easy. Company is seldom agreeable to the sick. Indeed every thing that disturbs the imagination increases the disease; for which reason every person in a fever ought to be kept perfectly quiet, and neither allowed to see nor hear any thing that may in the least affect or discompose his mind.

Though the patient in a fever has the greatest inclination for drink, yet he seldom has any appetite for solid food; hence the impropriety of urging him to take victuals is evident. Much solid food in a fever is every way hurtful. It oppresses nature, and, instead of nourishing the patient, serves only to feed the disease. What food the patient takes should be in small quantity, light, and of easy digestion. It ought to be chiefly of the vegetable kind, as panada, roasted apples, gruels, and such like.

Poor people, when any of their family are taken ill, run directly to their rich neighbours for cordials, and pour wine, spirits, &c. into the patient, who perhaps never had been accustomed to taste such liquors when in health. If there be any degree of fever, this conduct must increase it, and if there be none, this is the ready way to raise one. Stuffing the patient with sweetmeats and other delicacies is likewise very pernicious. These are always harder to digest than common food, and cannot fail to hurt the stomach.

Nothing is more desired by a patient in a fever than fresh air. It not only removes his anxiety, but cools the blood, revives the spirits, and proves every way beneficial. Many patients are in a manner stifled to death in fevers for want of fresh air; yet such is the unaccountable infatuation of most people, that the moment they think a person in a fever, they imagine he should be kept in a close chamber, into which not one particle of fresh air must be admitted. Instead of this, there ought to be a constant stream of fresh air into a sick person’s chamber, so as to keep it moderately cool. Indeed its degree of warmth ought never to be greater than is agreeable to one in perfect health.

Nothing spoils the air of a sick person’s chamber, or hurts the patient more, than a number of people breathing in it. When the blood is inflamed, or the humours in a putrid state, air that has been breathed repeatedly will greatly increase the disease. Such air not only loses its spring, and becomes unfit for the purpose of respiration, but acquires a noxious quality, which renders it in a manner poisonous to the sick.

In fevers, when the patient’s spirits are low and depressed, he is not only to be supported with cordials, but every method should be taken to cheer and comfort his mind. Many, from a mistaken zeal, when they think a person in danger, instead of solacing his mind with the hopes and consolations of religion, fright him with the views of hell and damnation. It would be unsuitable here to dwell upon the impropriety and dangerous consequences of this conduct; it often hurts the body, and there is reason to believe seldom benefits the soul.

Among common people, the very name of a fever generally suggests the necessity of bleeding. This notion seems to have taken its rise from most fevers in this country having been formerly of an inflammatory nature; but true inflammatory fevers are now seldom to be met with. Sedentary occupations, and a different manner of living, have so changed the state of diseases in Britain, that there is now hardly one fever in ten where the lancet is necessary. In most low, nervous, and putrid fevers, which are now so common, bleeding is really hurtful, as it weakens the patient, sinks his spirits, &c. We would recommend this general rule, never to bleed at the beginning of a fever, unless there be evident signs of inflammation. Bleeding is an excellent medicine when necessary, but should never be wantonly performed.

It is likewise a common notion, that sweating is always necessary in the beginning of a fever. When the fever proceeds from an obstructed perspiration, this notion is not ill-founded. If the patient only lies in bed, bathes his feet and legs in warm water, and drinks freely of water-gruel, or any other weak diluting liquor, he will seldom fail to perspire freely. The warmth of the bed, and the diluting drink, will relax the universal spasm, which generally affects the skin at the beginning of a fever; it will open the pores, and promote the perspiration, by means of which the fever may often be carried off. But instead of this, the common practice is to heap clothes upon the patient, and to give him things of a hot nature, as spirits, spiceries, &c. which fire his blood, increase the spasms, and render the disease more dangerous.

In all fevers a proper attention should be paid to the patient’s longings. These are the calls of Nature, and often point out what may be of real use. Patients are not indeed to be indulged in every thing that the sickly appetite may crave; but it is generally right to let them have a little of what they eagerly desire, though it may not seem altogether proper. What the patient longs for, his stomach will generally digest; and such things have sometimes a very happy effect.

When a patient is recovering from a fever, great care is necessary to prevent a relapse. Many persons, by too soon imagining themselves well, have lost their lives, or contracted other diseases of an obstinate nature. As the body after a fever is weak and delicate, it is necessary to guard against catching cold. Moderate exercise in the open air will be of use, but great fatigue is by all means to be avoided; agreeable company will also have a good effect. The diet must be light, but nourishing. It should be taken frequently, but in small quantities. It is dangerous at such a time to eat as much as the stomach may crave.

CHAP. XIV.
OF INTERMITTING FEVERS, OR AGUES.

Intermitting fevers afford the best opportunity both of observing the nature of a fever, and also the effects of medicine. No person can be at a loss to distinguish an intermitting fever from any other, and the proper medicine for it is now almost universally known.

The several kinds of intermitting fevers take their names from the period in which the fit returns, as quotidian, tertian, quartan, &c.

CAUSES.——Agues are occasioned by effluvia from putrid stagnating water. This is evident from their abounding in rainy seasons, and being most frequent in countries where the soil is marshy, as in Holland, the Fens of Cambridgeshire, the Hundreds of Essex, &c. This disease may also be occasioned by eating too much stone fruit, by a poor watery diet, damp houses, evening dews, lying upon the damp ground, watching, fatigue, depressing passions, and the like. When the inhabitants of a high country remove to a low one, they are generally seized with intermitting fevers, and to such the disease is most apt to prove fatal. In a word, whatever relaxes the solids, diminishes the perspiration, or obstructs the circulation in the capillary or small vessels, disposes the body to agues.

SYMPTOMS.——An intermitting fever generally begins with a pain of the head and loins, weariness of the limbs, coldness of the extremities, stretching, yawning, with sometimes great sickness and vomiting; to which succeed shivering and violent shaking. Afterwards the skin becomes moist, and a profuse sweat breaks out, which generally terminates the fit or paroxysm. Sometimes indeed the disease comes on suddenly, when the person thinks himself in perfect health; but it is more commonly preceded by listlessness, loss of appetite, and the symptoms mentioned above.

REGIMEN.——While the fit continues, the patient ought to drink freely of water-gruel, orange-whey, weak camomile-tea; or, if his spirits be low, small wine-whey, sharpened with the juice of lemon. All his drink should be warm, as that will assist in bringing on the sweat, and consequently shorten the paroxysm[^[58]].

Between the paroxysms the patient must be supported with food that is nourishing, but light and easy of digestion, as veal or chicken-broths, sago, gruel with a little wine, light puddings, and such like. His drink may be small negus, acidulated with the juice of lemons or oranges, and sometimes a little weak punch. He may likewise drink infusions of bitter herbs, as camomile, wormwood, or water-trefoil, and may now and then take a glass of small wine, in which gentian root, centaury, or some other bitter, has been infused.

As the chief intentions of cure in an ague are to brace the solids, and promote perspiration, the patient ought to take as much exercise between the fits as he can bear. If he be able to go abroad, riding on horseback, or in a carriage, will be of great service. But if he cannot bear that kind of exercise, he ought to take such as his strength will permit. Nothing tends more to prolong an intermitting fever, than indulging a lazy indolent disposition.

Intermitting fevers, under a proper regimen, will often go off without medicine; and when the disease is mild, in an open dry country, there is seldom any danger from allowing it to take its course; but when the patient’s strength seems to decline, or the paroxysms are so violent that his life is in danger, medicine ought immediately to be administered. This however should never be done till the disease be properly formed, that is to say, till the patient has had several fits of shaking and sweating.

MEDICINE.——The first thing to be done in the cure of an intermitting fever, is to cleanse the stomach and bowels. This not only renders the application of other medicines more safe, but likewise more efficacious. In this disease, the stomach is generally loaded with cold viscid phlegm, and frequently great quantities of bile are discharged by vomit; which plainly points out the necessity of such evacuations. Vomits are therefore to be administered before the patient takes any other medicine. A dose of ipecacuanha will generally answer this purpose very well. A scruple or half a dram of the powder will be sufficient for an adult, and for a younger person the dose must be less in proportion. After the vomit begins to operate, the patient ought to drink plentifully of weak camomile-tea. The vomit should be taken two or three hours before the return of the fit, and may be repeated at the distance of two or three days. Vomits not only cleanse the stomach, but increase the perspiration, and all the other secretions, which render them of such importance, that they often cure intermitting fevers without the assistance of any other medicine.

Purging medicines are likewise useful and often necessary in intermitting fevers. A smart purge has been known to cure an obstinate ague, after the Peruvian bark and other medicines had been used in vain. Vomits however are more suitable in this disease, and render purging less necessary; but if the patient be afraid to take a vomit, he ought in this case to cleanse the bowels by a dose or two of Glauber’s salt, jalap, or rhubarb.

Bleeding may sometimes be proper at the beginning of an intermitting fever, when excessive heat, a delirium, &c. give reason to suspect an inflammation; but as the blood is seldom in an inflammatory slate in intermitting fevers, this operation is rarely necessary. When frequently repeated, it tends to prolong the disease.

After proper evacuations the patient may safely use the Peruvian bark, which may be taken in any way that is most agreeable to him. No preparation of the bark seems to answer better than the most simple form in which it can be given, viz. in powder.

Two ounces of the best Peruvian bark, finely powdered, may be divided into twenty-four doses. These may either be made into boluses as they are used, with a little syrup of lemon, or mixed in a glass of red wine, a cup of camomile-tea, water-gruel, or any other drink that is more agreeable to the patient[^[59]].

In an ague which returns every day, one of the above doses may be taken every two hours during the interval of the fits. By this method the patient will be able to take five or six doses between each paroxysm. In a tertian or third-day ague it will be sufficient to take a dose every third hour during the interval, and in a quartan every fourth. If the patient cannot take so large a dose of the bark, he may divide each of the powders into two parts, and take one every hour, &c. For a young person a smaller quantity of this medicine will be sufficient, and the dose must be adapted to the age, constitution, and violence of the symptoms[^[60]].

The above quantity of bark will frequently cure an ague; the patient, however, ought not to leave off taking the medicine as soon as the paroxysms are stopped, but should continue to use it till there is reason to believe the disease is entirely overcome. Most of the failures in the cure of this disease are owing to patients not continuing to use the medicine long enough. They are generally directed to take it till the fits are stopped, then to leave it off, and begin again at some distance of time; by which means the disease gathers strength, and often returns with as much violence as before. A relapse may always be prevented by the patient’s continuing to take small doses of the medicine for some time after the symptoms disappear. This is both the most safe and effectual method of cure.

An ounce of gentian root, calamus aromaticus, and orange-peel, of each half an ounce, with three or four handfuls of camomile-flowers, and an handful of coriander-seed, all bruised together in a mortar, may be used in form of infusion or tea. About half an handful of these ingredients may be put into a tea-pot, and an English pint of boiling water poured on them. A cup of this infusion drank three or four times a day will greatly promote the cure. Such patients as cannot drink the watery infusion, may put two handfuls of the same ingredients into a bottle of white wine, and take a glass of it twice or thrice a day. If patients drink freely of the above, or any other proper infusion of bitters, a smaller quantity of bark than is generally used, will be sufficient to cure an ague[^[61]].

Those who cannot swallow the bark in substance, may take it in decoction or infusion. An ounce of bark in powder may be infused in a bottle of white wine for four or five days, frequently shaking the bottle, afterwards let the powder subside, and pour off the clear liquor. A wine glass may be drank three or four times a day, or oftener, as there is occasion. If a decoction be more agreeable, an ounce of the bark, and two drams of snake-root bruised, with an equal quantity of salt of wormwood, may be boiled in a quart of water, into an English pint. To the strained liquor may be added an equal quantity of red wine, and a glass of it taken frequently.

In obstinate agues, the bark will be found much more efficacious when assisted by brandy, or other warm cordials, than taken alone. This I have had frequently occasion to observe in a country where intermittent fevers were endemical. The bark seldom succeeded unless assisted by snake-root, ginger, canella alba, or some other warm aromatic. When the fits are very frequent and violent, in which case the fever often approaches towards an inflammatory nature, it will be safer to keep out the aromatics, and to add salt of tartar in their stead. But in an obstinate tertian or quartan, in the end of autumn or beginning of winter, warm and cordial medicines are absolutely necessary[^[62]].

As autumnal and winter agues generally prove much more obstinate than those which attack the patient in spring or summer, it will be necessary to continue the use of medicines longer in the former than in the latter. A person who is seized with an intermitting fever in the beginning of winter, ought frequently, if the season proves rainy, to take a little medicine, although the disease may seem to be cured, to prevent a relapse, till the return of the warm season. He ought likewise to take care not to be much abroad in wet weather, especially in cold easterly winds.

When agues are not properly cured, they often degenerate into obstinate chronical diseases, as the dropsy, jaundice, &c. For this reason all possible care should be taken to have them radically cured, before the constitution has been too much weakened.

Though nothing is more rational than the method of treating intermitting fevers, yet, by some strange infatuation, more charms and whimsical remedies are daily used for removing this than any other disease. There is hardly an old woman who is not in possession of a nostrum for stopping an ague; and it is amazing with what readiness their pretensions are believed. Those in distress eagerly grasp at any thing that promises sudden relief; but the shortest way is not always the best in the treatment of diseases. The only method to obtain a safe and lasting cure, is gradually to assist Nature in removing the cause of the disorder.

Some indeed try bold, or rather fool-hardy experiments to cure agues, as drinking great quantities of strong liquors, jumping into a river, &c. These may sometimes have the desired effect, but must always be attended with danger[^[63]]. When there is any degree of inflammation, or the least tendency to it, such experiments may prove fatal. The only patient whom I remember to have lost in an intermittent fever, evidently killed himself by drinking strong liquor, which some person had persuaded him would prove an infallible remedy.

Many dirty things are extolled for the cure of intermitting fevers, as spiders, cobwebs, snuffings of candles, &c. Though these may sometimes succeed, yet their very nastiness is sufficient to set them aside, especially when cleanly medicines will answer the purpose better. The only medicine that can be depended upon, for thoroughly curing an intermittent fever, is the Peruvian bark. It may always be used with safety: and I can honestly declare, that in all my practice I never knew it fail, when combined with the medicines mentioned above, and duly persisted in.

Where agues are endemical, even children are often afflicted with that disease. Such patients are very difficult to cure, as they can seldom be prevailed upon to take the bark, or any other disagreeable medicine. One method of rendering this medicine more palatable, is to make it into a mixture with distilled waters and syrup, and afterwards to give it an agreeable sharpness with the elixir or spirit of vitriol. This both improves the medicine, and takes off the nauseous taste. In cases where the bark cannot be administered, the saline mixture may be given with advantage to children[^[64]].

Wine-whey is a very proper drink for a child in an ague; to half an English pint of which may be put a tea-spoonful of the spirit of hartshorn. Exercise is likewise of considerable service; and when the disease proves obstinate, the child ought, if possible, to be removed to a warm dry air. The food ought to be nourishing, and sometimes a little generous wine should be allowed.

To children, and such as cannot swallow the bark, or when the stomach will not bear it, it may be given by clyster. Half an ounce of the extract of bark, dissolved in four ounces of warm water, with the addition of half an ounce of sweet oil, and six or eight drops of laudanum, in the form recommended by Dr. Lind for an adult, and this to be repeated every fourth hour, or oftener, as the occasion shall require. For children the quantity of extract and laudanum must be proportionally lessened. Children have been cured of agues by making them wear a waistcoat with powdered bark quilted between the folds of it; by bathing them frequently in a strong decoction of the bark, and by rubbing the spine with strong spirits, or with a mixture of equal parts of laudanum and the saponaceous liniment.

We have been the more full upon this disease, because it is very common, and because few patients in an ague apply to physicians unless in extremities. There are, however, many cases in which the disease is very irregular, being complicated with other diseases, or attended with symptoms which are both very dangerous and very difficult to understand. All these we have purposely passed over, as they would only bewilder the generality of readers. When the disease is very irregular, or the symptoms dangerous, the patient ought immediately to apply to a physician, and strictly to follow his advice.

To prevent agues, people must endeavour to avoid their causes. These have been already pointed out in the beginning of this section; we shall therefore only add one preventive medicine, which may be of use to such as are obliged to live in low marshy countries, or who are liable to frequent attacks of this disease.

Take an ounce of the best Peruvian bark; Virginian snake-root, and orange-peel, of each half an ounce; bruise them all together, and infuse for five or six days in a bottle of brandy, Holland gin, or any good spirit; afterwards pour off the clear liquor; and take a wine glass of it twice or thrice a day. This indeed is recommending a dram; but the bitter ingredients in a great measure take off the ill effects of the spirit. Those who do not chuse it in brandy, may infuse it in wine; and such as can bring themselves to chew the bark, will find that method succeed very well. Gentian root, or calamus aromaticus, may also be chewed by turns for the same purpose. All bitters seem to be antidotes to agues, especially those that are warm and astringent.

CHAP. XV.
OF AN ACUTE CONTINUAL FEVER.

This fever is denominated acute, ardent, or inflammatory. It most commonly attacks the young, or persons about the prime or vigour of life, especially such as live high, abound with blood, and whose fibres are strong and elastic. It seizes people at all seasons of the year; but is most frequent in the spring and beginning of summer.

CAUSES.——An ardent fever may be occasioned by any thing that overheats the body, or produces plethora, as violent exercise, sleeping in the sun, drinking strong liquors, eating spiceries, a full diet, with little exercise, &c. It may likewise be occasioned by whatever obstructs the perspiration, as lying on the damp ground, drinking cold liquor when the body is hot, night-watching, or the like.

SYMPTOMS.—A rigour or chilliness generally ushers in this fever, which is soon succeeded by great heat, a frequent and full pulse, pain of the head, dry skin, redness of the eyes, a florid countenance, pains in the back, loins, &c. To these succeed difficulty of breathing, sickness, with an inclination to vomit. The patient complains of great thirst, has no appetite for solid food, is restless, and his tongue generally appears black and rough.

A delirium, excessive restlessness, great oppression of the breast, with laborious respiration, starting of the tendons, hiccup, cold clammy sweats, and an involuntary discharge of urine, are very dangerous symptoms.

As this disease is always attended with danger, the best medical assistance ought to be procured as soon as possible. A physician may be of use at the beginning, but his skill is often of no avail afterwards. Nothing can be more unaccountable than the conduct of those who have it in their power, at the beginning of a fever, to procure the best medical assistance, yet put it off till things come to an extremity. When the disease, by delay or wrong treatment, has become incurable, and has exhausted the strength of the patient, it is in vain to hope for relief from medicine. Physicians may indeed assist Nature; but their attempts must ever prove fruitless, when she is no longer able to co-operate with their endeavours.

REGIMEN.—From the symptoms of this disease, it is evident, that the blood and other humours require to be diluted; that the perspiration, urine, saliva, and all the other secretions, are in too small quantity; that the vessels are rigid, and the heat of the whole body too great: all these clearly point out the necessity of a regimen calculated to dilute the blood, correct the acrimony of the humours, allay the excessive heat, remove the spasmodic stricture of the vessels, and promote the secretions.

These important purposes may be greatly promoted by drinking plentifully of diluting liquors; as water-gruel, or oatmeal-tea, clear whey, barley-water, balm-tea, apple-tea, &c. These may be sharpened with juice of orange, jelly of currants, raspberries, and such like: orange-whey is likewise an excellent cooling drink. It is made by boiling among milk and water a bitter orange sliced, till the curd separates. If no orange can be had, a lemon, a little cream of tartar, or a few spoonfuls of vinegar, will have the same effect. Two or three spoonfuls of white wine may occasionally be added to the liquor when boiling.

If the patient be costive, an ounce of tamarinds, with two ounces of stoned raisins of the sun, and a couple of figs, may be boiled in three English pints of water to a quart. This makes a very pleasant drink, and may be used at discretion. The common pectoral decoction is likewise a very proper drink in this disease. A tea-cupful of it may be taken every two hours, or oftener, if the patient’s heat and thirst be very great[^[65]].

The above liquids must all be drank a little warm. They may be used in smaller quantities at the beginning of a fever, but more freely afterwards, in order to assist in carrying off the disease by promoting the different excretions. We have mentioned a variety of drinks, that the patient may have it in his power to chuse those which are most agreeable; and that when tired of one, he may have recourse to another.

The patient’s diet must be very spare and light. All sorts of flesh-meats, and even chicken-broths, are to be avoided. He may be allowed groat-gruel, panado, or light bread boiled in water; to which may be added a few grains of common salt, and a little sugar, which will render it more palatable. He may eat roasted apples with a little sugar, toasted bread with jelly of currants, boiled prunes, &c.

It will greatly relieve the patient, especially in an hot season, to have fresh air frequently let into his chamber. This, however, must always be done in such a manner as not to endanger his catching cold.

It is too common in fevers to load the patient with bed-clothes, under the pretence of making him sweat, or defending him from the cold. This custom has many ill effects. It increases the heat of the body, fatigues the patient, and retards, instead of promoting, the perspiration.

Sitting upright in bed, if the patient is able to bear it, will often have a good effect. It relieves the head, by retarding the motion of the blood to the brain. But this posture ought never to be continued too long: and if the patient is inclined to sweat, it will be more safe to let him lie, only raising his head a little with pillows.

Sprinkling the chamber with vinegar, juice of lemon, or vinegar and rose-water, with a little nitre dissolved in it, will greatly refresh the patient. This ought to be done frequently, especially if the weather is hot.

The patient’s mouth should be often washed with a mixture of water and honey, to which a little vinegar may be added, or with a decoction of figs in barley-water. His feet and hands ought likewise frequently to be bathed in lukewarm water; especially if the head is affected.

The patient should be kept as quiet and easy as possible. Company, noise, and every thing that disturbs the mind, is hurtful. Even too much light, or any thing that affects the senses, ought to be avoided. His attendants should be as few as possible, and they ought not to be too often changed. His inclinations ought rather to be soothed than contradicted; even the promise of what he craves will often satisfy him as much as its reality.

MEDICINE.——In this and all other fevers, attended with a hard, full, quick pulse, bleeding is of the greatest importance. This operation ought always to be performed as soon as the symptoms of an inflammatory fever appear. The quantity of blood to be taken away, however, must be in proportion to the strength of the patient and the violence of the disease. If after the first bleeding the fever should increase, and the pulse become more frequent and hard, there will be a necessity for repeating it a second, and perhaps a third, or even a fourth time, which may be done at the distance of twelve, eighteen, or twenty-four hours from each other, as the symptoms require. If the pulse continues soft, and the patient is tolerably easy after the first bleeding, it ought not to be repeated.

If the heat and fever be very great, forty or fifty drops of the dulcified or sweet spirit of nitre may be made into a draught, with an ounce of rose-water, two ounces of common water, and half an ounce of simple syrup, or a bit of loaf-sugar. This draught may be given to the patient every three or four hours while the fever is violent; afterwards once in five or six hours will be sufficient.

If the patient be afflicted with retching, or an inclination to vomit, it will be right to assist Nature’s attempts, by giving him weak camomile-tea, or lukewarm water to drink.

If the body is bound, a clyster of milk and water with a little salt, and a spoonful of sweet oil or fresh butter in it, ought daily to be administered. Should this not have the desired effect, a tea-spoonful of magnesia alba, or cream of tartar, may be frequently put into his drink. He may likewise eat tamarinds, boiled prunes, roasted apples, and the like.

If about the tenth, eleventh, or twelfth day, the pulse becomes more soft, the tongue moister, and the urine begins to let fall a reddish settlement, there is reason to expect a favourable issue to the disease. But if, instead of these symptoms, the patient’s spirits grow languid, his pulse sinks, and his breathing becomes difficult; with a stupor, trembling of the nerves, starting of the tendons, &c. there is reason to fear that the consequences will be fatal. In this case blistering plasters must be applied to the head, ancles, inside of the legs or thighs, as there may be occasion; poultices of wheat-bread, mustard, and vinegar, may likewise be applied to the soles of the feet, and the patient must be supported with cordials, as strong wine-whey, negus, sago-gruel with wine in it, and such like.

A proper regimen is not only necessary during the fever, but likewise after the patient begins to recover. By neglecting this, many relapse, or fall into other diseases, and continue valetudinary for life. Though the body is weak after a fever, yet the diet for some time ought to be rather light than of too nourishing a nature. Too much food, drink, exercise, company, &c. are carefully to be avoided. The mind ought likewise to be kept easy, and the patient should not attempt to pursue study, or any business that requires intense thinking.

If the digestion is bad, or the patient is seized at times with feverish heats, an infusion of Peruvian bark in cold water will be of use. It will strengthen the stomach, and help to subdue the remains of the fever.

When the patient’s strength is pretty well recovered, he ought to take some gentle laxative. An ounce of tamarinds and a dram of sena may be boiled for a few minutes in an English pint of water, and an ounce of manna dissolved in the decoction; afterwards it may be strained, and a tea-cupful drank every hour till it operates. This dose may be repeated twice or thrice, five or six days intervening between each dose.

Those who follow laborious employments ought not to return too soon to their labour after a fever, but should keep easy till their strength and spirits are sufficiently recruited.

CHAP. XVI.
OF THE PLEURISY.

The true pleurisy is an inflammation of that membrane called the pleura, which lines the inside of the breast. It is distinguished into the moist and dry. In the former the patient spits freely; in the latter, little or none at all. There is likewise a species of this disease, which is called the spurious or bastard pleurisy, in which the pain is more external, and chiefly affects the muscles between the ribs. The pleurisy prevails among labouring people, especially such as work without doors, and are of a sanguine constitution. It is most frequent in the spring season.

CAUSES.——The pleurisy may be occasioned by whatever obstructs the perspiration; as cold northerly winds; drinking cold liquors when the body is hot; sleeping without doors on the damp ground; wet clothes; plunging the body into cold water, or exposing it to the cold air, when covered with sweat, &c. It may likewise be occasioned by drinking strong liquors; by the stoppage of usual evacuations; as old ulcers, issues, sweating of the feet or hands, &c. the sudden striking in of any eruption, as the itch, the measles, or the small-pox. Those who have been accustomed to bleed at a certain season of the year are apt, if they neglect it, to be seized with a pleurisy. Keeping the body too warm by means of fire, clothes, &c. renders it more liable to this disease. A pleurisy may likewise be occasioned by violent exercise, as running, wrestling, leaping, or by supporting great weight, blows on the breast, &c. A bad conformation of the body renders persons more liable to this disease, as a narrow chest, a straitness of the arteries of the pleura, &c.

SYMPTOMS.—This, like most other fevers, generally begins with chillness and shivering, which are followed by heat, thirst, and restlessness. To these succeeds a violent pricking pain in one of the sides among the ribs. Sometimes the pain extends towards the back bone, sometimes towards the fore-part of the breast, and at other times towards the shoulder blades. The pain is generally most violent when the patient draws his breath.

The pulse in this disease is commonly quick and hard, the urine high-coloured; and if blood be let, it is covered with a tough crust, or buffy coat. The patient’s spittle is at first thin, but afterwards it becomes grosser, and is often streaked with blood.

REGIMEN.——Nature generally endeavours to carry off this disease by a critical discharge of blood from some part of the body, by expectoration, sweat, loose stools, thick urine, or the like. We ought therefore to second her intentions by lessening the force of the circulation, relaxing the vessels, diluting the humours, and promoting expectoration.

For these purposes the diet, as in the former disease, ought to be cool, slender, and diluting. The patient must avoid all food that is viscid, hard of digestion, or that affords much nourishment; as flesh, butter, cheese, eggs, milk, and also every thing that is of a heating nature. His drink may be whey, or an infusion of pectoral and balsamic vegetables[^[66]].

Barley-water, with a little honey or jelly of currants mixed with it, is likewise a very proper drink in this disease. It is made by boiling an ounce of pearl-barley in three English pints of water to two, which must afterwards be strained. The decoction of figs, raisins, barley, recommended in the preceding disease, is here likewise very proper. These and other diluting liquors are not to be drank in large quantities at a time, but the patient ought to keep continually sipping them, so as to render his mouth and throat always moist. All his food and drink should be taken a little warm.

The patient should be kept quiet, cool, and every way easy, as directed under the foregoing disease. His feet and hands ought daily to be bathed in lukewarm water; and he may sometimes sit up in bed for a short space, in order to relieve his head.

MEDICINE.——Almost every person knows, when a fever is attended with a violent pain of the side, and a quick hard pulse, that bleeding is necessary. When these symptoms come on, the sooner this operation is performed the better; and the quantity at first must be pretty large, provided the patient is able to bear it. A large quantity of blood let at once, in the beginning of a pleurisy, has a much better effect than repeated small bleedings. A man may lose twelve or fourteen ounces of blood as soon as it is certainly known that he is seized with a pleurisy. For a younger person, or one of a delicate constitution, the quantity must be less.

If, after the first bleeding, the stitch, with the other violent symptoms, should still continue, it will be necessary, at the distance of twelve or eighteen hours, to let eight or nine ounces more. If the symptoms do not then abate, and the blood shews a strong buffy coat, a third or even a fourth bleeding may be requisite. If the pain of the side abates, the pulse becomes softer, or the patient begins to spit freely, bleeding ought not to be repeated. This operation is seldom necessary after the third or fourth day of the fever, and ought not then to be performed, unless in the most urgent circumstances.

The blood may be many ways attenuated without bleeding. There are likewise many things that may be done to ease the pain of the side without this operation, as fomenting, blistering, &c. Fomentations may be made by boiling a handful of the flowers of elder, camomile, and common mallows, or any other soft vegetables, in a proper quantity of water. The herbs may be either put into a flannel bag, and applied warm to the side, or flannels may be dipped in the decoction, afterwards wrung out, and applied to the part affected, with as much warmth as the patient can easily bear. As the clothes grow cool, they must be changed, and great care taken that the patient do not catch cold. A bladder may be filled with warm milk and water, and applied to the side, if the above method of fomenting be found inconvenient. Fomentations not only ease the pain, but relax the vessels, and prevent the stagnation of the blood and other humours. The side may likewise be frequently rubbed with a little of the volatile liniment[^[67]].

Topical bleeding has often a very good effect in this disease. It may either be performed by applying a number of leeches to the part affected, or by cupping, which is both a more certain and expeditious method than the other.

Leaves of various plants might likewise be applied to the patient’s side with advantage. I have often seen great benefit from young cabbage-leaves applied warm to the side in a pleurisy. These not only relax the parts, but likewise draw off a little moisture, and may prevent the necessity of blistering-plasters; which however, when other things fail, must be applied.

If the stitch continues after repeated bleedings, fomentations, &c. a blistering-plaster must be applied over the part affected, and suffered to remain for two days. This not only procures a discharge from the side, but takes off the spasm, and by that means assists in removing the cause of the disease. To prevent a strangury when the blistering-plaster is on, the patient may drink freely of the Arabic emulsion[^[68]].

If the patient is costive, a clyster of thin water-gruel, or of barley-water, in which a handful of mallows, or any other emollient vegetable has been boiled, may be daily administered. This will not only empty the bowels, but have the effect of a warm fomentation applied to the inferior viscera, which will help to make a derivation from the breast.

The expectoration of spitting may be promoted by sharp, oily, and mucilaginous medicines. For this purpose an ounce of the oxymel, or the vinegar of squills, may be added to six ounces of the pectoral decoction, and two table-spoonfuls of it taken every two hours.

Should the squill disagree with the stomach, the oily emulsion may be administered[^[69]]; or, in place of it, two ounces of the oil of sweet almonds, or oil of olives, and two ounces of the syrup of violets, may be mixed with as much sugar-candy powdered, as will make an electuary of the consistence of honey. The patient may take a tea-spoonful of this frequently, when the cough is troublesome. Should oily medicines prove nauseous, which is sometimes the case, two table-spoonfuls of the solution of gum ammoniac in barley-water may be given three or four times a-day[^[70]].

If the patient does not perspire, but has a burning heat upon his skin, and passes very little water, some small doses of purified nitre and camphire will be of use. Two drams of the former may be rubbed with five or six grains of the latter in a mortar, and the whole divided into six doses, one of which may be taken every five or six hours, in a little of the patient’s ordinary drink.

We shall only mention one medicine more, which some reckon almost a specific in the pleurisy, viz. the decoction of the seneka rattle-snake root[^[71]]. After bleeding and other evacuations have been premised, the patient may take two, three, or four table-spoonfuls of this decoction, according as his stomach will bear it, three or four times a-day. If it should occasion vomiting, two or three ounces of simple cinnamon-water may be mixed with the quantity of decoction here directed, or it may be taken in smaller doses. As this medicine promotes perspiration and urine, and likewise keeps the body easy, it may be of some service in a pleurisy, or any other inflammation of the breast.

No one will imagine that these medicines are all to be used at the same time. We have mentioned different things, on purpose that people may have it in their power to chuse; and likewise, that when one cannot be obtained, they may make use of another. Different medicines are no doubt necessary in the different periods of a disorder; and where one fails of success, or disagrees with the patient, it will be proper to try another.

What is called the crisis, or height of the fever, is sometimes attended with very alarming symptoms, as difficulty of breathing, an irregular pulse, convulsive motions, &c. These are apt to frighten the attendants, and induce them to do improper things, as bleeding the patient, giving him strong stimulating medicines, or the like. But they are only the struggles of Nature to overcome the disease, in which she ought to be assisted by plenty of diluting drink, which is then peculiarly necessary. If the patient’s strength however be much exhausted by the disease, it will be necessary at this time to support him with frequent small draughts of wine-whey, negus, or the like.

When the pain and fever are gone, it will be proper, after the patient has recovered sufficient strength, to give him some gentle purges, as those directed towards the end of the acute continual fever. He ought likewise to use a light diet, of easy digestion, and his drink should be butter-milk, whey, and other things of a cleansing nature.

Of the BASTARD PLEURISY.

That species of pleurisy which is called the bastard or spurious, generally goes off by keeping warm for a few days, drinking plenty of diluting liquors, and observing a cooling regimen.

It is known by a dry cough, a quick pulse, and a difficulty of lying on the affected side, which last does not always happen in the true pleurisy. Sometimes indeed this disease proves obstinate, and requires bleeding, with cupping, and scarifications of the part affected. These, together with the use of nitrous and other cooling medicines, seldom fail to effect a cure.

Of the PARAPHRENITIS.

The paraphrenitis, or inflammation of the diaphragm, is so nearly connected with the pleurisy, and resembles it so much in the manner of treatment, that it is scarce necessary to consider it as a separate disease.

It is attended with a very acute fever, and an extreme pain in the part affected, which is generally augmented by coughing, sneezing, drawing in the breath, taking food, going to stool, making water, &c. Hence the patient breathes quick, and draws in his bowels to prevent the motion of the diaphragm; is restless, anxious, has a dry cough, a hiccup, and often a delirium. A convulsive laugh, or rather a kind of involuntary grin, is no uncommon symptom of this disease.

Every method must be taken to prevent a suppuration, as it is impossible to save the patient’s life when this happens. The regimen and medicine are in all respects the same as in the pleurisy. We shall only add, that in this disease emollient clysters are peculiarly useful, as they relax the bowels, and by that means make a derivation from the part affected.

CHAP. XVII.
OF A PERIPNEUMONY, OR INFLAMMATION OF THE LUNGS.

As this disease affects an organ which is absolutely necessary to life, it must always be attended with danger. Persons who abound with thick blood, whose fibres are tense and rigid, who feed upon gross aliment, and drink strong viscid liquors, are most liable to a peripneumony. It is generally fatal to those who have a flat breast, or narrow chest, and to such as are afflicted with an asthma, especially in the decline of life. Sometimes the inflammation reaches to one lobe of the lungs only, at other times the whole of the organ is affected; in which case the disease can hardly fail to prove fatal.

When the disease proceeds from a viscid pituitous matter obstructing the vessels of the lungs, it is called a spurious or bastard peripneumony. When it arises from a thin acrid defluxion on the lungs, it is denominated a catarrhal peripneumony, &c.

CAUSES.——An inflammation of the lungs is sometimes a primary disease, and sometimes it is the consequence of other diseases, as a quinsey, a pleurisy, &c. It proceeds from the same causes as the pleurisy, viz. an obstructed perspiration from cold, wet clothes, &c. or from an increased circulation of the blood by violent exercise, the use of spiceries, ardent spirits, and such like. The pleurisy and peripneumony are often complicated; in which case the disease is called a pleuro-peripneumony.

SYMPTOMS.——Most of the symptoms of a pleurisy likewise attend an inflammation of the lungs; only in the latter the pulse is more soft, and the pain less acute; but the difficulty of breathing, and oppression of the breast, are generally greater.

REGIMEN.——As the regimen and medicine are in all respects the same in the true peripneumony as in the pleurisy, we shall not here repeat them, but refer the reader to the treatment of that disease. It may not however be improper to add, that the aliment ought to be more slender and thin in this than in any other inflammatory disease. The learned Dr. Arbuthnot asserts, that even common whey is sufficient to support the patient, and that decoctions of barley, and infusions of fennel roots in warm water with milk, are the most proper both for drink and nourishment. He likewise recommends the steam of warm water taken in by the breath, which serves as a kind of internal fomentation, and helps to attenuate the impacted humours. If the patient has loose stools, but is not weakened by them, they are not to be stopped, but rather promoted by the use of emollient clysters.

It has already been observed, that the spurious or bastard peripneumony is occasioned by a viscid pituitous matter obstructing the vessels of the lungs. It commonly attacks the old, infirm, and phlegmatic, in winter and wet seasons.

The patient at the beginning is cold and hot by turns, has a small quick pulse, feels sense of weight upon his breast, breathes with difficulty, and sometimes complains of a pain and giddiness of his head. His urine is usually pale, and his colour very little changed.

The diet in this, as well as in the true peripneumony, must be very slender, as weak broths, sharpened with the juice of orange or lemon, and such like. His drink may be thin water-gruel sweetened with honey, or a decoction of the roots of fennel, liquorice, and quick grass. An ounce of each of these may be boiled in three English pints of water to a quart, and sharpened with a little currant-jelly, or the like.

Bleeding and purging are generally proper at the beginning of this disease; but if the patient’s spittle is pretty thick, or well concocted, neither of them are necessary. It will be sufficient to assist the expectoration by some of the sharp medicines recommended for that purpose in the pleurisy, as the solution of gum ammoniac with oxymel of squills, &c. Blistering plasters have generally a good effect, and ought to be applied pretty early.

If the patient does not spit, he must be bled according as his strength will permit, and have a gentle purge administered. Afterwards his body may be kept open by clysters, and the expectoration promoted, by taking every four hours two table-spoonfuls of the solution mentioned above.

When an inflammation of the breast does not yield to bleeding, blistering, and other evacuations, it commonly ends in a suppuration, which is more or less dangerous, according to the part where it is situated. When this happens in the pleura, it sometimes breaks outwardly, and the matter is discharged by the wound.

When the suppuration happens within the substance or body of the lungs, the matter may be discharged by expectoration; but if the matter floats in the cavity of the breast, between the pleura and the lungs, it can only be discharged by an incision made betwixt the ribs.

If the patient’s strength does not return after the inflammation is to all appearance removed; if his pulse continues quick though soft, his breathing difficult and oppressed; if he has cold shiverings at times, his cheeks flushed, his lips dry; and if he complains of thirst, and want of appetite, there is reason to fear a suppuration, and that a phthisis or consumption of the lungs will ensue. We shall therefore next proceed to consider the proper treatment of that disease.

CHAP. XVIII.
OF CONSUMPTIONS.

A consumption is a wasting or decay of the whole body from an ulcer, tubercles, or concretions of the lungs, an empyema, a nervous atrophy, or a cachexy.

Dr. Arbuthnot observes, that in his time consumptions made up above one-tenth part of the bills of mortality in and about London. There is reason to believe they have rather increased since, and we know from experience, that they are not less fatal in some other towns of England than in London.

Young persons, between the age of fifteen and thirty, of a slender make, long neck, high shoulders, and flat breasts, are most liable to this disease.

Consumptions prevail more in England than in any other part of the world, owing perhaps to the great use of animal food and malt liquors, the general application to sedentary employments, and the great quantity of pit-coal which is there burnt; to which we may add the perpetual changes in the atmosphere, or variableness of the weather.

CAUSES.——It has already been observed, that an inflammation of the breast often ends in an imposthume: consequently whatever disposes people to this disease, must likewise be considered as a cause of consumption.

Other diseases, by vitiating the habit, may likewise occasion consumptions; as the scurvy, the scrophula, or king’s evil, the venereal disease, the asthma, small-pox, measles, &c.

As this disease is seldom cured, we shall endeavour the more particularly to point out its causes, in order that people may be enabled to avoid it. These are:

——Confined or unwholesome air. When this fluid is impregnated with the fumes of metals or minerals, it proves extremely hurtful to the lungs, and often corrodes the tender vessels of that necessary organ.

——Violent passions, exertions, or affections of the mind; as grief, disappointment, anxiety, or close application to the study of abstruse arts or sciences.

——Great evacuations; as sweating, diarrhœas, diabetes, excessive venery, the fluor albus, an over-discharge of the menstrual flux, giving suck too long, &c.

——The sudden stoppage of customary evacuations; as the bleeding piles, sweating of the feet, bleeding at the nose, the menses, issues, ulcers, or eruptions of any kind.

——Injuries done to the lungs, calculi, &c. I lately saw the symptoms of a phthisis occasioned by a small bone sticking in the bronchæ. It was afterwards vomited along with a considerable quantity of purulent matter, and the patient, by a proper regimen, and the use of the Peruvian bark, recovered.

——Making a sudden transition from a hot to a very cold climate, change of apparel, or whatever greatly lessens the perspiration.

——Frequent and excessive debaucheries. Late watching, and drinking strong liquors, which generally go together, can hardly fail to destroy the lungs. Hence the bon companion generally falls a sacrifice to this disease.

——Infection. Consumptions are likewise caught by sleeping with the diseased; for which reason this should be carefully avoided. It cannot be of great benefit to the sick, and must hurt those in health.

——Occupations in life. Those artificers who sit much, and are constantly leaning forward, or pressing upon the stomach and breast, as cutlers, taylors, shoemakers, seamstresses, &c. often die of consumptions. They likewise prove fatal to singers, and all who have occasion to make frequent and violent exertions of the lungs.

——Cold. More consumptive patients date the beginning of their disorders from wet feet, damp beds, night air, wet clothes, or catching cold after the body had been heated, than from all other causes.

Sharp, saline, and aromatic aliments, which heat and inflame the blood, are likewise frequently the cause of consumptions.

We shall only add, that this disease is often owing to an hereditary taint, or a scrophulous habit; in which case it is generally incurable.

SYMPTOMS.——This disease generally begins with a dry cough, which often continues for some months. If a disposition to vomit after eating be excited by it, there is still greater reason to fear an approaching consumption. The patient complains of a more than usual degree of heat, a pain and oppression of the breast, especially after motion; his spittle is of a saltish taste, and sometimes mixed with blood. He is apt to be sad; his appetite is bad, and his thirst great. There is generally a quick, soft, small pulse; though sometimes the pulse is pretty full, and rather hard. These are the common symptoms of a beginning consumption.

Afterwards the patient begins to spit a greenish, white, or bloody matter. His body is extenuated by the hectic fever, and colliquative sweats, which mutually succeed one another, viz. the one towards night, and the other in the morning. A looseness, and an excessive discharge of urine, are often troublesome symptoms at this time, and greatly weaken the patient. There is a burning heat in the palms of the hands, and the face generally flushes after eating; the fingers become remarkably small, the nails are bent inwards, and the hairs fall off.

At last the swelling of the feet and legs, the total loss of strength, the sinking of the eyes, the difficulty of swallowing, and the coldness of the extremities, shew the immediate approach of death, which however the patient seldom believes to be so near. Such is the usual progress of this fatal disease, which, if not early checked, commonly sets all medicine at defiance.

REGIMEN.——On the first appearance of a consumption, if the patient lives in a large town, or any place where the air is confined, he ought immediately to quit it, and to make choice of a situation in the country, where the air is pure and free. Here he must not remain inactive, but take every day as much exercise as he can bear.

The best method of taking exercise is to ride on horseback, as this gives the body a great deal of motion without much fatigue. Such as cannot bear this kind of exercise, must make use of a carriage. A long journey, as it amuses the mind by a continual change of objects, is greatly preferable to riding the same ground over and over. Care however must be taken to avoid catching cold from wet clothes, damp beds, or the like. The patient ought always to finish his ride in the morning, or at least before dinner; otherwise it will oftener do harm than good.

It is pity those who attend the sick seldom recommend riding in this disease, till the patient is either unable to bear it, or the malady has become incurable. Patients are likewise apt to trifle with everything that is in their own power. They cannot see how one of the common actions of life should prove a remedy in an obstinate disease, and therefore they reject it, while they greedily hunt after relief from medicine, merely because they do not understand it.

Those who have strength and courage to undertake a pretty long voyage, may expect great advantage from it. This, to my knowledge, has frequently cured a consumption after the patient was, to all appearance, far advanced in that disease, and where medicine had proved ineffectual. Hence it is reasonable to conclude, that if a voyage were undertaken in due time, it would seldom fail to perform a cure[^[72]].

Such as try this method of cure ought to carry as much fresh provisions along with them as will serve for the whole time they are at sea. As milk is not easily obtained in this situation, they ought to live upon fruits, and the broth of chickens, or other young animals which can be kept alive on board. It is scarce necessary to add, that such voyages should be undertaken, if possible, in the mildest season, and that they ought to be towards a warmer climate[^[73]].

Those who have not courage for a long voyage may travel into a more southern climate, as the south of France, Spain, or Portugal; and if they find the air of these countries agree with them, they should continue there, at least till their health be confirmed.

Next to proper air and exercise, we would recommend a due attention to diet. The patient should eat nothing that is either heating or hard of digestion, and his drink must be of a soft and cooling nature. All the diet ought to be calculated to lessen the acrimony of the humours, and to nourish and support the patient. For this purpose he must keep chiefly to the use of vegetables and milk. Milk alone is of more value in this disease than the whole materia medica.

Asses milk is commonly reckoned preferable to any other; but it cannot always be obtained; besides, it is generally taken in a very small quantity; whereas, to produce any effects, it ought to make a considerable part of the patient’s diet. It is hardly to be expected, that a gill or two of asses milk, drank in the space of twenty-four hours, should be able to produce any considerable change in the humours of an adult; and when people do not perceive its effects soon, they lose hope, and so leave it off. Hence it happens that this medicine, however valuable, very seldom performs a cure. The reason is obvious; it is commonly used too late, is taken in too small quantities, and is not duly persisted in.

I have known very extraordinary effects from asses milk in obstinate coughs, which threatened a consumption of the lungs; and do verily believe, if used at this period, that it would seldom fail; But if it be delayed till an ulcer is formed, which is generally the case, how can it be expected to succeed?

Asses milk ought to be drank, if possible, in its natural warmth, and, by a grown person, in the quantity of half an English pint at a time. Instead of taking this quantity night and morning only, the patient ought to take it four times, or at least thrice a-day, and to eat a little light bread along with it, so as to make it a kind of meal.

If the milk should happen to purge, it may be mixed with old conserve of roses. When that cannot be obtained, the powder of crabs claws may be used in its stead. Asses milk is usually ordered to be drank warm in bed; but as it generally throws the patient in a sweat when taken in this way, it would perhaps be better to give it after he rises.

Some extraordinary cures in consumptive cases have been performed by women’s milk. Could this be obtained in sufficient quantity, we would recommend it in preference to any other. It is better if the patient can suck it from the breast, than to drink it afterwards. I knew a man who was reduced to such a degree of weakness in a consumption, as not to be able to turn himself in bed. His wife was at that time giving suck, and the child happening to die, he sucked her breasts, not with a view to reap any advantage from the milk, but to make her easy. Finding himself however greatly benefited by it, he continued to suck her till he became perfectly well, and is at present a strong and healthy man.

Some prefer butter-milk to any other, and it is indeed a very valuable medicine, if the stomach be able to bear it. It does not agree with every person at first; and is therefore often laid aside without a sufficient trial. It should at first be taken sparingly, and the quantity gradually increased, until it comes to be almost the sole food. I never knew it succeed unless where the patient almost lived upon it.

Cows milk is most readily obtained of any, and though it be not so easily digested as that of asses or mares, it may be rendered lighter by adding to it an equal quantity of barley-water, or allowing it to stand for some hours, and afterwards taking off the cream. If it should notwithstanding prove heavy on the stomach, a small quantity of brandy or rum, with a little sugar, may be added, which will render it both more light and nourishing.

It is not to be wondered, that milk should for some time disagree with a stomach that has not been accustomed to digest any thing but flesh and strong liquors, which is the case with many of those who fall into consumptions. We do not however advise those have been accustomed to animal food and strong liquors, to leave them off all at once. This might be dangerous. It will be necessary for such to eat a little once a-day of the flesh of some young animal, or rather to use the broth made of chickens, veal, lamb, or such like. They ought likewise to drink a little wine made into negus, or diluted with twice or thrice its quantity of water, and to make it gradually weaker till they can leave it off altogether.

These must be used only as preparatives to a diet consisting chiefly of milk and vegetables, which the sooner the patient can be brought to bear, the better. Rice and milk, or barley and milk, boiled with a little sugar, is very proper food. Ripe fruits roasted, baked, or boiled, are likewise proper, as goose or currant berry tarts, apples roasted, or boiled in milk, &c. The jellies, conserves, and preserves, &c. of ripe subacid fruits, ought to be eaten plentifully, as the jelly of currants, conserve of roses, preserved plums, cherries, &c.

Wholesome air, proper exercise, and a diet consisting chiefly of these and other vegetables, with milk, is the only course that can be depended on in a beginning consumption. If the patient has strength and sufficient resolution to persist in this course, he will seldom be disappointed of a cure.

In a populous town in England[^[74]], where consumptions are very common, I have frequently seen consumptive patients, who had been sent to the country with orders to ride, and live upon milk and vegetables, return in a few months quite plump, and free from any complaint. This indeed was not always the case, especially when the disease was hereditary, or far advanced; but it was the only method in which success was to be expected: where it failed, I never knew medicine succeed.

If the patient’s strength and spirits flag, he must be supported by strong broths, jellies, and such like. Some recommend shell-fish in this disorder, and with some reason, as they are nourishing and restorative[^[75]]. All the food and drink ought however to be taken in small quantities, lest an overcharge of fresh chyle should oppress the lungs, and too much accelerate the circulation of the blood.

The patient’s mind ought to be kept as easy and cheerful as possible. Consumptions are often occasioned, and always aggravated, by a melancholy cast of mind; for which reason music, cheerful company, and every thing that inspires mirth, are highly beneficial. The patient ought seldom to be left alone, as brooding over his calamities is sure to render them worse.

MEDICINE.——Though the cure of this disease depends chiefly upon regimen and the patient’s own endeavours, yet we shall mention a few things which may be of service in relieving some of the more violent symptoms.

In the first stage of a consumption, the cough may sometimes be appeased by bleeding; and the expectoration may be promoted by the following medicines. Take fresh squills, gum-ammoniac, and powdered cardamum seeds, of each a quarter of an ounce; beat them together in a mortar, and if the mass proves too hard for pills, a little of any kind of syrup may be added to it. This may be formed into pills of a moderate size, and four or five of them taken twice or thrice a-day, according as the patient’s stomach will bear them.

The lac ammoniacum, or milk of gum-ammoniac, as it is called, is likewise a proper medicine in this stage of the disease. It may be used as directed in the pleurisy.

A mixture made of equal parts of lemon-juice, fine honey, and syrup of poppies, may likewise be used. Four ounces of each of these may be simmered together in a sauce-pan, over a gentle fire, and a table-spoonful of it taken at any time when the cough is troublesome.

It is common in this stage of the disease to load the patient’s stomach with oily and balsamic medicines. These, instead of removing the cause of the disease, tend rather to increase it, by heating the blood, while they pall the appetite, relax the solids, and prove every way hurtful to the patient. Whatever is used for removing the cough, besides riding and other proper regimen, ought to be medicines of a sharp and cleaning nature; as oxymel, syrup of lemon, &c.

Acids seem to have peculiarly good effects in this disease; they both tend to quench the patient’s thirst and to cool the blood. The vegetable acids, as apples, oranges, lemons, &c. appear to be the most proper. I have known patients suck the juice of several lemons every day with manifest advantage, and would for this reason recommend acid vegetables to be taken in as great quantity as the stomach will bear them.

For the patient’s drink, we would recommend infusions of the bitter plants, as ground-ivy, the lesser centaury, camomile flowers, or water-trefoil. These infusions may be drank at pleasure. They strengthen the stomach, promote digestion, rectify the blood, and at the same time answer all the purposes of dilution, and quench thirst much better than things that are luscious or sweet. But if the patient spits blood, he ought to use, for his ordinary drink, infusions or decoctions of the vulnerary roots, plants, &c.[^[76]]

There are many other mucilaginous plants and seeds, of a healing and agglutinating nature, from which decoctions or infusions may be prepared with the same intention; as the orches, the quince-seed, coltsfoot, linseed, sasaparilla, &c. It is not necessary to mention the different ways in which these may be prepared. Simple infusion or boiling is all that is necessary, and the dose may be at discretion.

The conserve of roses is here peculiarly proper. It may either be put into the decoction above prescribed, or eaten by itself. No benefit is to be expected from trifling doses of this medicine. I never knew it of any service, unless where three or four ounces at least were used daily for a considerable time. In this way I have seen it produce very happy effects, and would recommend it wherever there is a discharge of blood from the lungs.

When the spitting up of gross matter, oppression of the breast, and the hectic symptoms, shew that an imposthume is formed in the lungs, we would recommend the Peruvian bark, that being the only drug which has any chance to counteract the general tendency which the humours then have to putrefaction.

An ounce of the bark in powder may be divided into eighteen or twenty doses, of which one may be taken every three hours through the day, in a little syrup, or a cup of horehound tea.

If the bark should happen to purge, it may be made into an electuary, with the conserve of roses, thus: Take old conserve of roses a quarter of a pound, Peruvian bark in powder an ounce, syrup of orange or lemon, as much as will make it of the consistence of honey. This quantity will serve the patient four or five days, and may be repeated as there is occasion.

Such as cannot take the bark in substance, may infuse it in cold water. This seems to be the best menstruum for extracting the virtues of that drug. Half an ounce of bark in powder may be infused for twenty-four hours in half an English pint of water. Afterwards let it be passed through a fine strainer, and an ordinary tea-cupful of it taken three or four times a-day.

We would not recommend the bark while there are any symptoms of an inflammation of the breast; but when it is certainly known that matter is collected there, it is one of the best medicines which can be used. Few patients indeed have resolution enough to give the bark a fair trial at this period of the disease, otherwise we have reason to believe that some benefit might be reaped from it.

When it is evident that there is an imposthume in the breast, and the matter can neither be spit up nor carried off by absorption, the patient must endeavour to make it break inwardly, by drawing in the steams of warm water or vinegar with his breath, coughing, laughing, or bawling aloud, &c. When it happens to burst within the lungs, the matter may be discharged by the mouth. Sometimes indeed the bursting of the vomica occasions immediate death, by suffocating the patient. When the quantity of matter is great, and the patient’s strength exhausted, this is commonly the case. At any rate the patient is ready to fall into a swoon, and should have volatile salts or spirits held to his nose.

If the matter discharged be thick, and the cough and breathing become easier, there may be some hopes of a cure. The diet at this time ought to be light, but restorative, as chicken-broths, sago-gruel, rice-milk, &c. the drink, butter-milk, or whey, sweetened with honey. This is likewise a proper time for using the Peruvian bark, which may be taken as directed above.

If the vomica or imposthume should discharge itself into the cavity of the breast, betwixt the pleura and the lungs, there is no way of getting the matter out but by an incision, as has already been observed. As this operation must always be performed by a surgeon, it is not necessary here to describe it. We shall only add, that it is not so dreadful as people are apt to imagine, and that it is the only chance the patient in this case has for his life.

A nervous consumption is a wasting or decay of the whole body, without any considerable degree of fever, cough, or difficulty of breathing. It is attended with indigestion, weakness, and want of appetite, &c.

Those who are of a fretful temper, who indulge in spirituous liquors, or who breathe an unwholesome air, are most liable to this disease.

We would chiefly recommend, for the cure of a nervous consumption, a light and nourishing diet, plenty of exercise in a free open air, and the use of such bitters as brace and strengthen the stomach; as the Peruvian bark, gentian root, camomile, horehound, &c. These may be infused in water or wine, and a glass of it drank frequently.

It will greatly assist the digestion, and promote the cure of this disease, to take twice-a-day twenty or thirty drops of the elixir of vitriol in a glass of wine or water. The chalybeate wine is likewise an excellent medicine in this case. It strengthens the solids, and powerfully assists Nature in the preparation of good blood[^[77]].

Agreeable amusements, cheerful company, and riding about, are however preferable to all medicines in this disease. For which reason, when the patient can afford it, we would recommend a long journey of pleasure, as the most likely means to restore his health.

What is called a symptomatic consumption cannot be cured without first removing the disease by which it is occasioned. Thus, when a consumption proceeds from, the scrophula or king’s evil, from the scurvy, the asthma, the venereal disease, &c. a due attention must be paid to the malady from whence it arises, and the regimen and medicine directed accordingly.

When excessive evacuations of any kind occasion a consumption, they must not only be restrained, but the patient’s strength must be restored by gentle exercise, nourishing diet, and generous cordials. Young and delicate mothers often fall into consumptions, by giving suck too long. As soon as they perceive their strength and appetite begin to fail, they ought immediately to wean the child, or provide another nurse, otherwise they cannot expect a cure.

Before we quit this subject, we would earnestly recommend it to all, as they wish to avoid consumptions, to take as much exercise without doors as they can, to avoid unwholesome air, and to study sobriety. Consumptions owe their present increase not a little to the fashion of sitting up late, eating hot suppers, and spending every evening over a bowl of hot punch or other strong liquors. These liquors, when too freely used, not only hurt the digestion, and spoil the appetite, but heat and inflame the blood, and set the whole constitution on fire.

CHAP. XIX.
OF THE SLOW OR NERVOUS FEVER.

Nervous fevers have increased greatly of late years in this island, owing doubtless to our different manner of living, and the increase of sedentary employments; as they commonly attack persons of a weak relaxed habit, who neglect exercise, eat little solid food, study hard, or indulge in spirituous liquors.

CAUSES.——Nervous fevers may be occasioned by whatever depresses the spirits, or impoverishes the blood; as grief, fear, anxiety, want of sleep, intense thought, living on poor watery diet, unripe fruits, cucumbers, melons, mushrooms, &c. They may likewise be occasioned by damp, confined, or unwholesome air. Hence they are very common in rainy seasons, and prove most fatal to those who live in dirty low houses, crowded streets, hospitals, jails, or such-like places.

Persons whose constitutions have been broken by excessive venery, frequent salivations, too free an use of purgative medicines, or any other excessive evacuations, are most liable to this disease.

Keeping on wet clothes, lying on the damp ground, excessive fatigue, and whatever obstructs the perspiration, or causes a spasmodic stricture of the solids, may likewise occasion nervous fevers. We shall only add, frequent and great irregularities in diet. Too great abstinence, as well as excess, is hurtful. Nothing tends so much to preserve the body in a sound state as a regular diet; nor can any thing contribute more to occasion fevers of the worst kind than its opposite.

SYMPTOMS.——Low spirits, want of appetite, weakness, weariness after motion, watchfulness, deep sighing, and dejection of mind, are generally the forerunners of this disease. These are succeeded by a quick low pulse, a dry tongue without any considerable thirst, chillness and flushing in turns, &c.

After some time the patient complains of a giddiness and pain of the head, has a nausea, with reachings and vomiting; the pulse is quick, and sometimes intermitting; the urine pale, resembling dead small-beer, and the breathing is difficult, with oppression of the breast, and slight alienations of mind.

If towards the ninth, tenth, or twelfth day, the tongue becomes more moist, with a plentiful spitting, a gentle purging, or a moisture upon the skin; or if a suppuration happens in one or both ears, or large pustules break out about the lips and nose, there is reason to hope for a favourable crisis.

But if there is an excessive looseness, or wasting sweats, with frequent fainting fits; if the tongue, when put out, trembles excessively, and the extremities feel cold, with a fluttering or slow creeping pulse; if there is a starting of the tendons, an almost total loss of sight and hearing, and an involuntary discharge by stool and urine, there is great reason to fear that death is approaching.

REGIMEN.——It is very necessary in this disease to keep the patient cool and quiet. The least motion would fatigue him, and will be apt to occasion weariness, and even faintings. His mind ought not only to be kept easy, but soothed and comforted with the hopes of a speedy recovery. Nothing is more hurtful in low fevers of this kind than presenting to the patient’s imagination gloomy or frightful ideas. These of themselves often occasion nervous fevers, and it is not to be doubted but they will likewise aggravate them.

The patient must not be kept too low. His strength and spirits ought to be supported by nourishing diet and generous cordials. For this purpose his gruel, panado, or whatever food he takes, must be mixed with wine according as the symptoms may require. Pretty strong wine-whey, or small negus, sharpened with the juice of orange or lemon, will be proper for his ordinary drink. Mustard-whey is likewise a very proper drink in this fever, and may be rendered an excellent cordial medicine by the addition of a proper quantity of white-wine[^[78]].

Wine in this disease, if it could be obtained genuine, is almost the only medicine that would be necessary. Good wine possesses all the virtues of the cordial medicines, while it is free from many of their bad qualities. I say good wine; for however common this article of luxury is now become, it is rarely to be obtained genuine, especially by the poor, who are obliged to purchase it in small quantities.

I have often seen patients in low nervous fevers where the pulse could hardly be felt, with a constant delirium, coldness of the extremities, and almost every other mortal symptom, recover by using in whey, gruel, and negus, a bottle or two of strong wine every day. Good old sound claret is the best, and may be made into negus, or given by itself, as circumstances require.

In a word, the great aim in this disease is to support the patient’s strength, by giving him frequently small quantities of the above, or other drinks of a warm and cordial nature. He is not however to be overheated either with liquor or clothes; and his food ought to be light, and given in small quantities.

MEDICINE.——Where a nausea, load, and sickness at stomach, prevail at the beginning of the fever, it will be necessary to give the patient a gentle vomit. Fifteen or twenty grains of ipecacuanha in fine powder, or a few spoonfuls of the vomiting julep[^[79]], will generally answer this purpose very well. This may be repeated any time before the third or fourth day, if the above symptoms continue. Vomits not only clean the stomach, but, by the general shock which they give, promote the perspiration, and have many other excellent effects in slow fevers, where there are no signs of inflammation, and nature wants rousing.

Such as dare not venture upon a vomit, may clean the bowels by a small dose of Turkey rhubarb, or an infusion of senna and manna.

In all fevers, the great point is to regulate the symptoms, so as to prevent them from going to either extreme. Thus, in fevers of the inflammatory kind, where the force of the circulation is too great, or the blood dense, and the fibres too rigid, bleeding and other evacuations are necessary. But in nervous fevers, where nature flags, where the blood is vapid and poor, and the solids relaxed, the lancet must be spared, and wine, with other cordials, plentifully administered.

It is the more necessary to caution people against bleeding in this disease, as there is generally at the beginning an universal stricture upon the vessels, and sometimes an oppression and difficulty of breathing, which suggest the idea of a plethora, or too great a quantity of blood. I have known even some of the faculty deceived by their own feelings in this respect, so far as to insist upon being bled, when it was evident from the consequences that the operation was improper.

Though bleeding is generally improper in this disease, yet blistering is highly necessary. Blistering-plasters may be applied at all times of the fever with great advantage. If the patient is delirious, he ought to be blistered on the neck or head, and it will be the safest course, when the insensibility continues, as soon as the discharge occasioned by one blistering-plaster abates, to apply another to some other part of the body, and by that means keep up a continual succession of them till he be out of danger.

I have been more sensible of the advantage of blistering in this than in any other disease. Blistering-plasters not only stimulate the solids to action, but likewise occasion a continual discharge, which may in some measure supply the want of critical evacuations, which seldom happen in this kind of fever. They are most proper, however, either towards the beginning, or after some degree of stupor has come on, in which last case it will always be proper to blister the head.

If the patient is costive through the course of the disease, it will be necessary to procure a stool, by giving him every other day a clyster of milk and water, with a little sugar, to which may be added a spoonful of common salt, if the above does not operate.

Should a violent looseness come on, it may be checked by small quantities of Venice treacle, or giving the patient for his ordinary drink the white decoction[^[80]].

A miliary eruption sometimes breaks out about the ninth or tenth day. As eruptions are often critical, great care should be taken not to retard Nature’s operation in this particular. The eruption ought neither to be checked by bleeding nor other evacuations, nor pushed out by a hot regimen; but the patient should be supported by gentle cordials, as wine-whey, small negus, sago-gruel with a little wine in it, and such like. He ought not to be kept too warm; yet a kindly breathing sweat should by no means be checked.

Though blistering and the use of cordial liquors are the chief things to be depended on in this kind of fever; yet, for those who may chuse to use them, we shall mention one or two of the forms of medicine which are commonly prescribed in it[^[81]].

In desperate cases, where the hiccup and starting of the tendons have already come on, we have sometimes seen extraordinary effects from large doses of musk frequently repeated. Musk is doubtless an antispasmodic, and may be given to the quantity of a scruple three or four times a-day, or oftener if necessary. Sometimes it may be proper to add to the musk a few grains of camphire, and salt of hartshorn, as these tend to promote perspiration and the discharge of urine. Thus fifteen grains of musk, with three grains of camphire, and six grains of salt of hartshorn, may be made into a bolus with a little syrup, and given as above.

If the fever should happen to intermit, which it frequently does towards the decline, or if the patient’s strength should be wasted with colliquative sweats, &c. it will be necessary to give him the Peruvian bark. Half a drachm, or a whole drachm, if the stomach will bear it, of the bark in fine powder, may be given four or five times a-day in a glass of red port or claret. Should the bark in substance not sit easy on the stomach, an ounce of it in powder may be infused in a bottle of Lisbon or Rhenish wine for two or three days, afterwards it may be strained, and a glass of it taken frequently[^[82]].

Some give the bark in this and other fevers, where there are no symptoms of inflammation, without any regard to the remission or intermission of the fever. How far future observations may tend to establish this practice, we will not pretend to say; but we have reason to believe that the bark is a very universal febrifuge, and that it may be administered with advantage in most fevers where bleeding is not necessary, or where there are no symptoms of topical inflammation.

CHAP. XX.
OF THE MALIGNANT, PUTRID, OR SPOTTED FEVER.

This may be called the pestilential fever of Europe, as in many of its symptoms it bears a great resemblance to that dreadful disease the plague. Persons of a lax habit, a melancholy disposition, and those whose vigour has been wasted by long fasting, watching, hard labour, excessive venery, frequent salivations, &c. are most liable to it.

CAUSES.——This fever is occasioned by foul air, from a number of people being confined in a narrow place, not properly ventilated; from putrid animal and vegetable effluvia, &c. Hence it prevails in camps, jails, hospitals and infirmaries, especially where such places are too much crowded, and cleanliness is neglected.

A close constitution of the air, with long rainy or foggy weather, likewise occasions putrid fevers. They often succeed great inundations in low and marshy countries, especially when these are preceded or followed by a hot and sultry season.

Living too much upon animal food, without a proper mixture of vegetables, or eating fish or flesh that has been kept too long, are likewise apt to occasion this kind of fever. Hence sailors on long voyages, and the inhabitants of besieged cities, are very often visited with putrid fevers.

Corn that has been greatly damaged by rainy seasons, or long keeping, and water which has become putrid by stagnation, &c. may likewise occasion this fever.

Dead carcases tainting the air, especially in hot seasons, are very apt to occasion putrid diseases. Hence this kind of fever often prevails in countries which are the scenes of war and bloodshed. This shews the propriety of removing burying grounds, slaughterhouses, &c. at a proper distance from great towns.

Want of cleanliness is a very general cause of putrid fevers. Hence they prevail amongst the poor inhabitants of large towns, who breathe a confined unwholesome air, and neglect cleanliness. Such mechanics as carry on dirty employments, and are constantly confined within doors, are likewise very liable to this disease.

We shall only add, that putrid, malignant, or spotted fevers, are highly infectious, and are therefore often communicated by contagion. For which reason all persons ought to keep at a distance from those affected with such diseases, unless their attendance is absolutely necessary.

SYMPTOMS.——The malignant fever is generally preceded by a remarkable weakness or loss of strength, without any apparent cause. This is sometimes so great, that the patient can scarce walk, or even sit upright, without being in danger of fainting away. His mind too is greatly dejected; he sighs, and is full of dreadful apprehensions.

There is a nausea, and sometimes a vomiting of bile; a violent pain of the head, with a strong pulsation or throbbing of the temporal arteries; the eyes often appear red and inflamed, with a pain at the bottom of the orbit; there is a noise in the ears, the breathing is laborious, and often interrupted with a sigh; the patient complains of a pain about the region of the stomach, and in his back and loins; his tongue is at first white, but afterwards it appears black and chaped; and his teeth are covered with a black crust. He sometimes passes worms both upwards and downwards, is affected with tremors or shaking, and often becomes delirious.

If blood is let, it appears dissolved, or with a very small degree of cohesion, and soon becomes putrid; the stools smell extremely fœtid, and are sometimes of a greenish, black, or reddish cast. Spots of a pale purple, dun, or black colour, often appear upon the skin, and sometimes there are violent hæmorrhages, or discharges of blood from the mouth, eyes, nose, &c.

Putrid fevers may be distinguished from the inflammatory, by the smallness of the pulse, the great dejection of mind, the dissolved state of the blood, the petechiæ, or purple spots, and the putrid smell of the excrements. They may likewise be distinguished from the low or nervous fever by the heat and thirst being greater, the urine of a higher colour, and the loss of strength, dejection of mind, and all the other symptoms more violent.

It sometimes happens, however, that the inflammatory, nervous, and putrid symptoms are so blended together, as to render it very difficult to determine to which class the fever belongs. In this case the greatest caution and skill are requisite. Attention must be paid to those symptoms which are most prevalent, and both the regimen and medicines adapted to them.

Inflammatory and nervous fevers may be converted into malignant and putrid, by too hot a regimen or improper medicines.

The duration of putrid fevers is extremely uncertain; sometimes they terminate between the seventh and fourteenth day, and at other times they are prolonged for five or six weeks. Their duration depends greatly upon the constitution of the patient, and the manner of treating the disease.

The most favourable symptoms are, a gentle looseness after the fourth or fifth day, with a warm mild sweat. These, when continued for a considerable time, often carry off the fever, and should never be imprudently stopped. Small miliary pustules appearing between the petechiæ or purple spots are likewise favourable, as also hot scabby eruptions about the mouth and nose. It is a good sign when the pulse rises upon the use of wine, or other cordials, and the nervous symptoms abate; deafness coming on towards the decline of the fever, is likewise often a favourable symptom[^[83]], as are abscesses in the groin or parotid glands.

Among the unfavourable symptoms may be reckoned an excessive looseness, with a hard swelled belly; large black or livid blotches breaking out upon the skin; apthæ in the mouth; cold clammy sweats; blindness; change of the voice; a wild flaring of the eyes; difficulty of swallowing; inability to put out the tongue; and a constant inclination to uncover the breast. When the sweat and saliva are tinged with blood, and the urine is black, or deposits a black sooty sediment, the patient is in great danger. Starting of the tendons, and fœtid, ichorous, involuntary stools, attended with coldness of the extremities, are generally the forerunners of death.

REGIMEN.——In the treatment of this disease we ought to endeavour as far as possible to counteract the putrid tendency of the humours; to support the patient’s strength and spirits; and to assist Nature in expelling the cause of this disease, by gently promoting perspiration and the other evacuations.

It has been observed, that putrid fevers are often occasioned by unwholesome air, and of course they must be aggravated by it. Care should therefore be taken to prevent the air from stagnating in the patient’s chamber, to keep it cool, and renew it frequently, by opening the doors or windows of some adjacent apartment. The breath and perspiration of persons in perfect health soon render the air of a small apartment noxious; but this will sooner happen from the perspiration and breath of a person whose whole mass of humours are in a putrid state.

Besides the frequent admission of fresh air, we would recommend the use of vinegar, verjuice, juice of lemon, Seville orange, or any kind of vegetable acid that can be most readily obtained. These ought frequently to be sprinkled upon the floor, the bed, and every part of the room. They may also be evaporated with a hot iron, or by boiling, &c. The fresh skins of lemons or oranges ought likewise to be laid in different parts of the room, and they should be frequently held to the patient’s nose. The use of acids in this manner would not only prove very refreshing to the patient, but would likewise tend to prevent the infection from spreading among those who attend him. Strong scented herbs, as rue, tansy, rosemary, wormwood, &c. may likewise be laid in different parts of the house, and smelled to by those who go near the patient.

The patient must not only be kept cool, but likewise quiet and easy. The least noise will affect his head, and the smallest fatigue will be apt to make him faint.

Few things are of greater importance in this disease than acids, which ought to be mixed with all the patient’s food as well as drink. Orange, lemon, or vinegar whey, are all very proper, and may be drank by turns, according to the patient’s inclination. They may be rendered cordial by the addition of wine in such quantity as the patient’s strength seems to require. When he is very low, he may drink negus, with only one half water, and sharpened with the juice of orange or lemon. In some cases a glass of wine may now and then be allowed. The most proper wine is Rhenish; but if the body be open, red port or claret is to be preferred.

When the body is bound, a tea-spoonful of the cream of tartar may be put into a cup of the patient’s drink, as there is occasion; or he may drink a decoction of tamarinds, which will both quench his thirst, and promote a discharge by stool.

If camomile-tea will sit upon his stomach, it is a very proper drink in this disease. It may be sharpened by adding to every cup of the tea ten or fifteen drops of the elixir of vitriol.

The food must be light, as panado or groat-gruel, to which a little wine may be added, if the patient be weak and low; and they ought all to be sharpened with the juice of orange, the jelly of currants, or the like. The patient ought likewise to eat freely of ripe fruits, as roasted apples, currant or gooseberry tarts, preserved cherries, or plums, &c.

Taking a little food or drink frequently, not only supports the spirits, but counteracts the putrid tendency of the humours; for which reason the patient ought frequently to be sipping small quantities of some of the acid liquors mentioned above, or any that may be more agreeable to his palate, or more readily obtained.

If he is delirious, his feet and hands ought to be frequently fomented with a strong infusion of camomile flowers. This, or an infusion of the bark, to such as can afford it, cannot fail to have a good effect. Fomentations of this kind not only relieve the head, by relaxing the vessels in the extremities, but as their contents are absorbed, and taken into the system, they may assist in preventing the putrescency of the humours.

MEDICINE.——If a vomit be given at the beginning of this fever, it will hardly fail to have a good effect; but if the fever has gone on for some days, and the symptoms are violent, vomits are not quite so safe. The body however is always to be kept gently open by clysters, or mild laxative medicines.

Bleeding is seldom necessary in putrid fevers. If there be signs of an inflammation, it may sometimes be permitted at the first onset; but the repetition of it generally proves hurtful.

Blistering plasters are never to be used unless in the greatest extremities. If the petechiæ or spots should suddenly disappear, the patient’s pulse sink remarkably, and a delirium, with other bad symptoms, come on, blistering may be permitted. In this case the blistering plasters are to be applied to the head, and inside of the legs or thighs. But as they are sometimes apt to occasion a gangrene, we would rather recommend warm cataplasms or poultices of mustard and vinegar to be applied to the feet, having recourse to blisters only in the utmost extremities.

It is common in the beginning of this fever to give the emetic tartar in small doses, repeated every second or third hour, till it shall either vomit, purge, or throw the patient into a sweat. This practice is very proper, provided it be not pushed so far as to weaken the patient.

A very ridiculous notion has long prevailed, of expelling the poisonous matter of malignant diseases by trifling doses of cordial or alexipharmic medicines. In consequence of this notion, the contrayerva-root, the cordial confection, the mithridate, &c. have been extolled as infallible remedies. There is reason however to believe, that these seldom do much good. Where cordials are necessary, we know none that is superior to good wine; and therefore again recommend it both as the safest and best. Wine, with acids and antiseptics, are the only things to be relied on in the cure of malignant fevers.

In the most dangerous species of this disease, when it is attended with purple, livid, or black spots, the Peruvian bark must be administered. I have seen it, when joined with acids, prove successful, even in cases where the petechiæ had the most threatening aspect. But, to answer this purpose, it must not only be given in large doses, but duly persisted in.

The best method of administering the bark is certainly in substance. An ounce of it in powder may be mixed with half an English pint of water, and the same quantity of red wine, and sharpened with the elixir or the spirit of vitriol, which will both make it sit easier on the stomach, and render it more beneficial. Two or three ounces of the syrup of lemon may be added, and two table-spoonfuls of the mixture taken every two hours, or oftener, if the stomach is able to bear it.

Those who cannot take the bark in substance may infuse it in wine, as recommended in the preceding disease.

If there be a violent looseness, the bark must be boiled in red wine with a little cinnamon, and sharpened with the elixir of vitriol, as above. Nothing can be more beneficial in this kind of looseness than plenty of acids, and such things as promote a gentle perspiration.

If the patient be troubled with vomiting, a dram of the salt of wormwood, dissolved in an ounce and half of fresh lemon-juice, and made into a draught with an ounce of simple cinnamon water, and a bit of sugar, may be given and repeated as often as it is necessary.

If swellings of the glands appear, their suppuration is to be promoted by the application of poultices, ripening cataplasms, &c. And as soon as there is any appearance of matter in them, they ought to be laid open, and the poultices continued.

I have known large ulcerous sores break out in various parts of the body, in the decline of this fever, of a livid gangrenous appearance, and a most putrid cadaverous smell. These gradually healed, and the patient recovered, by the plentiful use of Peruvian bark and wine, sharpened with the spirits of vitriol.

For preventing putrid fevers we would recommend a strict regard to cleanliness; a dry situation; sufficient exercise in the open air; wholesome food, and a moderate use of generous liquors. Infection ought above all things to be avoided. No constitution is proof against it. I have known persons seized with a putrid fever, by only making a single visit to a patient in it; others have caught it by lodging for one night in a town where it prevailed; and some by attending the funerals of such as died of it[^[84]].

When a putrid fever seizes any person in a family, the greatest attention is necessary to prevent the disease from spreading. The sick ought to be placed in a large apartment, as remote from the rest of the family as possible; he ought likewise to be kept extremely clean, and should have fresh air frequently let into his chamber; whatever comes from him should be immediately removed, his linen should be frequently changed, and those in health ought to avoid all unnecessary communication with him.

Any one who is apprehensive of having caught the infection, ought immediately to take a vomit, and to work it off by drinking plentifully of camomile-tea. This may be repeated in a day or two, if the apprehensions still continue, or any unfavourable symptoms appear.

The person ought likewise to take an infusion of the bark and camomile flowers for his ordinary drink; and before he goes to bed, he may drink an English pint of pretty strong negus, or a few glasses of generous wine. I have been frequently obliged to follow this course, when malignant fevers prevailed, and have likewise recommended it to others with constant success.

People generally fly to bleeding and purging as antidotes against infection; but these are so far from securing them, that they often, by debilitating the body, increase the danger.

Those who wait upon the sick in putrid fevers, ought always to have a piece of spunge or a handkerchief dipt in vinegar, or juice of lemon, to smell to while near the patient. They ought likewise to wash their hands, and, if possible, to change their clothes, before they go into company.

CHAP. XXI.
OF THE MILIARY FEVER.

This fever takes its name from the small pustules or bladders which appear on the skin, resembling, in shape and size, the seeds of millet. The pustules are either red or white, and sometimes both are mixed together.

The whole body is sometimes covered with pustules; but they are generally more numerous where the sweat is most abundant, as on the breast, the back, &c. A gentle sweat, or moisture on the skin, greatly promotes the eruption; but, when the skin is dry, the eruption is both more painful and dangerous.

Sometimes this is a primary disease; but it is much oftener only a symptom of some other malady, as the small-pox, measles, ardent, putrid, or nervous fever, &c. In all these cases it is generally the effect of too hot a regimen or medicines.

The miliary fever chiefly attacks the idle and the phlegmatic, or persons of a relaxed habit. The young and the aged are more liable to it than those in the vigour and prime of life. It is likewise more incident to women than men, especially the delicate and the indolent, who, neglecting exercise, keep continually within doors, and live upon weak watery diet. Such females are extremely liable to be seized with this disease in child-bed, and often lose their lives by it.

CAUSES.——The miliary fever is sometimes occasioned by violent passions or affections of the mind; as excessive grief, anxiety, thoughtfulness, &c. It may likewise be occasioned by excessive watching, great evacuations, a weak watery diet, rainy seasons, eating too freely of cold, crude, unripe fruits, as plums, cherries, cucumbers, melons; &c. Impure waters, or provisions which have been spoiled by rainy seasons, long keeping, &c. may likewise cause miliary fevers. They may also be occasioned by the stoppage of any customary evacuation, as issues, setons, ulcers, the bleeding piles in men, or the menstrual flux in women, &c.

This disease in child-bed-women is sometimes the effect of great costiveness during pregnancy; it may likewise be occasioned by their excessive use of green trash, and other unwholesome things, in which pregnant women are too apt to indulge. But its most general cause is indolence. Such women as lead a sedentary life, especially during pregnancy, and at the same time live grossly, can hardly escape this disease in child-bed. Hence it proves extremely fatal to women of fashion, and likewise to those women in manufacturing towns, who, in order to assist their husbands, sit close within doors for almost the whole of their time. But among women who are active and laborious, who live in the country, and take sufficient exercise without doors, this disease is very little known.

SYMPTOMS.——When this is a primary disease, it makes its attack, like most other eruptive fevers, with a slight shivering, which is succeeded by heat, loss of strength, faintishness, sighing, a low quick pulse, difficulty of breathing, with great anxiety and oppression of the breast. The patient is restless, and sometimes delirious; the tongue appears white, and the hands shake, with often a burning heat in the palms; and in child-bed-women the milk generally goes away, and the other discharges stop.

The patient feels an itching or pricking pain under the skin, after which innumerable small pustules of a red or white colour begin to appear. Upon this the symptoms generally abate, the pulse becomes more full and soft, the skin grows moister, and the sweat, as the disease advances, begins to have a peculiar fœtid smell; the great load on the breast, and oppression of the spirits, generally go off, and the customary evacuations gradually return. About the sixth or seventh day from the eruption, the pustules begin to dry and fall off, which occasions a very disagreeable itching in the skin.

It is impossible to ascertain the exact time when the pustules will either appear or go off. They generally come out on the third or fourth day, when the eruption is critical; but, when symptomatic, they may appear at any time of the disease.

Sometimes the pustules appear and vanish by turns. When that is the case, there is always danger; but when they go in all of a sudden, and do not appear again, the danger is very great.

In child-bed-women the pustules are commonly at first filled with clear water, afterwards they grow yellowish. Sometimes they are interspersed with pustules of a red colour. When these only appear the disease goes by the name of a rash.

REGIMEN.——In all eruptive fevers, of whatever kind, the chief point is to prevent the sudden disappearing of the pustules, and to promote their maturation. For this purpose the patient must be kept in such a temperature, as neither to push out the eruption too fast, nor to cause it to retreat prematurely. The diet and drink ought therefore to be in a moderate degree nourishing and cordial; but neither strong nor heating. The patient’s chamber ought neither to be kept too hot nor cold; and he should not be too much covered with clothes. Above all, the mind is to be kept easy and cheerful. Nothing so certainly makes an eruption go in as fear, or the apprehension of danger.

The food must be weak chicken-broth with bread, panado, sago, or groat gruel, &c. to a gill of which may be added a spoonful or two of wine, as the patient’s strength requires, with a few grains of salt and a little sugar. Good apples roasted or boiled, with other ripe fruits of an opening cooling nature, may be eaten.

The drink may be suited to the state of the patient’s strength and spirits. If these be pretty high, the drink ought to be weak; as water-gruel, balm-tea, or the decoction mentioned below[^[85]].

When the patient’s spirits are low, and the eruption does not rise sufficiently, his drink must be a little more generous; as wine-whey, or small negus, sharpened with the juice of orange or lemon, and made stronger or weaker as circumstances may require.

Sometimes the miliary fever approaches towards a putrid nature, in which case the patient’s strength must be supported with generous cordials, joined with acids; and, if the degree of putrescence be great, the Peruvian bark must be administered. If the head be much affected, the body must be kept open by emollient clysters[^[86]].

MEDICINE.——If the food and drink be properly regulated, there will be little occasion for medicine in this disease. Should the eruption however not rise, or the spirits flag, it will not only be necessary to support the patient with cordials, but likewise to apply blistering plasters. The most proper cordial, in this case, is good wine, which may either be taken in the patient’s food or drink; and if there be signs of putrescence, the bark and acids may be mixed with wine, as directed in the putrid fever.

Some recommend blistering through the whole course of this disease; and where Nature flags, and the eruption comes and goes, it may be necessary to keep up a stimulus, by a continual succession of small blistering plasters; but we would not recommend above one at a time. If however the pulse should sink remarkably, the pustules fall in, and the head be affected, it will be necessary to apply several blistering plasters to the most sensible parts, as the inside of the legs and thighs, &c.

Bleeding is seldom necessary in this disease, and sometimes it does much hurt, as it weakens the patient, and depresses his spirits. It is therefore never to be attempted unless by the advice of a physician. We mention this, because it has been customary to treat this disease in child-bed-women by plentiful bleeding, and other evacuations, as if it were highly inflammatory. But this practice is generally very unsafe. Patients in this situation bear evacuations very ill. And indeed the disease seems often to be more of a putrid than of an inflammatory nature.

Though this fever is often occasioned in child-bed-women by too hot a regimen, yet it would be dangerous to leave that off all of a sudden, and have recourse to a very cool regimen, and large evacuations. We have reason to believe, that supporting the patient’s spirits, and promoting the natural evacuations, is here much safer than to have recourse to artificial ones, as these, by sinking the spirits, seldom fail to increase the danger.

If the disease proves tedious, or the recovery slow, we would recommend the Peruvian bark, which may either be taken in substance, or infused in wine or water, as the patient inclines.

The miliary fever, like other eruptive diseases, requires gentle purging, which should not be neglected, as soon as the fever is gone off, and the patient’s strength will permit.

To prevent this disease, a pure dry air, sufficient exercise, and wholesome food, are necessary. Pregnant women should guard against costiveness, and take daily as much exercise as they can bear, avoiding all green trashy fruits, and other unwholesome things; and when in child-bed, they ought strictly to observe a cool regimen.

CHAP. XXII.
OF THE REMITTING FEVER.

This fever takes its name from a remission of the symptoms, which happens sometimes sooner, and sometimes later, but generally before the eighth day. The remission is commonly preceded by a gentle sweat, after which the patient seems greatly relieved, but in a few hours the fever returns. These remissions return at very irregular periods, and are sometimes of longer, sometimes of shorter duration; the nearer however that the fever approaches to a regular intermittent, the danger is the less.

CAUSES.——Remitting fevers prevail in low marshy countries abounding with wood and stagnating water; but they prove most fatal in places where great heat and moisture are combined, as in some parts of Africa, the province of Bengal in the East Indies, &c. where remitting fevers are generally of a putrid kind, and prove very fatal. They are most frequent in close calm weather, especially after rainy seasons, great inundations, or the like. No age, sex, or constitution, is exempted from the attack of this fever; but it chiefly seizes persons of a relaxed habit, who live in low dirty habitations, breathe an impure stagnating air, take little exercise, and use unwholesome diet.

SYMPTOMS.——The first symptoms of this fever are generally yawning, stretching, pain, and giddiness in the head, with alternate fits of heat and cold. Sometimes the patient is affected with a delirium at the very first attack. There is a pain, and sometimes a swelling, about the region of the stomach; the tongue is white, the eyes and skin frequently appear yellow, and the patient is often afflicted with bilious vomitings. The pulse is sometimes a little hard, but seldom full, and the blood, when let, rarely shews any signs of inflammation. Some patients are exceedingly costive, and others are afflicted with a very troublesome looseness.

It is impossible to describe all the symptoms of this disease, as they vary according to the situation, the season of the year, and the constitution of the patient. They may likewise be greatly changed by the method of treatment, and by many other circumstances too tedious to mention. Sometimes the bilious symptoms predominate, sometimes the nervous, and at other times the putrid. Nor is it at all uncommon to find a succession of each of these, or even a complication of them at the same time, in the same person.

REGIMEN.——The regimen must be adapted to the prevailing symptoms. When there are any signs of inflammation, the diet must be slender, and the drink weak and diluting. But when nervous or putrid symptoms occur, it will be necessary to support the patient with food and liquors of a more generous nature, such as are recommended in the immediately preceding fevers. We must however be very cautious in the use of things of a heating quality, as this fever is frequently changed into a continual by an hot regimen, and improper medicines.

Whatever the symptoms are, the patient ought to be kept cool, quiet, and clean. His apartment, if possible, should be large, and frequently ventilated by letting in fresh air at the doors or windows. It ought likewise to be sprinkled with vinegar, juice of lemon, or the like. His linen, bed-clothes, &c. should be frequently changed, and all his excrements immediately removed. Though these things have been recommended before, we think it necessary to repeat them here, as they are of more importance to the sick than practitioners are apt to imagine[^[87]].

MEDICINE.——In order to cure this fever, we must endeavour to bring it to a regular intermission. This intention may be promoted by bleeding, if there be any signs of inflammation; but when that is not the case, bleeding ought by no means to be attempted, as it will weaken the patient and prolong the disease. A vomit however will seldom be improper, and is generally of great service. Twenty or thirty grains of ipecacuanha will answer this purpose very well; but, where it can be obtained, we would rather recommend a grain or two of tartar emetic, with five or six grains of ipecacuanha, to be made into a draught, and given for a vomit. This may be repeated once or twice at proper intervals, if the sickness or nausea continues.

The body ought to be kept open either by clysters or gentle laxatives, as weak infusions of senna and manna, small doses of the lenitive electuary, cream of tartar, tamarinds, stewed prunes, or the like; but all strong or drastic purgatives are to be carefully avoided.

By this course the fever in a few days may generally be brought to a pretty regular or distinct intermission, in which case the Peruvian bark may be administered, and it will seldom fail to perfect the cure. It is needless here to repeat the methods of giving the bark, as we have already had occasion frequently to mention them.

The most likely way to avoid this fever is to use a wholesome and nourishing diet, to pay the most scrupulous attention to cleanliness, to keep the body warm, to take sufficient exercise, and in hot countries to avoid damp situations, night air, evening dews, and the like. In countries where it is endemical, the best preventive medicine which we can recommend, is the Peruvian bark, which may either be chewed, or infused in brandy or wine, &c. Some recommend smoking tobacco as very beneficial in marshy countries, both for the prevention of this and intermitting fevers.

CHAP. XXIII.
OF THE SMALL-POX.

This disease, which originally came from Arabia, is now become so general, that very few escape it at one time of life or another. It is a most contagious malady; and has for many years proved the scourge of Europe.

The small-pox generally appear towards the spring. They are very frequent in summer, less so in autumn, and least of all in winter. Children are most liable to this disease; and those whose food is unwholesome, who want proper exercise, and abound with gross humours, run the greatest hazard from it.

The disease is distinguished into the distinct and confluent kind; the latter of which is always attended with danger. There are likewise other distinctions of the small-pox; as the crystalline, the bloody, &c.

CAUSES.——The small-pox is commonly caught by infection. Since the disease was first brought into Europe, the infection has never been wholly extinguished, nor have any proper methods, as far as I know, been taken for that purpose; so that now it has become in a manner constitutional. Children who have overheated themselves by running, wrestling, &c. or adults after a debauch, are most apt to be seized with the small-pox.

SYMPTOMS.——This disease is so generally known, that a minute description of it is unnecessary. Children commonly look a little dull, seem lifeless and drowsy for a few days before the more violent symptoms of the small-pox appear. They are likewise more inclined to drink than usual, have little appetite for solid food, complain of weariness, and, upon taking exercise, are apt to sweat. These are succeeded by slight fits of cold and heat in turns, which, as the time of the eruption approaches, become more violent, and are accompanied with pains of the head and loins, vomiting, &c. The pulse is quick, with a great heat of the skin, and restlessness. When the patient drops asleep, he wakes in a kind of horror, with a sudden start, which is a very common symptom of the approaching eruption; as are also convulsion-fits in very young children.

About the third or fourth day from the time of sickening, the small-pox generally begin to appear; sometimes indeed they appear sooner, but that is no favourable symptom. At first they very nearly resemble flea-bites, and are soonest discovered on the face, arms, and breast.

The most favourable symptoms are a slow eruption, and an abatement of the fever as soon as the pustules appear. In a mild distinct kind of small-pox the pustules seldom appear before the fourth day from the time of sickening, and they generally keep coming out gradually for several days after. Pustules which are distinct, with a florid red basis, and which fill with thick purulent matter, first of a whitish, and afterwards of a yellowish colour, are the best.

A livid brown colour of the pustules is an unfavourable symptom; as also when they are small and flat, with black specks in the middle. Pustules which contain a thin watery ichor are very bad. A great number of pox on the face is always attended with danger. It is likewise a very bad sign when they run into one another.

It is a most unfavourable symptom when petechiæ, or purple, brown, or black spots are interspersed among the pustules. These are signs of a putrid dissolution of the blood, and shew the danger to be very great. Bloody stools or urine, with a swelled belly, are bad symptoms; as is also a continual strangury. Pale urine and a violent throbbing of the arteries of the neck are signs of an approaching delirium, or of convulsion-fits. When the face does not swell, or falls before the pox come to maturity, it is very unfavourable. If the face begins to fall about the eleventh or twelfth day, and at the same time the hands and feet begin to swell, the patient generally does well; but when these do not succeed to each other, there is reason to apprehend danger. When the tongue is covered with a brown crust, it is an unfavourable symptom. Cold shivering fits coming on at the height of the disease are likewise unfavourable. Grinding of the teeth, when it proceeds from an affection of the nervous system, is a bad sign; but sometimes it is occasioned by worms, or a disordered stomach.

REGIMEN.——When the first symptoms of the small-pox appear, people are ready to be alarmed, and often fly to the use of medicine, to the great danger of the patient’s life. I have known children, to appease the anxiety of their parents, bled, blistered, and purged, during the fever which preceded the eruption of the small-pox, to such a degree, that Nature was not only disturbed in her operation, but rendered unable to support the pustules after they were out; so that the patient, exhausted by mere evacuations, sunk under the disease.

When convulsions appear, they give a dreadful alarm. Immediately some nostrum is applied, as if this were a primary disease; whereas it is only a symptom, and far from being an unfavourable one, of the approaching eruption. As the fits generally go off before the actual appearance of the small-pox, it is attributed to the medicine, which by this means acquires a reputation without any merit[^[88]].

All that is, generally speaking, necessary during the eruptive fever, is to keep the patient cool and easy, allowing him to drink freely of some weak diluting liquors; as balm-tea, barley-water, clear whey, gruels, &c. He should not be confined to bed, but should sit up as much as he is able, and should have his feet and legs frequently bathed in lukewarm water. His food ought to be very light; and he should be as little disturbed with company as possible.

Much mischief is done at this period by confining the patient too soon to his bed, and plying him with warm cordials or sudorific medicines. Every thing that heats and inflames the blood increases the fever, and pushes out the pustules prematurely. This has numberless ill effects. It not only increases the number of pustules, but likewise tends to make them run into one another; and when they have been pushed out with too great violence, they generally fall in before they come to maturity.

The good women, as soon as they see the small-pox begin to appear, commonly ply their tender charge with cordials, saffron, and marigold-teas, wine, punch, and even brandy itself. All these are given with a view, as they term it, to throw out the eruption from the heart. This, like most other popular mistakes, is the abuse of a very just observation, that when there is a moisture on the skin, the pox rise better, and the patient is easier, than when it continues dry and parched. But that is no reason for forcing the patient into a sweat. Sweating never relieves unless where it comes spontaneously, or is the effect of drinking weak diluting liquors.

Children are often so peevish, that they will not lie a-bed without a nurse constantly by them. Indulging them in this, we have reason to believe, has many bad effects both upon the nurse and child. Even the natural heat of the nurse cannot fail to augment the fever of the child, but if she too proves feverish, which is often the case, the danger must be increased[^[89]].

Laying several children who have the small-pox in the same bed has many ill consequences. They ought if possible never to be in the same chamber, as the perspiration, the heat, the smell, &c. all tend to augment the fever, and to heighten the disease. It is common among the poor to see two or three children lying in the same bed, with such a load of pustules that even their skins stick together. One can hardly view a scene of this kind without being sickened by the sight. But how must the effluvia affect the poor patients, many of whom perish by this usage[^[90]]!

A very dirty custom prevails among the lower class of people, of allowing children in the small-pox to keep on the same linen during the whole period of that loathsome disease. This is done lest they should catch cold; but it has many ill consequences. The linen becomes hard by the moisture which it absorbs, and frets the tender skin. It likewise occasions a bad smell, which is very pernicious both to the patient and those about him; besides, the filth and sordes which adhere to the linen being resorbed, or taken up again into the body, greatly augment the disease.

A patient should not be suffered to be dirty in an internal disease, far less in the small-pox. Cutaneous disorders are often occasioned by nastiness alone, and are always increased by it. Were the patient’s linen to be changed every day, it would greatly refresh him. Care indeed is to be taken that the linen be thoroughly dry. It ought likewise to be put on when the patient is most cool.

So strong is the vulgar prejudice in this country, notwithstanding all that has been said against the hot regimen in the small-pox, that numbers still fall a sacrifice to that error. I have seen poor women travelling in the depth of winter, and carrying their children along with them in the small-pox, and have frequently observed others begging by the way-side, with infants in their arms covered with the pustules; yet I could never learn that one of these children died by this sort of treatment. This is certainly a sufficient proof of the safety at least, of exposing patients in the small-pox to the open air. There can be no reason however for exposing them to public view. It is now very common in the environs of great towns to meet patients in the small-pox on the public walks. This practice, however well it may suit the purposes of boasting inoculators, is dangerous to the citizens, and contrary to the laws of humanity and sound policy.

The food in this disease ought to be very light, and of a cooling nature, as panado, or bread boiled with equal quantities of milk and water, good apples roasted or boiled with milk, and sweetened with a little sugar, or such like.

The drink may be equal parts of milk and water, clear sweet whey, barley-water, or thin gruel, &c. After the pox are full, butter-milk, being of an opening and cleansing nature, is a very proper drink.

MEDICINE.——This disease is generally divided into four different periods, viz. the fever which precedes the eruption, the eruption itself, the suppuration, or maturation of the pustules, and the secondary fever.

It has already been observed, that little more is necessary during the primary fever than to keep the patient cool and quiet, allowing him to drink diluting liquors, and bathing his feet frequently in warm water. Though this be generally the safest course that can be taken with infants, yet adults of a strong constitution and plethoric habit sometimes require bleeding. When a full pulse, a dry skin, and other symptoms of inflammation render this operation necessary, it ought to be performed; but, unless these symptoms are urgent, it is safer to let it alone; if the body is bound, emollient clysters may be thrown in.

If there is a great nausea or inclination to vomit, weak camomile-tea or lukewarm water may be drank, in order to clean the stomach. At the beginning of a fever, Nature generally attempts a discharge, either upwards or downwards, which, if promoted by gentle means, would tend greatly to abate the violence of the disease.

Though every method is to be taken during the primary fever, by a cool regimen, &c. to prevent too great an eruption; yet after the pustules have made their appearance, our business is to promote the suppuration, by diluting drink, light food, and, if Nature seems to flag, by generous cordials. When a low, creeping pulse, faintishness, and great loss of strength, render cordials necessary, we would recommend good wine, which may be made into negus, with an equal quantity of water, and sharpened with the juice of orange, the jelly of currants, or the like. Wine-whey, sharpened as above, is likewise a proper drink in this case; great care however must be taken not to overheat the patient by any of these things. This, instead of promoting, would retard the eruption.

The rising of the small-pox is often prevented by the violence of the fever; in this case the cool regimen is strictly to be observed. The patient’s chamber must not only be kept cool, but he ought likewise frequently to be taken out of bed, and to be lightly covered with clothes while in it.

Excessive restlessness often prevents the rising and filling of the small-pox. When this happens, gentle opiates are necessary. These however ought always to be administered with a sparing hand. To an infant, a tea-spoonful of the syrup of poppies may be given every five or six hours till it has the desired effect. An adult will require a table-spoonful in order to answer the same purpose.

If the patient be troubled with a strangury, or suppression of urine, which often happens in the small-pox, he should be frequently taken out of bed, and, if he be able, should walk across the room with his feet bare. When he cannot do this, he may be frequently set on his knees in bed, and should endeavour to pass his urine as often as he can. When these do not succeed, a tea-spoonful of the sweet spirits of nitre may be occasionally mixed with his drink. Nothing more certainly relieves the patient, or is more beneficial in the small-pox, than a plentiful discharge of urine.

If the mouth be foul, and the tongue dry and chapped, it ought to be frequently washed, and the throat gargled with water and honey, sharpened with a little vinegar or currant jelly.

During the rising of the small-pox, it frequently happens that the patient is eight or ten days without a stool. This not only tends to heat and inflame the blood, but the fæces, by lodging so long in the body, become acrid, and even putrid; from whence bad consequences must ensue. It will therefore be proper, when the body is bound, to throw in an emollient clyster every second or third day, through the whole course of the disease. This will greatly cool and relieve the patient.

When petechiæ, or purple, black, or livid spots appear among the small-pox, the Peruvian bark must immediately be administered in as large doses as the patient’s stomach can bear. For a child, two drachms of the bark in powder may be mixed in three ounces of common water, one ounce of simple cinnamon-water, and two ounces of the syrup of orange or lemon. This may be sharpened with the spirits of vitriol, and a table-spoonful of it given every hour. If it be given to an adult in the same form, he may take at least three or four spoonfuls every hour. This medicine ought not to be trifled with, but must be administered as frequently as the stomach can bear it; in which case it will often produce very happy effects. I have frequently seen the petechiæ disappear, and the small-pox, which had a very threatening aspect, rise and fill with laudable matter, by the use of the bark and acids.

The patient’s drink ought likewise in this case to be generous, as wine or strong negus acidulated with spirits of vitriol, vinegar, the juice of lemon, jelly of currants, or such like. His food must consist of apples roasted or boiled, preserved cherries, plums, and other fruits of an acid nature.

The bark and acids are not only necessary when the petechiæ or putrid symptoms appear, but likewise in the lymphatic or crystalline small-pox, where the matter is thin, and not duly prepared. The Peruvian bark seems to possess a singular power of assisting Nature in preparing laudable pus, or what is called good matter; consequently it must be beneficial both in this and other diseases, where the crisis depends on a suppuration. I have often observed where the small-pox were flat, and the matter contained in them quite clear and transparent, and where at first they had the appearance of running into one another, that the Peruvian bark, acidulated as above, changed the colour and consistence of the matter, and produced the most happy effects.

When the eruption subsides suddenly, or, as the good women term it, when the small-pox strike in, before they have arrived at maturity, the danger is very great. In this case blistering-plasters must be immediately applied to the wrists and ancles, and the patient’s spirits supported with cordials.

Sometimes bleeding has a surprising effect in raising the pustules after they have subsided; but it requires skill to know when this is proper, or to what length the patient can bear it. Sharp cataplasms however may be applied to the feet and hands, as they tend to promote the swelling of these parts, and by that means to draw the humours towards the extremities.

The most dangerous period of this disease is what we call the secondary fever. This generally comes on when the small-pox begin to blacken, or turn on the face; and most of those who die of the small-pox are carried off by this fever.

Nature generally attempts, at the turn of the small-pox, to relieve the patient by loose stools. Her endeavours this way are by no means to be counteracted, but promoted, and the patient at the same time supported by food and drink of a nourishing and cordial nature.

If, at the approach of the secondary fever, the pulse be very quick, hard, and strong, the heat intense, and the breathing laborious, with other symptoms of an inflammation of the breast, the patient must immediately be bled. The quantity of blood to be let must be regulated by the patient’s strength, age, and the urgency of the symptoms.

But, in the secondary fever, if the patient be faintish, the pustules become suddenly pale, and if there be great coldness of the extremities, blistering plasters must be applied, and the patient must be supported with generous cordials. Wine and even spirits have sometimes been given in such cases with amazing success.

As the secondary fever is in great measure, if not wholly, owing to the absorption of the matter, it would seem highly consonant to reason, that the pustules, as soon as they come to maturity, should be opened. This is every day practiced in other phlegmons which tend to suppuration; and there seems to be no cause why it should be less proper here. On the contrary, we have reason to believe, that by this means the secondary fever might always be lessened, and often wholly prevented.

The pustules should be opened when they begin to turn of a yellow colour. Very little art is necessary for this operation. They may either be opened with a lancet or a needle, and the matter absorbed by a little dry lint. As the pustules are generally first ripe on the face, it will be proper to begin with opening these, and the others in course as they become ripe. The pustules generally fill again, a second or even a third time; for which cause the operation must be repeated, or rather continued as long as there is any considerable appearance of matter in the pustules.

We have reason to believe that this operation, rational as it is, has been neglected from a piece of mistaken tenderness in parents. They believe that it must give great pain to the poor child; and therefore would rather see it die than have it thus tortured. This notion however is entirely without foundation. I have frequently opened the pustules when the patient did not see me, without his being in the least sensible of it; but suppose it were attended with a little pain, that is nothing in comparison to the advantages which arise from it.

Opening the pustules not only prevents the resorption of the matter into the blood, but likewise takes off the tension of the skin, and by that means greatly relieves the patient. It likewise tends to prevent the pitting, which is a matter of no small importance. Acrid matter, by lodging long in the pustules, cannot fail to corrode the tender skin; by which many a handsome face becomes so deformed as hardly to bear a resemblance to the human figure[^[91]].

It is generally necessary, after the small-pox are gone off, to purge the patient. If however the body has been open through the whole course of the disease, or if butter-milk and other things of an opening nature have been drank freely after the height of the small-pox, purging becomes less necessary; but it ought never wholly to be neglected.

For very young children, an infusion of senna and prunes, with a little rhubarb, may be sweetened with coarse sugar, and given in small quantities till it operates. Those who are farther advanced must take medicines of a sharper nature. For example, a child of five or six years of age may take eight or ten grains of fine rhubarb in powder over night, and the same quantity of jalap in powder next morning. This may be wrought off with fresh broth or water-gruel, and may be repeated three or four times, five or six days intervening between each dose. For children further advanced, and adults, the dose must be increased in proportion to the age and constitution[^[92]].

When imposthumes happen after the small-pox, which is not seldom the case, they must be brought to suppuration as soon as possible, by means of ripening poultices; and when they have been opened, or have broke of their own accord, the patient must be purged. The Peruvian bark and a milk diet will likewise be useful in this case.

When a cough, a difficulty of breathing, or other symptoms of a consumption, succeed to the small-pox, the patient must be sent to a place where the air is good, and put upon a course of asses milk, with such exercise as he can bear. For further directions in this case, see the article Consumptions.

OF INOCULATION.

Though no disease, after it is formed, baffles the powers of medicine more effectually than the small-pox, yet more may be done before-hand to render this disease favourable than any one we know, as almost all the danger from it may be prevented by inoculation. This salutary invention has been known in Europe above half a century; but, like most other useful discoveries, it has till of late made but slow progress. It must however be acknowledged, to the honour of this country, that inoculation has met with a more favourable reception here, than among any of our neighbours. It is still however far from being general, which we have reason to fear will be the case, as long as the practice continues in the hands of the faculty.

No discovery can be of general utility, while the practice of it is kept in the hands of a few. Had the inoculation of the small-pox been introduced as a fashion, and not as a medical discovery, or had it been practiced by the same kind of operators here, as it is in those countries from whence we learned it, it had long ago been universal. The fears, the jealousies, the prejudices, and the opposite interests of the faculty, are, and ever will be, the most effectual obstacles to the progress of any salutary discovery. Hence it is that the practice of inoculation never became in any measure general, even in England, till taken up by men not bred to physic. These have not only rendered the practice more extensive, but likewise more safe, and by acting under less restraint than the regular practitioners, have taught them that the patient’s greatest danger arose, not from the want of care, but from the excess of it.

They know very little of the matter, who impute the success of modern inoculators to any superior skill, either in preparing the patient or communicating the disease. Some of them indeed, from a sordid desire of engrossing the whole practice to themselves, pretend to have extraordinary secrets or nostrums for preparing persons for inoculation, which never fail of success. But this is only a pretence calculated to blind the ignorant and inattentive. Common sense and prudence alone are sufficient both in the choice of the subject and management of the operation. Whoever is possessed of these may perform this office for his children whenever he finds it convenient, provided they be in a good state of health.

This sentiment is not the result of theory, but of observation. Though few physicians have had more opportunities of trying inoculation in all its different forms, so little appears to me to depend on those, generally reckoned important circumstances, of preparing the body, communicating the infection by this or the other method, &c. that for several years past I have persuaded the parents or nurses to perform the whole themselves, and have found that method followed with equal success, while it is free from many inconveniences that attend the other[^[93]].

The small-pox may be communicated in a great variety of ways with nearly the same degree of safety and success. In Turkey, from whence we learned the practice, the women communicate the disease to children, by opening a bit of the skin with a needle, and putting into the wound a little matter taken from a ripe pustule. On the coast of Barbary they pass a thread wet with the matter through the skin between the thumb and fore-finger; and in some of the states of Barbary, inoculation is performed by rubbing in the variolous matter between the thumb and fore-finger, or on other parts of the body. The practice of communicating the small-pox, by rubbing the variolous matter upon the skin, has been long known in many parts of Asia and Europe, as well as in Barbary, and has generally gone by the name of buying the small-pox.

The present method of inoculating in Britain is to make two or three slanting incisions in the arm, so superficial as not to pierce quite through the skin, with a lancet wet with fresh matter taken from a ripe pustule; afterwards the wounds are closed up, and left without any dressing. Some make use of a lancet covered with the dry matter; but this is less certain, and ought never to be used unless where fresh matter cannot be obtained: when this is the case, the matter ought to be moistened by holding the lancet for some time in the steam of warm water[^[94]].

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

CHAP. XXIV.
OF THE MEASLES.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

OF THE SCARLET FEVER.

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

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

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

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

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

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

OF THE BILIOUS FEVER.

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

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

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

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

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

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

CHAP. XXV.
OF THE ERYSIPELAS, or St. ANTHONY’S FIRE.

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

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