Class. 
 
 "RCg/ 
 
 Book 
 
 A^:_ 
 
\ 
 
 Medical admonitions 
 
 TO 
 
 FAMILIES, 
 
 RESPECTING THE 
 
 PRESERVATION OF HEALTH, 
 
 AND THE 
 
 TREA TMENT OF THE SICK, 
 
 ALSO, 
 
 A TABLE OF SYMPTOMS, 
 
 &ERtriNG TO POINT OUT THE DEGREE OF DANGER, AND, TO DIST{$3USSH ONE 
 DISEASE FROM ANOTHER : 
 
 WIT ri 
 
 OBSERVATIONS 
 
 ON THE IMPROPER INDULGENCE OF CHILDREN.* &C* 
 
 By JAMES PARKINSON, m. », 
 
 HOXTON. 
 
 How best the fickle fabric to support 
 Of mortal man ; in healthy body how 
 A healthful mind thd longest to maintain. 
 
 ARMSTRONG. 
 
 JFirgt atncrican, from tfie jfaunS €ttglfelj Saitfim* 
 
 PORTSMOUTH, New-Hampshizs : 
 Printed for CHARLES PEIRCE,by N. S. & W. PEIRCE, 
 
 " . ' 1803. 
 

 
INTRODUCTION 
 
 TABLE of SYMPTOMS, 
 
 IN the moll trifling affairs, hardly any one will 
 be found who will entruft another, with the per- 
 formance of any bufinefs of the nature of which he 
 is uninformed, 
 
 Should any one be afked to truft another with 
 the turning of a toothpick, out of fome fubitance 
 which he valued, merely on the recommendation 
 of his having an excellent fet of tools, and an effay 
 on the art of turning, he would confider that fome 
 practice would be neceffary to give him the art of 
 turning the wheel, with due velocity and regu- 
 larity, and of holding the tool, and of applying it in 
 the moft proper manner. He would remark that 
 repeated obfervation and experience were required, 
 dve a knowledge of the grain of various fub- 
 s, and in what direction the grain of differ- 
 ent 
 
4 MEDICAL ADMONITIONS. 
 
 ent fubftanees mould be worked ; and that with? 
 out this knowledge, he would be likely to ftuver 
 to pieces the fubftance on which he operated, in- 
 ftead of making it affume an ufeful and beautiful 
 form. He would therefore fay, No, you mull ex- 
 cufe me, I muft apply to fpme artift of more judg- 
 ment and ability, for I will not have my toothpick 
 fpoiled. But often when life itfelf is at flake, much 
 lefs circumfpe&ion is employed than in the turning 
 of a toothpick — the treatment of fome dangerous 
 difeafe is confided to any one who pofleffes a medi- 
 cine cheft and the fmall fliare of fkill which is de- 
 rived from the perufal of fome treatife on domeflic 
 medicine. 
 
 To deftroy the ftrange infatuation on which fuch 
 fnconfiftency depends, would be a hopelefs endea- 
 vour ; but humanity fuggefts, nay, commands, 
 that every thing be done which may be likely to 
 Jeffen the evils refulting from it. If men will, in 
 fpite of remonftrance, rufli into danger, they are 
 not, therefore, to perifh unaided. Should any one 
 obftinately put to fea without a compafs to fteer 
 by, and without any knowledge refpecting the nav- 
 igating of a fhip j but what he picks up during 
 his voyage, by reference to fome treatife on navi- 
 gation, it would not be fufficient, merely to endea- 
 vor to diffuade him from making the raih attempt. 
 
 But 
 
MEDICAL ADMONITIONS. jj 
 
 But if he perfift, every poflible affiftance fhould be 
 yielded him : the perils he has to fhun fhould be 
 clearly pointed out, the different rocks and quick- 
 fands he is to avoid, fhould be marked ; and the 
 different circumftances fhould be defcribed which 
 may fhow his near approach to danger. 
 
 With a fimilar intention, is the following table 
 given ; it is by an attention to fymptoms, that the 
 phyfician is enabled to fteer his courfe with confi- 
 dence and fafety, and to difcover the dangers which 
 threaten. By a reference to the following table, 
 and by examining the fymptoms moft prominent 
 at the commencement of difeafe, domeftic pracli- 
 tioners therefore, may more readily detect the dif- 
 eafe which they wifh to remove j and will be then 
 better able to determine, as to the propriety of 
 taking the tafk of curing it on themfelves. If this 
 be refolved on, a reference to the table may alfo 
 ferve to fhow the degree of danger which is marked 
 by any particular fymptom, which may arife in 
 the progrefs of the diforder 3 and which calls for 
 very powerful affiftance. 
 
TABLE 
 
 SYMPTOMS. 
 
 ANXIETY. 
 
 vVHEN fever is accompanied by extreme anx» 
 iety, the patient fuftaining, at the fame time, a 
 eonliderable lofs of fpirits and ftrength, the fever 
 may be judged to be of a malignant kind, and to 
 require the moft powerful aid. 
 
 APHTHA, fee Thrush. 
 
 APPETITE, loss of 5 
 When accompanied by fqueamifhnefs, vomitings 
 distention and pain of the ftomach, eructations 
 and heart-burn, tveaknefs of the Jiomach has taken 
 place ; demanding a judicious regulation of the 
 diet* and the ufe of corroborant remedies. 
 
 Returning in fevers and other acute difeafes, a iign 
 of a fpeedy recovery. 
 
 For 
 
8 MEDICAL ADMONITIONS. 
 
 For things, feemingly improper, may often be in. 
 dulged, in fever, not only without any ill confe- 
 quence, but frequently with confiderable advan- 
 
 tage. 
 
 BELLY, pain of, in lying-in women. 
 If within a few days after delivery, a confiderable 
 degree of forenefs and pain is experienced in the 
 belly, preceded by cold fhiverings ; the pulfe 
 becoming quick and fmall, the fkin dry, the head 
 and back painful, the breathing difficult, and the 
 patient oppreffed with exceffive anxiety and 
 dejection of fpirits ! there is great reafon to fup- 
 pofe the Puerperal Fever, as it is termed, has come 
 on : requiring the moft judicious and prompt 
 exertions. 
 
 Violent pain of, chiefly pofleffing the parts about 
 the navel, vomiting and obftinate coftivenefs, 
 with fever, ihow the exiftence of iiifiammation of 
 the bowels, a difeafe which in general terminates 
 fatally in a very few days, if proper remedies 
 are not early adopted. 
 
 Griping pains of, chiefly about the naval, accom- 
 panied by troublefome urgings, and generally 
 preceding flimy or mucous ftools, in which fmall 
 ftreaks of blood are perceivable, fliow the difeafe 
 to be Dyfentery or Bloody Flux. 
 
 BLOOD, 
 
Medical admonitions. 9 
 
 BLOOD, raifed by Coughing. 
 In every cafe in which blood is raifed by coughing, 
 it may be concluded that fome blood-veffel in 
 the lungs is ruptured. This circumflance is gen- 
 erally followed by Conmmption, to mention this 
 inuft be fufficient to induce early attention, 
 
 Raifed by vomiting. 
 Blood thus difcharged, muft proceed from the 
 ftomach ; and except in cafes of interrupted 
 menflrual difcharge, is attended with no' fmall 
 degree of danger. 
 
 Spitting of, without cough or vomiting, 
 This always proceeds from the mouth only, and is 
 therefore unaccompanied by danger. 
 
 Difcharged from the Noftrils. 
 This feldom occurs but in fuch a ftate of the fyftem 
 as demands great care, that by a fpare regimen 
 and a due employment of exercife, fuch a degree 
 of' fulnefs of the blood-veffels be prevented, as 
 may produce Confumption in the young, or Apo- 
 plexy in the aged. 
 
 Flowing from the Fundament* 
 This may in general be concluded to proceed from 
 the Piles, if this be not the cafe, fome internal 
 mifchief is to be feared, 
 
 B BLOODY 
 
IO MEDICAL ADMONITIONS; 
 
 BLOODY STOOLS, >> BELLY, 
 
 GRIPING PAINS OF, 
 
 BREAST, SWELLING OF. 
 
 This fymptom fometimes comes on, as the difeafe, 
 termed the Mumps, fubfides, but is always with- 
 out danger. 
 
 SMALL KERNAL IN. 
 When a fmall, hard, moveable and painful kernel 
 appears in the breaft, a Cancer may be appre- 
 hended to be forming ; and therefore the moll 
 fpeedy afliftance fhould be obtained. 
 
 BREATHING, short. 
 Frequent little cough, with fliortnefs of breathing, 
 pain in fome part of the cheft, and fever, denote 
 Inflammation of the Lungs, which if not removed 
 within the iirft two or three days of the difeafe, 
 will either occafion death fpeedily, or produce a 
 lingering Confwnption. 
 
 BREATHING, difficult. 
 The breath drawn in with a loud wheezing found, 
 and the voice hoarfe, with a Couch accompanied 
 by a drill barking found, Ihow the difeafe to be 
 the Croup or Inflammation of the Wind Pipe ; the 
 removal of which can only be obtained by the 
 employment of proper means, in the firji hours 
 of the exiftence of the difeafe. 
 
 Returning 
 
MEDICAL ADMONITIONS, J I 
 
 Returning, by fits, accompanied by a fenfe of tight- 
 nefs acrofs the cheft, marks the difeafe to bf 
 
 Afthma. 
 
 CONVULSIONS, 
 
 In children, often precede the Small Pox? 
 
 Frequently accompany dentition, and may, in gene- 
 ral, be fpeedily cured, by properly lancing the 
 gums. 
 
 Often occafioned by worms irritating the ftomach 
 and bowels. 
 
 Of the whole body, with frothing at the mouth, 
 and total lofs of fenfibility, characterife Epilepfy, 
 or the Falling Sicknefs ; fo termed from the fub- 
 je&s of this difeafe falling fuddenly on the com- 
 ing on of the .fit. 
 
 With a fenfation as if a ball was riling in the throat, 
 flutterings and rumbling in the bowels, fhow 
 the difeafe to be Hyjlerics. 
 
 COSTIVENESS. 
 Obftinate coftivenefs, with fevere pain and con- 
 traction of the belly, point out the Colic. 
 
 When it happens to the makers of white lead, 
 painters, lapidaries, &c. there will be reafon to 
 fuppofe it is produced by the poifon of lead. 
 
 With 
 
t2 MEDICAL ADMONITIONS. 
 
 With extreme pain, fever, and vomiting, fliow m 
 
 jiammation of the bowels- 
 
 The fymptoms juft enumerated, may be produced 
 by a protrufion of fome part of the bowels, at a 
 hernia or rupture. 
 
 Often found with weak organs of digeftion. 
 
 COUGH. 
 
 Long continuing ihould excite apprehenfions, left 
 fome dangerous alteration be taking place in the 
 lungs. 
 
 With fhortnefs of breath, fever, and pain in the 
 cheft, the face fwelled and of a purplilh colour, 
 particularly point out inflammation of the lungs. 
 
 Continuing with fhortnefs of breath, after the other 
 fymptoms have fubfided, gives reafon to appre- 
 hend fuch a change in the fta'te of the lungs, as 
 may terminate in Confumption. 
 
 Frequent, with increafed difcharge from the 
 mouth, nofe and eyes, diftinguimes Catarrh. 
 
 And rednefs of the eyes, accompanying an erup- 
 tion on the fkin, with fever, are the fymptoms 
 oiMeqJles. 
 
 May fometimes be an hyfterical affection. 
 
 Is 
 
MEDICAL ADMONITIONS. 13 
 
 Is fometimes fymptomatic of an affedion cf the liver. 
 
 Difcharging purulent matter, and accompanied by 
 fever, increafmg twice in the twenty-four hours, 
 mows that Confumption has taken place. 
 
 Strangulating, convulflve, quickly repeated, and 
 accompanied with a peculiar hooping found, 
 
 Uooping Cough. 
 
 CRAMP IN THE LEGS. ' 
 
 A frequent fymptom in the difordef of the bowels, 
 termed the Cholera Morbus. 
 
 DEAFNESS. 
 Succeeding to a purulent difcharge from the ear, 
 is feldom cured. 
 
 Of confiderable length of duration, often depends 
 on the external paffage of the ear being ob- 
 ilrufted by wax, and confequently may be cured 
 by its removal. 
 
 DELIRIUM. 
 
 Preceded by cold fhivering, and fucceeding to ex- 
 ceffive indulgence in fpirituous liquors, demands 
 the utmoft attention, iince inflammation of the brain 
 may perhaps be forming. 
 
 In acute difeafes, never occurs without danger. 
 
 In 
 
14 MEDICAL ADMONITIONS. 
 
 In the beginning of fever, ought to excite the ut. 
 . moft alarm, it probably being the confequence 
 of inflammation of the brain. 
 
 Accompanying Eyflpelas, or St. Anthony's Fire, and 
 increafing as the difcafe proceeds, is an alarming 
 fymptom ; pointing out fome ferious affection 
 of the brain or its membranes. 
 
 Whenever violent, with rednefs of the face and 
 eyes, and fever, the patient experiencing great 
 inconvenience from light and noife, inflammation 
 of the brain may be concluded to be prefent. 
 
 DROPSICAL SWELLING, 
 Of the whole body, at the conclufion of Scarlet Fe- 
 ver, fliews a dangerous difpofition, and if not 
 . removed at it's firft appearance may terminate 
 fatally. 
 
 DROWSINESS, 
 With a difficulty of fpeech and of recollection, and 
 numbnefs of the limbs, demand the greateft at- 
 tention, being often the fore-runners of Palfy or 
 Apoplexy. 
 
 Accompanied by pain in the head and pit of the 
 ftomach, and preceded by ftiivering, fometimes 
 takes place on the commencement of the fever 
 of Small Pox. y 
 
 With 
 
MEDICAL ADMONITIONS. 1 5 
 
 With a frequent dry, hoarfe cough, and running 
 at the eyes and nofe, is generally followed by the 
 eruption of the Meajles. 
 
 EARS, 
 Extreme pain of, always to be confidered as a 
 fymptom demanding great attention ; Jfince it 
 generally ihows inflammation to have taken 
 place, which, if not removed in time, may ter- 
 minate in deafnefs for ]ife. 
 
 Senfe of linging in, with head-ach and continual 
 drowfinefs, threatens Palfy or Apoplexy. 
 
 ERUCTATIONS, 
 
 Frequent acid, denote a weaknefs of the Jlomach. 
 
 ERUPTION, SCARLET. 
 
 Gives name to the Scarlet Fever ; with which is fre- 
 quently found ulcerated Throat.. 
 
 Is alfoj generally, a fymptom in the malignant ulcer- 
 ated Sore Throat. 
 
 OF PIMPLES, 
 In their firft appearance fomewhat refembling the 
 foregoing eruption, but the cuticle being a little 
 elevated, and the eruption more cluttered, marks 
 it to be the Meajles. The making the neceflary 
 diftin&ion is more eafily accomplifhed, when the 
 eyes and noftrils fufFer an increafe of difcharge? 
 
 and the former look red and inflamed. 
 
 When 
 
1 6' MEDICAL ADMONITIONS. 
 
 When more diftincT: and more elevated, and the 
 noftrils and eyes are not affected, as in the for- 
 mer cafe, the difeafe may be concluded to be the 
 Small Pox, which will foon plainly appear, the 
 eruption afluming a puftular form. It mould 
 be remembered that the termination of this and 
 the former difeafe, will frequently depend on 
 their treatment in their firft ftages. 
 
 If it refembles the eruption juft mentioned, except 
 in its afluming, at its firft appearance, more of 
 a veficular form, and dying off on the third or 
 fourth day, the difeafe is the Swine or Chicken 
 Pox ; a difeafe without danger, and feldom de- 
 manding medicinal afliftance. 
 
 VESICULAR, 
 Appears of the fize of a millet feed in fevers, and 
 other difeafes, where there has been profufe 
 fweating, or in cafes where much blood has been 
 loft ; and is termed the Miliary Eruption. 
 
 OF RED SPOTS, 
 With a lighter centre, accompanied with an itch- 
 ing, refembling that which is produced by the 
 flinging of nettles, is called the Nettle Rajh. 
 
 Scaly, white, and itching, beginning about the 
 elbows, and fpreading to the hands, the body 
 and face, is the Leprofy. 
 
 OF 
 
MEDICAL ADMONITIONS. I J 
 
 OF SMALL PIMPLES, 
 Containing a pellucid fluid, appearing all over the 
 body, but chiefly at the bending of the limbs, 
 and itching violently, is the Itch. 
 
 On the head, terminating in ulcers, which dif- 
 charge a humour foon drying into a whitifh 
 cruft, is denominated Tinea, or Scald Head. 
 
 EXTREMITIES 
 Becoming cold, in acute difeafes, marks danger. 
 
 Becoming cold, with pain in the belly, or with 
 great heat of the body, alfo fhews danger. 
 
 EYES, . 
 
 Not doling during ileep, in fevers, is a bad fymp« 
 torn. 
 
 Red, painful, and watery, with incapability of 
 fuftaining the light, fhows inflammation of this 
 organ. 
 
 Appearing funk, dull, or watery, is a fymptom of 
 much danger in fevers. 
 '■ 
 
 FACE 
 Contracted, the eyes appearing funk, nofe fliarp, 
 the ears cold, the fkin dry and pale, the eye lids, 
 lips, and cheeks livid, mow life to be nearly at 
 
 an end. 
 
 Swelled^ 
 
 C 
 
1 8 MEDICAL ADMONITIONS. 
 
 Swelled, pale, and of a waxy hue, in children, 
 points out a difpofition to Rickets. 
 
 Pale and fallow in young female fubjects, 
 
 mows fuch a cacheclic difpo/ition, as if not remov- 
 ed may terminate in complaints of a very ferious 
 tendency. 
 
 FAINTING. 
 When it occurs frequently, points out a very de* 
 bilitated ft ate of the fyftem. 
 
 FEVER, 
 
 Accompanying pain in any internal part, mows in 
 general, that inflammation is eftablifhing itfelf in 
 that part ; and can only be removed by an im- 
 mediate employment of powerful means. 
 
 Incrcafing about noon and evening, with fweats 
 during the latter part of the night ; and the u- 
 rine depofiting a bran-like fediment, gives reafon 
 to fuppofe that fome change in the fyftem, full 
 of danger, has taken place. 
 
 FITS, 
 Happening juft before the eruption of the Small- 
 pox, are not always, though generally fucceeded 
 by a favourable kind. 
 
 GIDDINESS, 
 With ficknefs of the ftomach and lofs of appetite, 
 Ihows the Stomad to be foul. » Ac- 
 
MEDICAL ADMONITIONS. 19 
 
 Accompanied with head-ach, finging in the ears, 
 and impaired powers of recollection, threatens 
 apoplectic or paralytic attacks. 
 
 HANDS and FEET Swelling 
 IN SMALLPOX. 
 As the fwelling of the head and face fublides, is a 
 favourable fymptom. 
 
 HEAD - ACH. 
 Continuing, with violence, through the courfe of 
 fevers, fhews that a fatal termination of. the fever 
 is to be apprehended. 
 
 With giddinefs, ficknefs, and lofs of appetite, but 
 without fever, accompanies foulnefs of the Stomach. 
 
 With rednefs of the face and eyes, and fever, are 
 fymptoms of inflammation of the brain. 
 
 Accompanying Inflammation of the Eyes, is in gene- 
 ral a mark of danger. 
 
 With eructations, and lofs of appetite, points out 
 
 lndigejlion. 
 
 With pain and tenfion at the pit of the ftomach, 
 generally proceeds from wind pent in the ftom- 
 . ach. 
 
 When accompanied by a firicl Jiate of the bowels, 
 may be attributed to that circumftance* 
 
 With 
 
20 MEDICAL ADMONITIONS. 
 
 With florid countenance, and a full, fluggifli pulfe, 
 may arife from fullnefs of blood. 
 
 With chillinefs, flight fhiverings,and great latitude, 
 generally diftinguifh the commencement of fever. 
 
 HEAT 
 At the pit of the ftomach and four rifings, confti- 
 tute the Heart-burn^ arifmg from Weaknefs of the 
 ftomach. 
 
 May not, in putrid fevers^ arrive at fuch a degree 
 as to excite a neceflary degree of alarm, in the 
 friends of the patient. 
 
 With pain in any external part, gives reafon to 
 fufpect inflammation to be proceeding \o fuppura- 
 iion. 
 
 Internal, with cold limbs, in fevers, points out 
 great danger. 
 
 HICCUP, 
 
 Succeeding to confiderable evacuations, fliows much 
 danger. 
 
 Occurring in the progrefs of internal inflamma- 
 tion, gives reafon to fear the coming on of Mor- 
 tification. 
 
 Is an alarming fymptom in cafes of Suppreffion of 
 
 Urine. 
 
 Shows 
 
MEDICAL ADMONITIONS. 21 
 
 Shows great danger to exift in cafes of Jlrangulated 
 
 rupture. 
 
 Generally found to accompany eruptive fever of 
 meafles. 
 
 LASSITUDE, 
 And real debility, generally precede the other 
 fymptoms of fever. 
 
 And languor, in children, mould always excite vi- 
 gilance in parents and thofe who have the care 
 of children. 
 
 LEGS, SWELLING OF, 
 
 In a very flight degree, in perfons rather advanced 
 in years, and uiing but little exercife, is not to 
 be regarded as an alarming circumflance. 
 
 In perfons beyond the middle ftage of life, who 
 are afTe&ed by difficulty of breathing, may be 
 confidered as entirely depending on the diford» 
 ered iiate of the lungs ; and as pointing out the 
 neceffity of exertions being made for their relief, 
 
 With diminution of urine, and failure of ftrength, 
 fhould be coniidered as a warning that fome 
 important change in the fyftem is taking place, 
 perhaps tending to Dropjy. 
 
 LIPS, 
 
22 MEDICAL ADMONITIONS. 
 
 LIPS. 
 Eruptions on, fucceeded by fcabs, in fevers, is a fa* 
 vourable fymptom. 
 
 LOOSENESS, 
 Occurring in cafes of hectic fever, with night 
 fweats, mows danger. 
 
 MATTER, 
 
 Difcharged from the lungs, hectic fever being alio 
 prefent, a mark of confumption. 
 
 Of a purulent appearance may be difcharged from 
 the lungs, and if without hectic fever, confump- 
 tion may not fucceed, if very powerful means 
 are employed. 
 
 MENSES, 
 When fuppreffed in confumption no benefit will 
 be derived from endeavouring to procure their 
 return ; their fuppreffion being a fymptom, not 
 the caufe of confumption. 
 
 MIND, 
 Much dejected in the beginning of fevers, gene- 
 rally points out a confiderable degree of malig- 
 nancy in their nature. 
 
 PAIN, 
 Internal, with fever, requires particular attention ; 
 it in general denoting inflammation of fome inter- 
 nal part. 
 
 Suddenly 
 
MEDICAL ADMONITIONS. 23 
 
 Suddenly ceafing, in cafes of internal inflammation, 
 the countenance finking, the pulfe becoming 
 very quick and fmall, with frequent cold fhiver- 
 ings, gives caufe to fear the coming on of morti- 
 fication. 
 
 In cafes of internal inflammation, gradually dimin- 
 ifhing, and a fenfation of weight in the part 
 gradually arifing, with fome degree of anxiety, 
 fhews that fuppuration is taking place. 
 
 IN THE HEAD, 
 With fever, rednefs of the face and eyes, and ina- 
 bility to bear noife and light, are fymptoms of 
 inflammation of the brain or its membranes. 
 
 IN THE EAR, - 
 With feveriflinefs, fymptoms of inflammation in the 
 ear. 
 
 IN THE CHEST, 
 With a fenfe of oppreffion, and of heat under ths 
 breaft bone, with a falttfh tafte in the mouth, 
 generally precedes /pitting of blood. 
 
 In the cheft, with fever, difficulty and fhortnefs of 
 breathing, are marks of inflammation of the lungs. 
 If the other fymptoms here enumerated are pre- 
 fent, the difeafe may be concluded to exift, al- 
 though the pain be not confiderable. 
 
 ACROSS 
 
24 MEDICAL ADMONITIONS. 
 
 ACROSS THE CHEST. 
 Coming on fuddenly, during walking, and parti- 
 cularly whilft going up {lairs, or afcending a hill ; 
 a pain alfo being felt, at the fame time, about 
 the middle of the arm, are fymptoms of the dif- 
 eafe termed Angina Pecloris. 
 
 PAIN OF THE SIDE, 
 Increafed by drawing in the breath, and particu- 
 larly by coughing, with hard pulfe, and diffi- 
 culty of laying on the pained fide, denotes Pleurify 
 or Inflammation of the Pleura or membrane invert- 
 ing the infide of the cheft. 
 
 IN THE LEFT SIDE OF THE CHEST, 
 With fever, great anxiety, irregular pulfe, faint- 
 ing} and palpitations, are fymptoms of inflamma- 
 tion of the heart. 
 
 IN THE LEFT SIDE, 
 Under the ftiort ribs, with fulnefs and tenfion, dif- 
 tinguiihes the inflammation ofthefpken. 
 
 ON EITHER SIDE OF THE CHEST, 
 Not very acute, nor violently increafed during in- 
 fpiration, may occur in confequence of an affec- 
 tion of the mufcles of the cheft. 
 
 IN THE RIGHT SIDE, 
 
 Under the fhort ribs, extending to the moulder, 
 
 with fever, points out inflammation of the liver. 
 
 OVER 
 
MEDIC A& -ADMONITIONS. 25 
 
 OVER THE WHOLE BELLY, 
 Increafed by ftraitening the body, extreme forenefs 
 and fever, mark inflammation of the peritoneum, or 
 membrane lining the cavity of the belly* 
 
 Very violent vomitings, obftinate eoftivenefs and 
 fever, diftinguifh inflammation of the bowels. 
 
 ABOUT THE NAVEL, 
 Very fevere, with eoftivenefs and contraction of 
 the belly, are fymptoms of Colic. 
 
 With frequent flimy ftools, ftreaked with blood, 
 point out Dyfeniery or Bloody Flux. 
 
 AT THE BOTTOM OF THE BELLY, 
 With fulnefs and extreme tendernefs on preffure, 
 and frequent painful attempts to pafs urine* 
 which efcapes only in fmall quantities, mows 
 , inflammation to have poflefTed the bladder, 
 
 IN THE BACK, 
 One of the firft fymptoms of fever, and generally 
 occurs to a great degree in malignant and in erup- 
 tive fevers. 
 
 IN THE LOINS, 
 Palling forwards toward the bottom of the belly s 
 fever, vomitings, numbnefs of the thigh, and 
 drawing up or pain of the tefticles in the afFe&ed 
 fide, accompany inflammation of the kidneys. 
 
 D IN 
 
26 MEDICAL ADMONITIONS. 
 
 IN THE LARGE MUSCLES, AND IN THE JOINTS', 
 Without rednefs, fwelling, or fever, occurs in 
 
 Chronic Rheumatifnu 
 
 With fwelling, rednefs, and fever, diftinguifh acute 
 or Inflammatory Rheumatifm. 
 
 IN THE SHIN BONES, 
 Or in the head, fuffering a confiderable augmenta- 
 tion in the evening, demands immediate atten- 
 tion. 
 
 IN THE JOINTS OF THE GREAT TOE, 
 Inftep, or hand, generally preceded by fome affec- 
 tion of the ftomach, and coming on moft com- 
 monly in the night, characterizes the attacks of 
 
 Goat* 
 
 IN THE LIMBS, 
 Generally occurs at the commencement of fever. 
 
 AT THE PIT OF THE STOMACH, 
 With vomitings, may proceed from Gallstones. 
 
 At the commencement of fever, is often followed 
 by a difeafe of a confiderable degree of malignity. 
 
 Alfo frequently precedes the eruption of the Small 
 Pox or Meafles. 
 
 And heat in the ftomach, increafed by the fwal- 
 lowing of even fluids, with vomitings, extreme 
 anxiety, and fever, with are fymptoms of inflam- 
 mation of the ftomach, AT 
 
MEDICAL ADMONITIONS. , iy 
 
 AT THE BOTTOM OF THE BELLY, 
 With heat, fwelling, and tendernefs on preffure, 
 frequent vomitings and fever, are fymptoms of 
 inflammation of. the womb. Darting, in the region 
 of the womb, generally accompanies a fchirrous 
 4r a cancerous Jiate* 
 
 PALPITATION OF THE HEART, 
 
 May proceed from fome difeafe, originating in the 
 heart itfelf j or may be fymptomatic of general 
 debility. 
 
 With quick and difficult breathing, after moderate 
 exercife, and fallownefs of the complexion, marks 
 of chlorofis. 
 
 Irregular pulfe, extreme anxiety, and frequent fits 
 of fuffocation, generally accompany Dropfyofthe 
 
 Pericardium, 
 
 PAROXYSM, FEBRILE, 
 Returning repeatedly, after twenty-four hours in-, 
 termiffion, diftinguiflies the Quotidian Ague. 
 
 Returning after an intermiffion of forty-eight 
 hours, the Tertian Ague ; 
 
 And, after an intermiffion of feventy-two hours, 
 
 the Quartan Ague. 
 
 PULSE 
 
28 MEDICAL ADMONITIONS. 
 
 PULSE 
 Quick, fucceeding to cold fhivering, and accompa- 
 nied by heat, ihows the exiftence of fever. 
 
 Quick, hard and ftrong, with preternatural heat, 
 points out inflammatory fever. 
 
 Similar to the foregoing accompanies particular in- 
 flammation. 
 
 Hard, fmall and quick, is generally found with 
 inflammation ofthejiomach or bowels. 
 
 Quick, fmall and weak, with extreme debility in 
 fevers, mows the fever to be malignant, and 
 great danger to exift. 
 
 REDNESS OF THE SKIN. 
 Diffufed, hot and but little fwelled, the Ikin only 
 elevated as with a little roughnefs, diftinguifhes 
 the Eryflpelas, or St. Anthony's Fire. 
 
 OF THE CHEEKS, 
 Coming on with the he&ic fever, marks Confump- 
 tion. 
 
 RESPIRATION QUICK AND SHORT. 
 With fever, and tightnefs acrofs the cheft, indi- 
 cates inflammation of the lungs. 
 
 SHORT AND QUICK, 
 Pains in the fide of the cheft and fever, diftinguifh 
 Pleurify. DIFFICULT, 
 
MEDICAL ADMONITIONS. 29 
 
 DIFFICULT, 
 Recurring by fits, without fever generally marks 
 
 Ajlhma. 
 
 Awaking the patient with confiderable alarm, with 
 weight acrofs the cheft, and fwelling of the feet s 
 
 points out water in the cheji. 
 
 May alfo accompany Inflammation of the Liver, 
 various affections of the heart and large velfels, 
 diftenfion of the bowels by wind, and the pre- 
 ternatural enlargement of any of the bowels. 
 
 RESPIRATION. 
 Snoring and long, with the appearance of deep 
 fleep, diftinguifhes Apoplexy. 
 
 DIFFICULT, 
 A bad fymptom, in all fevers. 
 
 RIGIDITY, 
 At the fide of the face, and back of the neck, and 
 difficulty of fwallowing, are the firft- fymptoms 
 of a Locked Jaw. 
 
 SHIVERING, 
 Is the firft fymptom of every febrile or inflammatory 
 difeafe. 
 
 In fevers, not fucceeded by increafe of heat and 
 fweat, an unfavourable fymptom. 
 
 Occurring 
 
g© MEDICAL ADMONITIONS. 
 
 Occurring in the latter ftages of fever, the patient 
 being very low and weak, is alfo an unfavoura- 
 ble fign. 
 
 r 
 
 With delirium, following intoxication, threatens a 
 dangerous affection of the brain. 
 
 After violent inflammation, fhows that fuppuration 
 is taking place. 
 
 In the fmall-pox, about the ninth day, the fkin ap- 
 pearing fhrunk, and the puftules flattening, and 
 becoming pale at their bafes, fhows danger. 
 
 SICKNESS 
 Occurring after having been in the chamber of a 
 perfon in a fever, fometimes marks the firft im- 
 preflion of infection, requiring the immediate 
 employment of an emetic. 
 
 Accompanied with pain at the ftomach, heartburn, 
 and lofs of appetite, fhows the weaknefs of the 
 ftomach. 
 
 SIGHING 
 Frequent, in fevers, a bad fymptom. 
 
 SIGHT, EXTREMELY INDISTINCT, 
 
 In fevers, the patient being much exhaufted, fhows 
 much danger. 
 
 INDISTINCT. 
 
MEBICAL ADMONITIONS. 3 ; j[ 
 
 INDISTINCT. 
 The eyes becoming uneafy and hot, after reading, 
 &c. the eye requiring to be removed farther 
 for the examination of any minute object than 
 it* has been wont, mows the convexity of the 
 cornea' to have become morbidly difeafed, and 
 that the ufe of convex glaffes is pofitiveiy indi- 
 cated # . 
 
 Affe&ed by dark fpots and ftreaks- appearing on 
 the objefts viewed, fhows a ferious affection 
 of the eyes, but this is not, as has been fuppofecf, 
 a fign that blindnefs mull inevitably follow, fince 
 this affe&ion may fometimes be removed by pro= 
 per meamres. 
 
 SKIN, COLD, 
 Whilft great thirft and internal heat are experi- 
 enced, is a bad fymptom in a feven 
 
 PUNGENTLY 
 
 * In a publication of this kind, it would be worfe than 
 folly to facrifice utility to a fcrupulous adheience to order ; the 
 above indication is therefore introduced, although rather out of 
 place, from a conviction, that through inattention to this circum- 
 stance, the eyes are often confiderably injured. Objects require 
 painful exertion to obferve them diftinctly ; this being frequently 
 done, the organs of vifion are drained, and all the range of eye- 
 waters employed, when the cure is only to be found in the ufe of 
 a pair of fpe&acles, 
 
32 MEDICAL ADMONITIONS. 
 
 PUNGENTLY HOT, 
 Leaving a fmarting fenfation of heat on the fingers 
 of the examiner, fliows great malignancy in fever. 
 
 OF A GREENISH YELLOW. 
 Gives name to the Green Sicknefs. 
 
 YELLOW, 
 As well as the urine and the whites of the eyes, 
 and the ftools white, diftinguiflies Jaundice. 
 
 SLEEP 
 Returning, with appetite for food, may be confid- 
 ered as a moft favourable fymptom in every fever. 
 
 Calm, after delirium, is a favourable event. 
 
 SLEEPINESS 
 Often precedes and accompanies the Eryfipelas of 
 the face ; and if it increafes with the difeafe, it 
 points out much danger. 
 
 SNEEZING, 
 Difcharge of a limpid fluid from the eyes and 
 nofe, and frequent cough, mow that Catarrh 
 and Coryza, as it is termed, are forming. 
 
 SPIRITS 
 DEPRESSED IN THE BEGINNING OF FEVERS, 
 Shows the fever to be of a low and malignant 
 kind, 
 
 DEPRESSED 
 
MEDICAL ADMONITIONS. 33 
 
 DEPRESSED WITHOUT CAUSE, 
 
 Lofs of appetite, ficknefs, pain, and oppreflion in 
 
 the ftomach, diftinguifh hypocondrlacal affeclions. 
 
 SPITTING, 
 
 Bifcoloured with blood, raifed by coughing, fhows 
 fuch a ftate of the lungs as requires the greateft 
 care and attention. 
 
 SPOTS 
 
 LIVID, 
 Accompanied with putrid and bleeding gums, and 
 great weaknefs, are the ligns of Scurvy. 
 
 PURPLE, 
 A fymptom marking great danger in malignant 
 
 fever. 
 
 . STOMACH, 
 Pain of, may proceed from ulcers or worms. 
 
 VIOLENT PAIN OF, 
 With vomiting and fever, are fymptoms of inflam- 
 mation ofthejiomacb. 
 
 PAIN AT THE PIT OF, 
 With ficknefs, recurring at uncertain periods, and 
 fucceeded by flight yellownefs of the Ikin, accom- 
 panies the paffing of gall flones. 
 
 Painful diftention of, after even moderate eating, 
 
 generally proceeds from weaknefs of the ftom- 
 
 ach. 
 
 E STOOLS 
 
34 MEDICAL ADMONITIONS. 
 
 STOOLS 
 
 WHITE, 
 
 Shew an obftru&ion of the gall through the' duels; 
 
 hence alfo yellownefs of the fkin, or 'Jaundice. 
 
 BLACK, 
 With fudden relief from violent pain in inflamma- 
 tlon of the bowels, mow great danger. 
 
 SLIMY, 
 Sometimes bloody, and griping pains, are fymp- 
 toms of Dyfentery, or Bloody Flux. 
 
 STUPOR, 
 
 After wounds, or blows on the head, requires par- 
 ticular attention. 
 
 SWALLOWING 
 
 DIFFICULT, 
 And acutely painful, with fwelling and rednefs of 
 the back of the mouth or upper part of the 
 throat with fever, marks inflammatory fore Throat. 
 
 And not extremely painful, white crufts or floughs 
 forming in the upper part of the throat, and a 
 low fever, point out, efpecially if a fcarlet erup- 
 tion appears on the breaft, arms, &c. that the 
 fore Throat is of the ulcerated malignant kind. 
 
 Coming on gradually, and without pain or fever 
 gives reafon to fear a contraction is taking place 
 
 in 
 
MEDICAL ADMONITIONS. 35 
 
 in the gullet. Endeavours for it's cure are only 
 to be made with a profpect of fuccefs during the 
 commencement of the difeafe. 
 
 Of liquids, inability of, and dread of water, confti- 
 tute the difeafe termed Hydrophobia. 
 
 Of liquids, fometimes impeded in cafes that are 
 plainly Hyjierkal. 
 
 SWEAT, 
 GENERAL AND PROFUSE, 
 Occurring in cafes of inflammation, a favourable 
 fymptom. 
 
 PROFUSE, 
 Succeeding to hectic heat, with difficulty of breath- 
 ing, cough, and fpitting of purulent matter, dif- 
 tinguifh confumption, 
 
 BREAKING OUT GRADUALLY, 
 And continuing fome time, is, in general, a favour- 
 able fymptom in fevers. 
 
 Almoft always concludes the fit of Ague. 
 
 COLD, 
 
 Breaking out about the face and neck in fevers^ 
 ihows great weaknefs and danger. 
 
 SWELLING 
 OF THE HEAD AND FACE, 
 Takes place, in fmall-pox, according to the number 
 and confluency of the puftules. Ac- 
 
36 MEDICAL ADMONITIONS. 
 
 Accompanies and fucceeds Eryjipelas, or St. Antho- 
 ny's Fire in the face. 
 
 OF THE HANDS AND FEET, 
 In Small-Pox, fucceeds, to the fwelling of the head 
 zndface. 
 
 ABOUT THE ANGLES OF THE JAW, 
 With flight fever, diftinguifhes the Mumps. 
 
 OF THE HEAD, 
 In young children, who are heavy, drowfy, and 
 even at times convulfed, gives reafon to fear 
 Dropfy of the Brain. 
 
 OF THE FORE PART OF THE HEAD, 
 Large belly, the reft of the body thin, and the 
 joints enlarged, are fymptoms of the Rickets. 
 
 OF THE UPPER PART OF THE RIGHT SIDE OF 
 
 THE BELLY, 
 Gives reafon to apprehend Enlargement of the Liver. 
 
 OF THE BELLY, 
 Elaftic and fonorous, on being ftruck by the fin ? 
 gers, diftinguifhes the Tympany. 
 
 The ftroke of the fingers producing a difcoverable 
 fluctuation, diftinguifhes the A/cites, or the col- 
 lection of water in the cavity of the Belly. 
 
 AT 
 
MEDICAL ADMONITIONS. ' tf 
 
 AT THE BOTTOM OF THE BELLY, 
 With fuppreffion of urine, or frequent inclination 
 to void it, with pain, tendernefs, or prelfure, 
 characterize Inflammation of Urine. 
 
 OF THE SCROTUM, 
 Painful and hard, fhows inflammation of the part. 
 
 Not painful, rather pellucid, and giving the idea of 
 fluctuation on being gently ftruck with the fin- 
 ger, diftinguifhes Hydrocele, or Dropfy of the Tef- 
 
 ticle. 
 
 Gradually increafing downards, and enlarging 
 upon fneezing or coughing, mows Hernia, or 
 protrufion of fome part of the bowels. 
 
 OF THE FEET AND HANDS, 
 In Small-Pox, generally takes place as the fweiiing 
 of the face fubiides. 
 
 OF THE FEET, 
 Where confiderable difcharge of blood has taken place, 
 Ihows that a dangerous degree of debility is 
 brought on. 
 
 Is, in general, a fymptom demanding particular 
 attention. 
 
 OF ANY PART, 
 With heat, rednefs, tenfe'nefs and throbbing, fhows 
 an Abfcefs to be forming in that part. 
 
 Cold 
 
38 MEDICAL ADMONITIONS. 
 
 Cold, pallid, and retaining the impreflion of the 
 fingers, diftinguifhes oedematous fwellings. 
 
 IN THE BREAST, 
 Solid, the edges rather hard and not very painful, 
 is moft probably, fchirrous tumour •, which, unlefs 
 removed, will terminate in Cancer. 
 
 OF THE GLANDS 
 In the fides of the neck, with fwelling and chap- 
 ping of the lip, and large belly, ihow a fcrophu- 
 lous difpofition. 
 
 TASTE, 
 
 BITTER, 
 Sicknefs, want of appetite, and pain at the ftomach, 
 are fymptoms of indigeftion and iveaknefs of the 
 ftomach. - 
 
 ACID, 
 With the foregoing fymptoms, alfo occurs in weak- 
 nefs of the ftomach. 
 
 TEETH, 
 GRINDING OF, 
 In fever, a fymptom of danger. 
 
 In children, a fymptom of worms. 
 
 ACHING OF, 
 A fymptom of inflammation, or Caries. 
 
 Covered 
 
MEDICAL ADMONITIONS. 39 
 
 Covered with dark, foul, vifcous matter, in fevers, 
 generally marks malignancy. 
 
 TENDONS. 
 
 Twitching, at the wrift, in fevers, fhows danger. 
 
 TESTICLES 
 SWELLED, 
 Occurs fometimes at the clofe of the difeafe called 
 the Mumps. 
 
 DRAWN UP, 
 And affected with aching pain, with pain in the 
 back, ftretching forwards and downwards, with 
 ficknefs at the ftomach, are fymptoms of gravel 
 in the kidneys, or ureters, 
 
 THIRST 
 Generally prefent in fever. 
 
 Frequently occurs in fever ; but, when wanting, 
 where the tongue is parched and foul, fliows 
 danger. 
 
 Is generally a troublefome fymptom in Dropfy* 
 
 THROAT, 
 SWELLED AND RED, 
 Swallowing very painful, mark the inflammatory 
 Sore Throat, 
 
 OF 
 
40 MEDICAL ADMONITIONS. 
 
 OF A DEEP CRIMSON COLOUR, 
 With whitifh fpecks, fpreading and deepening ; 
 extreme debility, and the pulfe fmall and quick, 
 diftinguifh the putrid ulcerated Sore Throat. 
 
 THRUSH, OR APHTHA, 
 Little ulcers, generally white, appearing on the 
 tongue, infide of the lips, cheeks, &c. 
 
 When thefe occur to children, it may in general 
 be concluded either that the food of the child is 
 not fufficiently nutritious, or that the child 
 breathes an air too impure. 
 
 Frequently appear in the latter ft age of confumption. 
 
 Appearing in fever, not always to be confidered as 
 a fymptom of extreme danger, but fometimes as 
 a mark of a critical, and even favourable change 
 having taken place. 
 
 TONGUE, 
 TREMBLING AND BLACK, 
 A fymptom of danger in fever. 
 
 Parched, without thirft, in fevers, is a bad fymp- 
 tom. 
 
 HARD TUMOUR OF, 
 Though fmall, demands immediate care. 
 
 TOSSING ABOUT, 
 A frequent fymptom in dangerous fever 
 
 TREMOR, 
 
MEDICAL ADMONITIONS* 4* 
 
 TREMOR, 
 
 In fever, a fign of great debility. 
 
 VOMITING, • 
 Frequently fymptomatic of inflammation of the 
 kidney, and is generally excited by the palling 
 of gravel. 
 
 Very frequent, extreme pain in the ftomach, fever, 
 and fmall hard pulfe, diftinguilh Inflammation of 
 the Stomach* 
 
 With great pain in the bowels, fever, obftinate cof- 
 tivenefs, and hard and fmall pulfe, point out in- 
 flammation of the bowels and Jirangulated rupture. 
 
 After blows or wounds on the head, gives reafon 
 to fufped: very ferious injury. 
 
 BILIOUS; 
 With frequent bilious ftools and pains in the bow- 
 els, are the fymptoms of the difeafe termed Cho- 
 lera Morbus* 
 
 URINE; 
 DEPOSITING A BRANNY RED SEDIMENT, 
 And the foles of the feet and palms of the hands 
 frequently difagreeably hot, fliow he&ic fever to 
 be prefeut. 
 
 E BLOODY, 
 
42 MEDICAL ADMONITIONS. 
 
 BLOODY, 
 Shows a rupture, or morbid dilutation of fomc 
 blood veffel, in the kidneys, bladder, or urinary 
 paffage. 
 
 WITH A CREAM-COLOURED SEDIMENT, 
 Blended with fmall light-coloured flakes, mark the 
 
 exiftence of an Ulcer in the bladder* 
 
 \ 
 
 HIGH-COLOURED, 
 Generally accompanies inflammation, and inflamma- 
 tory/ever. 
 
 HIGH-COLOURED, 
 Depofiting a fediment of a pink, or of a brick-duft 
 colour, generally fhows difeafe of the liver. 
 
 IN THE COLD STAGE OF AGUES, 
 Generally limpid, in the hot Jlage high-coloured 
 and clear, and, during the abfence of the fever, 
 depofiting a reddifh fediment. 
 
 WITH AN OILY SKIN 
 On the furface, points out a dangerous wafting. 
 
 PASSING IN EXCESSIVE QUANTITY, 
 Proceeds from Diabetes. 
 
 COPIOUS AND VERY LIMPID, 
 But of a natural colour and quantity at intervals, 
 generally accompanies nervous affections. 
 
 May 
 
MEDICAL ADMONITIONS. 43 
 
 SUPPRESSION OF, 
 May occur as a fymptom of inflammation of the 
 kidneys, ureters, bladder, or of the urethra, or 
 urinary paffage ; it may alfo be occafioned by a 
 paralytic affection of thefe parts and by ftridures 
 in the urethra. 
 
 Paffed without the patient's knowledge in fevers 
 is a bad fymptom. 
 
 WAKEFULNESS, 
 
 Long continued, in fevers, with great eagernefs 
 
 of attention., denotes the approach of Delirium. 
 
 WEAKNESS, 
 And indifpofition to motion, a fymptom of Ckloro- 
 Jis or Green Sicknefs. 
 
 Extreme, at the beginning of fevers, generally 
 marks malignity. 
 
 YAWNING, 
 Generally occurs at the commencement of the 
 ague fit. 
 
Medical Admonitions. 
 
 MY DEAR FRIEND, 
 
 I COMPLY, with the utmoft willingnefs, with 
 your requeft to fupply you with fuch information 
 as may prevent you, on the one hand, from unne- 
 ceffarily incurring the expence of medical attend- 
 ance in the various trifling ails to which you and 
 your family may be fubjecled ; and, on the other, 
 from facrificing a friend, or perhaps a beloved child, 
 by delay or improper interference, in fosne infi- 
 dious difeafe. 
 
 I undertake the work with additional pleafure, 
 derived from the flattering confideration that I 
 may, by its publication, render an effential fervice 
 to thofe, who like yourfelf, being furrounded with 
 large families, are anxious to avoid unneceffary 
 expence : but are, at the fame time, aware of the 
 high degree of guilt which accompanies the omit- 
 ting to obtain all that is in their power to mitigate" 
 the fufFerings, or to fave the life of a fellow-creature. 
 
 I fhall not endeavour to furnifh you with in- 
 ftru&ions for the cure of difeafes in general. This 
 has indeed been induflrioufly attempted by feveral 
 
 ingenious 
 
46 MEDICAL ADMONITIONS. 
 
 ingenious writers on Domeftic Medicine, but cer- 
 tainly not with thofe beneficial confequences which 
 I hope their authors intended. On the contrary, 
 I fear that their difciples, not aware of the fliallow- 
 nefs of the knowledge thus gained, immediately 
 on the appearance of difeafe, fly with confidence to 
 tHeir oracles ; but, incapable of comprehending 
 the various circumftances comprifed in the anfwers 
 they receive, they frequently adopt the very means 
 they fliould have avoided ; and thereby increafe 
 the evils they were endeavouring to remove. It 
 is not a loofe and vague affertion, that the direc- 
 tions, given in fuch a work, are only intended for 
 thofe cafes in which a phyfician cannot be eafily 
 obtained, that will be •fufficient to deter a weak 
 mind from obftinately confiding, even in the moft 
 ferious cafes, in the knowledge derived from the 
 perufal of a fpecious, concife, and apparently com- 
 prehenfive method of cure. 
 
 Directions for the cure of difeafes fhall, in this 
 work, be confined to thofe in which no rifque can 
 be incurred, by trailing them to the management 
 of a domeftic practitioner. Such difeafes will not 
 only be accurately defcribed, but the fymptoms 
 will be carefully marked out which diftinguifh 
 them from thofe difeafes which differ from them 
 in degree of danger, and in the mode of treatment 
 
 they 
 
MEDICAL ADMONITIONS. 4.7 
 
 they require. The fymptoms of thofe difeafes in 
 which the attendance of a phyiician or other medi- 
 cal character, is required, will alfo be carefully 
 marked-; the particular circumftances which- ren- 
 der fuch further aid neceffary, will be pointed out; 
 and the mifchiefs, likely to arife from improper in- 
 terference, particularifed. Since the degree of vio- 
 lence, duration, and danger, as well as the confe- 
 quent injuries the patient may. experience, fre* 
 quently depend upon the means employed in the 
 firft moments of the attack in acute difeafes, and 
 upon the conduct adopted on the occurrence of 
 fudden and alarming circumftances in chronic dif- 
 eafes ; the moll proper means to be employed on 
 thefe occafions will be diftincHy laid down. The 
 Utility of thefe directions miift be fufficiently evi- 
 dent, as, particularly in the country, regular medi- 
 cal afliftance often cannot be obtained, in thefe 
 cafes of fudden emergency, with, fufficient fpeed ; 
 and the diftrefs and confufion of thofe around the 
 patient, will be likely to impede the due exercife 
 of their judgment ; and to prevent their exertions 
 being made, with that promptnefs which the iitua- 
 tion of the patient may demand. 
 
 Another important talk I fhall endeavour to per- 
 form, is that of inftru&ing the attendants on the 
 lick, how they may beft aid the effects of the means 
 
 prefcribed 
 
48 MEDICAL ADMONITIONS. 
 
 prefcribed by the phyfician. In vain may the moft 
 appropriate remedies be prefcribed, unlefs the di- 
 rections with which they are accompanied be duly 
 attended to. But unfortunately, it too often hap- 
 pens, that the orders of the phyfician do not ex- 
 actly coincide with the opinions of thofe about the 
 patient ; and whenever this happens, it is much to 
 be feared, that either the directions are not com- 
 plied with at all, or only to fuch an extent as by 
 no means will accomplifh the purpofe intended. 
 When prefumptuous nurfes, or the timid friends 
 of a patient, deviate from the directions of the 
 phyfician, by omitting that which he has recom* 
 mended, or by adopting that which has been fug- 
 gelted by fome neighboring doctrefs, the mifchiefs 
 unfortunately do not flop here ; for, not chufing 
 to have their folly known, they carefully conceal 
 from the phyfician their departure from his direc- 
 tions. Puzzled at finding the meafures, which he 
 fuppofes to have been employed, have failed of ef- 
 fecting thofe changes he expected ; and, unable to 
 account for appearances, the confequences of means 
 which have been ufed without his knowledge, the 
 phyfician is himfelf prevented from forming an ac- 
 curate judgment of the fituation of the patient. 
 
 Of fuch importance is the information which is 
 required under this head, that I mall not only take 
 
 every 
 
^MEDICAL ADMONITIONS. 49 
 
 every opportunity to communicate particular di- 
 rections > but fliall trefpafs on your time, in this 
 place, for the fake of offering to your confideration 
 One or two general obfervations. Medical men 
 have too frequently the opportunity of obferving, 
 that whenever, from the urgency of the cafe, mea- 
 fures apparently fevere are recommended, the 
 fympathizing relatives, with more tendernefs than 
 judgment, delay punifhing, as they term him, the 
 poor fufferer, until fome trifling change arifes, 
 which may afford them the fhadow of an excufe 
 for omitting them entirely j and thus is the critical 
 moment fuffered to flip, without employing thofe 
 remedies which alone could have faved the patient. 
 
 The tormenting reflections, which muft harrafs 
 the minds of thofe, who become convinced of hav- 
 ing thus facriiiced their friend or relation, muft 
 exceed the powers of conception ; they not only 
 fuffering regret for their lofs ; but, alfo experienc- 
 ing the painful compunction, of having robbed 
 the object of their affection of the only chance that 
 exifted, of obtaining a refcue from "the hands of 
 death. One of the firft objects of enquiry, on the 
 death of a beloved friend or relative, is, whether 
 the utmoft that art could do has been performed ; 
 the mind feeking to obtain fome confolation, from 
 the affurance that no meafures had been omitted, 
 from which any advantage could have been de- 
 G rived. 
 
50 MEDICAL ADMONITIONS. 
 
 rived. Frequently it happens, that this enquiry is 
 inftituted, with too much feverity and unfairnefs r 
 by the afflicted, felf-accufing furvivors. Fear left 
 they mould have imprudently oceafioned the event 
 they deplore, magnifies every fufpicion j and the 
 recollection of the moft trifling circumftances fixes 
 the barbed fting in their mind. 
 
 On this eifential point, therefore, I fliall think it 
 neceflary frequently to dwell ; and to endeavour, 
 by the arguments which each particular cafe may 
 produce, to obtain that ftrict compliance with or- 
 ders, without which the belt adapted medicine* 
 may fail of their effects. 
 
 In doing this another talk will arife ; that of re- 
 futing thofe vulgar errors and prejudices which 
 frequently occafion an injurious interference, as 
 well as an equally pernicious neglect during the firft 
 attack of the difeafe. By fhewing how unsup- 
 ported fuch opinions are by reafen, and by pointing 
 out the mifchiefs arifing from their influence, much 
 benefit muft therefore arife. You will, I hope, be- 
 lieve, that I entertain no wild expectation of con- 
 quering the prejudices of doctreffes and of nurfes 
 themfelves. No ! The object of endeavour under 
 this head, is entirely to warn the friends of the 
 fick, againft the delufive prophecies and counfels 
 of thefe mod dangerous fibyls. 
 
 By 
 
MEDICAL ADMONITIONS. 5 1 
 
 By expofmg the evils refuking from the too fre- 
 quent practice of domeftic quackery, it may be 
 hoped too, that the benevolence of the rich may 
 be dire&ed into more ufeful channels. At prefent 
 it too frequently happens, that perfons of influence 
 and property are too much difpofed, with the help 
 of a family medicine cheft, and a treatife on domeftic 
 medicine, to become the difpenfers of phyfic to all 
 their poor neighbors ; and to believe, that they are 
 thereby rendering more fervice to the community, 
 than by contributing to the fupport of thofe na- 
 tional benefits, public hofpitals, 
 
 Having made thefe prefatory obfervations, I mail 
 commence my promifed undertaking with a few, 
 I truft ufeful, remarks on a difeafe, which, from 
 the frequency with which it occurs, and from the 
 danger with which it is accompanied, claims our 
 frrft attention. 
 
 FEVER. 
 
 Fevers begin with fome degree of cold ftiiver- 
 mg, to which increafed heat and quickened pulfe 
 fucceed, with diminution of ftrength and interrup- 
 tion and diforder of feveral fun&ions. In the pro- 
 grefs of every fever may be difcovered three dif- 
 ferent ftates, which are termed the cold, the hot, 
 
 and 
 
52 MEDICAL ADMONITIONS. 
 
 and the fweating ftages or fits : thefe, fucceeding 
 in the order here defcribed, conftitute a paroxyfm. 
 When thefe paroxyfms fucceed each other, with 
 but little abatement of the fymptoms between them, 
 flight tranfitory chills take the place of a cold fhiv- 
 ering, and are foon fucceeded by the hot fit ; this 
 continues for feveral hours, and leflens as a flight 
 perfpiration comes on, but which is often very 
 trifling, and fometimes, as well as the cold fit, is 
 hardly perceptible. The increafe and abatement 
 of the fymptoms, not being fo confiderable as dif- 
 tinctly to mark the different ftages of each parox- 
 fym, the difeafe appears to be one continued hot 
 fit, and is therefore termed a Continued Fever. 
 When, between each paroxyfm, there occurs an 
 evident, but fhort abatement, or remiflion of the 
 violence of the fymptoms, the difeafe is called a 
 Remittent Fever. When an interval of fome 
 hours occurs between each paroxyfm, in which 
 there is a complete inter miflion, the difeafe is 
 termed an Intermittent Fever or Ague. 
 
 Continued Fevers are divided, according to their 
 duration, into Slow or Acute ; they are again di- 
 vided into Inflammatory or Nervous ; the latter 
 fometimes acquiring the farther diftinclion of Pu- 
 trid or Malignant. 
 
 Intermittent 
 
MEDICAL ADMONITIONS. 53 
 
 Intermittent Fevers are alfo divided, according 
 to the length of the interval between each parox- 
 yfm, into Quotidians, Tertians, and Quartans. 
 
 There are other neceffary divifions of Fever, but 
 thefe are the moll important, and fufficient, I hope, 
 to authorife me to make the following obfervation. 
 
 In a difeafe, which requires fuch numerous divi- 
 fions to mark the differences between its feveral 
 fpecies, it mull be obvious, that much lludy and 
 experience mull be neceffary to enable any one to 
 make a proper difcrimination ; and, as thefe dis- 
 tinctions are indifpenfably neceffary to be made, 
 previous to the determining on the plan of cure, 
 you mull plainly fee that the cure ought only to 
 be attempted by thofe, who have carefully ftudied 
 the nature of the difeafe, and have diligently ob- 
 ferved its feveral varieties. It mull indeed be al- 
 lowed, that it is not difficult to perceive thefe dif- 
 ferences, and point out thefe diilinctions, when the 
 difeafe has nearly paffed through its courfe. But, 
 in almoll every cafe of fever, it is neceffary that 
 this dillinclion fhould be made, in an early period 
 of the difeafe ; for fhould any one, who attempts 
 the cure of fever, not be able, in its beginning, to 
 make the neceffary difcrimination, there exifls the 
 greatefl probability, that the evils he fuffers to in- 
 creafe, as well as thofe which he brings on by im- 
 proper 
 
54 MEDICAL ADMONITIONS. 
 
 proper treatment, will be too great and too numer- 
 ous to be fubdued, when the nature of the difeafe 
 becomes known, and the moft proper means for 
 its removal is adopted. 
 
 .It is very eafy to lay down nice and accurate 
 diftinctions between difeafes, in books, and the 
 mind of the reader is often fatisfied of the eafe, 
 with which he could make a practical application 
 of them ; but every phyfician knows, that thefe 
 difcriminations are not eafily made in the firft 
 images of difeafes, but by thofe who poffefs that 
 knowledge to obtain which, both ftudy and expe- 
 rience are required. 
 
 For the fake of exemplification, it is proper to 
 remark, that the firft fymptoms of an acute inflam- 
 matory fever, and thofe of a flow nervous fever, 
 are often To fimilar as to point out, very equivo T 
 cally, the difference between thefe difeafes ; fo ^hat 
 little chance can exift of any one, but an experien- 
 ced obferver, afcertaining the fpecies of the fever, 
 until the occurrence of fuch fymptoms, as mall, not 
 only ftrongly mark its peculiar nature, but may 
 alfo mew that the difeafe, aggravated by delay or 
 injurious treatment, requires the utmoft exertions 
 of even the moft fkilful phyfician, to prevent a 
 fatal termination. 
 
 Since 
 
MEDICAL ADMONITIONS. $$ 
 
 Since thefe fevers are well known to arife from 
 two different, nay, contrary ftates of the fyftem, 
 their indications of cure muft therefore be onpofite 35 
 it mull be obvious, that the adopting of the treat- 
 ment adapted to the one, in the endeavour to re- 
 move the other, mull be likely to be fuceeeded by 
 very injurious confequenees ; and yet, from what 
 has preceded, it is very evident, that this miftake 
 is very liable to be made by thofe domeftic practi- 
 tioners, who undertake the cure of fever, without 
 a fufpicion of their own incapacity. 
 
 The difference which takes place in fevers from 
 the change of feafons, and the nature of the reign- 
 ing epidemic, ought to be enquired into previoufly 
 to inftituting a plan of cure : fince, from thefe 
 circumftances, a confiderable difference may be oc- 
 calioned, in the nature of the difeafe, and confe- 
 quently in its mode of cure. But, from this infor- 
 mation, the domeftic practitioner mull generally be 
 precluded ; it being, of courfe, confined to thofe ? 
 whofe profeflion gives them the opportunity of 
 remarking the progrefs of the difeafe, in many dif- 
 ferent fubjects. 
 
 The fmall-pox, meafles, and other eruptive dif- 
 eafes, as well as feveral diforders which differ very 
 much in their refpeclive natures, do yet agree in 
 this particular, that their firft appearance very ex« 
 
 acllr 
 
56 MEDICAL ADMONITIONS. 
 
 actty refembles that of fimple fever ; and they of- 
 ten, even for the firft two or three days, are with- 
 out any particular fymptom, by which their pecu- 
 liar nature can be afcertained, unlefs by thofe, who 
 are informed of the nature of the prevailing epi- 
 demic ; and are well acquainted with thofe parti- 
 cular fymptoms, which are the threatening precur- 
 fors of thefe feveral difeafes. The mifchievous ef- 
 fects which muft arife from the interference of the 
 ignorant, in thefe cafes, muft be fo obvious, as not 
 to require to be here particularifed. 
 
 INTERMITTENT FEVERS 
 
 O R 
 
 AGUES. 
 
 Intermittent Fevers are compofed of feveral 
 diftincl paroxyfms, in general, returning with a 
 ihivering, having an evident intermiflion between 
 each paroxyfm. 
 
 The ague begins its attacks with inducing a con- 
 liderable degree of weaknefs and laflitude, with fre- 
 quent ftretching and yawning ; foon after a fenfa- 
 tion of cold is felt in the back and extremities, 
 which foon pervades the whole body ; this increa- 
 fes, until the limbs, as well as the trunk of the bo- 
 dy, become agitated with frequent violent fhiver- 
 
 lBgS. 
 
MEDICAL ADMONITIONS. §f 
 
 ings. This ftate continues fome timCj during 
 which a violent pain of the back and head^ and, a 
 fenfation refembling a ftri&ure acrofs the ftomach^ 
 frequently diftrefs the patient ; and the fenfe of 
 coldnefs becomes fo great, that no endeavours to 
 obtain warmth are of the leaft avail ; the agitation 
 of the whole frame being alfo, fometimes, fo vio- 
 lent, that the patient is with difficulty held in his 
 chair j the pulfe becomes fmall and frequent ; thg 
 breathing, oppreffed ; and the urine, clear and al- 
 moft colourlefs. Thefe are the principal fymptoms 
 .which diftinguifh the Cold Fit, 
 
 Thefe fymptoms fubfiding by degrees, give way 
 to warm flufhings, which gradually increafe, until 
 rednefs and heat, much greater than natural, is ex^ 
 tended over the whole body ; the patient, at length, 
 burning with fueh extreme heat as to be now, as 
 folicitous for the refrefhing fenfation of cold, as he 
 was before anxious to mitigate its violence. His 
 fufferings become now increafed by an almofHn- 
 fatiable thirfl, and a pain of the head, fometimes 
 ending in delirium, and fometimes bringing on a 
 lethargic and almoft apoplectic ftate ; the pulfe 
 becomes more hard and full ;' the refpiration, freer; 
 and the urine, high coloured, but without fedi- 
 ment. Thefe are the chief fymptoms obfervable 
 in the Hot Fit. 
 
 H After 
 
58 MEDICAL ADMONITIONS, 
 
 After thefe complaints have exifted fome time, 
 the heat gradually declines, the thirft leffens, and 
 the fkin is relaxed, a fweat gently breaks out on 
 the head, and gradually diftufes itfelf over the 
 whole body : this increafes, until it becomes pro- 
 fufe, after which it abates, and by degrees entirely 
 ceafes. During this ftage, which is termed the 
 Sweating Fit, the pulfe becomes flower and fofter, 
 and the breathing more free ; the urine, after the 
 fweat has continued fome time, depofits a fediment^ 
 which is generally of a reddifh colour. 
 
 The above ftages of the difeafe having been 
 gone through, the patient enjoys an intermiffion 
 of the fymptoms, which lafts according to the par- 
 ticular type which the difeafe airumes. 
 
 According to the length of time in which the 
 paroxyfm returns, the ague obtains its name. If 
 the paroxyfm returns every day it is termed a 
 Quotidian, if every third day a Tertian, if every 
 fourth day a Quartan, &c. 
 
 The remote caufes of agues are, firft, the effluvia 
 which arife from marines or moift grounds acted 
 on by heat ; fecondly, cold, efpecially when accom- 
 panied by moifture. Thefe will neceffarily act with 
 more certainty, if a predifpofition to the difeafe 
 exifls. This predifpofition may be induced by too 
 
 fpare 
 
MEDICAL ADMONITIONS. 59 
 
 fpare living, exceffive fatigue, watching, exceilive 
 fludy, indulgence in crude and watery food and 
 in fpirituous liquors, and by preceding difeafes ; 
 particularly fuch as have been attended with large 
 evacuations, in a word, by every thing which 
 tends to weaken the fyftem. 
 
 Although the fymptoms, which have been defcri- 
 oed, may appear to be fufficiently characteriftic, to 
 prevent agues from being miftaken for any other 
 difeafe, even by a domeftic pra&itioner ; yet fuch 
 an error may be very likely to take place : for in- 
 termittents are often accompanied by fuch irregu- 
 lar fymptoms, as render it very difficult to afcer- 
 tain the real nature of the difeafe. 
 
 The fagacious Sydenham obferves, that "It has 
 "happened in every epidemical conftitution, that 
 "in fome of thofe who had the fever (the inter- 
 "mittent fever) the fit did not begin with chills 
 "and fhivering, but the patient was attacked with 
 "fymptoms refembling true apoplexy. What need 
 " (he fays) of more words, for it affumes fo many 
 "fhapes as to imitate almoft all the difeafes to 
 "which mankind is liable ?" 
 
 Need there be any referve then ufed, in point- 
 ing out this difeafe as one of thofe, which does not 
 come within the -reach of domeftic practice ; iince, 
 
 from 
 
6o MEDICAL ADMONITIONS. 
 
 from the ambiguity of its firft appearances, fuch 
 miftakes may take place as may prove dangerous 
 in their confequences ? Befides, fevers frequently 
 occur, which, at firft, appear in a continued form j 
 but in which, after a little time, certain fymptoms 
 appear, pointing out, to the difcerning obferver, a 
 difpofition to affume the form of an intermittent. 
 In fuch cafes, the greateft fkill is required ; for on 
 the mode of treatment adopted, at this period, the 
 length of the difeafe, and the life of the patient, 
 may depend : fince, if due care be now taken, the 
 difeafe may be brought to intermit, and foon after, 
 wards be entirely removed ; but, if this opportu r 
 nity be loft, its violence may be increafed, and its 
 duration dangeroufly protracted. 
 
 So much danger to a patient, and alarm to his 
 attendants, will fometimes be produced, by an in- 
 termittent fuddenly changing into a continued 
 fever, as ought to deter family practitioners from 
 attempting the cure of ague. Another cafe of 
 alarm and confufion, to which they will be expofed, 
 is the irregularity with which the paroxyfm re- 
 turns. The deviation is frequently fuch, as will 
 prevent, even the moft intelligent, from directly 
 determining, whether the fever is, or is not, an 
 intermittent. 
 
 After. 
 
MEDICAL ADMONITIONS. til 
 
 After what has t»een already remarked, it cannot 
 be expected that a full and regular plan of cure 
 fhould be detailed here. Inftead of this, a general 
 idea of the mode of cure fhall be given, with a few 
 detached, but, it is hoped, ufeful obfervations on 
 the regimen and conduct of the patient. 
 
 The virtues of the Peruvian bark, in the cure 
 pf agues, are fo univerfally known, that it may 
 have the appearance of an artful cautiori, to fuggeft, 
 that any difficulty or danger can arife, from the 
 endeavours to obtain the cur,e of ague by its means. 
 But every medical man knows, that*, with the ague, 
 may exift certain States of the vifcera, which, if not- 
 corrected, previoufly to administering the bark, the 
 ague may be, indeed, removed, but other difeafes, 
 of a very ferious and alarming nature, may be in- 
 duced. On the other hand, cafes occur very fre- 
 quently, in which, although the bark be given 
 very early, and in large quantities, the ague con- 
 tinues to harrafs the constitution for a considerable 
 time 5 and, at length, brings on fuch an enfeebled 
 State of the fyStem, as may terminate in dropfy, 
 and even in death itfelf. 
 
 Agreeable to your requeSt, I fhall occaSionally 
 point out fome few paffages in your once favour- 
 ite book (Buchan's DomeStic Medicine), as feem to 
 be likely to be more productive of harm than of 
 
 good; 
 
*>2 MEDICAL ADMONITIONS. , 
 
 good ; accompanying them with fuch obfervations, 
 as may, in my opinion, prevent you, and my other 
 readers, from being lulled into the neglect arifing 
 from a falfe fecurity ; or from being excited to the 
 adoption of ram and dangerous meafures. The fol- 
 lowing paffage is certainly not fufficiently guarded, 
 to prevent its being productive of very ill confe- 
 quences. — "Intermitting fevers, under a proper 
 "regimen, will often go off without medicine ; and 
 "when the difeafe is mild, in an open, dry coun- 
 "try, there is feldom any danger from allowing it 
 "to take its courfe ; but when the patient's ftrength 
 "feems to decline, or the paroxyfms are fo violent, that 
 "his life is in danger, medicine ought immediately 
 "to be adminiftered." Domejlic Medicine, i ith edit, 
 "p. 149- 
 
 The injuries which the ftrongeft conftitution fuf- 
 fers, from repeated attacks of agues, are often fo 
 confiderable, as to produce the worft of confequen- 
 ces. Surely, therefore, much evil may be feared 
 from a paffage like this, which is fo likely to add 
 to that fupinenefs, with which many are difpofed 
 to fuffer the ravages of difeafe. The doctor after- 
 wards fays — "When the difeafe is very irregular, or 
 "the fymptoms dangerous, the patient ought imme- 
 diately to apply to a phyflcian. ,, But advice like 
 this cannot but be prejudicial, both to the patient 
 
 and 
 
MEDICAL ADMONITIONS. 63 
 
 arid the phyfician $ for if a patient is not to apply 
 to a phyfician, until the fymptoms are fo violent^ 
 that his life is brought into danger, the opportu- 
 nity of obtaining his recovery may be pail: by : and 
 the fatal termination of the difeafe will often be 
 imputed to the want of fkill, in the attending phy- 
 fician ; when, its caufe is only to be found, in the 
 having permitted the tampering with domeftic 
 medicine to have produced fuch effects, as no exer- 
 tions of art could remove. 
 
 The empirical practice of thofe, who depend or 
 amulets and charms for the cure of this difeafe, is 
 not of very dangerous tendency 5 any farther, than 
 as it tends to place the patient in a ftate of imagi- 
 nary fecurity ; which induces him to wafle that 
 time, in which he might, by proper means, have 
 gotten rid of the difeafe. There are, indeed, nu= 
 merous inflances, in which we have reafon to fup- 
 pofe, that the force of ftrong expectation has pro- 
 duced fuch effects on the fyftem, as have put off 
 the paroxyfm, and even cured the difeafe. There 
 are alfo feveral hiftories of cafes related, in which 
 the cure of ague has been produced by fudden and 
 violent affections of the mind : by a fimiiar opera- 
 tion, perhaps, it is, that thofe remedies act, the 
 taking of which occafions a great degree of horror 
 and difguft ; fuch is the frequently mentioned 
 remedy of fwallowing a large fpider, maflied, and 
 
 • formed 
 
'J.l MEDICAL ADMONITIONS; 
 
 formed into a bolus, or involved in its web. Othe£ 
 remedies recommended by thefe practitioners are 
 not fo innocent,. fuch as a large dofe of gin, with 
 the addition of pepper, or the fudden application 
 of cold water to the whole furface of the body* 
 A melancholy inftance of the ill effe&s of the lat- 
 ter practice I once witneffed, in a young man, who 
 had been for fome time afflicted with an autum- 
 nal quartan : the good woman of the houfe, hav- 
 ing purpofely procured his removal out of the bed; 
 fuddenly threw over him a pail of cold water : the 
 whole furface of the body direftly had its florid hue 
 changed for a livid purple, a considerable oppref- 
 fion of the cheft, with other alarming fymptoms, 
 directly came on, and, notwithstanding the em- 
 ployment of the moft powerful means to fave him, 
 he expired in a few hours. 
 
 The REGIMEN mull neceuarily be adapted to 
 the feveral ftages of the diforder. In the cold fit, 
 it is moft likely, the patient will not be inclined to 
 take much ; a little barley-water, water gruel, or 
 camomile-tea, for the fake of promoting ficknefs, 
 will perhaps be all that is neceflary. During the 
 hot fit, the drinks may be barley-water, mint-tea, 
 or orgeat ; to which may be added,, if the patient 
 wifhes it, the juice of lemons or oranges, and a 
 fmall quantity of the fyrup of capillaire ; although 
 the fweat is, in general, fuppofed to be fooner in- 
 duced, 
 
MEDICAL ADMONITIONS. 6^ 
 
 duced, by thefe drinks being given flightly warm, 
 yet it is hot neceffary, that the patient mould be 
 entirely debarred, from the luxury of a draught of 
 cold toaft and water. When the fweating begins, 
 the drinks I have juft enumerated may have a little 
 white wine added to them j and, if the patient be 
 able to take it, he may have a bafon of beef-tea, 
 fago, falop, &c. During the time of intermiflion, 
 the diet mould be as nutritious, as the patient's 
 appetite and digeflion may prompt him to adopt. 
 
 Every thing which contributes to keep up the 
 natural difcharge, by the pores of the fkin, and 
 which gives ftrength and tone to the vefTels, is ufe- 
 ful in the cure of this difeafe ; hence exercife muft 
 be peculiarly proper, fince nothing tends more to 
 produce thefe beneficial effects. The exercife mould 
 be of that kind, to which the patient has been moft 
 accuftomed ; and taken in the open air, unlefs wet 
 weather, or damp fltuation, forbids it. Care muft 
 be likewife taken, that it be not ufed to fuch a 
 degree, as to occafion much fatigue ; fince that 5 
 inftead of reftoring ftrength, muft induce debility. 
 
 Prevention. Thofe who are particularly liable 
 to returns of this difeafe, ftiould endeavour to 
 mend that peculiar ftate of the fyftem, which is 
 known to produce a difpofition to it. This is to 
 be accomplifhed by avoiding, as much as pofllble ? 
 I the 
 
66 MEDICAL ADMONITIONS* 
 
 the circumftances above enumerated, under the 
 head of remote caufes, and carefully attending to 
 the advice juft given, as to regimen and exercife. 
 
 INFLAMMATORY FEVER. 
 
 This fever is very rarely met with, efpecially in 
 this climate, unlefs accompanied with the inflam- 
 mation of fome particular part.* 
 
 A confiderable degree of fhivering, and fevere 
 pain in the fmall of the back, are the firft fymptoms 
 of this fever. Thefe are fucceeded by an intenfe 
 heat of the whole body ; the countenance becomes 
 of a deep crimfon colour, every veffel appearing 
 turgid with blood ; the eyes are red, and fufFer 
 much uneafinefs from the admiffion of light ; the 
 arteries in the neck and temples throb violently ; 
 the pulfe is ftrong, rapid, and full j the ikin, tongue, 
 and all the infide of the mouth, are parched j the 
 urine of a very high red colour j and the patient 
 complains of the moft infatiable and diftreffing 
 thirft. He likewife fuffers from difficulty of breath- 
 ing, and a confiderable pain and confufion in his 
 head ; and toffes about in the bed, from exceffive 
 reftleflhefs. A delirious ftate foon comes on ; and, 
 
 if, 
 
 * Dr. Blane obferves, that the continued inflammatory fever 
 is very uncommon in the Weft-Indies. 
 
MEDICAL ADMONITIONS. 67 
 
 if the difeafe be not oppofed by fuccefsful means, 
 this fymptom becomes fo violent, that the exertions 
 of four or five perfons will be hardly Sufficient to 
 retain the patient in his bed. Soon after this, hic- 
 cough, ftarting of the tendons, involuntary dis- 
 charges, and cold, clammy fweats, Shew, that na- 
 ture is nearly exhaufted, and the difeafe invincible. 
 
 Fevers which, in the courfe of a few days, will 
 mew Strong marks of their being of the putrid kind, 
 may commence with fymptoms fo nearly refem- 
 bling thofe of the fever juft defcribed, as to render 
 it very difficult to diftinguifh the one from the 
 other. But thefe difeafes differ fo much, in their 
 real nature, and in the mode of cure they require, 
 that a miftake would, moft probably, be Succeeded 
 by the moft dreadful confequences. 
 
 The cure of this fever is to be obtained by timely 
 bleedings, proportioned to the ftrength of the 
 patient, and the violence of the difeafe ; antimo- 
 nial medicines, given with a careful attention to 
 their dofes, and the effecls they produce ; the free 
 adminiftration of opening medicines ; and the ufe 
 of vegetable acids, neutral falts, fudorifics, &c. as 
 the fymptoms may indicate. But fhould even the 
 difficulty of afcertaining the difeafe be removed, 
 and the malady be exactly known by the family 
 practitioner, he certainly would not dare to attempt 
 
 its 
 
6S MEDICAL ADMONITIONS. 
 
 its removal : when, from his inability, not only of 
 making a proper felection of the means, but of de- 
 termining alfo the extent to which they may be 
 employed, the life of his patient might very likely 
 be loft. 
 
 Regimen. This difeafe depending on too great 
 an action and fulnefs of the veffels, it is obvious, 
 we fhould carefully avoid fuch things, as may be 
 likely to increafe either of thefe circumftances. 
 The room mould be kept cool, by a conflant fuc- 
 ceflion of frefh air ; the covering of the patient 
 fhould not be fuch, as to allow of the accumula- 
 tion of the heat of the body. The body ihould be 
 kept, as nearly as poflible, in a ftate of reft ; and, 
 if the head appears to be difpofed to be deranged, 
 the body mould be placed, as much as poflible, in 
 an erect pofture. Animal food, of every kind, 
 muft be ftrictly refrained from, even in the form 
 of broths j as well as all aromatic, fpirituous, and 
 even the weakeft fermented liquors. Thirft may 
 be allayed by drinking freely of watery liquors, 
 made pleafantly acid with the juices of lemons, cit- 
 rons, oranges, currants, &c. for this purpofe, bar- 
 ley-water, mint and balm tea, anfwer very well ; 
 and, for the fake of greater variety, orange-whey, 
 tamarind drink, lemonade, orgeat, and capillaire, 
 may be mentioned, as being well calculated for the 
 fame purpofe. Oranges, currants, grapes, in faft, 
 
 every 
 
MEDICAL ADMONITIONS. 69 
 
 every fruit which the feafon affords, may be al- 
 lowed ; and, when other fruit is not to be obtained, 
 apples, roafted or boiled, may fupply their place. 
 
 The chamber mould be kept as quiet as poflible, 
 and fomewhat darkened. The patient fhould con- 
 verfe no more than is abfolutely neceffary ; and 
 every circumftance, likely to intereft his mind, 
 mould carefully be kept from him. If the pro- 
 moting of fweating be intended, the hands and 
 feet mould be frequently bathed, or fomented with 
 warm water. 
 
 The prefent opportunity muft not be paiTed over, 
 of remarking on the evil confequences arifing from 
 the neglecting of the phyfician's orders, with r-e- 
 fpect to the conduct of the patient, as to his regi- 
 men, &c. It is too frequent a practice, as has been 
 before obferved, with nurfes, and other attendants 
 on the lick, to make fuch alterations, in this refpect, 
 as may reduce the plan recommended, a little 
 nearer to their own ideas ; and it generally hap- 
 pens, that this liberty is taken, even in thofe difea- 
 fes, where an attention to thefe circumftances is 
 moft neceffary : for there the reftri&ions propofed 
 are fuch, as are moft likely to meet with oppofi- 
 tion from the ignorant. Thus, by a miftaken ten- 
 dernefs, the diet above prefcribed, will often be va- 
 ried, and the life of the patient brought into dan- 
 ger, 
 
JO MEDICAL ADMONITIONS. 
 
 ger, by thofe who think, a patient muft foon be 
 ftarved under fuch a regimen. But, with the hope 
 of preventing this dangerous interference, it muft 
 be here obferved, that, in this ftate, the patient 
 will not only derive no more fupport from the moft 
 nourifhing diet, than from that which is here di- 
 rected, but that he will be rendered, by it, more 
 languid and uncomfortable : for the ftomach, par- 
 ticipating in difeafe with the reft of the fyftem, 
 performs its functions very imperfectly ; hence a 
 very fmall part of this food is digefted, and con- 
 verted into chyle, while the remainder occafions to 
 the patient, the moft diftreiling fenfations of anx- 
 iety and oppreflion. 
 
 SLOW NERVOUS FEVER. 
 
 It is fuppofed, by fome phyficians, that the flow 
 nervous fever, and the putrid malignant fever, are 
 the fame fpecies of difeafe : and that the putrefcent 
 ftate of the fluids, difcoverable in the latter, is an 
 incidental circumftance ; and therefore, only ren- 
 ders it a variety of the fpecies : whilft others have 
 fuppofed them to be difeafes of entirely different 
 fpecies. But fince, from the occurrence of fymp- 
 toms denoting putridity, a confiderable difference 
 is required in the treatment, it is thought proper, 
 without entering into the merits of the queftion, 
 
 to 
 
MEDICAL ADMONITIONS. Jl 
 
 to treat of them feparately ; as the more appro- 
 priate mode of treatment, in each cafe, may thereby 
 be more clearly fhewn. 
 
 The infidious manner in which this difeafe makes 
 its attacks, is one reafon of* its fo frequently termi- 
 nating fatally. The firft departure from health is 
 fo gradual, and the fymptoms fo ambiguous, that 
 very frequently the patient will have fufFered the 
 difeafe to have made a very confiderable progrefs, 
 before he efteems it neceffary to apply for afliftance: 
 and often will a difcerning phyfician, when firft 
 called in this difeafe, difcover a patient to be in a 
 very alarming condition, who is not fufpected, by 
 himfelf or his attendants, to be in the leaft degree 
 of danger. If this be duly confidered, it muft im- 
 prefs the mind of every one, with a conviction of 
 the neceffity of immediate application for regular 
 medical help, at the firft appearance of thofe fymp- 
 toms, which, in the following hiftory of the difeafe, 
 mark its beginning. If this be done, there is the 
 greateft probability, that the train of dreadful 
 fymptoms, which is there defcribed as coming in 
 fucceflion, will be checked in their approach. 
 
 The History of the Disease. This difeafe, 
 in general, begins with extreme liftlefsnefs, and un- 
 willingnefs to move, with a fenfe of wearinefs ; 
 indifference to £ood, naufea, depreflion of fpirits j 
 
 and 
 
72 MEDICAL ADMONITIONS. 
 
 and frequent flight and irregular chills, alternating 
 with tranfitory flufties of heat. A dull and heavy 
 pain, with a fcnfe of coldnefs, pofTefTes the back 
 part of the head, and is accompanied by a flight 
 giddinefs ; the difinclination to motion increafes, 
 the countenance is flirunk and pale, bearing evi- 
 dent marks of anxiety ; the breathing is perform- 
 ed with fome little difficulty, the patient complain- 
 ing of an oppreflion on the cheft, and a tightnefs 
 acrofs the pit of the ftomach ; frequently fighing, 
 without knowing for what caufe. The fymptoms 
 generally get worfe as evening comes on ; nature 
 obtaining, at night, fome flight refrefhment, from 
 fhort flumbers, interrupted by difagreeable dreams. 
 The urine, in this firft ftage of the difeafe, is moftly 
 clear and colourlefs. Thefe fymptoms gradually 
 increafe for a few days, when the pulfe becomes 
 fmaller, and at the fame time quicker, than natural; 
 the tongue gets lightly covered with a thin mu- 
 cous coat, which feems hardly to adhere to it. 
 After the firft week is paft, the fymptoms will, in 
 general, be found much increafed ; the fight of 
 food, efpecially of an animal nature, excites difguft; 
 the ihiverings are lefs, but the heat is in general 
 more increafed, and the cheeks are frequently very- 
 much fluihed ; the anxiety and inquietude of the 
 patient becomes more intolerable, the giddinefs and 
 pain of the head more diftrefling, light and noife 
 
 occafioning 
 
Medical admonitions. y^ 
 
 tfc'cafioning much uneafmefs ; the tongue becomes" 
 dry, red, and divided by large chaps : the urine, 
 about this time, frequently depofits a bran-like fed- 
 iment. The patient obtains no refrefhment from 
 his {lumbers, whicli are very much difturbed ; he" 
 frequently mutters vague and unconnected fenten- 
 ces ; the hands tremble fo, as to prevent his guid- 
 ing them to his mouth ; the fingers are in con- 
 ftant motion ; the tendons agitated with frequent 
 ftartings ; the pulfations fo fmall and quick, aslwith 
 difficulty to be counted ; the tongue trembles 5 
 and is with difficulty put beyond the lips. A pro- 
 fufe fweating in fome, and a frequent purging in 
 others, alfo occur, as the difeafe advances. If the 
 remedies which have been had recourfe to, fail of 
 producing the wifhed effects, fymptoms will foon 
 appear, declaring, the near approach of death : thefe 
 are, a coldnefs of the extremities, which feem 
 ihrunk, and of a pale, and almoft livid hue ; the 
 nails appear almofl of a blue colour ;• the eyes lofe 
 their fenfibility and luftre, fwimming in tears* 
 which now and then trickle down the cheeks y 
 the ftools and urine are voided without the patient's- 
 knowledge ; the brain becomes fo affected, that all 
 recollection and fenfe is loft. A conftant delirium 
 accompanies this ftate, but without any efforts of 
 violence :, the deranged ftate of the mind, however, 
 being fufftciently evident, from a conftaiit mut- 
 
74 MEDICAL ADMONITIONS, 
 
 tering of incoherent and fcarcely articulated founds 
 Convulfive motions affecting the whole frame, or 
 an infenfible comatofe ftate generally clofing the 
 fcene. 
 
 But fbmetimes, even when the greateit part of 
 the above fymptoms have come on, and death ap- 
 pears, to a common obferver, as the inevitable con- 
 fequence ; a fudden amendment will take place, 
 produced, either by the happy effects of medicine, 
 or fome unexpected, favourable effort of nature. 
 Inftances of fuch recoveries are by no means un- 
 common j and render the caution, contained in 
 the following paragraph, abfolutely neceffary. 
 
 When the greater part of the above defcribed 
 appearances, are obferved in a patient, the defpair, 
 and confequent inactivity, produced in his attend- 
 ants, however they may be regretted, can by no 
 means be wondered at : the fymptoms feeming to* 
 mew, that death muff foon put an end to the cal- 
 amities of the unhappy fufferer. So great a degree 
 of defpair, indeed, poffeffes the by-ftanders, in thefe 
 diftrefiing cafes ; that frequently, when the medi- 
 cal man fees confiderable ground of hope, they will, 
 in the ftrongeft terms, condemn all attempts for his 
 recovery, as ufelefs and cruel : fince they imagine,- 
 that by thefe fuppofed vain attempts, his torments 
 are increafed, and their* duration prolonged. To 
 
 the 
 
 
MEDICAL ADMONITIONS. J$ 
 
 the frequency with which this idea is adopted, may- 
 be attributed the death of numbers : for it feldom 
 happens, when this opinion is entertained, that the 
 ftrongeft remonftrances of the phyfician, can pro- 
 duce the leaft exertions of the attendants, except, 
 indeed, during the time he is prefent ; for imme- 
 diately after his departure, all exertions ceafe. 
 
 It is a circumftance that muft have occurred 
 often, to every medical man, that having left a pa- 
 tient, in this, or the putrid fever, with the moft 
 earneft entreaties to his attendants, to fupply him 
 regularly with medicines, and almoft conftantly 
 with nourishment, he fhall be told, at his next 
 vifit, that they have not been able to procure the 
 fwallowing of a drop of either : and mould he or- 
 der the experiment to be made before him, it will 
 frequently happen, that the patient will take what 
 is Dffered to him, not only with eafe, but with 
 avidity. Such conduct cannot find a fufficient ex- 
 cufe in mifapplied tendernefs j fince the confe- 
 quence, refulting from fo culpable an omiffion, may 
 be the death of one, who otherwife might have 
 been faved : for, in all the long catalogue of difea- 
 fes to which we are fubjecl, there are none, in which 
 fymptoms of fo alarming an appearance are to be 
 found, and where fo great a poflibility of recovery 
 may exift, as in this, and the putrid malignant fe- 
 ver. Inftances of recovery, from thefe difeafes, 
 
 have 
 
g6 MEDICAL ADMONITIONS. 
 
 have been fo really wonderful ; that fo long as the 
 patient breathes, his attendants ihould not devote 
 themfelves to defpair ; but Ihould perfift in their 
 endeavours with unabated affiduity. 
 
 Having already given you reafon to fuppofe, that 
 I would not fcruple to ftep out of my way, to give 
 an ufeful admonition, I fhall not apologize for the 
 digreflion, but point out one of the difadvantages 
 refulting from intemperance. A phyfician, who is 
 called to a patient afflicted with this or the putrid 
 fever, will not fail to make enquiry refpecting his 
 former mode of living ; fince on the anfwer he ob- 
 tains, his prognoftic of the event of the difeafe will 
 coniiderably depend : for, fixould the patient have 
 unhappily devoted himfelf, to habits of debauchery, 
 and intoxication, there will be greater reafon to ap- 
 prehend a fatal termination of the difeafe. 
 
 To attempt to furnifh the domeftic practitioner, 
 with information fufficient, to enable him to under- 
 take the cure of this fever, would be fruitlefs ; fince 
 it would be certainly fafer, to omit medicine en- 
 tirely ; than to entruft the management of the pa- 
 tient, in fo dangerous a malady, to any but thofe, 
 who are enabled, by their knowledge of the human 
 frame, and of the difeafes to which it is fubjecl:, to 
 diftinguifh critical and falutary changes, from thofe 
 which are of a contrary tendency. 
 
 So 
 
MEDICAL ADMONITIONS. fy 
 
 So general is an averfion to medicine, and fo 
 great is its fway over weak minds ; that every 
 eircumftance, which tends to fupport its tyranny, 
 ought to be oppofed : fince it is not to be doubted, 
 that many have loft their lives, rather than mortify 
 their tafte, or give up prejudices, which would ap- 
 pear ridiculous even in a child. Dr. Buchan, whilft 
 treating of the nervous fever, fays, "Though blift- 
 " ering, and the ufe of cordial liquors, are the chief 
 h things to be depended en, in this kind of fever ; yet, 
 ^for thofe who may choofe to ufe them, we mall mention 
 & one or two of the forms of medicine, which are 
 * c commonly prefcribed in it. 1 ' Now it is very 
 reafonable to fuppofe, that many, who are guided 
 by thofe ftrong averfions and prejudices, which I 
 have jufl mentioned ; if attacked with the difeafe 
 we are treating of, would eagerly catch at this au- 
 thority, and refufe to make ufe of any thing, but 
 blifiers and cordial liquors / they being, they would fay, 
 the chief things to be depended on, in this kind of fever ; 
 leaving other remedies for thofe who may choofe to ufe 
 them. The very great attention, which has been, 
 of late years, paid to this fever, has rendered the 
 practice of phyficians, of thefe days, exceedingly 
 fuccefsful ; fo much fo, that the cafe muft be at- 
 tended by extraordinarily dangerous circumftan- 
 ces, to prevent a cure being accompliflied ; even if 
 the patient have but a fmall degree of ftrength left. 
 
 But, 
 
7$ MEDICAL ADMONITIONS. 
 
 But, notwithstanding this, the beft informed phy- 
 ficians know, that the various diftrefling fymptoms 
 which occur, oblige them to have recourfe to fev- 
 eral powerful, and ufeful articles of the materia me- 
 dica. 
 
 The Regimen. After the ftomach and bowels 
 have been cleared, the patient may be fupplied with 
 food of a light and nutrient kind ; fuch as fago, 
 rice gruel, panada, and falop, according as his in- 
 clination may dictate. Good white wine may be 
 added to thefe, as may be indicated by the ftate of 
 the pulfe, and degree of languor ; and, for the fake 
 of variety, he may be allowed to drink of red wine 
 negus, bottled cyder, perry, and particularly, if the 
 patient entertains a defire for it, porter. Animal 
 food mould be avoided ; unlefs the patient is anx- 
 ious for it, when it will feldom do harm. But 
 when the patient regains a defire for food, it will 
 be beft to begin with puddings of various kinds, 
 fliell fifh, &c. refuming his ufual diet gradually, as 
 he finds his health return. 
 
 PUTRID MALIGNANT FEVER. 
 
 The effluvia arifing from the human body, ac- 
 cumulated, and long retained in the cloathing, &c. 
 and the effluvia arifing from the bodies of thofe 
 
 labouring 
 
MEDICAL ADMONITIONS. 79 
 
 labouring under this difeafe, are allowed to be the 
 moll ufual caufes of this fever. 
 
 The Symptoms. This fever fometimes comes 
 on with a great degree of rapidity ; but moft fre- 
 quently it attacks in the fame flow and infidioui 
 manner, as was remarked to be the cafe, with the 
 flow nervous fever, juft defcribed. The fhiverings, 
 with which it in general commences, are, in fome 
 Cafes very flight and tranfitory ; in others, they 
 are very violent. The fliivering is fucceeded by 
 febrile heat ; with pain in the head, loins, and, for 
 the moft part, alfo in the limbs ; the dejedtion of 
 fpirits, as well as the lofs of power in the whole 
 nervous fyftem, is particularly obfervable. The 
 pulfe is fmall, hard,, and quick. Naufea and vomi- 
 ting, are, alfo, among the fymptoms which appear 
 fit the commencement of this fever. The eyes foon 
 have their luftre diminifhed ; their glaffy part ap- 
 pearing dull, and that part which is termed the 
 white of the eye, becoming of a yellow hue, blend- 
 ed with red. The patient's breathing becomes la- 
 borious ; and interrupted by frequent, deep, in- 
 voluntary fighings : and the cheeks affume a deep 
 crimfon, approaching to a purple. As the difeafe 
 advances, the pulfe increafes in quicknefs, but lofes 
 its hardnefs. The heat increafes ; fo as to give a 
 very uneafy and lafting fenfation of heat, to the fin- 
 gers of any one, who applies them to the 1km of 
 
 the- 
 
Sc MEDICAL ADMONITIONS. 
 
 the patient. Small red fpots appear on the fkin r 
 refembling thofe remaining after the bites of fleas. 
 The tongue gets exceedingly dry, and is, in gene- 
 ral, covered with a hard rough coat, of a dark 
 brown colour ; the gums, and part of the teeth, 
 are coated with a fimilar covering. At length, if 
 the remedies ufed, do not prove fufficient for the 
 removal of the difeafe, the pulfations of the arteries 
 are reduced to indiftinct, tremulous vibrations ; the 
 fpots in the ikin increafe in number, and change 
 their colour to a livid or dark purple. The patient 
 conftantly employs his trembling fingers, as though 
 engaged in picking flocks off the bed-clothes, or, 
 as in purfuit of fome infecl: : this he continues, 
 until a ftate of fleepinefs fucceeds to that of deliri- 
 um ; which foon terminates in fo lethargic a ftate, 
 that the patient can hardly be roufed, by the utmoft 
 endeavours of the attendants. Difcharges of blood 
 from the noftrils, mouth, kidneys, &c. fometimes 
 happen juft before the death of the patient ; which 
 is generally preceded, alfo, by convulfive motions 
 of the whole frame. 
 
 The urine, through the whole of the difeafe, 
 differs much in its appearance. The ftools vary 
 much, in different fubjects, as to their frequency : 
 in general, there exifts a coftive ftate of the bowels, 
 in the firft days of the fever ; and a fatiguing and 
 deprefting purging, towards the clofe. Sweating. 
 
 which 
 
MEDICAL ADMONITIONS. 8 1 
 
 which, in general, is obtained with great difficulty* 
 in the early part of the fever ; often comes On very 
 profufely, after the firft eight or ten days ; when 
 it is fometimes critical, and denotes a favourable 
 termination of the fever : but fometimes it is 
 merely a confequence of the debilitated ftate of the 
 fyftem, which, in that cafe, it invariably increafes* 
 
 When the fcene is contemplated, which has been 
 juft defcribed ; the propriety of not offering, in a 
 publication of this kind, to deliver a plan of cure, 
 muft be fo obvious -, as to render it unneceffary to 
 offer any other reafons, than thofe which were 
 given, when treating of fevers in general. 
 
 When doubt and alarm are excited, by fuch a 
 variety of diftreffing fymptoms, the friends of the 
 patient muft poffefs, more than ufual hardinefs, to 
 venture to affume the office of the phyfician. But, 
 unfortunately, there are many perfons, who, al- 
 though they will not defend on their own judge- 
 ment, in propofing a mode of cure, will fubmit, at 
 the recommendation of fome ignorant, but well 
 meaning friend, to ufe fuch remedies, with bold- 
 nefs, which a perfon, properly informed, would 
 ufe with the utmoft timidity. Thus, bleeding is 
 often had recourfe to, immediately on the appear- 
 ance of fever, it being the popular opinion, that 
 bleeding is the moll effectual means of removing 
 t that 
 
8 5$ . MEDICAL ADMONITIONS. 
 
 that difeafe ; whereas, the fact is, that there is not 
 one cafe of fever in a hundred, that will admit of 
 this evacuation. Cafes of this, and of the preced- 
 ing fever, in which it is proper, are very rare in- 
 deed. The mifchiefs, which fucceed to its being 
 improperly had recourfe to, in thefe fevers, are, in 
 general, fo great ; that no exertions, however fk.il- 
 ful and vigorous, prove fuflicient, afterwards, to 
 fave the life of the patient. 
 
 Dr. James's Powder and Emetic Tartar are med- 
 icines, which are, almoft always, employed, by fam- 
 ily practitioners, in their attempts to remove fevers* 
 But the operations of thefe, and of other antimo- 
 nial medicines, are, in general, fo violent, as to re- 
 quire the utmoft caution in admiriiftering them. 
 Not only is it neceflary, that their dofes fhould be 
 exactly adapted ; but alfo, that a ftrict attention 
 mould be paid, at the fame time, to various other 
 eirciimftances, to fecure their beneficial effects. 
 When, in addition to thefe confiderations, it is re- 
 collected, that debility of the fyftem is that ftate, 
 which moft certainly renders this difeafe fatal, the 
 affertion rnuft obtain belief, that the ignorant em- 
 ployment of remedies, fo powerfully debilitating, 
 mufl be accompanied with the greateft degree of 
 danger. The celebrated Dr. Goldfmith loft his 
 life, by the imprudent adminiftration of Dr. James's 
 Powder, as was clearly proved in the account of 
 
 his- 
 
MEDICAL ADMONITIONS, ' ' 83 
 
 |i£s illnefs, publifhed by his worthy medical attend- 
 ant, Dr. Hawes. Numerous other inftances might 
 be adduced, of mifchiefs fucceeding the employ- 
 ment of this, and fimilar medicines, by domeftic 
 practitioners. 
 
 Another dangerous mode of treatment, which 
 is frequently adopted in families, on the firft ap- 
 pearance of fever, is ; that of confining the patient 
 to his bed, under a great load of bed-clothes, in a 
 clofe, heated chamber y and plying him, profufely, 
 with hot and fpirituous drinks, for the purpofe of 
 forcing out perfpiratign. But this effect feldom 
 follows the ufe of thefe means y but, on the con- 
 trary, the conferences of thus increaling, that 
 heat, which already exifts in a morbid degree, will 
 be found to be ; the augmenting of the parched 
 ftate of the Ikin, and Hill more rigidly doling its 
 pores ; whilft the vigour of the fyftem, is, at the 
 fame time exhaufted, by this accumulation of irri- 
 tating circumftances. 
 
 Regimen, and. Management of the Pa- 
 tient. Previoufly to delivering the advice which 
 may be thought proper on this head, it is neceffary 
 to obferve, that fo much depends on the care and 
 vigilance of the attendants, that na ordinary nurfe 
 ought to be trufted with this office ; unlefs the 
 phyfician is exceedingly exacl; and decilive, in his 
 
 erders 
 
84 MEDICAL ADMONITIONS. 
 
 orders ; and the friends of the patient equally care- 
 ful in feeing, that his directions are literally obeyed. 
 
 Whilft endeavouring to obtain the cure of this 
 fever, the phyfician will be anxious to iupport the 
 ftrength of the patient, and to oppofe the tendency, 
 to putrefcency, which takes place in the fyftem, 
 To aflift in the accomplifhing of thefe intentions, 
 is the office of the nurfe ; and of thofe, who take 
 on themfelves the kind, and important tafk, of 
 tending the fick : and is only to be executed, with 
 advantage to the patient, by paying a ftrict atten- 
 tion to the following points : the due adminiftra- 
 tion of nourishment and medicines ; the free admif- 
 iion of frefh air ; the preventing of the accumula- 
 tion of putrid effluvia ; and the careful ufe of fuch 
 means, as may be directed, for the alleviation of 
 particular fymptoms. 
 
 With refpect to nourimment ; it mould not 
 only be light and eafy of digeftion, but it mould 
 alfo be of an antifeptic nature. It may, therefore, 
 be compofed of fago, falop, panada, &c. to which 
 may be added, wine, in a quantity proportioned 
 to the ftate of the patient. A glafs of pure wine, 
 fuch as is molt agreeable to his palate, may be alfo 
 frequently allowed ; in which may be dipped a 
 piece of toaft or bifquit. Where it is thought 
 proper to truft more to their antifeptic, than to 
 
 their 
 
MEDICAL ADMONITIONS. 85 
 
 their cordial properties, wines made from fruit of 
 our own growth, are preferable ; fuch as wine 
 made from currants, which contain a greater pro- 
 portion of the vegetable acid, or, at leaft, in a lefs 
 involved ftate, than is to be found in the foreign 
 wines. Cyder and perry, efpecially if bottled, are 
 exceedingly beneficial. But if, as is frequently the 
 cafe, nature requires the free ufe of cordials ; none 
 are fo falutary as claret, hock, or even the more 
 generous wines, fuch as port, fherry, or Madeira. 
 Where the circumftances of the patient prevent his 
 obtaining any of thefe, in the quantity required, 
 bottled ale, or porter, will prove very ufeful fub- 
 ilitutes. Nothing will be more ferviceable, in cor- 
 recting the ftate of the fluids, than the free ufe of 
 ripe and frefh-gathered fruits ; of thefe, the moll 
 preferable are currants, mulberries, oranges, ftraw- 
 berries, grapes, and rafpberries. When thefe can- 
 not be had, their place may be fupplied, by thofe 
 fruits which may be in feafon ; or which allow of 
 being preferved fome time, as apples, pears, &c. 
 and if thefe cannot be obtained, recourfe muft 
 be had to dried fruits and jellies, or marmalade, 
 made by boiling the juices, or pulps of fruits with 
 fugar. Jelly, made of ilinglafs or hartfhorn £hav- 
 ings, is very ufeful ; being a very proper Vehicle 
 for the wine and acids ; and conveying nourifli- 
 ment, at the fame time, into the fyftem. Beef-tea 3 
 
 or 
 
86 MEDICAL ADMONITIONS. ' 
 
 or broths, when ordered, fliould be made ftrong 
 of the meat ; but carefully cleared from every par- 
 ticle of fat. The drinks, which may confift of ap- 
 ple-liquor, wine negus, barly-water, &c. fliould be 
 .given cold, and impregnated with the juice of 
 lemons, oranges, or citrons. Inftead of common 
 water, Seltzer water mould be ufed, for all the 
 drinks, which are prepared without heat. When 
 the difeafe is nearly gone off, and the ftomach ap- 
 pears to be regaining its powers, of digefling and 
 affimilating the aliment it receives ; beef-tea, and 
 broths made of different animal fubftances, mould 
 be given more freely, and even folid animal food, 
 may be permitted : efpecially if the patient anx- 
 ioufly requeft it : fince it very feldom happens, 
 that any ill confequence follows, from indulging 
 the patient in thofe defires : befides, that the vex- 
 ation and difappointment, confequent to the refu- 
 fal, might not be without injurious effecls. 
 
 During the violence of the febrile heat, the pa- 
 tient fliould be allowed the indulgence of cold 
 fpring water, for his drink j and may frequently 
 be refrefhed, by wiping his face ; hands, and arms, 
 with cloths dipped in cold water, to which a little 
 vinegar has been added. This recommendation, 
 of the application of cold water to the furface of 
 the body, may not feem to accord with the cafe I 
 
 related, 
 
MEDICAL ADMONITIONS. ■ 87 
 
 related, when treating of ague, of a young man, 
 who was killed by having a pailful of cold Water 
 thrown over him. But this poor fellow, worn 
 down by a quartan ague, had been endeavouring, 
 during the fliivering fit, to excite fome heat, by 
 hovering over the fire ; and had juft retired to \\\i 
 bed, ftill fliivering, when the unfortunate affufion 
 took place. But, in fever, Dr. Currie, phyfician 
 to the Infirmary of Liverpool, has fhewn, that cold 
 water may be poured over the naked body, not 
 only without injury, but with confiderable benefit ; 
 but this muft be done, where circumftances are 
 widely different, from thofe which exifted in this 
 cafe :— the ftrength mould riot be greatly reduced ; 
 the heat mould be fteadily above the temperature 
 of health ; and no fenfe of chilliriefs mould be pre- 
 jfent. The practice, fuccefsfully employed by Dr, 
 Currie, is not, however, to be adopted, without 
 due information : the rules juft mentioned, may, 
 however, be of fome advantage in directing the 
 ufe of cold water, as a drink, &c. 
 
 Before I conclude thefe inftrudtions, On the arti- 
 cle of regimen, it is neceffary to add 5 with refpect 
 to the ufe of wine, that, although it be abfolutely 
 neceffary during the continuance of this fever ^ 
 and that, in fuch quantities, as to render it furpri- 
 fing how confiderable a portion may be taken 3 
 without producing any of thofe effects, which 
 
 would 
 
83 MEDICAL ADMONITIONS. 
 
 would have proceeded from even a much left quan- 
 tity, if taken by the fame perfon, when in health : 
 yet, as foon as the fever has left the patient, much 
 caution becomes neceffary in the- ufe of it ; fince 
 very difagreeable circumftances may follow, from 
 too free ufe of it at this time. Several inftances 
 have been feen, where patients juft recovered from 
 this fever, during which they had fwallowed, with 
 falutary effects, confiderable quantities of wine* 
 have, upon drinking only a few glaffes during 
 their convalefcent ftate, experienced the return of 
 a confiderable degree of febrile heat, and even of 
 delirium : nor, have thefe confequences been either 
 foon or eafily removed. For although, during the 
 difordered ftate of the fyftem, accompanying the 
 fever, the patient be able to bear a much greater 
 quantity of wine, than when in perfect, health ; 
 yet, when the fever entirely ceafes, the wine, not 
 only affects him as before ; but feems to have be- 
 come capable of producing injurious confequences, 
 in proportion to the degree of debility induced. 
 
 For the fake of preventing the accumulation of 
 putrid vapours about the patient, great attention 
 mould be paid to the ventilation of the room, and 
 to the frequent changing of the bed clothes. The 
 patient mould not be confined to one room, but 
 be removed from one to another : that which he 
 
 has 
 
MEDICAL ADMONITIONS. 
 
 has left, having the windows and doors all thrown 
 open, for the free paffage of the air j the floors 
 wiped with cloths, dipped in vinegar j and fuch of 
 the bed-clothes, as are not changed, expofed to the 
 current of air; fmce, by their known capacity for re- 
 taining effluvia, they may become fo loaded with 
 contagious and putrid matter, as to prove infectious 
 to the attendants, and perhaps to impede the re- 
 covery of the patient. The apartment may be 
 frequently fprinkled with rofe-water, or vinegar, 
 and filled with the odours of ftrong fmelling plants. 
 The fick perfon, in fome cafes, ihould be kept out 
 of bed as much as poilible ; and placed fo, as to 
 face the current of air ; the body being defended 
 fufficiently by the clothing, to prevent any incon- 
 venience being experienced ; but not fo much fo, 
 as to heat the patient. It mull: be allowed, that 
 this practice is not admiflible, in every cafe of put- 
 rid fever ; fmce circumftances may arife, which will 
 render it highly improper : thefe circumftances, 
 depending on various combinations, of the feafon 
 of the year, weather, conftitution of the patient, 
 &c. will be difcovered and pointed out by the phy- 
 fician. But there is much lefs reafon to fear, that 
 this practice will be too frequently adopted ; than 
 that it will be neglected, in thofe cafes in which it 
 is recommended. For, too often, in this point, 
 are the wifhes of the phyfician oppofed, and his 
 
 M directions 
 
go MEDICAL ADMONITIONS. 
 
 directions difobeyed : the languor of the patient, 
 and his unwillingnefs to be moved, with the pre- 
 judices againft a practice fo novel, forming, very 
 often, almoft infuperable obftacles. Indeed, it is 
 very difiicult to perfuade thofe, who have not wit- 
 nefTed the effects refulting from this mode of prac- 
 tice, that it is not neceffary, for every perfon in a 
 fever to be kept clofely confined to his bed, under 
 a load of bed-clothes, and fupplied with heating 
 drinks. It frequently happens, therefore, that no 
 fooner has a phyfician left the room ; than the 
 patient is fupplied with warm liquors, the windows 
 and curtains are clofed, and the bed-clothes, which 
 had been removed, are replaced. Such oppofition 
 to the directions of a phyfician, viewed in the moft 
 favourable light, is highly cenfurable : its being, in 
 a great meafure, the effect of ignorance, is all that / 
 prevents it from being really criminal. 
 
 Among the fymptoms which occur in this fever, 
 no one requires more care and management, than 
 the delirium, which, in general, accompanies the # 
 difeafe, almoft through its whole courfe. During 
 this delirious ftate, the patient is agitated with 
 vague and irregular exertions, both of body and 
 mind ; which muft necelfarily, in proportion to 
 their frequency, and length of continuance, exhauft 
 the vital powers. To leffen thefe exertions, mould 
 be the talk of fome difcerning and intelligent at- 
 tendant ; 
 
MEDICAL ADMONITIONS. 9 1 
 
 tendant ; who ftiould gently reprefs the patient's 
 efforts, and foothe his anxiety. 
 
 Dr. Blane, in his obfervations on this fever, has 
 fome remarks on delirium, which, from their ex- 
 treme utility, and from their being only to be found 
 in a publication, not likely to be read but by pro- 
 fefiional men, I {hall introduce here ; with the 
 hope of more widely extending the comforts, which 
 they were meant to procure, to the unfortunate 
 victims of this difeafe. "Delirium," he faysj 
 "feems chiefly to confift in a falfe reference of our 
 "fenfations, whether external or internal : and 
 "this is, in no fort of fever more evident, than in 
 "this. When any painful impreffion, for inftance, 
 "is made by an external body, the patient, if in a 
 "ftate of delirium, does not refer it juftly to the 
 "part affected ; but the -general agitation, and in- 
 " coherence of fentiments, will be aggravated for 
 "the time. I have known a degree of heat applied 
 "to the extremities, fufficient to blifter them ; yet 
 "the part did not fhrink, though the raving and 
 "general uneafinefs were in>reafed. In like man- 
 "ner, with regard to internal fenfations, when an 
 "irritation is excited, to expel the urine, or faces, 
 "the mind does not recognife it as fuch, but from 
 "a fenfe of uneafinefs, probably miftaken for fome- 
 " thing elfe, an effort is made to relieve nature, 
 
 which 
 
p3 MEDICAL ADMONITIONS. 
 
 "which is done without a proper confcioufnefs, 
 "and certain fymptoms are produced, which are 
 "well known marks of danger in this fever. In 
 "watching thofe, who have been under the in- 
 "fluence of delirium, I have obferved it increafe, 
 "when any particular want of nature purged ; and 
 "this would continue for fome time, the patient 
 "being incapable of procuring himfelf immediate 
 "relief, on account of the falfe reference of fenfa- 
 "tion, that has been mentioned ; but he would 
 "become calm after voiding the urine or faces, or 
 " after receiving fomething to drink, according to 
 "the particular want that was prefent at the 
 
 "time."* "Delirium is one of the molt con- 
 
 "ftant and alarming fymptoms in this difeafe, and 
 "the removing of it depends much upon the attend- 
 ants, as well as the phyfician. 1 have feen a 
 
 "temporary flop put to the patient's raving, by 
 "making him drink, or upon his difcharging 
 "his urine or faeces ; for he is then unconfcious 
 "of thirft and other natural wants, is therefore 
 "ignorant of the means of fatisfying them ; and 
 "when he does fo, he fancies he is about fomething 
 "elfe, which is the fubjecl: of his delirious thoughts. 
 "This obfervation leads to a material practical 
 "purpofe ; for it follows from it, that unremitting 
 "attention mould be given to the patient's feel- 
 ings, 
 
 * Obfervations wi the Difeafes of Seamen, by Gilbert Blane, 
 M. D. p. 374. 
 
MEDICAL ADMONITIONS. 93 
 
 "ings, and all his poffible wants, as thofe natural 
 "notices, and inftinctive cravings, which occur in 
 "health, are now wanting, in confequence of the 
 "depraved ftate of fenfation."* 
 
 It was remarked before, when treating of the 
 flow nervous fever, that, on the appearance of thofe 
 fymptoms, which are, in general, fuppofed to be 
 the harbingers of death ; defpair takes fuch ftrong 
 poffeilion of the minds of the attendants, that it is 
 with the utmoft difficulty the phyfician obtains 
 thofe exertions, which may poffibly fave the life of 
 the patient ; and which, being omitted, he well 
 knows, his death will be inevitable. The caution 
 given there, is equally proper in this place ; iince 
 it too often happens in this fever, as well as in the 
 former, that patients are loft for want of being, 
 almoft momentarily, fupplied, with cordial and 
 nouriftiing drinks : this omiffion proceeding from 
 the attendants fuppofing thefe exertions to be ufe- 
 lefs, and even cruel. Another reafon, often given, 
 by thofe, who have neglected to make ufe of the 
 neceffary means, is, the patient's incapability of 
 iwallowing : when, perhaps, if the phyfician him- 
 ielf Ihould make the trial, he would experience very 
 little difficulty, in getting him to fwaliow a confid- 
 erable quantity. To afcertain the caufe of this 
 
 difference 
 
 * Obfervations on the Difeafes of Seamen,, by Gilbert Blane, 
 M. D. p. 398. 
 
94 MEDICAL ADMONITIONS. 
 
 difference cf fuccefs, in the different attempts of 
 the nurfe and the phyfician ; and to point out the 
 proper method to be ufed in thefe fituations, will 
 
 be at leaft proper to attempt. 
 
 / 
 
 In tlie advanced periods of thefe fevers, the brain, 
 and whole nervous fyftem, are in fo deranged a 
 ftate ; that a flight IKmulous feldom excites the 
 correfponding idea, which it was ufed to produce 
 in health ; and, frequently occafions no impreflion 
 at all. When a patient is in this ftate, the merely 
 emptying a fpoonful of liquor into the mouth, is 
 not fufficient to excite thofe mufcles into action, by 
 which the act of fwallowing is performed ; the li- 
 quid, therefore, remains in the mouth, until it 
 efcapes out at the corner of the lips ; or elfe, from 
 a drop infinuating itielf into the windpipe, the 
 whole quantity, from the violence and fuddennefs 
 of the irritation, is thrown forcibly out at the mouth 
 and noftrils. The appearances, in either of thefe 
 cafes, feem, at firft fight, to warrant the conclufion 
 which is generally drawn from them, that the pa- 
 tient has totally loft the power of fwallowing : but, 
 if the patient be fo much aroufed from this deli- 
 rious, or comatofe ftate, as to be apprized of the 
 nature and intention of the endeavours that are 
 making, he will generally be found ready enough 
 to afTift them. After routing him, by gently fhak- 
 
 ing, 
 
MEDICAL ADMONITIONS. 95 
 
 ing, fpeaking to him, railing him in the bed, &c. a 
 fpoon, filled with the liquor, that is intended to be 
 given him, iliould he put to his mouth ; moving it. 
 about againft the tongue, lips, and fides of the 
 mouth, until he is difcovered to have fwailowed 
 the few drops that have fallen from the fpoon. It 
 now appearing, that the mufcles ferving to degluti- 
 tion, are capable of performing their office, the 
 whole quantity is to be poured into the mouth, and 
 followed by as much more as may be thought ne- 
 ceffary ; fince, after having been thus roufed into 
 action, it will be fome little time, before they re- 
 lapfe into their previous ftate of infenfibility. 
 
 Another circurnftance alfo occurs, in the coma- 
 tofe ftate of thefe fevers, from which the nurfes 
 are too likely to form a prognoftic, which mull 
 necefTarily confirm them in their defpondency j 
 but this fymptom frequently is to be feen, without 
 bearing that fatal import, which is commonly fup- 
 pofed. Where death comes on flowly, and the 
 natural actions flop gradually, fome little time be- 
 fore life ceafes, the mucus or phlegm colle&s in the 
 back part of the fauces, from the infenfibility and 
 lofs of power in thofe parts, which, in health, ferve 
 to expel it j and, by occafioning an interruption 
 to the palfage of the air, in infpiration and expira- 
 tion, a rattling noife is produced, which is termed, 
 
 by 
 
Q6 MEDICAL ADMONITIONS. 
 
 by the nurfes, the rattles. Whenever, therefore, 
 this accumulation of phlegm, and confequent rat- 
 tling, takes place, in any cafe, where the difeafe 
 has continued for a little time; the good women, ex- 
 peeling that death will foon follow, refolutely op- 
 pofe the making of any attempts for the recovery 
 of the patient, or the fupport of his ftrength. But, 
 in the advanced periods of thefe fevers, this fymp- 
 tom may frequently appear, without being accom- 
 panied by that degree of danger, which is in gen- 
 eral fuppofed : for a confiderable quantity of mucus 
 is fecreted, at this time, by the glands, which are 
 placed about the back part of the fauces ; and is 
 there gradually collected, in confequence of the 
 patient, from the difordered ftate of his brain, not 
 experiencing any inconvenience from it ; and, 
 therefore, employing no efforts for its removal. 
 
 The mucus thus accumulated, and rendered ex- 
 ceedingly tenacious, by the increafed evaporation, 
 from the patient's breathing with his mouth open ; 
 by obftruc~ting, and almoft clofing the pafTage, pro- 
 duces the effect above mentioned. At the fame 
 time, in confequence of this mode of breathing, 
 the teeth, gums, and tongue become dry ; appear- 
 ing as if covered with a dry, hard, and black 
 varnifh, and feem to denote immediate diflblution. 
 But it frequently happens, that if, inftead of aban- 
 doning 
 
MEDICAL ADMONITIONS. §f 
 
 doning the patient in defpair ; the neceffary exer- 
 tions are made, the patient is raifed and fupported 
 in his bed, the mouth and throat conftantly moif- 
 tened by nourishing and cordial drinks, thefe fyiru> 
 toms will foon difappear, and the patient probably 
 recover. 
 
 Prevention. The necelHty of conftantly 
 ventilating the chamber of the fick, and of filling 
 it with the fumes of vinegar, &c. to expedite the 
 cure of the patient, has been already ftated. But, 
 it is neceffary to be more particular on this head 5 
 fince, by the proper management of fuch means, 
 the fpreading of the infection to the attendants, 
 the reft of the family, and even the neighbourhood, 
 can alone be prevented. 
 
 By the ingenious and affiduous enquiries of mod- 
 ern phylicians, we have obtained confiderable~in- 
 formation, as to, the nature of the contagion, which 
 produces fever. They have even traced it to the 
 fources, whence it arifes ; and have difcovered it 
 in the miafma, or vapour riling from foul and ftag- 
 nant waters, and from marfhy lands j in the efflu- 
 via from an healthy body, which has been fuffered 
 to accumulate in foul clothing, and clofe apart- 
 ments -, and the effluvia arifing from the body of 
 one affected with fever. 
 
 N It 
 
98 MEDICAL ADMONITIONS. 
 
 It lias been afcertained, by a variety of experi- 
 ments, 
 
 I. That various fubftances may become imbued 
 with thefe effluvia, and retain them for a confider- 
 able time. 
 
 II. That thefe effluvia, fuffered to remain long 
 at reft, in fuch fubftances ; not only retain their 
 noxious powers unimpaired, but feem to poffefs an 
 higher degree of virulence, and more aclive pow- 
 ers, than thofe which arife immediately from an 
 human body. 
 
 III. That the fphere of action of thefe effluvia 
 extends, but to a fmall diftance from the body, 
 whence they arife ; or from the fubftance, in which 
 
 they are contained. 
 
 IV. That their power of communicating infec- 
 tion, is leffened, in proportion, as they are diffufed 
 through the atmofphere. 
 
 V. That the fpace of time is very different, ac- 
 cording to different circumftances, in which infec- 
 tion manifefts its prefence, by any evident changes 
 produced in the fyftem : thefe changes fometimes 
 immediately following its introduction ; whilft, in 
 other cafes, ten days or a fortnight will elapfe, be- 
 fore its effects are difcoverable. 
 
 VI. 
 
MEDICAL ADMONITIONS. 99 
 
 VI. That infection, like fome other poifons, 
 does not affect thofe who are accuftomed to it - 9 
 especially, if it be gradually applied. Hence thofe 
 about whom the poifon is generated, may be lefs 
 fufceptible of injury from its influence : and phy- 
 ficians and nurles efcape, while the vifitors of the 
 iick, become infected. 
 
 VII. That cold, which, in general, has been 
 thought to have produced different effects, con- 
 tributes to the increafe of infection, 
 
 I am convinced, that, when you confider the 
 dangers, to which the juftly celebrated phyficians 
 muft have expofed themfelves, who have eftab- 
 lifhed thefe facts, by experiments, and accurate ob- 
 fervations ; you will readily allow, that the world 
 is highly indebted to them, for their enthufiaftic 
 exertions in the caufe of humanity j and will, per- 
 haps, feel, with me, a confiderable regret, that any 
 motive fhould induce an intelligent phyfician, to 
 whom all this is known, to affert, in a popular 
 work, that " very few of the valuable difcoveries 
 " in medicine, have been made by phyficians : they 
 "have, in generaj, been the effect of chance, or 
 M of neceffity, and have been ufually oppofed by the 
 "faculty, 'till every one elfe was convinced of their 
 *' importance." 
 
 Domeftic Medicine. Introducl. p. xxii. 
 
 Such 
 
IOO MEBICAL ADMONITIONS. 
 
 Such an accufation as this, unfupported by a 
 tittle of evidence, cannot require a defence to be 
 fet up againft it -> however much, it may merit a 
 fevere comment. t 
 
 But to return to that, which is of much more 
 confequence. — We were remarking, that cold con- 
 tributes to the increafe of infection. The import- 
 ance of this obfervation to every family, and its 
 contradicting the generally received opinion, de- 
 mands, that the arguments advanced in its favour, 
 by Dr. Blane, mould appear in his own words. — 
 " Cold is favourable to infection, by preventing 
 " ventilation ; for people exclude the air, in order 
 " to keep themfelves warm ; and the poor, in par- 
 " ticular, do fo, on account of their bad clothing, 
 " and their not being able to afford fuel, to make 
 "good fires. Heat is the great deftroyer of infection, 
 il and feems to act by evaporating, and thereby 
 " diffipating it ; and the effect of fires in apart- 
 ** ments, is to produce a conftant change of air ; 
 " thereby preventing its ftagnation and corruption, 
 " and the accumulation of unwholefome effluvia."* 
 
 To leffen the probability of the contagion being 
 diffeminated, all unneceffary intercourfe with the 
 lick, mould be avoided : and in addition to the 
 means already propofed, for-correcting the air of 
 
 the 
 * Obfervations on the Difeafes of Seamen, by Gilbert Blane, 
 M. D. p. 250. 
 
MEDICAL ADMONITIONS. IOI 
 
 the apartments, the mode recommended by Dr, 
 James Carmichael Smyth, for obtaining the nitrous 
 or marine acid, in a ftate of vapour, may be em- 
 ployed. It confTfts in decomposing nitre, or com- 
 mon fait, by means of heated vitriolic acid, which 
 may be done, as follows.— Put half an ounce of 
 vitriolic acid, into a glafs, or china cup, or deep 
 faucer ; warm it, by placing it in heated fand, add- 
 ing to it, from time to time, fome common fait. 
 By a fimilar procefs, as fuggefted by Mr. W. Bliz- 
 ard, Surgeon of the London Hofpital, " the kali 
 " acetatum (diuretic fait, of the ftiops) being added 
 " to the vitriolic acid, the acetous acid become* 
 " inftantly feparated from its alkaline bafis, and 
 " prefents itfelf, pungent, and refrefhing, in a de- 
 " gree even beyond the foffil acids." * 
 
 The neceffity of an attention to thefe admoni- 
 tions, may be rendered, perhaps, more evident, by 
 confidering ; that the effluvia exhaled from one 
 perfon, during the night, will, in general, be found 
 to be very pungent and difgufting, to any other 
 perfon, who may enter his bed-room ; whilft the 
 perfon, from whom they may have arifen, will 
 hardly be fenfible of any particular odour. The 
 fame is to be obferved of clothing ; iince the fmell 
 proceeding from foul clothing, is often extreme- 
 
 iy 
 
 * Suggeftions for the improvement of Hofpitals, and other 
 charitable Inftitutions, p. 54, 
 
J©2 MEDICAL ADMONITIONS. 
 
 ly ofFenfive to others, whilft the wearer of them 
 does not experience the lcafl inconvenience, The 
 organs of fmell, in the perfon who generates thefe 
 effluvia, being as little fufceptible of impreflion 
 from their fenfible properties ; as his fyftem may 
 be, from any peculiar virulence, they may pofFefs. 
 Hence, much mifchief may arife ; fince a perfon 
 may thus carry about with him, a matter not 
 only highly ofFenfive to others ; but, perhaps, pof- 
 fefling properties very dangerous to any other 
 perfon, who may come within the fphere of its 
 action : whilft he is himfelf unconfcious of its pof- 
 fefling either of thefe active powers. 
 
 Another caution, not in general fumciently at- 
 tended to ; is to properly ventilate, and fumigate, 
 the clothes, which had been worn by the patient, 
 in the early days of the difeafe ; and which, being 
 moll probably the fame which were worn, at the 
 time when he was expofed to the influence of the 
 contagious matter, may ftill retain a fufficient 
 quantity of the poifon to communicate the difeafe. 
 
 Great care is neceffary, in the management of 
 the patient, even after the total removal of the 
 fever. He will be now left in fuch a ftate of de- 
 bility, that the flighteft exertions may prove too 
 much for him : even the congratulations of his 
 rejoicing friends muft be reftrained ; and great 
 
 care 
 
MEDICAL ADMONITIONS. I&3 
 
 Care be taken, that he be not exhaufted, by con- 
 verfations with repeated vifitors. The food, which 
 his returning appetite demands, perhaps with 
 avidity, mould be given in fmall quantities, and 
 frequently : and the quantity of his wine, as al- 
 ready mentioned, mould be confiderably dimin- 
 ished. Exercife mould be adopted, with the great- 
 eft cate ; left too much fatigue be induced. Some 
 caution, alfo, muft be employed, as to the expo- 
 fure to the air, in guarding againft the cold, by 
 proper clothing ; particularly j by the ufe of flannel 
 next the fkin. Removal into the country, is gen- 
 erally recommended to the convalefcent j but par- 
 ticular care is neceffary, that he be not imme- 
 diately fent to a fituation, in which the air is much 
 colder, thart that from which he is removed ; left 
 an inflammation of the inteftines, or lungs, be in- 
 duced. 
 
 Should any one have reafon to fuppofe, he has 
 received the infection of this fever, from the ap- 
 pearance of thofe fymptoms, which mark its com- 
 mencement ; and particularly, from a difagreeable 
 fenfe of finking and uneafinefs at the pit of the 
 ftomach ; it will be advifable, as foon as poffible, 
 to cleanfe the ftomach by an emetic, and to gently 
 open the bowels ; immediately after which, fweat= 
 ing may be promoted, by freely drinking white 
 
 wine 
 
104 MEDICAL ADMONITIONS. 
 
 wine whey. Should thefe means not prove fufEU 
 dent, a blifter may be applied to the nape of the 
 neck ; — or rather, if thefe fail, immediate applica- 
 tion fhould be made, for the advice of the intelli- 
 gent and experienced phyfician. 
 
 By the late difcoveries refpe&ing the conftituent 
 principles of atmofpheric air, phyficians have" been 
 enabled to eftablifh certain principles, on which 
 they can proceed with greater confidence, in the 
 treatment of this, and many other difeafes. A 
 knowledge of thefe difcoveries, and of their appli- 
 cation by the healing art, cannot but be a pleafing 
 and interefting acquifition to any one ; but it is 
 more, — it is a branch of fcience, which fhould be 
 generally known. The friends of the lick, pof- 
 iefTed of this knowledge, and confequently apprifed 
 of the principles, on which the phyfician proceeds 
 to obtain a cure, can then more powerfully aid his 
 endeavours : nor is this all — they alfo gain a know- 
 ledge of the principles, on which they ought to 
 proceed, for the prefervation of their own health. 
 The Medical Extracts of Dr. Thornton communi- 
 cate this information, in a moft pleafing manner. 
 Medical men wifh not for ignorance, either in their 
 patient, or his friends : they know, that whilft ex- 
 ercifmg the duties of their profeffion, the know- 
 ledge of the firft principles of medical fcience, will 
 
 always 
 
MEDICAL ADMONITIONS. IO5 
 
 always yield them the ftrongeft aid ; whilft igno- 
 rance wilL beft provide the prey of the rapacious 
 empiric. 
 
 I have given a flight fketch of the principles, on 
 which airs of different purity are employed in dif- 
 ferent difeafes, whilft treating of Consumption. I 
 fhall therefore, here, only introduce the evidence 
 of the ingenious Rev. Joseph Townsend, author 
 of the Guide to Health, &c. as to the ufe of vital 
 air in this difeafe. "In my putrid fever, when- 
 ever the air of my chamber was artificially oxygen* 
 ated, as my phyfkian, Dr. Thornton, often witnef- 
 fed, my refpiration was pleafant, my oppreftion at 
 my cheft relieved, and I was enabled to breathe 
 freely through the noftrils, without the afliftance 
 of my mouth, which I could not do before the 
 room was oxygenated. At the fame time, I am 
 convinced that my appetite was greatly increafed* 
 my occaiional fleeps rendered fotind and undiftur- 
 bed, and my digeftion considerably quickened." 
 
 On account of the comfort it muft yield to par-* 
 ents, to learn that infants are not fo liable to fevers 
 as adults, I fhall clofe thefe remarks on this fever, 
 with the opinion of Dr. Underwood on this Cub* 
 
 The Do&of has obferved, for" many years, as 
 
 well in the hofpital, as in private practice, that in- 
 
 O fants 
 
106 MEDICAL ADMONITIONS* 
 
 fants do not readily take common fevers, though 
 expofed, for a long time, to that contagion, which 
 has appeared to affect adults around them. He alfo 
 obferves, that every phyiician attending lying-in 
 hofpitals, mull not only have known many infants 
 fuckled, without injury, through the whole ftage 
 of bad fevers, from which mothers have recovered; 
 but alfo, in other inftances, fucking greedily within 
 an hour or twO of their mother's death. 
 
 REMITTING FEVER. 
 
 Such fevers, as fufFer irregular abatements, or 
 remiffions, of their violence* are termed Remitting 
 Fevers. Remitting fevers hold a middle place, be- 
 tween continual and intermittent fevers. Con- 
 tinued fevers, in changing to intermittents, in gen- 
 eral, take on the appearance of a remittent, before 
 they clearly intermit. Intermittents, alfo, which 
 are becoming continued fevers, have irregular re- 
 millions, in the place of thofe clear interrniflions, 
 which before charaderifed them. 
 
 This, like other fevers, commences with a cold- 
 nefs and fhivering ; accompanied by violent pains 
 in the head, and back ; great dejection of fpirits, 
 lofs of ftrength, and frequently a conliderable diffi- 
 culty of breathing. Sicknefs at the ftomach, gid- 
 
 dinefs, 
 
MEDICAL ADMONITIONS. 1 07 
 
 dinefs, and frequent hiccups, fhew that the firft 
 pafiages are charged with offenfive matters. The 
 cold ftage is fucceeded by a confiderable degree of 
 heat ; the pulfe, which in the cold fit was fmali 
 and quick, becomes fuller, but abates not of its 
 quicknefs. The pain of the head and back increafe ; 
 and the naufea is augmented, until it terminates in 
 copious vomitings of bile ; difcharges of bile, by 
 ftool, alfo often take place. Thefe fymptoms con- 
 tinuing fome time, the fkin, which had hitherto 
 been dry and hot, becomes inoiftened with fweat ; 
 which fometimes flows very freely. Soon after 
 this, the fymptoms abate, fome cealing entirely, 
 whilft others are much leffened ; the patient flat- 
 tering himfelf with the hopes of health fpeedily 
 returning ; but thefe pleafmg illufions, are foon 
 diffipated, by a return of the paroxyfm ; which 
 comes on with increafed violence. The diforder 
 proceeds thus, the paroxyfms alternating with the 
 remiilions, until the remiflions, which leflen each 
 time, are, at laft, entirely loft \ the fever afluming 
 a continued form. The difcharges now become 
 very offenfive ; a conftant delirium and reftleffnefs 
 takes place ; and, if the fever be not oppofed by 
 means fufficiently powerful, ftartings of the ten- 
 dons, profufe clammy fweats, and convulsions, come 
 Gn ; which foon terminate in the death of the 
 patient. 
 
 In 
 
J08 MEDICAL ADMONITIONS. 
 
 In the cure of this fever, one important indica- 
 tion is, the removal of the accumulated bile ; but 
 the fame motives, which have forbidden, the de- 
 tailing of the mode of cure, in the other fpecies of 
 fever, prevent its admiffion, in the prefent inftance. 
 In this difeafe, the moft vigilant attention is re- 
 quired ; nor will this be fufficient, unlefs united 
 to fkill and experience. 
 
 Early, regular afiiftance mould be procured, in- 
 deed, in every cafe of fever ; but, in no cafe, is the 
 watchful eye of the phyfician more neceflary, than 
 in this : for if he be called early in the difeafe, and 
 difcover the nature of the fever, which is, in gen- 
 eral, fumciently apparent to the experienced ; he, 
 by timely and well adapted evacuations, will re- 
 move that accumulation of fordid matter, in the 
 firft paffages j which, in the courfe of the difeafe, 
 would be likely to occafion much trouble and dan- 
 ger. As the difeafe proceeds, he will be enabled to 
 afcertain the critical moment, when he may ven- 
 ture on the free ufe of the bark ; the omiffion of 
 which, might, moft probably, occafion the lofs of 
 the patient ; or, if ufed incautioufly, would render 
 every fymptom more violent ; and the difeafe, of 
 courfe, lefs likely to be removed. Should fuch. 
 circumftances occur, as may feem to forbid the ufe 
 of this valuable medicine ; the intelligent phyfician 
 
 will 
 
MEDICAL ADMONITIONS. ( I09 
 
 will often be enabled, by a due attention to the 
 rules of his art, to effecl: thofe neceflary changes, 
 which will render the employment of it fafe and 
 beneficial. 
 
 Languor, naufea, giddinefs, and disinclination 
 to motion, often precede, for fome days, the fhiv- 
 ering, which introduces this fever. At this junc- 
 ture, the adminiilering of an emetic ; and fome 
 gentle medicine, to produce a difcharge from the 
 bowels, would probably prevent the coming on of 
 the fever j efpecially, if fucceeded by a proper ufe 
 of the bark. 
 
 By a regard to the rules, already laid down, the 
 attendants on the lick, may derive fuificient in- 
 ftructions for their conduct in the progrefs of this 
 
 fever. 
 
 HECTIC FEVER. 
 
 In hectic fever, there are two evident exacerba- 
 tions, in every twenty-four hours : one of thefe 
 happens about noon, and continues the greater 
 part of the afternoon, then fuffers a flight remif- 
 iion ; as evening comes on, a frefli exacerbation 
 takes place, which continues until after midnight j 
 another remiffion taking place about two or three 
 o'clock in the morning, about which time, or, in 
 
 general, 
 
JIO MEDICAL ADMONITIONS. 
 
 general, later, a profufe fweating alfo frequently 
 comes on. During the feverifh ftate, an exceffive 
 heat is felt, in the palms of the hands, and the foles 
 of the feet. The urine is, in general, of a high 
 colour, and depofits a bran-like fediment ; but of 
 a reddifh hue. This fever is generally fuppofed to 
 exifl only as a fymptom of fome other difeafe, and 
 as a confequence of the injury of fome particular 
 part. It moft frequently occurs, when a collection 
 of matter has taken place. 
 
 Since hectic fever is not a primary difeafe, I 
 mould not have treated of it feparately, if I had 
 preferred an attention to the rules of arrangement, 
 to the important point of calling the attention par- 
 ticularly, to that ftate I have juft defcribed ; which 
 never exifts without danger ; and which is often 
 to be found, where it has not excited the leaft 
 alarm. 
 
 Wherever this difeafe is met with, there may it 
 be expected, that the fyftem is harrafled by fome 
 local affection, of a dangerous tendency ; and if 
 proper medical help has not been yet obtained, no 
 time mould be loft, before application is made to 
 fome one, to whom ftudy and practice have given 
 acutenefs, in difcovering the difference of difeafes, 
 as well as a knowledge of the moft judicious modes 
 of treatment. 
 
 INFLAMMATION. 
 
MEDICAL ADMONITIONS. Ill 
 
 INFLAMMATION. 
 
 INFLAMMATION, unlefs very trifling, is pre- 
 ceded by a fenfe of coldnefs, and by fhivering t 
 to thefe fucceed an increafe of the heat of the whole 
 body, oppreffion, and thirft : the pulfe becoming 
 full, hard, and quick ; and the urine high coloured. 
 A fenfation of fulnefs and teniion, with a preter- 
 natural fenfibility, is experienced in the part, which 
 is the feat of the inflammation \ with a degree 
 of heat, proportioned to the degree of the dif- 
 eafe ; and a pulfatile, or throbbing pain, which is 
 more or lefs violent, in fome cafes, than in others : 
 the difference depending, in a great meafure, on 
 the ftructure of the affected part. The blood vef- 
 fels, as far as the inflammation extends, are dif- 
 tended with blood : and thofe veffels appear to be 
 filled with red blood, which, in a natural flate, do 
 not appear to receive it at all, 
 
 The blood, which is taken away in thefe difeafes ? 
 is, when immediately drawn, of a dark colour j 
 and in a more fluid Itate, than that which is taken 
 away in health, or in thofe difeafes where inflam- 
 mation does not exifl ; whilft coagulating, its fur- 
 face is mottled with waves of a purpliih hue ; but 
 as foon as the coagulation has taken place, the fur- 
 face of the coagulated part becomes covered with 
 
112 MEDICAL ADMONITIONS. 
 
 a buff cruft : but this appearance is not conftant j 
 fince, though it might otherwife fhew itfelf, it may- 
 be prevented, by certain circumftances in the tak- 
 ing it from the vein, in the receiving it in the 
 veffel, &c. 
 
 Inflammation may terminate either by difper- 
 fion, fuppuration, or mortification. 
 
 Refolution, or difpcrfion, is faid to take place, 
 when the cure is performed, while the texture of 
 the part remains entire. This termination may be 
 expected, when the difeafe is flight, and when 
 proper means have been had recourfe to, in the 
 early part of the difeafe. 
 
 If the difeafe be violent, or fhould it not be op- 
 pofed by means, fumciently powerful ; the pulfa- 
 tile or throbbing pain increafes, with the other 
 fymptoms, until fuppuration, or the formation of 
 matter, takes place. This is known by the pain, 
 heat, and rednefs abating : and, at length, by the 
 difcovery of a fluctuation of a fluid, in the difeafed 
 part. 
 
 But fhould the difeafe have exifted a confiderable 
 time ; and, inftead of yielding any of thofe appear- 
 ances, from which we might conclude that fuppu- 
 ration was about to take place ; the pain, heat, and 
 rednefs fhould increafe to a confiderable degree ; 
 
 it 
 
MEDICAL ADMONITIONS. Ilj 
 
 it may then be feared, that the difeafe will termi- 
 nate in a gangrene or mortification. When thy 
 change is taking place, the Colour of the part, from 
 a bright fcarlet, becomes a dark crimfoh ; blifters 
 arife on the part ; the tumour fubfides, the part 
 becoming foft and flaccid ; and from being vio- 
 lently pained, becomes nearly irifehiiblel The deep 
 red colour is now exchanged for a livid purple : 
 the part at length becomes quite black, and having 
 loft all life, exhales a cadaverous fmell ; and, if 
 health fliould be reftored, is at laft thrown off by 
 the action of the furrounding live parts. 
 
 It cannot be neceiTary to be more particular, as 
 to the terminations of inflammation : the defcrip- 
 tion df tlie appearances which take place, on the 
 feveral terminations jiift mentioned, may be, how- 
 ever, highly ufeful ; fince, by ah attention to it, 
 thofe who venture oil the dangerous practice of 
 domeftic quackery, may be enabled to difcover 
 when danger is threatened, in confequehce of their 
 neglect, or improper interference. 
 
 In every inflammation, there is an increafed ac- 
 tion of the veffels of the part, and, indeed, of the 
 heart itfelf, and of the whole fyftem of blood- 
 veffeisn 
 
 To 
 
114 MEDICAL ADMONITIONS. 
 
 To effect the cure of inflammation, therefore j 
 „ thofe means mould be employed, which are known 
 to be effectual, in reftraining this inordinate action. 
 Among the firft of thefe, may be reckoned bleed- 
 ing. Blood, therefore, mould be taken away, in 
 the firft place— — but, arrived at this point, how 
 fhall I proceed ? Shall I attempt to furnifh the un- 
 informed with particular rules, by which he fhall 
 determine, as to the quantity of blood to be taken 
 away, as to the mode in which it is to be drawn, 
 &c. ? You muft plainly fee, that this ought not to 
 be attempted ; and that 1 mould rather fay, that 
 every cafe of inflammation, which requires general 
 bleeding, muft be a malady of fo ferious a nature, 
 as to demand all that art and fcience can perform. 
 I mall, therefore, here only make fome general ob- 
 fervations, on the means of cure : fhewing the 
 many difficult and important points, in which an 
 accurate decifion will be demanded ; and leave it 
 to you, and the reft of my readers, to judge of the 
 propriety of taking, without the beft advice, even 
 this firft ftep, in the attempt to obtain a cure. 
 
 In afcertaining the quantity of blood to be taken 
 away, not only muft the fex, age, and ftrength, be 
 confidered ; but alfo the degree of violence of the 
 difeafe, and the importance of the part affefted, to 
 the ceconomy of the fyftem. The quantity being 
 determined on, it is next neceflary to afcertain, 
 
 from 
 
MEDICAL ADMONITIONS. IIjJ 
 
 from what part the blood lhall be taken. In fome 
 cafes, where it is required, to produce a confidera- 
 ble effect on the whole fyftem ; it may be taken 
 from the moft convenient part, however diftant 
 from the part affected : but where it is only necef- 
 fary to leffen the quantity of the blood, determined 
 into the difeafed part 5 topical bleedings mould 
 be employed, as near as convenient to the inflam- 
 mation. If topical bleeding be refolved on, the 
 Situation of the difeafed part, and other circum- 
 ftances, muff point out the mode j whether by 
 opening a vein, near the part, or by the applica- 
 tion of leeches, or by cupping. When it is deter- 
 mined, as to the quantity, and the mode by which 
 it is to be taken away ; it is neceffary to confider, 
 in what fpace of time, the given quantity mould 
 be obtained. In moft cafes, the evacuation mould 
 be procured in as little time as poffible ; the more 
 fpeedily the difcharge being made, the more con- 
 fiderable, in general, being the curative effects : but 
 in other cafes, if the blood be not taken away, with 
 the utmoft flownefs and caution ; a fufficient quan- 
 tity will not be obtained, to be productive of any 
 real benefit. Nor is it a matter of trifling confe- 
 quence, to afcertain whether a flight topical bleed- 
 ing may be fufflcient, for the removal of the difeafe ; 
 or whether a more large and general bleeding be 
 neceffary : for, on the one hand, if too fmall a 
 
 quantity 
 
Il6 MEDICAL ADMONITIONS, 
 
 quantity be taken, the difeafe will not be removed \ 
 and, on the other, from too large a quantity being 
 taken away, there is danger of inducing other dif- 
 eafes, more difficult of removal than the original 
 complaint. 
 
 One of the moft powerful means, next to bleed- 
 ing, of relieving the overloaded veffels, and of lef- 
 fening the difeafe, is the proper adminiftration of 
 purgative medicines : but no fmall degree of judge- 
 ment is neceffary, in determining what kind of pur- 
 gative fhould be employed ; fince, in fonie cafes, 
 thofe only mould be had recourfe to, as produce 
 the leaft irritation ; fuch as manna, neutral falts, 
 &c. whilft, in other cafes, thofe of the ftrongeil 
 kind, fuch as calomel, fcammony, jallap, &c. muft 
 be had recourfe to. This evacuation fhould not be 
 perfifted in to the fame degree, in every cafe ; and 
 there are cafes, where even greater relief will be 
 experienced, by procuring an evacuation of a dif- 
 ferent kind ; fuch as that by perfpiration, which 
 will fometimes, Indeed, be productive of more ad- 
 vantage than even bleeding itfelf. In thofe cafes, 
 where fudorifics are employed, purgative medi- 
 cines, any farther than juft to obviate coftivenefs, 
 are ibmetimes, not only unneceffary, but even in- 
 compatible with the ufe of fudorifics ; fince, by the 
 neceffary fhifting of pofture, occafioned by their 
 operation, there is a probability of giving a check 
 
 to 
 
MEDICAL ADMONITIONS. Iiy 
 
 to the flow of perfpiration ; and thereby occanon*- 
 ing, an increafe of the original complaint. 
 
 Neutral falts, vegetable acids, &c. are ufeful ; 
 fince they appear to poflefs, a power of diminifhing 
 the increafed action of the blood-veffels, and, confe- 
 quently, the impetus of the blood flowing into the 
 difeafed part. 
 
 The external applications, which may be ufefully 
 employed, in the cure of inflammation, are nume- 
 rous, and mull be varied, according to what is 
 pointed out by the different indications. Hot wa- 
 ter, plain, or impregnated with the virtue of med- 
 icinal herbs, or in the form of fleam^ will be ufeful 
 in fome cafes ; whilft, in others, not only cold 
 water, but ice itfelf, may be beneficially employed. 
 Cataplafms alfo may be necefiary j and thefe may 
 be fedative, or {Simulating ; relaxing, or conftring- 
 ing ; as the cafe may require. Sometimes, particu- 
 larly where the inflammation is deeply feated, or 
 poffeffes any of the internal parts, the ufe of blis- 
 ters becomes advifable. 
 
 You may now expecl: me to proceed, in defcrib- 
 ing the refpective cafes, alluded to ; and in laying 
 down particular rules to guide you, in the choice 
 of the feveral applications, jufl mentioned : but call 
 your eyes, once more, on the foregoing enumera- 
 tion of remedies j and then fay, whether the ufe 
 
 . of 
 
I I 8 MEDICAL ADMONITIONS. 
 
 of fuch various, and even oppofite means, mould be 
 entrufted, in cafes of fuch importance, to thofe who 
 are totally unacquainted, with the ftructure of the 
 human body, with the various powers it poueffes, 
 the energies with which it is endued, and the chan- 
 ges it undergoes by difeafe. Be affured that from 
 a want of knowledge of general principles, the moft 
 dangerous miftakes may be made, in the feleclion 
 of thefe remedies ; and that, in certain periods of 
 the difeafe, the employment of fome of thofe means, 
 which, in other ftages, might be fuccefsfully em- 
 ployed, would certainly be followed by an increafe 
 of the inflammation ; and, in many cafes, might 
 occanon an immediate termination in gangrene. 
 
 Not only is ikill required in appropriating the 
 different remedies, to the different ftag'es of the 
 difeafe ; but great nicety of judgement muft be 
 exercifed, to enable the practitioner to adapt the 
 remedy to the difeafe, whilft gliding from one 
 ftage to another j fince each may depend on a con- 
 trary ftate of the fyftem, and consequently, require 
 an oppoiite mode of treatment. Thus in the early 
 part of the difeafe, when it is poffible to carry it off 
 by refolution ; and it is fafe and expedient, to pro- 
 cure this mode of termination : cooling and difcu- 
 tient applications muft be adopted : but if refolu- 
 tion cannot be accomplifhed, emollient, and even 
 ftimulating fomentations and cataplafms, muft be 
 
 ufed, 
 
MEDICAL ADMONITIONS. 119 
 
 tiled, to procure a fpeedy fuppuration, but, as foori 
 as this procefs is completed, a change mull "again 
 take place in the treatment. Another change muft 
 follow, when the difeafe is likely to terminate in 
 gangrene ; and the nature of the applications muft 
 be determined, by the confideration, not only of 
 the circumftances then obfervable, but of thofe alfo 
 which have preceded ; both requiring to be weighed 
 in the mind, with the greateft attention. 
 
 Even the refolution, or cure of inflammation, in 
 Its firhY ftage, fhould not be attempted, without 
 fome confideration 5 fince there are often impor- 
 tant advantages to be gained, by allowing the fup'- 
 purative procefs to take place : fuch as, the remo- 
 val of fome extraneous fubftance ; the prevention 
 or removal of fome other difeafe ; the formation 
 of a critical abfcefs ; and cafes alfo occur, where 
 the means which would be required to be ufed, for 
 the removal of the inflammation, would do more 
 injury to the conftitution, than the permitting the 
 inflammation to proceed to fuppuration. 
 
 For obvious reafons, I mail not attempt to trace 
 out a plan, by which you may be enabled to under- 
 take the treatment of fo dangerous a ftate, as that 
 which accompanies gangrene. Hoping that the 
 formidable appearance which this malady aflumes, 
 will be fufEcient to deter any one from prefuming 
 
 ■ to 
 
120 MEDICAL ADMONITION*.. 
 
 to attempt its cure, unlefs pofleffed of the neceflary 
 knowledge of the animal ceconomy ; and of the 
 means, by which the morbid deviations, to which 
 it is fubject, may be corrected. 
 
 Lefs difficulty arifes, in the endeavour to lay 
 down rules for the regimen and management of 
 the patient ; as the general outline of that part of 
 his treatment, which is more particularly the prov- 
 ince o'f the nurfe and attendants, will be laid down 
 by the phyfician or furgeon. In the early part of 
 the complaint, when there exifts a probability of 
 difmifling the difeafe, by refolution ; the utmoft 
 affiduity mould be exerted, that the effects of the 
 remedies which are adminiftered, mould be fec- 
 onded, by avoiding or moderating thofe irritations, 
 which are almoft conftantly applied to the fyftem. 
 The increafe of heat, therefore, mould be -pre- 
 vented, bv allowing the free accefs of cold air into 
 the room ; but in many cafes, although it may be 
 advifable that the patient breathe the cool air, yet 
 it may not be proper, that it fhould come in con- 
 tact with the furface of the body : this is more 
 particularly the cafe, when the inflammation has 
 attacked the internal parts, as the bowels. In 
 thefe cafes, the body mould, therefore, be defended 
 from the immediate action of the cold air. But al- 
 though it be thus recommended to protect the 
 body from the cold, yet great care mould be taken 
 
 that 
 
MEDICAL ADMONITIONS. 1 2 J 
 
 that this be not done in fuch a manner, as to allow 
 the heat of the body to accumulate, except in thofe 
 cafes where it is defirable to produce an increafe of 
 perfpiration. The patient mould be kept perfectly 
 Hill, iirice, by the action of the mufcles, the motion 
 of the blood is accelerated. Great care mould be 
 alfo taken, that the aliment be of that kind, which 
 is leaft likely to irritate : confifting only of panada, 
 fago, barley-water, ripe fruits, &c. Rigoroufly a- 
 voiding all animal food, fpirits, wine, &c. even in 
 the fmalleft quantity* In thofe cafes where the dif- 
 eafe exifts, in any confiderable degree, all aliment 
 mould, at leaft for a time, be entirely abftained 
 from : the patient being, however", plentifully fup- 
 plied with drinks, of the raoft fimple and watery 
 kinds 5 as toaft and water, and mint or balm tea, 
 to each of which may be added, as much of the 
 juice of lemons or oranges, as may render them a- 
 greeable to the palate. In fome cafes, indeed, where 
 the vital powers are too much diminifhed, a more 
 generous mode of living will be directed by the 
 phyfician or furgeon : and this will be enjoined, 
 not merely where it is wiihed to bring on the ter- 
 mination by fuppuration ; but even, fometimes, in 
 thofe cafes, where the cure or refolution of inflam- 
 mation, in its firft ftage, is propofed. That the 
 power of making fo nice, and fo neceffary a dif- 
 crimination, as will be neceifary to enable an^ one 
 (^ to 
 
122 MEDICAL ADMONITIONS, 
 
 to point out the cafes, in which the one, or the 
 other, of thefe modes fhall be adopted,.is not likely 
 to fall to the lot,, at leaft, of ordinary domeftic prac- 
 titioners, muft, I think, be allowed ; and is one 
 proof of the impropriety of trufting the cure of in- 
 ilammation in fuch hands. 
 
 When the procefs of fuppuration is commenced, 
 it will be neceffary to make fome variation in the 
 patient's regimen. Broths, and even fmall quanti- 
 ties of folid animal food, may, in moft cafes, be now 
 permitted ; for the fake of fupporting the animal 
 powers, and enabling nature to accomplifh the work 
 fhe has begun. 
 
 But when gangrene is about to take place, the 
 utmoft caution is required, in determining on the 
 moft proper regimen to be adopted : for although 
 it frequently happens, that where gangrene comes 
 on, the vital powers are much exhaufted, and that, 
 of courfe, a cordial and invigorating regimen be- 
 comes neceffary : yet it fometimes is- the cafe, that 
 o-angrene is the immediate effect of violent action ; 
 a difpofition to which ftill exifting in the fyftem, 
 and rendering the ufe of ftimulating medicines and 
 diet, likely to aggravate the difeafe. 
 
 Prevention. It is neceffary, that thofe things 
 be avoided, which experience teaches us has the 
 power of producing fulnefs, and increafed action 
 
 of 
 
MEDICAL ADMONITIONS. 123 
 
 of the blood-veffels : fuch is the indulgence in full 
 meals of animal food, ftrongly feafoned dimes, fpi- 
 ceries, &c. and the abufe of fermented and fpiritu- 
 ous liquors. Animal food mould, therefore, be 
 taken in very fmall quantities ; and the meals be 
 chiefly compofed of vegetable fubftances, to which 
 variety may, in fome meafure, be given, by the dif- 
 ferent modes of preparation : nor -ihould even 
 thefe be taken in a greater quantity, than is juft 
 fufEcient to fatisfy the demands of nature. Spirits 
 muft, of neceffity, be entirely prohibited ; and wine, 
 and all fermented liquors, taken very fparingly. 
 
 Gentle exercife, which is likely, by promoting 
 the excretions, to prevent the occurrence of pletho- 
 ra, or fulnefs of blood, ihould be freely employed. 
 
 If any particular part has been once attacked by 
 inflammation, it will, for a confiderable time after, 
 be much difpofed to fuffer a return of the com- 
 plaint : to prevent this, belides adopting the advice 
 already delivered, that particular part Ihould be de- 
 fended from the partial a&ion of cold. If it be 
 fome internal part that has been thus afFeded, the 
 furrounding parts ihould be covered with flannel, 
 which ihould be worn, with its rougheft fide im- 
 mediately next to the fkin ; this will not only de- 
 fend them from the action of cold, but be produc- 
 tive of other beneficial effe&s, which, however, 
 need not be here particularifed, * Among 
 
124 MEDICAL ADMONITIONS. 
 
 Among the circumftances which ocgifion inflam- 
 mation, particularly of the internal parts, is the 
 too fudden tranfition to an atmofphere, differing 
 much, in its degree of temperature, from that to 
 which the perfon has juft before been expofed. 
 This is indeed fo frequently the caufe of danger- 
 ous difeafes, that it cannot but be beneficial to ren- 
 der it an object of attention, and to point out the 
 moft efficacious means of preventing its dangerous 
 confequences. When the body has, by any means, 
 fuch as the employment of violent exercife, or fit- 
 ting in an heated room, acquired a great degree of 
 heat, the blood, by its rarefaction, has its volume 
 enlarged ; and an increafed action in the veffels 
 takes place. If, whilft in this ftate, the body be 
 fuddenly expofed to the cold, the veffels on the fur- 
 face become conftricted, and the blood is repelled 
 into the internal parts ; where, mould any exciting 
 caufe happen to be prefent, a congeftion and inflam- 
 mation in fome of the vifcera may be the proba* 
 ble confequence. 
 
 After having been thus expofed to. the action 
 of cold, at a time when the body was heated be- 
 yond its natural ftate, the object, of endeavour 
 mould be, to regain a regular circulation of the 
 blood ; but, unfortunately, it often happens, that, 
 not only the means adapted to the indication are 
 omitted ; but that other means, which are moft 
 
 likely 
 
MEDICAL ADMONITIONS. 1 25 
 
 likely to aggravate the injury, are had recourfe 
 to : fuch is the ufe of fpirituous liquors, which, at 
 thefe times, by their ftimulus applied to the ftomach 
 and bowels, already in a ftate verging on inflamma- 
 tion, muft frequently produce thofe evils which they 
 were intended to prevent. 
 
 Another miftake is too frequently made, in hav- 
 ing recourfe to fpirkuous liquors, and heating 
 drinks, previoufly to the expofure to cold air £ 
 thefe, by their flimulus, increafe the action of the 
 blood-veffels of the vifcera, and difpofe them to run 
 into difeafed action ; when, by the application of 
 cold to the furface, immediately after, the blood is 
 driven inwards. 
 
 Having pointed out the mifchiefs likely to arife 
 from the meafures generally adopted, to prevent ill 
 confequences from the expofure to cold, whilft the 
 body is heated ; I fhall endeavour to lay before 
 you, the moft proper mode to be employed. 
 
 Suppofe, then, any one, after having been for 
 fome time in a heated room, is expofed to the 
 cold air of the evening j or that after being heat- 
 ed by walking, or other exercife, he is expofed to 
 a current of cold air, or fits for fome time in a cold 
 and damp room ; and that a confiderable chill, or 
 a fenfation of extreme coldnefs, feems to pervade 
 the whole body : in this cafe we may conclude, 
 
 that 
 
126 MEDICAL ADMONITIONS. 
 
 that only the addition of fome exciting caufe is 
 neceffary, to occafio*i inflammation of the lungs, or 
 of fome other important part ; and therefore, 
 fhould immediately proceed to endeavour, at ob- 
 taining an equable ftate of the circulation. This 
 will be beft done, by a very gradual expofure to an 
 atmofphere of a higher temperature ; gently exer- 
 cifing the body, and drinking of fome warm, weak 
 liquor, as weak wine and w r ater, gruel, or barley- 
 water, until an agreeable warmth returns. If any 
 fhivering has been experienced, it may be neceffary 
 to lay down between blankets, and drink warm, 
 diluting liquors, until a moifture is produced on 
 the fkin. Should any flight pain or uneafinefs be 
 felt, this treatment becomes the more neceffary, 
 and fhould be continued, until that fymptom no 
 longer exifts. 
 
 Nearly equal danger arifes, from too fuddenly 
 pafling out of an atmofphere of a very cold tem- 
 perature, to one of a much warmer. Impelled by 
 a defire to get rid of the difagreeable, and even 
 painful fenfations, arihng from expofure to fevere 
 cold, thofe who have been thus expofed, generally 
 feek the warmeft room, and the neareft place to 
 the fire ; and, not unfrequently it happens, that in 
 addition, to drive out the cold more completely, 
 fpirituous and other heating liquors are alfo had re- 
 
 courfe 
 
MEDICAL ADMONITIONS. I2J 
 
 courfe to. Should a chillinefs continue after this 3 
 the fire is increafed, and a more free potation of 
 fome fpirituous liquor is indulged in. By this con- 
 duel, inflammation of the bowels, ftomach, or lungs, 
 is frequently occaiioned ; and, indeed, it is feldom 
 that it is adopted, with entire impunity ; fince a 
 catarrh, or, as it is commonly called, a cold, moft 
 commonly, at leaft, fucceeds. 
 
 As to procure a compliance with advice, it is 
 neceffary to fhew the reafons on which that aclvice 
 is founded j I muft inform you, that after expo- 
 fure to the cold air, efpecially for any confiderable 
 length of time, the body is in a ftate moft highly 
 fufceptible of injury from the application of heat. 
 This takes place on the fame principle, that when 
 the eyes have been fecluded fome time from the 
 light, they will, on its being again admitted, be 
 ftruck by the appearance of extraordinary fplen- 
 dour ; and, that the hand will be more fenfibly af- 
 fected, on Being plunged into a veffel of warm 
 water, if it have been previoufly held in cold 
 water, or fnow. 
 
 A very little confideration will be fufficient to 
 convince you, that, during this ftate of the fyftem, 
 the expofure to fuch powerful ftimulants, as the 
 heat of a large fire and ftrong drinks , muft be 
 highly dangerous i and that, after expofure to fe- 
 
 vere 
 
128 MEDICAL ADMONITIONS. 
 
 vere cold, it is beft to pcrfift, for a little time, in 
 fome gentle exercife ; to approach the fire very 
 gradually, and to drink only of fome diluting^ 
 weak drink, fuch as tea, barley-water, milk and 
 water, &c. always remembering, that, when the 
 body has been either chilled, or much heated, that 
 it be brought back to its natural warmth by degrees. 
 
 I cannot here refrain from recommending to 
 your attention, an excellent little pamphlet, by 
 Dr. Beddoes, entitled, A Guide for Self-Preferva- 
 tion ; and I doubt not, but on perufing it, you will 
 join with me in wifliing for its general circulation ; 
 efpecially among the poor, for whom, by its price, 
 and by the ftyle in which it is written, it is evident 
 that it is benevolently intended. 
 
 Of fo much real importance is it to flop the 
 career of inflammation, at its very outfet, that I 
 earneftly requeft you, in every cafe in which pain oc* 
 curs with fever •, to obtain immediately the beft advice : 
 remembering, that if inflammation be fuffered to 
 proceed a certain length, although not fo far as to 
 endanger the patient's life ; it is very probable, 
 that it may be productive of very ferious incon- 
 veniences, which he may be obliged to fuffer the 
 remainder of his life. 
 
 INFLAMMATION 
 
MEDICAL ADMONITIONS. 129 
 
 Inflammation of the brain. 
 
 In this difeafe, there exifts a very confiderabk 
 degree of fever, a violent and deep-feated pain in 
 the head, a fulnefs of the vefffels and rednefs of the 
 face, and of the eyes : with exceffive dry fkin, and 
 parched tongue. The patient obtains no fleep, is 
 very much affected by the leaft noife, or the admif- 
 lion of light into the bed-room ; and, generally, a 
 Very high and furious delirium occurs. This dif- 
 eafe foon runs through its courfe ; and, if proper 
 means are not. had recotirfe to very early, the pa- 
 tient will be loft within a very few days. 
 
 Whatever irritates the membranes invefting the 
 brain, or ftimulates the fubftance of the brain itfelf, 
 may become an exciting caufe of inflammation of 
 the brain : among thefe caufes, the inoft frequent 
 are, external injuries, the drinking of large quan- 
 tities of fpirituous liquors, violent exertions of the 
 mind, and the expofure of the bare head to the 
 ardent rays of the fun* 
 
 Large and repeated bleedings, cathartics', and 
 blifters, with the other remedies enumerated in 
 the fection of general inflammation, will be em- 
 ployed by the phyfician in this dreadful difeafe. 
 The regimen will, at the fame time, be ordered to 
 be as fpare as pofiible. 
 
 R Te 
 
130 MEDICAL ADMONITION?. 
 
 To enlarge on the means of cure adapted to this 
 difeafe, and on the management of the patient, 
 would be to engage the reader's time, without a 
 poffibility of yielding him any ufeful information : 
 fince, in a difeafe which is fo rapid in its progrefs, 
 and is fo frequently fatal in its termination, no 
 confideration whatever, mould induce any one to 
 attempt its cure, unlefs he poffeffes real medical 
 knowledge. Befides, fome of the fymptoms of 
 this difeafe, are frequently to be met with, accom- 
 panied by circumftances of fo ambiguous a nature ; 
 that, unlefs the obferver has difcernment fufficient 
 to enable him to mark the real ftate of the fyftem, 
 his well intended exertions may foon deflroy his 
 Unfortunate patient. 
 
 Thofe, whofe nervous fyftems have been debil- 
 itated, and whofe conftitutions have been impaired, 
 by the frequent ufe of fpirituous liquors, are very 
 fubjecl to be attacked with a fever, which is accom- 
 panied with a delirium, fimilar to that which has 
 been juft defcribed : the fever beginning its attack, 
 with fymptoms, which feern to point it out to be 
 of an inflammatory kind : but the exceflive debility 
 which, in general, takes place in a day or two, 
 plainly fhews ; that the adopting, in this cafe, the 
 profufe evacuations required in the true and fimple 
 inflammation of the brain, muft be fucceeded by 
 the deftruction of the patient. 
 
 INFLAMMATION 
 
MEDICAL ADMONITIONS. l$l 
 
 INFLAMMATION OF THE EYE. 
 
 This difeafe begins with a flight rednefs of that 
 part, which is termed the white of the eye ; as this 
 gradually increafes, the eye becomes hot, feeling 
 as though particles of duft were on its furface. 
 The eye-lids fwell, and the admifiion of light to 
 the eye is accompanied with great inconvenience. 
 Tears flow from the eyes in conflderable quantity, 
 almoft fcalding the cheeks as they trickle down. 
 
 By the ufe of well adapted remedies, at, and be» 
 fore this period of the difeafe, a refolution of the 
 "inflammation will generally be procured. 
 
 But when the difeafe is neglected, or not oppofed 
 by means fufficiently powerful j the rednefs increafes 
 to fuch a degree, that the part of the eye which 
 was before white, becomes of an uniform crimfon 
 colour : the blood-veflels being fo diftended, that 
 the furface becomes rough and irregular ; and fo 
 much elevated, that the cornea, or tranfparent 
 membrane, on the fore part of the eye, appears to 
 be funk. The pain extends to the bottom of the 
 eye ; and conflderable pain is alfo felt in the head. 
 When the difeafe has proceeded thus far, it feldom 
 goes off without leaving a fpeck on the cornea, 
 which fometimes deprives the patient of his fight : 
 
 fometimes, 
 
1^2 MEDICAL ADMONITIONS. 
 
 fometimes, alio, a fuppuration takes place in the 
 eye itfelf, which is fucceeded by total blindnefs ; 
 the eye, in fome cafes, finking in the focket ; and, 
 in others, being fo enlarged, as not to be contained 
 within the eye-lids. 
 
 The occafional caufes of this difeafe may be, 
 external violence, applied to the eye-lid, or the eye 
 itfelf. Extraneous bodies under the eye-lids ; fuch 
 as particles of dufl, or fand ; acrid fluids, or vapours, 
 &c. Expofure of the eyes to a ftrong light, and 
 much exercife of the eyes in viewing minute objects, 
 Inflammation of the eyes may alfo be the confe- 
 quence of morbid acrimony, exifting in the fyftem : 
 it may likewife accompany other difeafes of the 
 eyes, and of the neighbouring parts j fuch as the 
 turning inwards of the eye-lids ; ftithes, or ftyes, 
 which grow on the eye-lids, and which may be 
 either encyfted, fcirrhous, or w r arty ; tetters, and 
 ulcerations on the edge of the eye-lid j and a great 
 number of other difeafes, which it is unneceffary 
 to enumerate here. 
 
 When this difeafe is fimple, in no very confid- 
 erable degree, and the exciting caufe no longer 
 exifting, attempts for its cure may be made, by 
 applying leeches to the temple, on the fame fide 
 with the affected eye, in a number proportioned 
 tq the age and ftrength of the patient ; a blifter 
 
 may 
 
MEDICAL ADMONITIONS, 13^ 
 
 xnay be applied on the temple, after the bleeding- 
 has ceafed, and a briik purgative alfo be given, ufing 
 for a lotion fimple rofe- water, or about four grains 
 of white vitriol, dilTolved in two ounces of rofe or 
 elder flower water. 
 
 The defending of the eyes from the light, is a 
 eircumftance of no fmall importance ; the follow- 
 ing obiervatiqn, therefore, mould be carefully at- 
 tended to. The difeafed eye, however clofely 
 fecluded from light, will always be injured by th« 
 action of light on the found eye ; fince each eye 
 will fympathife with the other, in all its motions. 
 The patient mould, therefore, confine himfelf to a 
 dark room ; as he need not then keep oiF the cold 
 air, by thofe means which he mull otherwife ufe 
 for excluding the light. Should the difeafe not be 
 conliderably diminimed, by the ufe of thefe means, 
 application for regular afiiftance mould be imme- 
 diately made : fince we may now conclude, the 
 difeafe is fo obftinate, that mould time be wafted 
 f)y the employment of unmccefsful meafures, or 
 mould the family practitioner be led unfortunately 
 to adopt flronger means, there will be danger, that 
 his temerity may be punifhed by the poignant 
 reflection, that, by his well meant interference, he 
 has deprived his unfortunate patient of fight. The 
 alarm, which undoubtedly I mean to excite here, 
 will not, I am confident, be efteemed unnecefTary ; 
 
 when 
 
134 MEDICAL ADMONITIONS. 
 
 when the delicacy and - importance <ff the affected 
 organ, the numerous intricate caufes on which the 
 diieafe may depend, and the mocking manner in 
 which it may terminate, be attentively confidered. 
 
 The divifion of the inflammation into external 
 and internal, is of confiderable importance to be 
 attended to in this place. From an inability to 
 make a diftinclaon between thefe, arifes the greateft 
 danger of the uninformed practitioner occahoning 
 total blindnefs to his patient : fince the inflamma- 
 tion of the deeper feated parts of the eye may occur, 
 without the appearance of fuch external figns, as 
 will point out to him the great danger which 
 exifts. Means, therefore, may be adopted, propor- 
 tioned only to the external appearances ; and the 
 fight, be irretrievably loft, in a very few hours. 
 
 I am aware, that you will think, I ought to have 
 particularifed a few other lotions, on the fuppofi r 
 tion, that the lotion I have mentioned above mould 
 not prove ufeful. Jkit as the difference of irrita- 
 bility of the eye, in various cafes ; and the different 
 degrees of the difeafe, mint determine the ftrength, 
 and the nature of thefe applications ; it would be 
 unfafe to offer any more definitive directions, than 
 that care mould be taken, that none be ufed of fuch 
 ftrength, as to occafion any increafe of pain. It is 
 true, that fome very celebrated furgeons, recom- 
 mend 
 
MEDIAL ADMONITIONS. ' 135 
 
 mend the ufe of fuch remedies as occasion, for a 
 time a very coniiderable augmentation of the pain : 
 but applications of this kind muft be ufed, with 
 the greateft circumfpe&ion ; lince, mould they fail 
 of their wifhed for effect, they cannot but be likely 
 to increafe the complaint.* There are few families 
 who do not poffefs fome lotion for the eyes, which 
 they recommend, as adapted for almoft every di£ 
 eafe, to which the eyes are fubjeft : but certainly* 
 when the various caufes of this difeafe, and the 
 vaft number of its fpecies and varieties, are con- 
 fidered, as well as the many affections of the fyftem 
 with which it may be intimately conne&ed ; every 
 one muft be fatisned, that there is no one remedy 
 whatever, which can be had recourfe to indifcrim- 
 inately, in all thofe cafes, without frequently pro- 
 ducing confiderable mifchiefs* 
 
 Even in thofe cafes, which are not diftinguiihedi 
 by any alarming fymptoms 5 and in which the piai- 
 dence of the family practitioner, induces him to 
 
 make 
 
 * Mr. Ware, in his ingenious publication, on the Difeafes of 
 the Eye, recommends the dropping of the Thebaic tincture into 
 the inflamed eye. In the hands of this gentleman, and of many 
 other furgeons, this has proved a very powerful remedy : but 
 when ufed by thofe who are not able to make the neceffary di£ 
 crimination, between fuch cafes in which it may be ufed with 
 benefit, and others in which it may prove injurious, very ill 
 confequences may be produced. 
 
t$6 MEDICAL ADMONiffcONS. 
 
 make ufe of only the mildeft applications, ill con- 
 fluences may be produced by domeftic tamper- 
 ings : fdr frequently, when the difeafe, though 
 &ot violent, does not yield to the endeavours which 
 are made, the veflels, from the mere duration of 
 the inflammation, lofe their tone ; and hence is 
 produced an additional caufe of the continuance of 
 the difeafe, and that in one of its moil obfiinate 
 ftates. 
 
 In many cafes, the difeafe is fupported by an af- 
 fection of the whole fyftem, the nature of which 
 may be with difficulty difcovered ; but until this 
 be done, and the fault of the habit corrected, no 
 topical applications can be of arty fervice. 
 
 Newly born, and very young children, are fubject 
 to a fpecies of inflammation of the eyes, which ve- 
 ry frequently, for w T ant of proper and timely help* 
 produces blindnefs. It begins with rednefs and 
 fwelling of the eye-lids ; the fwelling foon becomes 
 fo confiderable ? that the eye can hardly be feen, 
 even when force is made ufe of for their feparation. 
 This is foon fucceeded, by the formation of a very 
 confiderable quantity of a thick yellow matter, 
 which is diffufed between the eye and eye-lids ; and 
 which oozes out very freely, on the leaft preflure. 
 This difeafe will oftentimes, if proper means are 
 not timely ufed, continue a confiderable time j the 
 
 eye-lids 
 
MEDICAL ADMONITIONS. 1 §j 
 
 eye-lids remaining fo fwelled, for many days, that 
 the real flate of the eyes cannot be difcovered : and 
 frequently it happens, upon the fubfiding of the 
 fwelling, that the diftrefled parents difcover, too 
 late, that, in confequence of their neglect, or im- 
 prudence, their unfortunate child is irremediably 
 blinded. From that wonderful infatuation, by 
 which the difeafes of children are delivered over to 
 the management of ah ignorant nurfe, this melan- 
 choly cataftrophe, in general, proceeds, Thofe' 
 who have the opportunity of making the obferva- 
 tion, know, that even among the middling clafs of 
 people, application for regular aid is very feldoni 
 made, even in this dreadful malady, until the difeafe 
 is fo far advanced, as to render a melancholy ter- 
 mination moll probable. 
 
 You will not wonder, that I dare not prefume 
 to recommend any plan for general adoption, in 
 fo diilrefsful a cafe ; indeed the oiily advice that 
 can be given, in fuch a work as this, is to make the 
 earlieft application to fome experienced furgeon^ 
 and to pay the moil implicit attention to his di- 
 rections. 
 
 As to the prevention of inflammation of the eyes> 
 
 the following cautions may be ufeful. When the 
 
 eyes are difpofed to be eafily inflamed, a long and 
 
 earneft exercife of them ihould be carefully avoided. 
 
 ' S Caution 
 
138 MEDICAL ADMONITIONS* 
 
 Caution mould be ufed, not only in viewing highltr 
 illuminated and vivid objects as little as poflible ; 
 but even long poring on duller objects, fhould be 
 avoided. Acrid fumes and vapours are very hurt- 
 ful ; and perhaps few more fo, than the fmoke of 
 tobacco. Difcharges, to which the conftitution 
 has been long accuftomed, mould not be unadvis- 
 edly fuppreffed ; and where there is evidence of the 
 exiflence of any particular acrimony in the fyftem, 
 that mould be corrected ; and until that is accom- 
 plifhed, a purulent difcharge mould be obtained 
 from behind the ears, the pole of the neck, or 
 from fome part, as near as can be conveniently had 
 to the head. 
 
 THE QUINSEY, or SORE THROAT. 
 
 Of this troublefome, and fometiines dangerous 
 complaint, there are five diftinct fpecies ; which 
 often require a considerable degree of penetration 
 and experience in the obferver, to enable him to 
 afcertain the nature of the difeafe, or the part in 
 which it is fituated ; both which circumftances are 
 abfolutely necenary to be known, before any 
 attempts are made for the cure. 
 
 INFLAMMATION 
 
MEDICAL ADMONITIONS, I39 
 
 INFLAMMATION OF THE TONSILS, 
 
 OR THE 
 
 INFLAMMATORY SORE THROAT. 
 
 At the poftcrior part of the infide of the mouth, 
 may be perceived two round glandular fubftances £ 
 which are termed, the tonfils : between thefe is ex- 
 tended a membranous fubftance, called the veil of 
 the palate, from the middle of which is fufpended 
 the uvula, a flefhy fubftance, in general about half 
 an inch in length ; but varying much in ftze in 
 different perfons, and in the fame perfons, at dif- 
 ferent times. In thefe parts, is this difeafe in gen- 
 eral feated ; and is difcoverable by the exiftence of 
 fever, with rednefs, fwelling, pain, and a fenfe of 
 tightnefs in thofe parts, accompanied by a difficulty 
 in performing the action of fwallowing. 
 
 The commencement of this difeafe is, in general, 
 marked with a fliivering, and is fucceeded by febrile 
 heat j as this heat increafes, the fkin becomes dry 
 and parched ; and the pulfe becomes quicker and 
 flronger than natural. Soon after, or imme- 
 diately at the coming on of thefe fymptoms, an 
 uneafy fenfation is felt in the throat, with a diffi- 
 culty of fwallowing. A confiderable flow of'vifcid 
 faliva takes place ; which, from the uneafinefs pro- 
 duced by the attempts to fwallow it, is fuffered to 
 accumulate in the mouth j occafioning no fmall 
 
 inconvenience 
 
I40 MEDICAL ADMONITIONS. 
 
 inconvenience to the patient. When the difeaie 
 exifts in a high degree, the power of fwallowing is 
 almoft loft j the liquids, which the fuffering patient 
 attempts to force down, being thrown back from 
 the mouth, or, in confequence of a drop falling into 
 the windpipe, is thrown out with violence, both 
 at the mouth and noftrils. 
 
 This difeafe generally terminates, either by refo- 
 lution, or fuppuration ; gangrene hardly ever tak- 
 ing place. 
 
 Among the caufes of this difeafe, may be men* 
 tioned the expofure to violent degrees of heat or 
 cold ; particularly the fudden expofure of the body* 
 when much heated, to exceflive cold, or the partial 
 application of a ftream of cold air ; indulgence in 
 fpirituous liquors, and highly feafoned dimes ; eat- 
 ing heartily of animal food, without a due mix- 
 ture of vegetables j &c< 
 
 Thofe who arc moft liable to this difeafe, are the 
 middle aged, and thofe of a full habit. It is moft 
 frequently to be obferved, in thofe feafons, when 
 vicifiitudes of heat and cold chiefly occur. The 
 having once been affected with this difeafe, leaves 
 a ftrong difpofition to future attacks, 
 
 For the removal of this difeafe, evacuations, by- 
 Heeding and cathartics, mult be adopted j and other 
 
 cooling 
 
MEDICAL ADMONITIONS, 144 
 
 cooling means rauft alfo be employed. The extent^ 
 to which thefe are to be ufed, is only to be after- 
 tained, when a judgment is formed of the degree 
 to which the impending difeafe might be likely to 
 attain. Of this, a fkilful phyfician will, in general, 
 be able, by a careful attention to the particular ap- 
 pearances of the difeafed parts, the ftate of the pulfe 9 
 the temperament of the patient, &c. to make a con- 
 jecture fufficiently near the truth to enable him, 
 if called in on the firft hours of the difeafe, to dif- 
 perfe the inflammation, without any evil confe- 
 quences. Since it is obvious, that to do this s 
 requires both penetration and fkill, few furely will 
 be found hardy enough to make this attempt, with- 
 out poffeffing thefe indifpenfible requifites. 
 
 If another argument were neceffary againft do-* 
 meftic practice in this difeafe, it is to be found in 
 the difficulty which the unexperienced muft find in 
 always afcertaining the nature of the difeafe ; thus 
 an appearance will frequently take place, which 
 might induce any one, who is not accuftomed to 
 obferve the difeafe, to fuppofe it of the ulcerated 
 kind. ■ The appearance alluded to, is produced by 
 feveral little openings or pits in the tonlils, which 
 being filled with mucus, are very likely to be mif- 
 taken for incipient ulcerations. A miftake pro- 
 duced by this circumitance, would be of a very 
 
 ferious 
 
142 MEDICAL ADMONITIONS. 
 
 ferious nature ; fince it muft lead to a mode of 
 treatment oppofite to that which is really indicated. 
 
 Confiderable diftrefs is fometimes occafioned, by 
 the inflammation fuddenly quitting the throat, and 
 attacking fome important part, frequently the lungs. 
 Much circumfpection and attention is neceflary, in 
 this cafe, even from the moft experienced ; and 
 the domeftic practitioner mould be appriled, that 
 the greateft danger may follow this change, if not 
 difcovered fufficiently foon to allow the early em- 
 ployment of the neceffary means. 
 
 With refpecl to the regimen of the patient, it 
 muft be of the moil cooling and diluting kind. 
 Barley-water, rendered agreeable to the palate by 
 the addition of black or red currant jelly j linfeed 
 tea, fweetened with honey, &c. may be ufed for 
 common drinks : but the directions of fome one, 
 who is well verfed in the nature of the difeafe, will 
 be needed, for particular directions in this refpecl ; 
 fince the regimen which is proper, whilft there are 
 hopes of difcufling the inflammation, may require 
 to be altered, when fuppuration appears to be about 
 to take place. 
 
 The patient is, in a great meafure, obliged, by 
 the inconveniences he fuftains, to breathe with his 
 lips open j in confequence of which, the moifture 
 
 evaporating 
 
MEDICAL ADMONITIONS. 143 
 
 evaporating from the inflamed furface, leaves it 
 parched and dry j a ftate favourable neither to di& 
 cuffion nor fuppuration : to remedy this, he mould 
 conftantly hold fome fluid in his mouth. Although 
 attempts to fwallow are accompanied with confide 
 erable pain, he fhould frequently get down fome 
 lubricating drink ; remembering, that the pain con- 
 fequent to fwallowing is produced, not fo much by 
 the paffage of the liquid which is fwallowed, but 
 by that action of the inflamed parts, by which 
 deglutition is performed : hence as much pain is* 
 in general, produced by fwallowing a tea-fpconfui 
 of any liquid, or even the faliva, which fo con-* 
 ftantly demands deglutition, as would be occa- 
 fioned by fwallowing a much greater quantity $ 
 wherefore the patient fhould, by trials, difcover 
 nearly the quantity which can be thrown down at 
 each exertion, and then never make the attempt 
 with a lefs quantity. 
 
 Gargles are frequently of the greateft ufe in this 
 complaint ; but the ingredients, of which they are 
 eompofed, mlift be pointed out by the degree and 
 ftate of the difeafe. 
 
 Bathing the feet in warm water, oftentimes 
 gives great relief, when the fwallowing is difficult. 
 Similar benefit has been experienced from the fteam 
 of warm water, received in the mouth, through a 
 funnel, or fome proper apparatus, External 
 
144 MEDICAL ADMONITIONS. 
 
 External applications are frequently of the great= 
 eft fervice. In the advanced ftage of the difeafe, 
 emollient cataplafms applied to the neck and under 
 the ears, contribute much to the relief of the 
 patient. But the moft evident advantages, refult- 
 ing from the ufe of external remedies, are thofe 
 which are produced by the ufe of flimulating appli- 
 cations, fuch as hartfhorn and oil, cataplafms of 
 oatmeal and flour of muflard, blifters, &c. applied 
 to the neck, when the patient firft difcovers any 
 uneafinefs in the throat ; for frequently, as foon as 
 thefe applications have excited a heat and rednefs 
 externally, the internal inflammation will begin to 
 leiTen. 
 
 For the prevention of this difeafe, the directions 
 fhould be adverted to, which have been already 
 given, when treating of inflammation in general 5 
 particularly attending t6 the admonition, of defend- 
 ing the external furface over the part which is dif- 
 pofed to inflammation, by additional covering ; and 
 with fuch fubflances neareft to the Ikin, as may, by 
 gently irritating it, promote the a&ion of the vef- 
 Jfels on the furface. 
 
 THE 
 
MiiCicAL admonitions, 145 
 
 tfffi tUf RID OR MALIGNANT ULCER- 
 ATED SORE THROATi 
 
 In this difeafe, the tenuis, and att the internal 
 fauces, are affe&ed with rednefs, fwelling, and gan- 
 grenous ulcers, producing a difficulty, both in fwal- 
 lowing and breathing, accompanied by a fever of 
 the putrid kind* 
 
 This difeafe begins, in general, With frequent 
 chills and fhiverings, exceffive languor, depreffion 
 of fpirits, with continual naufea, and frequent urg- 
 ings to vomit. Thefe are fucceeded by a febrile 
 ftate, in which the pulfe is quicker and fmaller than 
 natural : at the fame time, the patient becomes 
 fenfible of a ftiffnefs of the neck, with a roiighnefs 
 and heat in the throat, refeifoblihg the fehfation 
 produced by the application of pepper; Soon after- 
 wards, a fearlet eruption is thrown out on the Ikin* 
 firft on the face and neck, and then over the whole 
 body 1 hd extremities. The back part of the infide 
 Of the mOuth, the uvula, tonfils, &c. upon infpee* 
 Hon, appear red, and a little fwelled, and then fev- 
 eral fpots appear on the parts juft mentioned, of a 
 grey or afh colour ; the voice becomes particularly 
 hoarfe and rough, and the pulfe quicker and fmaller* 
 As the fever increafes, thefe fpots extend themfdves * 
 in proportion to the violence of the difeafe 5 fre- 
 quently fpreading and running one into the other, 
 T with 
 
I46 MEDICAL ADMONITIONS. 
 
 with the utmoft rapidity, the debility becoming 
 exceflive, and a continual difcharge of a thin acrid 
 humour taking place from the nofe and mouth, 
 corroding both the lips and noftrils. As the dif- 
 eafe proceeds, the greyifh crufts are difcovered to 
 be deep gangrenous floughs, beneath which the 
 parts are undermined to a vail extent ; the breath 
 becomes exceedingly offenfive, and the difeafe foon 
 increafes to fuch a degree, unlefs happily oppofed 
 by fuccefsful means, as to carry off the patient, 
 fometimes within the third day of the difeafe. 
 
 From this flight Iketch, the domeftic practitioner 
 niuft be apprifed of the malignity of this difeafe, 
 and the rapidity of its progrefs ; and he may alfo 
 be auured, that he will not always be able to dif- 
 tinguifli it, at its firft attack, even from the inflam- 
 matory fore throat, juft defcribed 3 it fometimes 
 requiring a very careful inveftigation, before the 
 real nature of the difeafe can be afcertained. A 
 miftake here would not only occafion an omiflion 
 of the proper remedies, but the employment of 
 fuch means, as mud neceflarily very much expe- 
 dite a fatal termination of the difeafe. For the 
 evacuations which would be requifite in the cure 
 of the inflammatory fore throat, cannot fail but fo 
 to reduce the patient, if employed in this difeafe, 
 that no fubfequent endeavours might be fuflicient 
 $0 fave him. The operation of a fmart dofe of 
 
 phyfic 
 
MEDICAL ADMONITIONS. I47 
 
 phyfic would be fometimes fufficient to fink a 
 patient irrecoverably. 
 
 The endeavours of the phylician will be, to fup- 
 port the ftrength of the patient, oppofe the feptic 
 tendency of the whole fyftem, and leffen the effects 
 of the acrid matter poured out upon the fauces. 
 In accomplifhing thefe intentions, the phylician 
 muft depend on the affiduity and zeal of the attend- 
 ants : if their exertions are not regular and unre- 
 mitting, his efforts will be in vain. Medicine will 
 prove but of little efficacy, if the animal powers are 
 not fupported by proper nourifhment : the attend- 
 ants muft, therefore, conftantly fupply the patient 
 with fago, falop, panada, &c. to which muft be 
 added, fuch wine as may be moft agreeable to . his 
 palate. Red port made into negus, may be alfo 
 given freely : ripe acid fruits, and fermenting 
 liquors, as bottled cyder, perry, champaigne, &c. 
 mould conftitute part of the patient's drink. . But 
 previoufly to the fwallowing of nutriment, anti- 
 feptic gargles and injections mould be very fedu- 
 loufly employed, for clearing away the fharp and 
 and feptic humour from the mouth and throat, to 
 prevent, as much as poffible, its being fwallowed ; 
 fince from the efcape of it into the alimentary canal, 
 a moft troublefome and dangerous diarrhaea fre- 
 quently occurs towards the clofe of the complaint. 
 It is impoflible to be more explicit here refpedting 
 
 diet, 
 
I48 MEDICAL ADMONITIONS, 
 
 diet, as this muft fo much depend on the ftate of 
 the patient, the period of the difeafe, and the con- 
 dition of the ftomach, as to require it to be par- 
 ticularly pointed out, after a careful confideration 
 of thefe circumftances. 
 
 The patient mould be fo placed in his bed, that 
 the difeharge may run freely out at the corners of 
 the mouth ; great attention muft alfo be paid to 
 the cleanlinefs of his clothing, and the ventilation 
 of his apartment. 
 
 When it falls to the lot of a tender parent, to 
 yiew the progrefs of this difeafe in a darling child, 
 the fcene is truly diftrefling. For too often here, 
 from an ill judged tendernefs, the parent will not 
 fufFer the ravages of this horrid malady to be 
 checked, from a repugnance to increafe his tem- 
 porary fufferings. It is true, that almoft all the 
 means that are indicated, in fome meafure do this ; 
 for in fuch a ftate of the fauces, to fwallow the 
 mod bland fluid fubftance muft give pain, and this 
 muft neceffarily be excited in a greater degree, by 
 forcing the patient to fubmit to warn the throat 
 with antifeptic gargles, and to fwallow {harp acid 
 liquors, and unpalatable medicines. But for the 
 fake of preventing this mifapplication of tender- 
 nefs, it fhould be confidered, that although for the 
 time the pain is augmented, yet in confequence of 
 
 th£ 
 
MEDICAL ADMONITIONS, $49 
 
 the fymptoms being moderated by this mode o£ 
 treatment, the quantity of pain muft on the whole 
 be thereby much leflened ; befides the grand and 
 important end of faving life being alfo probably 
 anfwered. And furely, although the principle is. 
 fo often acted on, no parent will avow a right of 
 rifquing the life of a child, for the indulgence of 
 his own lympathetic feelings* The reflection, that 
 he has, by his interpolition, leffened his fufferings, 
 but, at the fame time, haftened, or even occalioned 
 his death, is widely different from the rapturous 
 ideas of him, who, with an almoft rent heart, has 
 allowed or even prompted, that to be done, which, 
 painful at the moment to fuffer, did, in the end, 
 alleviate the fufferings of his child, and reftore him 
 to his cardies. 
 
 In no difeafe more than this, is there required fo 
 implicit a confidence in the phyfician, and, of courfe, 
 fo exact a compliance with all his directions ; lince 
 the moft trifling omiflion may occafion the death 
 of the patient, , 
 
 THE CROUP, OR QUINSY OF THE TRA- 
 CHEA OR WINDPIPE. 
 
 The exquifite degree of danger, which always 
 accompanies this difeafe, the rapidity with which 
 its fymptoms proceed, and the probability of its 
 
 efcaping 
 
150 MEDICAL ADMONITIONS. 
 
 efcaping a fufficiently early detection, will induce 
 me to be rather diffufe in its defcription j hoping, 
 that parents may thereby be enabled to difcover it, 
 immediately on its appearance, and be induced to 
 apply for medical aid in the firft moments of the 
 difeafe. 
 
 The unfortunate fubje&s of this malady are, 
 almoft always, children under twelve years of age. 
 The attack is, in general, preceded by fymptoms 
 refembling thofe of a common cold j "but fome- 
 times it comes on fuddenly, beginning with a flight 
 forenefs of the throat, a hoarfenefs, or rather a 
 peculiar ringing found in fpeaking, a fhrill barking 
 cough, and a remarkable wheezing which accom- 
 panies the refpiration. Both infpiration and expi- 
 ration are performed in a much longer time than 
 is natural, and evidently with difficulty ; and when 
 the child coughs, which is rather frequent, and in 
 redoubled fits, the face is much fwelled and nufhed, 
 and the child is violently agitated. At the begin- 
 ning, the cough produces little or no expe&oration. 
 Upon prefling with the finger on the neck, imme- 
 diately oppofite to the windpipe, the uneafmefs of 
 the child is evidently increafed. There is, in gen- 
 eral, little or no difficulty in fwallowing, nor any 
 appearance of inflammation upon infpecling the 
 fauces. As the difeafe increafes, the pulfe quickens, 
 the heat augments, and an exccflive reftleflhefs takes 
 
 place. 
 
MEDICAL ADMONITIONS. I£I 
 
 place. This reftlefmefs foon increafes to fuch a de- 
 gree, that the patient cannot be retained many mo- 
 ments in the fame pofture ; the breathing becomes 
 more and more difficult and laborious, and the pe- 
 culiar wheezing founds which accompanies it fo in* 
 creafes, as to be heard at a confiderable diftance. 
 The cough alfo increafes in frequency, and, at the 
 fame time, in the violence of its efforts, by which 
 are brought away fmall quantities of a matter of a 
 purulent appearance, and portions Gf a white tubular 
 membranous fubftance. The fymptoms continue 
 to increafe in violence, until a fpafm of the mufcles 
 of the parts taking place, the patient is fuffocated ; 
 the djfeafe often completing its courfe in the fpace 
 of three or four days and nights. 
 
 By the diffe&ions of thofe who have been de- 
 ftroyed by this difeafe, the caufe of thefe various 
 fymptoms is rendered very evident. A preterna- 
 tural membrane having been found to line the 
 whole inner furface. of the trachea, in fome parts 
 adhering to it, and in others a little feparated from 
 it ; a matter refembling pus appearing to be inter- 
 pofed between the trachea and its morbid coverings 
 and fometimes the preternatural membrane and 
 the above-mentioned pus like matter is found, not 
 only to cover the whole inner furface of the tracheay 
 but even to reach into the bronchia, 
 
 On 
 
tj2 MEDICAL ADMONITIONS. 
 
 On the firft appearance of thofe fymptoms whicli 
 tnark the exiftence of this difeafe, immediate appli- 
 cation fhould be made for medical affiftance, and 
 not a moment fhould be wafted* before the propo- 
 fed remedies mould be tried. 
 
 But fince it may fometimes happen, that medical 
 advice cannot be immediately procured, by an at- 
 tention to the following directions the difeafe may 
 be checked in its progrefs, if not entirely removed. 
 As foon as the difeafe is difcovered, from three to 
 fix leeches, according to the age and ftrength of 
 the patient, may be applied to the upper and fore 
 part of the neck, and the bleeding promoted by the 
 application of clothes wrung out of warm water. 
 As foon as the leeches fall off and before the bleed- 
 ing has ceafed, the patient may be laid between the 
 blankets, and fupplied with warm barley water to 
 excite fweating, the front of the neck being covered 
 with a blifter. In performing thefe various opera- 
 tions, fo much time muft elapfe, as to afford a fuf- 
 ficient opportunity of obtaining proper medical 
 attendance j and as the fubfequent treatment 
 muft depend on the effecl:s produced, by the means 
 which have been already employed, it would not 
 be proper here to proceed in an account of the 
 mode of treatment, which can only be dire&ed by 
 the attending phyfician. 
 
MEDICAL ADMONITIONS. - IJ3 
 
 A deep, hard-founding cough, almoft exactly 
 refembling the cough in the croup, fometimes 
 occurs in children, but without any of the other 
 chara&eriftic fymptoms of this difeafe. In thefe 
 cafes, the ordinary demulcent remedies, in general, 
 foon fucceed in removing the cough. Dr. Ferriar^ 
 of Manchefter, obferves, that, *the diftin&ions 
 between this fpurious croup and the genuine 
 difeafe are only to be learned, from much atten- 
 tion to the different cafes of the difeafe ; for the 
 found of the cough is fo fimilar in both, as to 
 infpire even the moft experienced with fome de- 
 gree of doubt. I have fat by the child's bed-fide: 
 repeatedly, watching for the moment Of danger, 
 while the cough was increafing in violence ; and 
 have been only undeceived, by finding that no 
 tremor or palpitation came on towards midnight, 
 that the reftlefsnefs abated, and that fleep feemed 
 to become more compofed." The fpurious difeafe* 
 feems to be unaccompanied with inflammation 5 
 but the genuine croup has been clearly proved to 
 be an highly inflammatory difeafe, by repeated dif- 
 fe&ions. And here trufting that you will excufe 
 the digreihon, I will offer a few words, with the 
 hope of leffening the too general repugnance of 
 relatives to the examination of thofe, who have 
 fallen victims to any ambiguous difeafe. 
 
 Some of the moll learned arid pblifhed nations 
 U have 
 
1 54 MEDICAL ADMONITIONS. 
 
 have coniidered the procefs of opening the body* 
 and embalming it, as a mark of refpecl, without 
 which the body ought never to be configned to the 
 tomb. Even at the prefent moment, in this king- 
 dom, and over a confiderable part of Europe, this 
 procefs is deemed fo honorable, as to be confined 
 by cuftom to thofe only of the moft elevated rank. 
 Thus, whilft. fufFering humanity in vain petitions 
 for fuch an infpection, as may, perhaps, afford the 
 information which may fave the lives and leffen 
 the torments of numbers, pride obtains, with the 
 utmoft alacrity, the complete difemboweling of 
 one, who, whilft living, received almoft the adora- 
 tion of a divinity. But, perhaps, the deeply 
 rooted prejudices of fentiment are not likely to 
 be overcome, merely by contrafting them with the 
 filly adoptions of vanity and pride. 
 
 At the very point of time in which a beloved 
 object is matched away, it mull be expected, that 
 the mind will indignantly revolt at any meafure 
 which does not accord with thofe nicely attuned 
 feelings, which the revered memory of departed 
 excellence, and the violent grief at the cruel depri- 
 vation, neceffarily produce. The mind, diftracl:- 
 edly alive, is impreffed with the utmoft horror at 
 the idea of any mutilation or injury to that form, 
 which, by the unalterable laws of nature, muft, in 
 i few hours, entirely difTolve away. Imagination 
 
 paints 
 
MEDICAL ADMONITIONS. 1 55 
 
 paints the fpirit of the departed as difplcafed by 
 this affumed injurious violation of its former resi- 
 dence : but imagination mould rather depid a 
 countenance, beaming with kind, commiferation 
 and benignity, and expreuive of the purefl delight 
 at perceiving, that its perilhing exuvi<s may be ren- 
 dered ufeful, in mitigating the fufferings of furviv* 
 ing relatives. The only hopes which can be enter- 
 tained of overcoming this repugnance to anatomi- 
 cal examination, founded, as it mufl be acknow* 
 ledged to be, on the finefl feelings of human nature, 
 is, by an appeal to kindred feelings, to that tender 
 fympathy which difpofes its polfeffor to feel the 
 fufferings of others as his own ; and to that benev- 
 olence, which induces him to make the moll im- 
 portant facrifices, with the hope, that pain and 
 mifery may be averted from others. 
 
 Let it then be recollected, that the knowledge of 
 thofe difeafes, which it is in the power of art to 
 relieve, or remove, has chiefly been obtained by 
 anatomical enquiries ; and that, in a perfeverance 
 in thefe, mull be placed our hopes of obtaining a 
 more accurate knowledge of fuch difeafes, as have 
 hitherto refilled the powers of medicine. He who 
 now, from an improper indulgence of his tender- 
 nefs, refufes to permit the required examination, 
 may experience the mortification of fuffering him- 
 felf, or of witneffing the fufferings of another part 
 
 of 
 
J 56 MEDICAL ADMONITIONS. 
 
 of the family, from a limilar malady ; when, per« 
 haps, by the propofed enquiry, that intelligence 
 might have been gained, by which the difeafe 
 might now have been removed. The acknow- 
 ledged hereditary difpofition to fimilar difeafes, in 
 children of the fame family, is a circumftance 
 which cannot be reflected on, without confirming 
 the propriety of what has been juft remarked. 
 
 The difeafe, of which we are now again to fpeak, 
 affords a ftrong inftance of the advantages which 
 proceed from anatomical inveftigations, in ambi- 
 guous cafes. The real nature of this difeafe, and, 
 of courfe, the proper means of treating it, have 
 only been known of late years ; the difcovery 
 being the confequence of obferving the appearan- 
 ces of the parts after death. 
 
 For the purpofe of preventing this dreadful 
 difeafe, befides attending to the general rules, 
 already given for the prevention of inflammation, 
 great care mould be taken, that children mould 
 not be expofed to extremely cold air, for any con- 
 fiderable time. With the hope of rendering chil- 
 dren hardy and robuft, they are fent out, in the 
 arms of their nurfes, during the molt fevere cold 
 weather, for hours together, and, too commonly, 
 not fufEciently clad. The poor infant, at the firft 
 expofure, declares, by its cries, the uneafmefs it fuf- 
 fers ; but after a little time, overcome by the 
 
 feverity 
 
MEDICAL ADMONITIONS. 
 
 •V 
 
 feverity of the cold, it falls faft afleep.* In this 
 
 ftate 
 
 * From the found fleep in which children are feen who are 
 thus expofed, it may be imagined, that the cold is no more 
 than they can bear, without a chance of injury. But that this 
 fleep itfelf may be the confequence of the exceffive cold, appears 
 to be very probable* upon recollecting the effects of cold, as 
 defcribed in the firft voyage of Capt. Cooke for making difcov- 
 eries in the fouthern hemifphere. During their ftay at Terra 
 del Fuego, Mr. Banks, and Dr. Solander, with a party compofed ■ 
 of draughtfmen, &c. had made an excurfion into the interior 
 of the country. It being eight in the evening, the blafts of 
 wind very piercing, and the fnow falling thick, they were paf- 
 fing through a fwamp, towards a wood, in the covert of which 
 they propofed building a hut, and kindling a fire* to defend 
 themfelves from the feverity of the weather. Dr. Solander 
 having often paffed over mountains in cold countries, was fen- 
 fible, that extreme cold, when joined with fatigue, occafions a 
 drowfinels that is not eafily refifted ; he therefore intreated his 
 friends to keep in motion, however difagreeable it might be to 
 them. His words were— ^Whoever fits down, will fleep ; and 
 whoever fleeps, will wake no more. — -Every one feemed ac- 
 cordingly armed with refolurion ; but, on a fudden, the cold 
 became (o intenfe, as to threaten the moft dreadful effeds. It 
 was now very remarkable, that thfe doctor hirafelf, who had 
 fo forcibly admoniftjed and alarmed his party, was the firft that 
 infilled to be fuffered to repofe. In fpite of the moft earneft 
 intreaties of his friends, he lay down amidft the fnow ; and it 
 was with difficulty they kept him awake. One of the black 
 fervants alfo became weak and faint, and was on the point of 
 following this bad example. A party was therefore detached, 
 %o make a fire at the firft commodious fpot they could find. 
 Mr. Banks and four more remained with the Doctor and Rich- 
 mond 
 
I58 MEDICAL ADMONITIONS. 
 
 ftate, with their extremities fo chilled as to be of a 
 dark crimfon hue, may children be feen every win- 
 ter, in all the public walks round the metropolis. 
 On their return home, the chilled appearance of 
 their arms and legs excites the attention and the 
 exertions of their parents or nurfes, who imme- 
 diately laying them on their knees, chafe them 
 before the fire, until the parts have acquired a con- 
 fiderable degree of warmth. The danger of this 
 ludden tranfition from one extreme of temperature 
 to another, has been already remarked : I fhall 
 only, therefore, obferve here, that by fuch improper 
 management, this difeafe, or inflammation of the 
 lungs, is very likely to be induced. ^^ 
 
 mond the black, who with the utmoft difficulty were perfuaded 
 to come on ; and when they had traverfed the greateft part of 
 the fwamp, they exprefTed their inability of going any farther. 
 When the black was told, that if he remained there he would 
 foon be frozen to death, his reply was, that he was fo much 
 exhaufted with fatigue, that death would be a relief to him. 
 Dr. Solander faid, he was not unwilling to go, but that he 
 muft firft take fome fleep ; ftill perfifting in acting contrary to 
 the opinion which he had himfelf delivered to the company. 
 Thus refolved, they both fat down, fupported by fome bufhes, 
 and in a fhort time fell afleep. Intelligence now came from 
 the advanced party, that a fire was kindled about a quarter of 
 a mile farther on the way. Mr. Banks then awakened the 
 Doctor, who had already almofl loft the ufe of his limbs, though 
 it was but a few minutes fince he fat down ; neverthelefs he 
 confented to go on, but every meafure taken to relieve the 
 black proved ineffectual. 
 
MEDICAL ADMONITIONS. 159 
 
 This expofure of infants to extreme cold, is not 
 defenfible on any hypothelis ; and fo far from 
 being calculated to render them hardy, it is more 
 probable, that, by thus occafioning difeafes, it will 
 render them tender and weakly. The parents of 
 children who refide in cities, ftruck with the ap- 
 pearances of ftrong health, which fometimes mark 
 the countenances of little cottagers, who, almoft 
 unprotected by clothing, brave the coideft and 
 raoft inclement feafons, flatter themfelves, that, by 
 iimilar expofure, they ihali obtain for their children 
 an exemption from difeafe. But this expectation 
 is the refult of a very erroneous calculation. The 
 vaft number of little victims, who fall by various 
 difeafes, the conferences of this expofure to every 
 inclemency of feafon, is not reckoned ; and the 
 poor invalids, whom difeafe or weaknefs, produced 
 by the fame caufe, keeps within doors, are un- 
 known to the paffenger, who makes his eftimate 
 only from thofe few who have hitherto efcaped, 
 hotwithftanding the miferies to which they have 
 been expofed. That thofe who thus efcape, may 
 originally have been of the moil ftrong conftitu- 
 tions, is reafonable to fuppofe : they are therefore, 
 of courfe, children of fuch an appearance, as will 
 be moft likely to excite a favourable opinion of 
 their mode of being reared. 
 
 If this flatement were not true, and, on the coft- 
 
 trarv. 
 
\6o MEDICAL ADMONITIONS. 
 
 trary,, if the children of nifties bore this expofure 
 to extreme cold without injury, ftill this would not 
 authorife that expofure which I have here made a 
 fubjecr of reprehenfion. To prove this, let it be 
 confidered, that the expofure of the children of the 
 poor is regular and uniform, their lodging is gene- 
 rally fo wretched, that the difference of tempera- 
 ture between the external air and that of their 
 hovel is feldom very confiderable ; and that they 
 are, therefore, but little expofed to fudden and con- 
 fiderable changes of temperature. But it is very 
 different with thofe children, whofe caufe I am 
 wifhing to plead, who dwell chiefly in apartments, 
 from which the cold air is excluded as much as 
 poffible, and which are alfo heated by large fires. 
 Thefe children mull be generally in fuch a ftate* 
 that the fudden expofure to cold may be very likely 
 to occafion the moft ferious confequences. 
 
 Another circumfiance which may probably occa- 
 fion this difeafe, and which, therefore, ought to be 
 carefully prevented, is exertion of the voice by hol- 
 lowing, fcreaming, &c. In two of the cafes I have 
 witneffed, the difeafe feemed to have been thus 
 produced. In the one cafe, a child, three years 
 old, whofe legs had been fcaHed by boiling water, 
 had fcreamed inceffantly, and with the utmoft vio- 
 lence, for five or fix hours : and was feized, the fol- 
 lowing night, with this difeafe, of which if: died. In 
 
 the 
 
MEDICAL ADMONITIONS. l6l 
 
 the other cafe, a boy, about feven years of age, had 
 been celebrating in a proceflion, the day of quit- 
 ting fchool for vacation, and had, according to a 
 very filly cuftom, been engaged with his fchool- 
 fellows in huzzaing, almoft during the whole time, 
 with his utmoft exertion. He was attacked the 
 fame evening with this difeafe, and was, the next 
 day, evidently in a confiderable degree of danger j 
 but happily recovered, in confequence of being 
 freely blooded, bliftered, &c. 
 
 QUINSY OF THE PAROTID GLAND, 
 
 OR THE MUMPS. 
 
 This difeafe is diftinguifhed by a confiderable 
 fwellinsj, which arifes very rapidly, in general, on 
 each fide of the neck, becoming large, and fome- 
 times painful : the fwelling increafes for three or 
 four days, when it begins to decline, and in a few 
 days entirely difappears. It frequently happens, 
 that, as the fwelling of the neck fubfides, the tefti- 
 cles of the male, and the breafts of the female, are 
 affe&ed with hard and painful tumours. A flight 
 fever is obfervable through the whole progrefs of 
 this difeafe, which goes off, in general, as the fwel- 
 ling declines. 
 
 This difeafe, in common, requires but little med- 
 
 ical-affiftance ; it being generally fufficient, that the 
 
 W patient 
 
1 62 MEDICAL ADMONITIONS. 
 
 patient keeps himfelf in the houfe, with a moder- 
 ately warm covering round the neck ; that he 
 drinks freely of warm diluting liquors ; and pre- 
 ferves the bowels rather in a relaxed ftate, by the 
 occafional ufe of gentle laxatives. ' 
 
 Dr. Cullen obferves, that "fometimes, when the 
 fwelling of the tefticles does not fucceed to that of 
 the fauces, or when the one or the other has been 
 fuddenly repreffed, the pyrexia, or fever, becomes 
 more confiderable, is often attended with delirium, 
 and has fometimes proved fatal." Inftances of this 
 kind are, indeed, not very frequent ; but this obfer- 
 vation ought to excite a confiderable degree of vigi- 
 lance, as the increafe of fever may demand the moft 
 vigorous exertions. 
 
 This circumftance will alfo ferve to evince the 
 danger of confiding in domeftic practice, even in a 
 diieafe apparently trifling ; fince, in this cafe, the 
 danger may become very confiderable, before it is 
 detected. 
 
 INFLAMMATION OF THE EAR. 
 
 There frequently occurs, in the progrefs of the 
 foregoing difeafe, a painful affection of the ear, 
 which caufes much trouble to the patient. This is 
 generally occafioned by inflammation in the cavity 
 
 of 
 
MEDICAL ADMONITIONS. 1 63 
 
 of the ear, and may be produced independent of 
 this difeafe, by expofure to cold, &c. In flight 
 cafes, this affection may be removed by a little 
 warm oil of almonds dropped into the ear, with 
 the application of a warm bread and milk poultice, 
 or a bag of camomile flowers, which have been 
 infufed in boiling water, and which fhould be ap- 
 plied as warm as poffible. 
 
 But, mould it not foon give way to thefe means, 
 it will be neceffary to obtain proper chirurgical 
 advice, left fuppuration mould take place, and be 
 fucceeded by a total lofs of hearing in the ear 
 which is affected. 
 
 TOOTH-ACH. 
 
 The term tooth-ach, is, indeed, only expreilive of 
 pain of the tooth ; which may be produced by 
 almoft all the various difeafes to which the teeth 
 are fubject. In other words it is only the name of 
 a fymptom of fome difeafe with which the tooth is 
 affected. The common acceptation of the term, as 
 the name of a difeafe itfelf, is productive of very 
 erroneous practice, among the profeffors of domes- 
 tic medicine j a confiderable number of contrary 
 means fwelling their catalogue of fpecifics, for the 
 cure of this fymptom 5 whiift the actual difeafe, 
 
 and 
 
164 MEDICAL ADMONITIONS. 
 
 and the caufe on which this fymptom depends, are 
 unheeded. 
 
 Tooth-ach is, generally, a fymptom of a Caries 
 of the tooth j or of fuch a difeafe of the tooth, as 
 will, if not cured, terminate in Caries. It fome- 
 times occurs in confequence of the teeth being 
 affected by fcurvy, and fometimes it follows the 
 ufe of mercury. It may alfo be occaficned by acrid 
 matters applied to a tooth already difeafed, or it 
 may proceed from a rheumatic affection. The dif- 
 eafe from which it proceeds may exift in the body 
 of the tooth, or in that part, termed its roots ; the 
 feat of the difeafe, which may be defcribed as tooth- 
 ach, may be, even in the antrum highmori, a cavity 
 in the bone of the upper jaw. 
 
 The applications, which in general, are had re- 
 courfe to on thefe various occafions, are ardent 
 fpirits, effential oils, and various other medicines 
 poffefling confiderable cauftic power. Sometimes, 
 with the expectation of deftroying the nerve, aqua 
 fortis is dropped in the tooth. The mifchiefs which 
 refult from fuch applications to parts which are in 
 the higheft ftate of irritability and inflammation, 
 are often of a very ferious nature. 
 
 From the enumeration I juft now made of a few 
 of the many caufes, from which this very painful 
 difeafe may proceed, it muft appear very obvious, 
 
 * that 
 
MEDICAL ADMONITIONS. 1 65 
 
 that the general mode of proceeding of thofe who 
 fuffer from it, is in the higheft degree improper. 
 When the pain becomes difficult to bear, recourfe 
 is had to a variety of applications, external and in- 
 ternal ; which, being felected without judgement, 
 feldom produce any beneficial effects ; but moft 
 commonly, in confequence of. their being highly 
 ftimulant, or even efcharotic, the fufferings of the 
 patient are increafed, the difeafe augmented, and 
 the tooth often irreparably injured. Should thefe 
 means fail, which, as may be fuppofed, is generally 
 the cafe, application is made to fome neighbouring 
 tooth-drawer, and the marked, though perhaps 
 found, tooth, is removed without any further en- 
 quiry. 
 
 The general ftate of the fyftem, the predifpofing, 
 as well as the exciting caufe, and the real nature 
 of the difeafe, ihould be carefully enquired into. 
 If this be done by an intelligent profeffional char- 
 acter, the patient may not only obtain prefent 
 relief j but, by the difeafe being fpeedily removed, 
 future pain and decay of the tooth may be alfo 
 prevented. 
 
 To give advice fufficient to enable domeftic prac- 
 titioners to treat, with propriety, all the different 
 cafes of this difeafe, is impoflible. To provide them 
 with fuch a mode of treating tooth-ach, at its com- 
 mencements 
 
1 65 MEDICAL ADMONITIONS. 
 
 mencement, as will not only be generally fafe, but 
 as will alfo be likely to render farther affiftance un- 
 neceffary, is all that can be here attempted. 
 
 Should a tooth, which, on examination, appears 
 to be perfectly found, be affected with exceffive 
 pain ; it will be proper, as foon as poffible, to put 
 the feet and legs into warm water, in which they 
 may remain about a quarter of an hour. After 
 this, the patient mould go into bed, fecuring on 
 the pained fide of the face, a piece of doubled flan- 
 nel, wetted with any fpirits, made warm, by being 
 held in a faucer over ihe flame of a candle : he 
 mould alfo drink freely of warm barley-water, or 
 of any other diluting drink ; and endeavour to ex- 
 cite perfpiration, as fpeedily as poffible, by breathing 
 under the bed-clothes, &c. Should the pain ftill 
 continue, leeches may be applied externally, near 
 the angle of the jaw, and, a blifter alfo may be 
 applied behind the ear. 
 
 If the tooth is conflderably decayed, a doflil of 
 lint dipped in the tincture of opium, or a fmall pill 
 of the opium pill of the fhops, may be introduced 
 into the cavity, and occafionally renewed. If this 
 fimple, but frequently efficacious, plan mould fail, 
 application muft be made to fome furgeon, or fkil- 
 ful dentifl. 
 
 TEETHING 
 
MEDICAL ADMONITIONS. 1 6/ 
 
 TEETHING. 
 
 It was originally my intention to have allotted 
 one part of this work, entirely to the difeafes of 
 children, and to obfervations refpe&ing their cloth- 
 ing, diet, &c. But, on confidering how fully and 
 ably their difeafes have been treated by Dr. Under- 
 wood, and that Dr. Buchan has announced his 
 intention of publifhing an effay, On the Duties and 
 Office of a Mother •, (a work which, from the atten- 
 tion the Dodor has paid to this fubjecl:, cannot 
 fail to be in the higheft degree ufeful,) I refolved 
 only to interfperfe fuch detached obfervations, on 
 the difeafes of children, as appeared likely to be 
 moft particularly interefting. The mifchiefs which 
 arife from dentition being., moft probably the con* 
 fequence of the inflammation of the membrane 
 invefting the teeth, this appeared to be the moft 
 appropriate place for the introduction of thefe 
 remarks on teething. 
 
 The complaints occafioned by dentition are nu- 
 merous, and frequently highly dangerous ; feverifh 
 complaints^ and inflammation of the lungs, and of 
 other important parts, frequently arifing from this 
 caufe. The two front teeth, in the lower jaw, are 
 thofe which ufually firft appear -, and this, feldom 
 before the fourth, or after the tenth, month. The 
 two oppofite ones in the upper jaw next appear ; 
 and the remainder in irregular fucceflion. 
 
 The 
 
1 68 MEDICAL ADMONITIONS. 
 
 The fymptoms of dentition are, fwelling, rednefs, 
 and fpreading of the gums ; flufhings of the cheeks, 
 and flavering from the mouth. Sometimes erup- 
 tions appear on various parts of the fkin, and gene- 
 rally the bowels are difordered, and the ftools in- 
 creafed in number. The child is employed, almoft 
 conftantly, in endeavouring to mitigate his pain, 
 by biting any fubftance he can thruft in his mouth. 
 The urine fuffers various changes, fometimes com- 
 ing away quite pale, and at other times high col- 
 oured 5 and depofiting, fometimes a thick white, 
 and at other times a reddifh, fediment. 
 
 The fymptoms already defcribed, are thofe which 
 occur in cafes of eafy dentition ; but with difficult 
 and painful dentition, fymptoms arife which are 
 not only dangerous, but are often fuch as the expe- 
 rienced only can trace to their real caufe. Such 
 are, various fpafmodic affections, violent convul- 
 sive fits, cough, fhortnefs of breathing, and acute 
 fever. 
 
 When the firft defcribed fet of fymptoms begin 
 to appear, care mould be taken, that the child's 
 bowels are kept rather open, and that his food be 
 rather lightened, both in quantity and quality. 
 Expofure to the air mould be continued, nearly as 
 much as in perfect health ; but the fkin mould be 
 guarded from the effects of much cold. But mould 
 
 any 
 
MEDICAL ADMONITIONS* l6g 
 
 any of the latter-mentioned fymptoms appear, a 
 free incifion mould be made down to the tooth* 
 which is painfully wounding and diftending, not 
 merely the gum, but the irritable membrane which 
 immediately invefts the teeth until their protru- 
 liom 
 
 Far is it from my expectation, that I mould 
 be able to add a fingle argument to thofe which 
 have been already employed by others, for the 
 purpofe of procuring a more ready fubmiflion to 
 this fafe, ufeful, and often abfolutely heceffary, 
 operation. Induced, however, by the hope, that 
 I may chance to place the circiimftances in a differ- 
 ent, and perhaps ftronger light, I will juft call your 
 attention to the ftate of the parts, and to the actual 
 effects of the operation. I Will then leave it to yoii 
 to determine, not merely whether, having it in our 
 power to remove them, the actual torments of the 
 child ought to be permitted, becaufe the parent 
 mall not be teized with fentimental and fympa- 
 thetic feelings for the fancied fufferings of his child'', 
 under an operation abfolutely not fo painful as the 
 fcratch of a pin. No ! the queftion on which you 
 fhall be called to decide, is one of a much more 
 ferious nature,* 
 
 When the teeth haVe acquired that lize and form 
 
 which nature intended, they are pufhed forward 5 
 
 diftending the membrane which invefts them, which, 
 
 X with 
 
 \ 
 
170 MEDICAL ADMONITIONS. 
 
 with the gums, become inflamed and very fenfible. 
 In cafes of eafy dentition, thefe however foon yield* 
 and the teeth are protruded without much diffi- 
 culty. But in cafes where the cutting of the teeth 
 is much protracted, the inflammation and the fen- 
 fibility of the gums, and of the membrane invert- 
 ing the tooth, are very confiderable, and, in this 
 ftate of extreme tendernefs, become tightly ftretched 
 over the fharp points of the fubjacent teeth, necef- 
 farily producing exquifite pain, which is fufficiently 
 manifefted by the frequent fhrieks, and almoft con- 
 flant cries of the poor child. If thefe diftrefsful 
 appeals for help fail of exciting the parents to the 
 adoption of efficacious means of relief, fever, con- 
 vulflons, and death, foon enfue. But if, attending 
 to the plain language of nature, they permit the 
 painfully ftretched parts to be entirely divided, the 
 inflamed gums and membrane immediately recede, 
 the inflammation goes off, the pain ceafes, and the 
 tooth fometimes immediately protrudes. 
 
 Now fay, in thofe cafes where this operation is 
 fo directly demanded, as the price of the life of a 
 child, can a parent withhold it without fubjecting 
 
 himfelf to the charge of ? But much more 
 
 guilty are thofe, who actually entice the unhappy 
 mother to devote her child to the fufferings I have 
 juft defcribed, and even to death itfelf, by occa- 
 fioning her reliance on means totally incapable of 
 
 yielding. 
 
MEDICAL ADMONITIONS, 17I 
 
 yielding the fmallefl relief. Such are the various 
 forms of neck-laces, by which thefe perfons pre- 
 tenoVthat the fpeedy and eafy cutting of the teeth 
 will certainly be obtained, 
 
 So little pain is occafioned by lancing the gum 
 over the diftending tooth, and inch immediate re-? 
 lief is often derived from it, that it frequently hap- 
 pens, that a child, who, the moment before, ap- 
 peared to be in great agony, will bellow a grateful 
 fmile, the inflant the incifion is made ; and if, as 
 fometimes happens, the gum grows again over the 
 tooth, will not only cheerfully fubmit to the opei>. 
 ation, but even appear to iolicit it. 
 
 I have been more earneft in urging parents to 
 permit this little operation, fearing that the affer- 
 tion of Dr. Buchan, that " With regard to cutting 
 " the gums, we have feldom known it of any great 
 w benefit," may have, not a little, kept up that re- 
 pugnance in parents to the operation, with which 
 medical men fo often have to combat. Againfl 
 this affertion I am unwilling to oppofe my own 
 opinion alone, and mail therefore offer to your 
 notice the declarations of one, whofe authority, in 
 this inflance, is not likely to be difputed. " I am 
 convinced from experience, that this little opera- 
 , tion is often inexpreflibly ufeful, and appears to 
 have faved many lives, after the moil dangerous 
 fymptoms had taken place, and every other means 
 
 of 
 
 \ 
 
172 MEDICAL ADMONITIONS. 
 
 of cure had been made ufe of. 1 have feen the 
 
 like good effects from it, wli£n children have been 
 cutting a number of teeth in fucceflion, and have 
 bred them all with convulfions ; nothing having 
 relieved or prevented thefe terrible fymptoms, but 
 lancing the gums, which has removed them every 
 time it has been done, one or more teeth appearing 
 a day or two after each operation.*'* Similar re- 
 marks have been made by Mr. John Hunter. 
 
 Dr. Buchan farther fays, "In obftinate cafes how- 
 " ever, it ought to be tried. It may be performed 
 " by the finger-nail, tine edge of a fixpenny piece 
 " that is worn thin, or any fharp body which can 
 " be with fafety introduced into the mouth ; but 
 ? 6 the lancet, in a fkillful hand, is certainly the mofl 
 c< proper." 
 
 The conceffion that hi obftinate cafes it ought to 
 be tried, will, I fufpeft, have but little power in 
 overcoming the averfion to the operation ; when 
 it is confidered, that the immediately preceding 
 fentence contains the aflertion, that it has feldom 
 been known to be of any great benefit. 
 
 The mode in which Dr. Buchan fays it may be 
 performed is in every refpecl objectionable ; but 
 
 particularly 
 
 * Treatife on the Difeafes of Children, by Dr. Underwood, 
 vol. i. p. 328. 
 
MEDICAL ADMONITIONS. 173 
 
 particularly on account of its inefficacy, and of its 
 inducing parents to reft fatisfied with the operation 
 fo imperfectly performed, as not to afford the child 
 a probability of relief. Dr. Underwood obferves, 
 & When it is found neceffary to lance the gums, it 
 mould always be done effectually, with a proper 
 gum lancet, and not with a needle, a thin fix pence, 
 or fuch like inftrument, which will not fufficiently 
 divide the gum, nor the ftrong membrane that 
 covers the teeth."* 
 
 Befides lancing the gums, other remedies will be 
 required j but as thefe mull be adapted to the dif- 
 ferent fymptoms which arife, it is hardly poflible 
 to point them out here. 
 
 Sorenefs and flight ulcerations behind the ears, 
 frequently occur to children, during the time of 
 dentition ; and will even continue, for fome time, 
 not only without injury, but even with advantage 
 to the child. In fuch cafes, little more is required, 
 than to keep the bowels in a regular ftate, to keep 
 the fores clean, and covered with a fold of lint, 
 which has been made to imbibe a very fmall quan- 
 tity of oil of almonds. Sometimes thefe ulcera- 
 tions will be covered with gangrenous floughs, and 
 will fpread into deep fores, extending to the fides 
 of the neck. Here, it will be fufficient to fay, that 
 
 the 
 
 * Treatifc on the Difeafes c£ Children, vol. i. p.^27. 
 
174 MEDICAL ADMONITIONS. 
 
 the difagreeable fears, which are fometimes left by 
 tliefe fores, render the complaint fufficiently ferious, 
 to require the greatefl judgment in prefcribing the 
 appropriate external, as well as internal remedies ; 
 and therefore ought never to be trufted to the en- 
 tire management of a nurfe. 
 
 PNEUMONIC INFLAMMATION, 
 
 OR 
 
 INFLAMMATION OF THE LUNGS. 
 
 Inflammation of the membrane which is fpread 
 over the cavity of the cheft, and on the vifcera it 
 contains, is difcovered by pain in the affected part, 
 difficulty of breathing, cough and fever. 
 
 Whether the inflammation poffeffes any of the 
 vifcera themfelves, or the membrane which inverts 
 them and the whole furface of the cavity, is very 
 difficult to be afcertained. This, however, is not 
 of much coniequence ; fince the mode of treatment, 
 at lead, in the commencement of the attack, would 
 in each of thefe cafes, be very little different from 
 each other. 
 
 In general, the difeafe commences with fhivering, 
 to which confiderable heat fucceeds : the pain com- 
 ing on and increafing with the heat. In fome ca- 
 
 fes a 
 
MEDICAL ADMONITIONS. 1 75 
 
 fes, the fever will exift for fome hours, before the 
 pain and difficulty of breathing become very trou- 
 blefome ; and fometimes the pain and difficulty of 
 breathing will be very confiderable, although little 
 or no alteration in the Hate of the pulfe, or the 
 temperature of the body, takes place. 
 
 From this circumftance arifes a very confiderable 
 degree of ambiguity, which will demand, even 
 from thofe who are accuftomed to watch the rife 
 and progrefs of difeafe, the moft careful inveftiga- 
 tion j and muff: undoubtedly render it utterly un- 
 fafe to truft to the judgement of the unexperienced. 
 
 It is very evident, that the feat of the inflamma- 
 tion, and confequently of the pain, may vary in 
 different cafes ; fometimes occupying the middle 
 part of the cheft, beneath the breaft bone, extend- 
 to the back between the moulders. In thefe cafes 2 
 the feat of the difeafe is, moft probably, in the 
 mediaftinum, which makes the divilion between 
 the two fides of the cheft. 
 
 Sometimes the pain extends from the pit of the 
 ftomach, all round the body. ' The diaphragm 3 in 
 this cafe, may be fappofed to be inflamed. 
 
 When with fever, there exifts a pain in the region 
 of the heart, great anxiety, difficulty of breathings 
 
 cough. 
 
I76 MEDICAL ADMONITIONS. 
 
 cough, irregular pulfe, palpitation, and fainting, 
 the inflammation may be fuppofed to poffefs the 
 heart itfelf, or furrounding membrane. 
 
 Pleurify, as it is generally, and not improperly, 
 termed, is the moft common form, in which this 
 difeafe makes its attack. • An exceffively fharp and 
 pungent pain, in this cafe, feizes the fide, between 
 the fixth ancbfeventh rib, and is, in moft cafes, ei- 
 ther accompanied, or fucceeded, by a confiderable 
 degree of fever, and a full, hard, and quick pulfe ; 
 the urine being alfo, at the fame time, exceedingly 
 high colored. The pain, commonly, is not confin- 
 ed to one fpot, but darts from the fide towards the 
 breaft bone, or back, and fometimes extends itfelf, 
 with a particularly diftrefling aching pain, towards 
 the collar bone, 
 
 Thofe who are of a robuft habit, and of a florid 
 complexion, are moft difpofed to attacks of this 
 difeafe. Males, from their greater ftrength of fibre, 
 and from their being more expofed to the exciting 
 caufes, are more fubject to this malady than fe- 
 males. Young perfons are more liable to it than 
 the aged : and thofe who indulge much in eating, 
 particularly of animal food ; as well as thofe who 
 have fuffered a fuppreflion of fome habitual dif- 
 charge, by having a fulnefs of blood produced, 
 frequently fuffer from it. 
 
 The 
 
Medical admonitions. ijf 
 
 The exciting caufes of this difeafe may be, full 
 meals of vifcid and ftimulating fubftances, fuch as 
 fmoked and faked meats, joined with fpiceries 5 
 drinking freely of fermented or fpirituous liquors, 
 violent and long continued exercife, expofure to 
 damp and cold air, when the body has been pre- 
 vioufly heated, and the fudden tranfition from ex- 
 treme cold to heat. 
 
 The terminations of this difeafe, like other in- 
 flammations, may be, by refolution, fuppuration* 
 or gangrene ; befides which, it has a termination 
 peculiar to inflammation of the lungs, which is, an 
 effufion of blood into their cellular fubftance, which 
 interrupting the circulation of the blood and ref- 
 piration, foon produces fuffbcation ; an exudation 
 on the furfaee of the pleura, has been found, by 
 defection, frequently to have taken placgi 
 
 For the cure of this difeafe, large evacuations are 
 required : that which is particularly beneficial, is 
 the taking away of blood in a coniiderable quan- 
 tity, and from a large orifice, from the arm, and 
 even, in fome cafes, leeches or fcarifications may 
 be ufed, for the purpofe of topical bleeding. 
 
 tnftead of proceeding to detail particularly the 
 
 mode of cure in a difeafe, in which the confequen- 
 
 ces of failure are fo truly dreadful, and in the treat- 
 
 Y ment 
 
1^8 MEDICAL ADMONITIONS* 
 
 ment of which fo much knowledge and difcerii* 
 ment are required ; I will offer a few words of 
 advice, fuggefled by the mention of the firft mea^ 
 fure neceffary to be adopted in the endeavour to 
 obtain a cure. Bleeding, it has been remarked, is 
 neceffary in this difeafe ; and frequently is this in* 
 dicated to fuch an extent, as to excite alarm among 
 the friends of the fick, who will too frequently 
 remonftrate againfl what they will term, a farther 
 wafte of blood. Let the confequence of this con- 
 duct be confidered. The phyfician muft either per- 
 fifl in obtaining a compliance with his prefcription, 
 and fubmit to all the confequences of fcandal and 
 mifreprefentation, in cafe of a fatal termination ; 
 or, prompted by too much tendernefs for his char- 
 acter and reputation, he may concede to the fears 
 of the patients friends, and that which was nece£ 
 fary to the patient will be omitted. As a phyfi- 
 cian, it may be faid, would never give up a point, 
 on which the life of his patient depended, no real 
 injury can refult from this oppofition. But furely 
 it will be allowed, that the man muft poffefs a con- 
 fiderable fhare of fortitude, who will perfift in de- 
 manding an exact compliance, in a cafe which, if 
 all be done that art can do, may terminate in the 
 death of the patient ; and where the friends of the 
 fick fay, but in other terms, What you infill on 
 feall- be adopted j but if the patient die, you mufi 
 
 expect 
 
MEDICAL ADMONITIONS. 1 79 
 
 expect all the obloquy,that can be heaped upon you. 
 
 In no difeafe is a ftrjcl abflinance more neceffary, 
 than in this ; fince, in proportion to the ncurifh- 
 ment taken in, will be the increafe of the blood, 
 and confequently of the difeafe. Nothing but 
 watery drinks, as toaft and water, barley-water, 
 pe&oral drink, bread tea, &c. rendered pleafant by 
 the addition of the mildeft vegetable acids, ought 
 to be allowed, until the violence of the difeafe is 
 fubdued ; nor then mould the lighter kinds of 
 noUrifhment, as panada, &c. be allowed, but in the 
 moft cautious manner. ■ The drinks may be taken 
 frequently, but in fmall quantities at a time, and 
 never entirely cold. 
 
 If the difeafe is not removed by the firft attempts, 
 efpecially if two or three days of its duration have 
 elapfed, fymptoms, fo ambiguous in their appear- 
 ances, occur, as to require the greateft nicety in 
 determining to what the indications point. Fre- 
 quently it will be found neceflary to repeat the 
 bleedings feveral times, and that even in the firft 
 hours of the difeafe j but fometimes, when the ur- 
 gency of fome of the fymptoms, may feem to indi- 
 cate this repetition, other circumftances may occur, 
 which may take away from the clearnefs of the indi- 
 cation, and even feena to contradict it. Sometimes 
 this difeafe terminates by expedoration,with reipecfc 
 
 to 
 
l8d MEDICAL ADMONITIONS. 
 
 to which much judgment is neceffary fince, where 
 this proves to be the cafe, the future fafety of the 
 patient will depend upon properly encouraging 
 and regulating this difcharge. Sweating, although 
 fometimes recommended, as proper to be promoted 
 very early in the difeafe, yet we are taught, by a 
 very great authority, that it ought not to be excited 
 by art, unlefs with much caution. Much nicety is 
 required alfo in the management of the cough, 
 which often, by its feverity, very much diltreffes 
 the patient, often occafioning a confiderable aggra- 
 vation of the pain, and want of fleep. The exhibi- 
 tion of opiates will mitigate this troublefome fymp- 
 tom ; but it ought alfo to be known, that given 
 in certain ftages of the difeafe, and without certain 
 cautions, they will not only impede the cure, but 
 prove injurious in a very high degree. 
 
 • Convinced of the- difficulty in conducting this 
 difeafe to a cure by any but profeflional men, I have 
 intentionally avoided the talk of directing the man- 
 agement of the difeafe through its whole progrefs. 
 In confequence of that ambiguity, in which, it has 
 been before obferved, the fymptoms are often in- 
 volved, little benefit could arife, in a work of this 
 kind, from the enumeration of the various reme- 
 dies which different circumftances require ; fince 
 even the exiftence of thefe particular circumftances 
 is not always difcoverable, at leaft by domeftic prac- 
 
 titionersi 
 
MEDICAL ADMONITIONS. l8l 
 
 titioners.* An error in the treatment of this dif- 
 eafe might be fucceeded by the mofl fatal confe- 
 quences j fi'nce, if the patient fhould efcape fuddcn 
 fuffocation, from an extravafation of blood in the 
 cellular fubftance of the lungs, it is yet to be feared, 
 left fuppuration fhould take place, and the unhappy 
 patient fufter the lingering mifcries of an incurable 
 consumption. 
 
 One 
 
 * Dr. Buchan, after enumerating the remedies proper in this 
 difeafe, fays, "We have mentioned different things, on purpofe 
 " that people may have it in their power to choofe ; and iike- 
 " wife, that when one cannot be obtained, they may make ufe 
 " of another. Different medicines are no doubt neceiTary in the 
 " different periods of a diforder ; and where one fails of fuccefs, 
 " or difagrees with the patient, it will be proper to try another." 
 But in a difeafe fo dangerous in its nature, the vague and deful- 
 tory praclice of domeftic medicine muft be very hazardous. 
 For, as is well obferved by Dr. Duplanil, who has tranflated 
 Dr. Buchan's Domeftic Medicine into French, and has added 
 to it fome -excellent notes, in his obfervations on this paflage of 
 Dr. Buchan's, " Cependent, nous ne pouvons difconvenir que 
 " quelque nmple que fojt cette marche, ille demande une atten- 
 " tion dont tout le monde n'eft pas capable, on a done raifon de 
 *' dire que fi la regime eft fufceptible d'etre adminiftre par tous 
 " les hommes, les remedes ne doivent l'etre que par les perfonnes 
 " les plus prudentes and les plus eclairees." — "lNeverthelefs,we 
 cannot deny, that however plain this path may be, yet it re- 
 quires fuch attention as every one is not capable of giving. 
 It may therefore with propriety be faid, that although the diet 
 may be adminiftered by any one, yet medicines fhould not be 
 prefcribed by any but the moft cautious and well informed." 
 
I§2 MEDICAL ADMONITIONS. 
 
 One obfervation more muft be made, whiifl on 
 this fubjecl:, fince there is net a doubt, that an 
 attention to it may occafion the faving of many 
 lives. It is to be remarked, in the hiftory of this 
 difeafe, that in fome cafes very little change is per- 
 ceptible in the ftate of the pulfe, or the temperature 
 of the body ; and that the pain alfo may be but 
 inconfiderable, giving an idea to the patient, rather 
 of oppreflion than of pain ; fo that, excepting the 
 difficulty of breathing, which may be referred to 
 many other caufes, the patient will have few or no 
 marks, by which he can be led to fufpeel: the nature 
 of his complaint, and the danger of hisfituation, 
 until he is out of the reach of help. It too fre* 
 quently happens, that phyficians are called to the 
 amftance of thofe, who will fay, fhat having expe- 
 rienced little or no inconvenience, excepting a little 
 difficulty in breathing, they had waited with the 
 hope of its going off without any medical aid j and 
 too often it is found, that the infidious difeafe has, 
 in that time, injured the conftitution irreparably. 
 
 In every cafe, where the breathing becomes 
 changed from its natural ftate, without any evident 
 caufe, a morbid change of the lungs may be reafon- 
 ably fufpe&ed j and as this can never happen with- 
 out endangering the life of the patient, the beft 
 advice fhould be obtained, and as early as poflible. 
 
 Great 
 
Medical admonitions. 183 
 
 Great care mull be taken, after recovery from 
 this difeafe, that a relapfe is not produced : the 
 fpareft diet fnould therefore be ufed, the inclemen- 
 cies of the weather carefully guarded againft, mod- 
 erate exercife employed, and the cheft protected 
 from the action of cold, by conftantly wearing a 
 flannel waiftcoat next the fkin. All thofe circum- 
 ftances defcribed as caufes of this difeafe fliould be 
 carefully avoided. 
 
 INFLAMMATION OF THE LUNGS IN 
 CHILDREN, 
 
 The prefent fection is written with the eager 
 hope of calling the attention of parents to the firft 
 appearance of inflammation of the lungs in chil- 
 dren, fince its firft attack is, in general, made in fo 
 infidious a manner, that little or no alarm is excited $ 
 and the ravages of the difeafe are permitted, until 
 they exceed all probability of reftraint. Indeed, 
 the number of children loft by neglecting to oppofe 
 this malady on its firft appearance, muft very far 
 exceed the conjecture of any one who has not had 
 the opportunity of witneffing the many deaths from 
 this caufe. 
 
 The firft fymptom difcoverable in children, is, 
 In general, a flight degree of feverifli neat, which, 
 
 m 
 
I84 MEDICAL ADMONlTIONb. 
 
 in the courfe of a few hours, increafes, and is foori 
 accompanied by a quicknefs of the breathing* 
 This, however, is often hardly obfervable, requir- 
 ing, even from thofe who are accuflomed to wit- 
 nefs this difeafe, very nice attention to determine, 
 whether the refpiration is morbidly increafed or 
 not. If the difeafe Hill eludes the attention, and 
 proceeds in its courfe, the heat increafes, a fhort, 
 dry, hard, cough comes on, and the refpiration is 
 not only more quickened, and becomes more labori- 
 ous, but is performed with a rough whizzing found. 
 The child is now in a confiderable degree of danger; 
 but if, warned by this laft fymptom, immediate 
 afiiftance be obtained, it may probably yet be fwed. 
 Should this ftrong notice of danger pafs unheeded, 
 and the means of relief be longer deferred, every 
 exertion may be made in vain, and the child, after 
 the fevereft ftruggles, die in the courfe of a few 
 more hou*rs ; or gradually fall into one of the moft 
 diftrefling ftates which a parent can witnefs — a gra- 
 dual decline. 
 
 Quicknefs of breathing, flight cough, and heat 
 
 of the fkin, in children, mould therefore be always 
 
 regarded as fymptoms demanding immediate invef- 
 
 tigation. Since, although they may fometimes 
 
 occur trithout danger, they moft frequently will be 
 
 found to mark the exiftence of this alarming 
 
 malady. 
 
 When, 
 
Medical admonitions. 185 
 
 "When, therefore, thefe fymptoms are met with* 
 tinder the circumftances above mentioned, the dif- 
 eafe appearing to be manifeft, and proper advice 
 cannot be dire&ly obtained, a leech or two, accord- 
 ing to the age and ftrength of the child, mould be 
 put on the fore part of the cheft ; the child mould 
 then be immerfed in a warm bath, up to the middle* 
 or even to the arm-pits, from ten minutes to a 
 quarter of an hour ; and then wiped dry, Wrapped 
 in a blanket, arid placed in bed ; a blifter ihould be 
 applied to the cheft, cloths ihould be properly dif- 
 pofed to abforb the blood, which it is. to be hoped 
 will continue to flow, and frequent warm fippingSj 
 fuch as milk and water, barley-water, &c. fupplied, 
 fo as to produce a copious flow of peffpiration, 
 Generally, if thefe means be adopted, at this ftage 
 of the difeafe, the breathing will, in an hour or two, 
 diminifh in frequency j and, in about ten of twelve 
 hours, eafy, natural refpiration will return* 
 
 I have purpofely avoided mentioning the em- 
 ployment of medicine, in thefe cafes, fince though 
 thefe may be ferviceable in the higheft degree, when 
 adminiftered with a due attention to every circum- 
 fiance ; yet, as it would be impoffible to deliver 
 fatisfadory rules for their exhibition, in all the cafes 
 likely to happen, I have thought it right their ufe 
 ihould be deferred, until due advice Can be obtained* 
 I muft, however, add a word or two more refpe&- 
 Z ing 
 
I 86 MEDICAL ADMONITIONS. 
 
 ing fome of the means already fpecified, to prevent 
 any error in their employment, by which we might 
 be deprived of the advantages we expected from 
 them. Much care is neceflary, that the water of 
 the warm bath mould be nicely adjufted in its tem- 
 perature ; by its effects being firft tried on the 
 ufually uncovered part of the arm of the parent or 
 nurfe : employing it only of fuch a degree of heat, 
 as may be thus borne pleafantly. On the one hand, 
 mould it be of a lower temperature than this, a 
 fudden chill would pervade the fyftem, and every 
 fymptom be immediately aggravated. So, on the 
 other hand, if, deceived by the heat of the water, 
 having been only tried by the hand, or by that j>art 
 of the arm which, by conftant expofure, has become 
 infenfible to frnall variations of heat and cold ; and 
 not imputing the cries of the child to their real 
 caufe, the too great heat of the water, the child be 
 kept in water of too high a temperature, it will 
 come out of the water with the fever and other 
 fymptoms confiderably augmented, and inftead of 
 perfpiration fucceeding, the fkin wiU become more 
 parched than ever, and inflammation will be urged 
 on with irrefiftible rapidity. In one inftance, of 
 which I have been credibly informed, a child was 
 actually fo fcalded, by want of due attention in this 
 procefs, that blifters arofe in feveral parts of the 
 body, during the few hours the child furvjved. 
 
 Some 
 
MEDICAL ADMONITIONS. 187 
 
 Some caution is alfo neceffary, in the application 
 of the blifter to. the ftomach ; fmce, if fo placed, 
 that the blood, proceeding from the wound made 
 by the leech, be allowed to infinuate between it and 
 the fkin, it will be found, when, perhaps, it is too 
 late for its removal, that it has entirely failed, a 
 coagulum of blood having completely defended the 
 fkin from its action. 
 
 It does not unfrequently happen, that parents, 
 though warned of the danger which awaits a child ; 
 and repeatedly advifed to adopt the propofed reme- 
 dies, will not allow themfelves to be convinced of 
 the neceffity of employing fuch violent means, as 
 they will term them, for the removal of what they 
 will alfo term, a trifling ailment. 
 
 It will, by many, be hardly credited, that from 
 the circumftance of deferring to fend for medical 
 aid until towards the evening, the lives of many 
 children are loft. The child appears rather unwell 
 in the morning, the breathing becomes fhort in the 
 courfe of the day, the feveriflmefs and cough alfo 
 increaling ; and at the arrival of evening, fearing 
 a difturbed night, the family apothecary is fent for, 
 to provide a little draught to enfure a good night's 
 reft. Struck with the dangerous fituation of the 
 child, he endeavours to communicate his juft fears 
 and anxiety to the parents j but however iurprifing 
 
 it 
 
l88 MEDICAL ADMONITIONS. 
 
 it may appear, his admonitions will often be Kfi 
 tened to with incredulity, and even with unjuft 
 fhfpicion. It appears to the parents, that too murh 
 is about to be done ; the plan propofed, they ob- 
 ferve, is very inconvenient, eipecially at that time 
 of the evening. They therefore either plainly fay, 
 they fhall wait 'till morning ; or they promife to 
 employ the means, and afterwards change their 
 minds ; fo that, when vifited in the morning, the 
 child is perhaps found fo much worfe, as to render 
 the probability of fuccefs, from even the moil ap- 
 propriate means, very doubtful. It is not in this 
 difeafe alone, that this fatal obftinacy of parents is 
 found : every apothecary muft have repeatedly met 
 with it, in thofe difeafes, in which the fymptoms 
 are not of fuch a nature as to alarm the ignorant, 
 and where the curative means are attended with 
 any trouble, out of the ordinary way ; efpecially, 
 too, if application for advice is deferred until the 
 evening : which, putting all confideration of the 
 eafe or comfort of medical men out of the queftion, 
 and confidering only the benefit of the patient, and 
 the convenience of thofe around him, ought never 
 to be done. 
 
 PULMONARY 
 
MEDICAL ADMONITIONS. 1 89 
 
 PULMONARY CONSUMPTION, 
 
 OR - 
 
 ULCER OF THE LUNGS. 
 
 The chara&eriftics of this difeafe are, hectic fever, 
 cough, and a fpitting, chiefly compofed of matter. 
 
 A confumption may fucceed to catarrh, afthma, 
 inflammation of the lungs, and fpitting of blood : 
 it may alfo proceed from tubercles formed in the 
 lungs. Sometimes it is induced by a general affec- 
 tion of the fyftem : moft frequently it is accompa- 
 nied by a fcrophulous habit ; and fometimes it is a 
 confequence of the venereal difeafe, the mealies, or 
 the fmall-pox. 
 
 Thofe artificers who inhale great quantities of 
 duft from the bodies which are the fubjects of their 
 operations, fuch as leather-dreffers, flax-dreffers, &c. 
 are faid to be particularly liable to this malady. 
 The perfons moft difpofed to this difeafe are thofe 
 of a fair complexion, florid cheeks, flender make, 
 narrow cheft, prominent fhoulders, and a long neck. 
 
 The firft appearance of the difeafe will vary in 
 different cafes ; this variety depending, in a great 
 meafure, on the nature of the preceding difeafe. 
 The moft conftant fymptom, however, is a cough, 
 by which phlegm is frequently thrown up : this 
 phlegm becomes,by degrees, more thick and opaque, 
 
 refembling 
 
I90 MEDICAL ADMONITIONS. 
 
 refembling matter ; of which, at length, it becomes 
 almoft entirely compofed. The breathing is, in 
 general, from the firft, fliort and laborious ; and 
 accompanied with a tightnefs acrofs the cheft, as 
 though the cheft was confined with a cord. Some- 
 times painful ftitches are felt in various parts of the 
 cheft ; and, almoft in every cafe, the patient's 
 breathing is rendered worfe by laying down in bed. 
 It frequently alfo is obferved, that much greater 
 inconvenience is experienced by laying on one fide, 
 than on the other. The cheeks are often flufhed, 
 and a heat is felt in the palms of the hands and foles 
 of the feet, which increafes as the evening comes, 
 on. After a little time, this heat becomes more 
 diffufed, affecting the whole fyftem with febrile 
 fymptoms ; thefe generally come on about the mid- 
 dle of the day, being commonly preceded by a flight 
 rigor or chillinefs j and, after continuing two or 
 three hours, fubfide, but return as the evening 
 advances. The heat and thirft then becomes excef- 
 five, the breathing is quicker and more laborious, 
 the cough more frequent and dry, and the difcharge 
 of phlegm leffens, as the heat increafes. In this 
 reftlefs and diftreffed ftate, the patient paffes his 
 nights. As the morning appears, a profufe fweat 
 generally comes on, which, after continuing an 
 hour or two, gradually goes off, leaving the patient 
 in a very languid ftate. 
 
 The 
 
MEDICAL ADMONITIONS. IQj 
 
 The difeafe, in fome cafes, will remain nearly in 
 the fame ftate, for feveral weeks, or even months 5 
 the fymptoms, all this time, increafing very flowly, 
 and the patient alternating between hope and def- 
 pair, the former, however, in general prepondera- 
 ting. In other cafes, the difeafe proceeds more 
 rapidly, the fpit increafing very much, and becom- 
 ing of a thicker confiftence, and moftly of a yellow 
 colour. As the difeafe becomes more inveterate, 
 the fpit acquires a greenifh hue, the fever increafes ? 
 and the fweats become exceedingly profufe. The 
 patient is, at this period of the difeafe, confiderably 
 wafted, his nails curved inwards, his feet and legs 
 fwoln, his countenance ghaftly, the eyes appearing 
 to be funk in their fockets, the jaw-bones appearing 
 more elevated than natural, and a crimfon glow 
 frequently appearing on the cheeks. In this ftate 
 the patient does not continue long, before apthous 
 ulcers in the throat and mouth, or a frequent col- 
 liquative purging, Ihews, that the fatal termination 
 of the difeafe is near at hand. 
 
 No period* of life, from childhood to old age 
 itfelf, is exempt from this difeafe ; but the moft fre* 
 quent fubje&s of it are, the young and the middle 
 aged. 
 
 The treatment of this difeafe muft, even at its 
 commencement, differ very much in different cafes : 
 
 this 
 
tgi MEDICAL ADMONITIONS. 
 
 this variety of treatment chiefly depending on the 
 nature of the preceding, or accompanying difeafe. 
 Befides this, it is obvious, that a difference in the 
 treatment muft be required, according to a period 
 of the difeafe at which the cure is attempted. To 
 obtain benefit from medicine, in this difeafe, much 
 judgment is required to be exerted ; fince very evil 
 confequences may follow the ufe of a medicine at 
 one period of the difeafe, which, if ufed at another, 
 might prove of the greateft benefit. On the part 
 of the patient, is required the ftri&eft regularity, 
 and moft earneft perfeverance ; fince the beft calcu- 
 lated means can have but little chance of effecting 
 any confiderably beneficial change, unlefs perfevered 
 in for a confiderable time. 
 
 From medicines alone, there is, however, but 
 Very little to be hoped for, in this difeafe ; their 
 effects muft be feconded by a ftricl: attention to 
 various circurnftances, in the patient's mode of liv- 
 ing ; fuch as his diet, exercife, clothing, &c. Of 
 fuch importance, in the cure of this difeafe, is a 
 careful attention to thefe circumftances^ that the 
 probability of recovery would be much greater, in 
 trufting entirely to a due regulation of thefe, than 
 to medicine alone. 
 
 As medicine can only be trufted to, in this dif- 
 eafe, when in the hands of medical men, and as a 
 
 proper" 
 
MEDICAL ADMONITIONS. 1 93 
 
 proper regimen, is effehtial to the cure, and depends 
 fo much on the patient himfelf, and his attendants, 
 I fhall dwell more fully on this article. 
 
 The diet fhould be compofed of fuch things as 
 are fufficiently nourifhing ; and as are likely, by 
 their mild and antiseptic nature, to correct any 
 prevailing acrimony, and diminifh the difpofition 
 to inflammation. The lofs of flefh, and the extreme 
 languor which generally takes place, too frequently 
 induce the friends of the lick, with the hope of 
 recruiting his impaired vigour, and wafted habit, 
 to fupply him with food of the moft highly nour- 
 ifhing kind, with wine, and even fpirituous liquors; 
 and this, efpecially, when long indulged habits ren- 
 der the demands of the patient importunate. But 
 as the cafes are very rare indeed, where thefe indul- 
 gences will not aggravate every fymptom, and 
 accelerate the fatal termination of the difeafe ; they 
 muft not be permitted on every weak and trifling 
 argument, which the patient may adduce. 
 
 This caution is the more neceffary, fince, where 
 inclination is ftrong, reafons, light as air, are pro- 
 duced as the oftenfible motives for a deviation from 
 the rules laid down by the phyfician : but the friend, 
 or the phyfician, who, through too much complai- 
 fance, allows any weight to fuch arguments, by no 
 means fulfils his duty. 
 
 A a Di\ 
 
1C>4 MEDICAL ADMONITIONS. 
 
 Dr. Buchan, when treating of the regimen iil 
 this difeafe, fays, " We do not, however, advife 
 " thofe, who have been accuftomed to animal food 
 " and ftrong liquors, to leave them off all at once." 
 But I cannot help fufpecKng, that this advice, in a 
 work addreffed to patients themfelves, may fre- 
 quently prove injurious, by allowing too great a 
 latitude. For although the Doctor, aware of the 
 ill cohfequences of neglecting a due attention td 
 regimen ; and doubtlefsly with a view of prevent- 
 ing the evils which improper indulgences may occa- 
 sion, recommends, at firft, wine to be drank diluted 
 with twice or thrice its quantity of water ; yet as 
 wine generally turns four ort the ftomach of thofe 
 who are devoted to the pernicious cuftom of drink- 
 ing fpirituous liquors ; it is much to be feared, that 
 fuch perfons will be likely to prefume On this advice, 
 of not leaving them off all at once ; and will fubftitute, 
 for the wine, a little of that to which they have 
 hitherto been fo much accuftomed. There appears 
 to me two powerful reafons, why this change mould 
 be undertaken, refolutely, at once. In the firft 
 place, as the cure of the difeafe depends on a certain 
 change being made in the conftitution, the more 
 expeditioufly this change is brought about, the 
 greater the probability muft exift of its effecting a 
 cure. Since, during the time occupied by the en- 
 deavour to produce a gradual change, the chance 
 
 of 
 
MEDICAL ADMONITIONS. 1 95 
 
 of recovery may be entirely loft, by the accumulated 
 forces the difeafe may obtain. In the fecond place, 
 there is little or no chance of favourite habits being 
 overcome in this gradual manner ; the only mode 
 of obtaining a vi&ory, being by a refolute and firm 
 refinance ; every little indulgence allowed, like 
 ground yielded to an enemy, tending, in general, to 
 leffen the power of oppofing his attacks. Dr. Cad- 
 ogan, when pointing out the neceffity of a iimilar 
 abftinence, in gouty perfons, and the difadvantages 
 of attempting to do it by degrees, very juftly ob- 
 serves, " But the danger of attempting it in this 
 " manner is, that it will never be done ; and, like 
 " a procraftinating iinner, he will for ever put off 
 " his penitential refolution 'till to-morrow. If he did 
 " it all at once, I would be hanged if he died of the 
 ^ attempt ; he would be uneafy for three or foU£ 
 ^ days, that's all." 
 
 The argument for good living, which in this cafe 
 is commonly adopted by patients, and their friends, 
 is induced from the weak ftate which accompanies 
 the difeafe ; and from obferving the reftorative 
 effeds of highly nourifhing food, injthofe cafes of 
 temporary defection of ftrength, produced by long 
 failing, violent labour, or long continued exercife, 
 of any kind ; thence they fuppofe, that no method 
 is fo likely to remove the patient's extreme languor; 
 ^s the Supplying him, freely, with thofe things, 
 
 which 
 
I96 MEDICAL ADMONITIONS. 
 
 which in health appear to be the fource of ftrength 
 and vigour. As it cannot be expected, that the 
 directions of phyficians will be implicitly obeyed, 
 when the opinion of the patient and his friends im- 
 mediately militate againft them ; the pointing out 
 the fallacioufnefs of thofe opinions becomes necef- 
 fary. This failure of ftrength, and wafting of the 
 body, then, it muft be underftood, do not proceed 
 from a deficiency of aliment, but are the neceflary 
 confequences of a difeafed ftate of the fyftem ; and 
 are only to be remedied by altering that peculiar 
 ftate : until this be done, no advantage will refult 
 from any extraordinary fupply of food- 
 
 The neceflity of thus regulatingthe patient's food, 
 is rendered obvious, by the farther confideration, 
 that foon after every meal, the hectic fever, the 
 conftant attendant on this malady, is always, for a 
 time, augmented ; the increafe being greater, when 
 the food is highly nutritive and ftimulant, but lefs, 
 when it is light and mild. 
 
 The diet muft, therefore, almoft entirely, confift 
 of milk and vegetables ; by blending which, an 
 agreeable variety may be obtained. For breakfaft, 
 the patient may have milk, frefh from the cow ; or, 
 if it ftiould prove offenfive to the ftomach in this 
 ftate, it may be deprived of its cream. With the 
 milk, may be eaten bifcuits, or toafted bread, either 
 dry, or fpread with honey, or the jelly or marmal- 
 ade of fruits. E> r - 
 
MEDICAL ADMONITIONS. I gj 
 
 Dr. Buchan fays, " If it (the milk) mould, not- 
 < c withftanding, prove heavy on the ftomach, a fmall 
 *' quantity of brandy, or rum, with a little fugar, 
 " may be added, which will render it both more 
 "light and nourifhing." The late Dr.Fothergillvery 
 juftly obferved, " There is one ufual addition made 
 " to milk, which, I think, mould be either wholly 
 ',' profcribed, or the moft exprefs directions given 
 " concerning it, 1 mean the common addition of 
 " brandy or rum to affes or cows milk." — Ardent 
 fpirits, he obferves, occafion the milk to difagree, 
 and augment the difeafe. 
 
 Boiled bread and milk, water-gruel, . and milk- 
 pottage, are very proper j and, if more agreeable, 
 may be fubftituted for what has been already recom- 
 mended. For dinner, a tolerable extenfive range 
 may be afforded the patient, in the various fruits, 
 and other vegetable productions of the feafon. 
 Apples drefled in different ways, turnips, afparagus, 
 lettuces, dandelion, potatoes, parfnips, rice boiled 
 into a pudding, either alone, or with the addition 
 of an egg and milk, and puddings of various kinds, 
 form a bill of fare, within the bounds of which, no 
 one, furely, will refufe to confine himfelf, when it 
 yields him almoft the only chance of a reftoration 
 to health. For fupper the patient may have falop, 
 fago, tapioca, panada, or any of thofe articles whicfy 
 have been recommended as proper for breakfaft. 
 
 The 
 
j 98 medical Admonitions. 
 
 The drinks through the day may be, butter-milk v 
 fweetwort, affes milk, goats milk, barley-water, pec- 
 toral drink, &c. 
 
 I mean not to affert, that animal food is, in every 
 cafe, to be ftrictly prohibited, or to deny that there 
 may be cafes, in which its ufe may be advifable. 
 But thefe are fituations which are only to be pointed 
 out by a thorough knowledge of the difeafe, and 
 of the general ftate of the fyftem. 
 
 The kind of exercife, and the degree to which it 
 is ufed, at the commencement of this malady, muft 
 depend on the manner in which the firft attacks 
 were made. Thus, if it has been preceded by fpit- 
 ting of blood, or by confiderable inflammation of 
 the lungs, the exercife employed muft be of the gen- 
 tleft kind. But when the difeafe is produced by a 
 long continued cough, or repeated catarrhs, exercife 
 may be ufed to a greater extent. The necefuty of 
 this difference exifts, however, only in the firft ftage 
 of the difeafe ; for after the difeafe is once formed, 
 the fame rules for exercife will be proper in almoft 
 every cafe. 
 
 A general maxim for the regulation of exercife 
 in this difeafe is, that it be never employed to iuch 
 a degree, as that the heat of the body be much 
 increafed by it, or that it induce much fatigue. 
 
 As 
 
MEDICAL ADMONITIONS. I99 
 
 As the chief intention of exercife, in- this difeafe, 
 is to obtain the application of pure and frefh air to 
 the lungs, it is evident, that the kind of exercife^ 
 moft likely to anfwer the intention, is that by which 
 the patient is conveyed from one place to another^ 
 fuch as walking, riding, failing, &c. 
 
 Walking, in confequence of its quickening the 
 circulation of the blood, and fo foon inducing fa- 
 tigue, is the kind of exercife leaft likely to prove 
 beneficial in thefe cafes, and mull be had recourfe 
 to with great caution. 
 
 Riding on horfeback, is an exercife, in many 
 refpe&s, much preferable to walking ; as the patient 
 is, by this means fooner conveyed into a more 
 pure and falubrious atmofphere, and is, at the fame 
 time, able, by regulating the pace of his horfe, to 
 adapt his exercife to his ftrength, and to his ability 
 of bearing it. But the exercife of riding, as well 
 as that of walking, requires fome exertion on the 
 part of the patient, and therefore is not admiffible,, 
 except with the great eft caution, in thofe cafes where 
 there exiftsa fufpicioh of inflammation* or impend- 
 ing hemorrhage. 
 
 In thofe cafes where the expofiire to the open 
 air is neceffarvj but where weaknefs, or any other 
 circumftance, renders it neceffary that this mould be 
 done with the leaft poffible exertion, recourfe mufl 
 
 be 
 
200 MEDICAL ADMONITIONS^ 
 
 be had to the conveyance of a carriage ; which may- 
 be more or lefs open, according to the mildnefs or 
 inclemency of the weather. 
 
 The mode of conveyance, which is to be preferred 
 to all others, when no injury is likely to be induced 
 by the violent exertions attendant on fea-ficknefs, 
 is that of failing ; fince here the patient may enjoy 
 the benefit of a fucceflion of frefh and falubrious 
 air, whilft the body is exercifed in the raoft regular 
 and equable manner ; at the fame time, the patient 
 may farther exercife himfelf, to the degree that his 
 ftrength will admit, and his cafe require. 
 
 Where the benefit of failing, or of a carriage, 
 cannot be obtained, and where the exercife of walk- 
 ing or riding on horfeback, is not adtniffible, 
 fwinging is a mode of exercife which may be em- 
 ployed with the greateft fafety and advantage. 
 
 It is not fufBcient that the patient breaths air 
 that is frefh, and untainted with noxious vapours ; 
 it is alfo neceffary, that the atmofphere, to which 
 he is expofed, be temperately and uniformly warm. 
 At the approach, therefore, of cold weather, the 
 patient mould remove to a Warmer climate ; vary- 
 ing the fituation, according as the viciflitudes of 
 the feafons may render it neceffary. The advanta* 
 ges to be derived from a change of climate, in thefe 
 cafes, are fo great, that, when joined with due 
 
 reftrictions 
 
MEblCAL ADMONITIONS. 201 
 
 reftriclions as to diet, it fometimes accomplices a 
 cure, in cafes where medicine alone would have 
 been of no avail. 
 
 It has been remarked, that the inhabitants of 
 this ifland are particularly liable to this difeafe ; 
 and this has been faid to be owing to the frequent 
 and fudden changes in the weather, and the almoft 
 conftant predominance of moifture in the atmof- 
 phere. A removal to a more temperate climate, 
 where tjie transitions of the weather are lefs confid- 
 erable, and lefs fudden, is therefore particularly 
 neceffary, for fuch as have reafon to appxehend 
 even a difpofition to this difeafe. 
 
 Air, extremely pure, is not, however, in this 
 difeafe, always proportionally falubrious ; on the 
 contrary, it has been found, that, in fome cafes s 
 advantage has been obtained from breathing an 
 atmofphere more impure than the common atmof- 
 pheric air. 
 
 Experiments fhew, that the atmofpheric air con- 
 tains two different airs ; the one termed vital or 
 oxygen air, which fupports refpiratioh and combuf- 
 tibn ; the other called azotic air, in which combuf- 
 tiori foon ceafes, and animals quickly die. 
 
 An animal being confined under a glafs, with a 
 
 certain quantity of atmofpheric air, will foon die : 
 
 B b and 
 
202 MEDICAL ADMONITIONS. 
 
 and the air remaining in the glafs being examined, 
 it will appear, that the oxygen is confumed, and that 
 the glafs now contains azotic air, and fixed, or car- 
 bonic acid air. Experiments alfo prove, that this 
 change has been thus effected — the blood, which 
 arrives at the lungs of a dark colour, parts with 
 the carbon, or charcoal, it contains, which, uniting 
 with one part of the oxygen, forms the carbonic acid 
 air. Another part of the oxygen unites with the 
 hydrogen or inflammable air, which is feparated from 
 the blood, and with it forms the humid vapour that 
 iffues from the mouth. The other part of the oxygen 
 is imbibed by the blood in the lungs, which it ren- 
 ders of a bright red colour. Thus abforbed, the 
 oxygen becomes a general ftimulus to . the whole 
 animal fyftem. 
 
 Poffeffed of this knowledge, feveral intelligent 
 phyficians have employed the two conftituents of 
 atmofpheric air, in various proportions, in differ- 
 ent difeafes. By this they have difcovered, that 
 by breathing an increafed proportion of oxygen, the 
 infenfible perfpiration is increafed, digeflion is 
 quickened, the animal heat and the mufcular pow- 
 ers are increafed, and the refpiration rendered eafy; 
 and that by breathing air in which azotic air pre- 
 vails, febrile heat is moderated, and morbid action, 
 efpecially in the finer veffels of the lungs, is re- 
 trained. 
 
 Oxygenated 
 
MEDICAL ADMONITIONS. 203 
 
 Oxygenated air has been fuccefsfully employed in" 
 putrid fever, afthma, dyfpnoea, chlorofis, dyfpepfia, 
 ulcers of the leg, fcurvy, and other difeafes, by Drs. 
 Beddoes, Thornton, Carmichael Smyth, Darwin, 
 Ferriars, Pearfqn, &c. Azotic air, and chiefly air 
 termed the hydrocarbonate i has been fuccefsfully ap* 
 plied, by the fame gentlemen,. in pleurify, croup, 
 catarrh, fpitting of blood, and even in confump- 
 tion. 
 
 Hence,then, it appears, that fo far from a remo- 
 val into the pure air of the country, being indicated 
 in every cafe of confumption; that cafes muft often 
 occur, (thofe where inflammation prevails,) in 
 which the air, even of a crowded city, maybe pre- 
 ferable. 
 
 Pulmonary confumption is a difeafe, to which 
 thofe who are afflicted with a fcrophulous habit are 
 particularly difpofed ; and is, undoubtedly, very 
 frequently the confequence of fuch a difeafed habit,, 
 where, however, there may not be any other very 
 obvious mark of its exiftence. The benefit arifing 
 from the fea air, in fcropulous cafes, is well known, 
 and points out another reafon for preferring failing 
 to any other exercife, or mode of conveyance. 
 Still, however, remembering, that if the patient be 
 liable to very violent exertions from fea-ficknefs ; 
 and cannot, by proper accommodation, obtain an 
 
 entire 
 
2Q£ MEDICAL APMONITIQ^S. 
 
 entire exemption from the injurious effects of cold 
 and rain, more injury than advantage may follow 
 from a fea-voyage. 
 
 In confequence of the application of cold and 
 moifture to the fkin, the innumerable veflels difpo- 
 fed on the furface of the body become conftricted, 
 and the blood is driven back on the internal parts ; 
 inevitably occafioning additional injury to thofe 
 organs, which are already difeafed, and unable to 
 bear an additional load. To prevent this from 
 taking place, the utmoft care muft be taken in the 
 choice of the patient's clothing, which mould be fo 
 contrived, as to defend the furface from the aftion 
 of cold, and, at the fame time, fupport a free cir- 
 culation through the extreme veflels. Flannel 
 worn next the fkin, is of the utmoft fervice in thefe 
 refpects, fince, by exciting a flight irritation on the 
 fkin, it occafions an increafed determination of 
 blood and heat to the furface ; by which the inter- 
 nal parts are, of courfe, relieved. Befides this, it 
 allows the accumulation of heat to take place more 
 abundantly on the furface of the body, than would 
 be the cafe, if linen, or any other fubftance of a 
 clofer texture, were worn. Nor is it liable, if ren- 
 dered damp by perfpiration, to occafion cold chills, 
 when re-applied to the fkin, after having been a 
 little feparated from it ; a circumftance which can- 
 not fail but take place, when linen clothing is worn 
 next to the fkin. In 
 
MEDICAL ADMONITIONS. 'ipj 
 
 In, thofe cafes, where the irritation or\ the fur- 
 face is not defirable, and where the perfpiration is 
 confiderable, the fleecy hofiery will be $oun4 to be 
 more pleafant and beneficial than the flannel. 
 
 The clothing muft, in general, be light, but warm. 
 The cheft, in particular, fhould be well defended 
 from the colcl, and the feet from the damp.. 
 
 By a Ariel: attention to the above-mentioned di- 
 rections, cafes, which otherwife might prove fatal, 
 may frequently be brought to a favourable termi- 
 nation. To expect- fuccefs, however, it is neceuary 
 that thefe regulations be adopted in the early ftages 
 of the difeafe, and perfevered in with the ftricteft 
 conformity, for a coufiderable time. 
 
 INFLAMMATION OF THE STOMACH. 
 
 In this diftrefsful and ( dangerous malady, there 
 is an acute burning pain in the region of the ftom- 
 ach, vomiting, and fever. Exceflive thirft and reft- 
 Jeflnefs alfo harrafs the patient. The pulfe is fmall, 
 hard, and quick, and the debility and languor ex- 
 ceeds that which accompanies almoft any other cafe 
 "of inflammation. The breathing is performed with 
 confiderable pain, and the region of the ftomach is 
 extremely tender to the touch. If the difeafe is 
 not fubdued, hiccup, delirium, and convulfions, 
 
 foon 
 
206 MEDICAL ADMONITIONS. 
 
 foon come on, and with coldnefs of the extremi- 
 ties, and clammy fweats, point out that death muft 
 inevitably fucceed. 
 
 Inflammation of the ftomach may be occafioned 
 by acrid, or hard and indigeftible fubftanees, taken 
 into the ftomach, and drinking extremely cold 
 liquors whilft the body is in a heated ftate. It may 
 be alfo produced by various internal caufes, as well 
 as thofe general caufes of inflammation before re- 
 cited. 
 
 Among the moft powerful caufes of this difeafe, 
 may be confidered the fuddenly pafling from a cold 
 atmofphere into warm rooms. Of the evils which 
 may be thus produced, I have indeed already fpoken 
 fully ; but the leflbn cannot be too ftrongly im- 
 preffed, and the following opinion, from fo refpec- 
 table an authority, ought not to be here omitted. 
 Dr. Crichton, fpeaking of the evils arifing from 
 tranfitions from cold to heat, fays, "It may be re- 
 marked, that almoft all the cafes of inflammation of 
 the lungs or ftomach, to which the common people 
 of London are fubjecl, arife from fimilar caufes. 
 Either they have been riding in carts, or on the 
 tops of coaches, in very cold weather, and after- 
 wards have come into a warm room, probably an 
 alehoufe ; or elfe they have been working for hours 
 in drains, or in fimilar cold iituations. While they 
 
 remain 
 
MEDICAL ADMONITIONS. 20? 
 
 remain in the cold, no fymptoms of the diforder 
 occur. It aim oft always commences when they get 
 home."* 
 
 The ftomach may be affe&ed with that fpecies of 
 inflammation termed phlegmonic, or with that 
 which is of an erifypelatous kind. The hiftory 
 which has been jtift given, defcribes the progrefs of 
 the former, which is an acute difeafe : the exift- 
 ence of the latter, is generally made known by the 
 appearance of the following fymptoms. In the 
 beginning, a moderate degree of pain, and a fenfa- 
 tion of heat, is experienced at the pit of the ftom- 
 ach. A naufea, and fometimes retchings, are pro- 
 duced by the taking any fubftance into the ftomach j 
 an increafe of the pain always being excited, in 
 proportion to the degree of acrimony which the 
 fubftance poffeneg. As the difeafe proceeds, the 
 pain commonly increafes ; feldom, however, becom- 
 ing exceedingly acute, but fometimes teizing the- 
 patient for a confiderable time. Thirft, and a fre- 
 quency of the pulfe, are in general alfo obfervable j 
 but oftentimes the general ftate of the fyftem will 
 be very little affected. This kind of inflammation 
 has been frequently known to extend into the 
 throat, and even to reach to the internal furface of 
 the mouth, and fometimes it has occupied fuccet 
 ftvely the whole trad of the inteftines. 
 
 The 
 
 * Inquiry into the Nature and Origin of Mental Derange- 
 ment, vol. 1. p. 29. 
 
2o8 MEDICAL ADMONITIONS. 
 
 The benevolent family practitioner will necefla- 
 rily perceive, that fuch an affection of fo important 
 an organ as an acute inflammation of the ftomach. 
 is too replete with danger to allow him to attempt 
 to conduct the patient through the whole courfe of 
 this difeafe. A regular plan of cure is therefore 
 not intended to be here delivered, but only fuch 
 obfervations as may be likely to prove of benefit. 
 and which cannot occafion any mifchievous error. 
 
 A violent pain in the region of the ftomach, with 
 ficknefs and fever, ihould be always very ferioufly 
 attended to ; and if regular medical advice cannot 
 be directly obtained, the patient mould be copioufly 
 bled from the arm, the bowels emptied by means 
 of a clyfter of water-gruel or weak broth, and a 
 blifter be applied immediately over the pained part. 
 The patient fliould be immerfed in a tepid bath, all 
 his drinks mould be given lukewarm, and the tak- 
 ing any thing poflefling the leaft acrimony care- 
 fully avoided. 
 
 Should the difeafe be confiderably mitigated by 
 thefe means, yet the aid of the regular phyfician is 
 abfolutely neceffary, as it will ftill require the ut- 
 moft vigilance and care to prevent a relapfe. Great 
 danger would follow, if the patient, milled by a 
 deceitful truce, ihould, by omitting a due attention 
 to thofe things which may be beneficial or inju- 
 rious 
 
MEDICAL ADMONITIONS. 200 
 
 rious, occafion a return of the difeafe ; fince the 
 patient, weakened by the previous difeafe, and the 
 remedies by which it had been removed, is but lit- 
 tle able to fupport thofe evacuations which again 
 become neceffary* 
 
 When the difeafe is, to all appearance, entirely 
 removed, the greateft care will be necelfary for a 
 confiderable time afterwards, left a relapfe mould 
 be induced. For this reafon, thofe circumftances 
 which were enumerated, when fpeaking of the 
 caufes of this inflammation, muft be ftudioufly 
 avoided ; particularly the palling fuddenly into a 
 much warmer or much colder temperature. A 
 flannel waiftcoat worn next the fkin may prove 
 highly ferviceable, by defending the convalefcent 
 from thofe vici'flitudes of weather to which he muft 
 necefTarily be expofed. 
 
 In the other fpecies of this difeafe, which is evi- 
 dently more of a chronic kind, the length of its 
 duration will always allow of application to the 
 regular profeffor of the healing art ; which, in this 
 complaint, ought never to be precluded by the ex- 
 periments of the ignorant. This difeafe is always 
 accompanied by extremely troublefome, and fre- 
 quently by dangerous, fymptomsL; and which, fo 
 far from decidedly pointing out the nature of the 
 difeafe, are generally fo ambiguous, that much fkill 
 C c » is 
 
2IO MEDICAL ADMONITIONS. 
 
 is required to detect it. Whenever, therefore, aiiy 
 one is attacked with complaints, fimilar to thofe 
 laid down in the hiftory of this difeafe, fpeedy ap- 
 plication fhould be made for medical afliftance. 
 
 During the procefs for the cure of this difeafe, 
 and even for a confiderable time afterwards, the 
 fame cautions are requifite, as were mentioned 
 when fpeaking of the other fpecies. 
 
 An affection of the ftomach, in which confidera- 
 ble pain is experienced, from the confinement of 
 air in this bowel, will not be eahTy diftinguifhed, by 
 a common obferver, from inflammation. This is 
 a diftin&ion, which is, however, abfolutely necef- 
 fary to be made ; fince the mode of cure required 
 in the two cafes are widely different. Should the 
 patient, or his attendants, be mi-fled, and have re- 
 courfe to fpirituous and aromatic liquors, in in- 
 flammation of the ftomach, fuppofmg the difeafe 
 to be occalioned by an accumulation of wind, a 
 fatal termination of the difeafe will be moft rapidly 
 produced. 
 
 The naufea and urgings to vomit, may be fome- 
 times the caufe of a miftake, pregnant with the 
 greateft danger ; for upon a fuppofition that fome 
 offenfive matter is contained in the ftomach, an 
 emetic is frequently given, which muft neceflkrily 
 be productive of a considerable- increafe of the in- 
 flammation. INFLAMMATION 
 
MEDICAL ADMONITIONS. 211 
 
 INFLAMMATION OF THE BOWELS. 
 
 An acute, fixed, burning pain, with a confidera- 
 ble degree of tenfion of the belly, obftinate coilive- 
 nefs, hard and fmall pulfe, with fever, are the 
 fymptoms which chara&erife this dreadful malady. 
 
 This difeafe commences, generally, with flight 
 wandering pains in various parts of the belly ; but 
 which generally become fixed, about the region of 
 the navel. Soon after this, the pain becomes ex- 
 ceilively violent, as though caufed by the applica- 
 tion of fome burning fubflance to the bowels ; the 
 belly becomes fwelled, tenfe, and extremely tender 
 to the touch j the tongue is parched, and of a dark 
 brown colour, and the thirft unquenchable : fre- 
 quent and violent urgings to vomit come on ; the 
 urine is pafled but feldom ; and but feldom is any 
 difcharge of faeces obtained, in fpite of the greateft 
 efforts. The pulfe is hard, but fmall. The fever 
 is, in general, acute ; in fome cafes, being obferva- 
 ble before the coming on of the pain, and, in others, 
 not until afterwards. If efficacious remedies are 
 not had recourfe to, gangrene foon comes on. 
 This is known to be the cafe, by a fudden ceflatioi* 
 of the pain ; from which the patient, and his at- 
 tendants, are fometimes difpofed to derive flatter- 
 ing expectations : but the funk countenance, and 
 fluttering pulfe, with convulfions, and coldnefs of 
 the extremities, foon fhew what; fatal termination 
 has taken place. This 
 
212 MEDICAL ADMONITIONS. 
 
 This defcription would, perhaps, be fufficient to 
 enable any one to difcover the nature of this dif- 
 eafe, at its firft appearance ; but that it fometimcs 
 exifts, according to the greateft authorities, with- 
 out being marked by thofe fymptoms, which arc, 
 in general, its diftinguifhing criteria. Thus direc- 
 tions have fhewn, that inflammation of the bowels 
 has exifted, and terminated in gangrene, where 
 neither fever nor pain had been perceived, but in 
 a flight degree. 
 
 Inflammation of the bowels may fometimes, at 
 its commencement, be not immediately diftin- 
 guifhed from that of the flomach, or liver ; but 
 this is not of much importance, fmce the means of 
 cure necefiary to be adopted, at the firft, in either 
 of thefe cafes, would be beneficial in all. 
 
 The moll dangerous error, with refpeft to the 
 treatment of this difeafe, is when it is miftaken for 
 colicky pains ; to which family practitioners gene- 
 rally refer almoft every painful affection of the belly. 
 The remedies, which are almoft always had re- 
 courfe to, on thefe occafions, are aromatic, fpiri- 
 tuous, and heating liquors, under the delufive titles 
 of colic elixirs, family cordials, &c. Thefe, it is 
 evident, muft neceflarily accelerate the termination 
 of this difeafe, in mortification. 
 
 This difeafe may be occafioned by the fame cau : 
 
 fcs. 
 
medical' admonitions. 213 
 
 fes which were recited, when treating of inflamma- 
 tion of the ftomach. It may alfo be the fequel of 
 other difeafes, as of hernise, cofiivenefs, dyfentery, 
 worms, &c. 
 
 If the pain, before the difeafe has exifted long, 
 changes its Situation, and becomes lefs violent j if 
 the vomitings leflen, and llools are procured ; if 
 the heat leffens, and the pulfation of the artery at 
 the wrift feems to expand, it may be expe&ed, that 
 a refolution is taking place. But if the pain increa- 
 fes, and keeps conftantly in one point, and the belly 
 becomes more tenfe and tender to the touch 5 if 
 no ftools are obtained, and the vomitings come on 
 more frequently, and contain flercoraceous matter, 
 it is too evident that the difeafe is increaling ; and 
 fhould fudden ceflation of the pain, hiccups, clammy 
 fweats, blacknefs of the tongue, fallen countenance, 
 and coldnefs of the extremities, occur, thefe fymp- 
 toms will evince that death is very near. 
 
 No apology can be neceffary for declining to 
 give a regular plan, for the treatment: of this dread- 
 ful difeafe ; fince no directions, however explicit, 
 could fufHce to enable thofe, who do not poffefs 
 -real medical knowledge, to make the neceffary dis- 
 criminations, in inveftigating the nature of the 
 malady, arid in felecling proper remedies for its re- 
 moval. 
 
 Every 
 
J 14 MEDICAL ADMONITIONS. 
 
 Every painful affection of the belly, however 
 flight, fliould be immediately attended to. If the 
 belly become fwelled, hard, and painful to the 
 touch ; and the pulfe hard and contracted ; blood 
 fliould be taken freely from the arm, and the pa- 
 tient put into the warm bath, about the fame tem- 
 perature as the fkin ; or, if this cannot be conve- 
 niently done, flannels wrung out of hot water 
 fliould be applied to the belly, until a blifter can be 
 procured ; which fliould be applied as foon as pof- 
 fible after the bleeding. Mild emollient clyfters, of 
 barley-water, gruel, &c. may be given, until ftools 
 are obtained ; and the patient be put to bed be- 
 tween the blankets, and fupplied moderately with 
 the moft bland diluting liquors, fuch as barley-wa-. 
 ter, gruel, rice-gruel, &c. 
 
 . Dr. Buchan recommends, that "The clyfters may 
 
 " be made of barley-water, or thin gruel, ivithfalt." 
 
 But Dr. Duplanil, the tranflator of Domeftic Medp 
 
 icine, remarks, " Plus les douleurs font violentes, 
 
 " plus Tinflammation eft confiderable, & plus les 
 
 " remedes doivent etre adouciflants. Les lavements 
 
 <e avec le fel ne doivent done etre donnes, qu'avec 
 
 " circonfpe&ion. ,, — The more violent are the pains, 
 
 the more confiderable is the inflammation, and the 
 
 more appeafing ought the remedies to be. The 
 
 clyfters with fait, ought therefore not to be given, 
 
 but with circumfpection. 
 
 During 
 
MEDICAL ADMONITIONS. 215 
 
 During the time that is employed, in the ufe of 
 the above-mentioned means, proper advice may be 
 obtained ; for which reafon, and as the utmoft 
 caution is neceffary, in determining what internal 
 remedies may be ventured on, they are not here 
 enumerated. 
 
 Dr. Buchan, whilft treating of inflammation of 
 the bowels, fays, "It has fometimes happened, after 
 " all other means of procuring a ftool have been 
 " tried to no purpofe, that this was brought about 
 " by immeriing the patient's lower extremities in 
 " cold water, or making him walk upon a wet 
 " pavement, and darning his legs and thighs with 
 " the cold water. This method, when others failj 
 " at leaft merits a trial. It is indeed attended with 
 " fome danger ; but a doubtful remedy is better 
 " than none." In cafes of obftinate coftivenefs, 
 where there is no reafon to fuppofe that any in- 
 flammation exi{ts, this experiment may be tried : 
 but in this difeafe, no circumftance can warrant 
 the adopting this practice ; fince there cannot be a 
 doubt, that by this application of cold, the blood 
 will be driven from the lower extremities, and be 
 afterwards thrown, in an increafed quantity, into 
 the veflels of the difeafed part, occafioning, not 
 only an increafe of the inflammation, but, in all 
 probability, a rapid termination of it in gangrene. 
 
 Similar 
 
2l6 MEDICAL ADMONITIONS. 
 
 Similar cautions, with thofe which were recom- 
 mended, at the clofe of the obfervations on the in- 
 flammation of the ftomach, will be neceffary to be 
 attended to, to prevent a return of this difeafe* 
 
 INFLAMMATION OF THE LIVER. 
 
 It has been affertcd, by very great authorities* 
 that the inflammation of the liver, was a dileafe, 
 very rarely to be met with ; but diffcclioris fhew, 
 that this malady occurs more frequently than has 
 been fuppofed, fcirrhous hardnefs, fuppuration, &c. 
 being often difcovered in the liver after death, 
 when inflammation has not been fufpect.ed. 
 
 Pain in the region of the liver, under the collar 
 bone, and in the fhoulder of the right fide, with 
 fever, fiiortnefs of breath, a dry cough, vomiting, 
 hiccup, and a difficulty in laying on the left fide, 
 are the moft confpicuous fymptoms produced by 
 an inflammation of this organ. 
 
 In general, the difeafe commences with a rigour, 
 or fhivering, which is fucceeded by febrile heat, 
 lofs of flrength, thirft, and general uneafinefs. 
 The pain is fometimes dull, but at other times very- 
 acute. The pulfe is ftronger and quicker than na-. 
 tural : the urine high coloured, and fmall in quan- 
 tity. 
 
 If 
 
MEDICAL ADMONITIONS. 2lj 
 
 If this inflammation be properly treated, in the 
 firft days of the difeafe, a refolution may, in general 
 be obtained. But fhould the difeafe not yield to 
 the means which are at firft employed, it is moft 
 likely that it will terminate in fuppuration. When 
 this takes place, the pulfe becomes fofter, frequent 
 ftiiverings pervade the whole fyftern, and the pain 
 confiderably abates, and is accompanied by a fenfa- 
 tion which is defcribed as refembling that which 
 would be produced by a weighty ftabftance added 
 to the part affected. The patient becoming heclic, 
 lofes his ftrength, and waftes gradually, until colli- 
 quative fweats and diarrhsea takes p»lace, when his 
 remaining ftrength is fooh exhaufted. The con- 
 tents of the abfcefs fometimes obtain a 1 difcharge 5 
 either through the biliary du&s, or through fome 
 Of the adjoining parts, with which adheiions have 
 been formed by the preceding inflammation. In 
 fome cafes, where the difeafe has proceeded with 
 great rapidity, it has been difeovered, that a gan- 
 grene had taken place. This termination is marked 
 by a ceffatiori from pain, prOftration of ftrength, 
 fmall, and fometimes intermitting pulfe, coldnefs 
 of the extremities, and convulftons. 
 
 This difeafe may either poffefs the convex, or 
 
 the concave part of the liver. From the variety 
 
 this may occafion in the fymptoms, fome difficulty 
 
 may occur in afcertaining the nature of the difeafe,* 
 
 D d even 
 
21 8 MEDICAL ADMONITIONS. 
 
 even to the moft experienced. Nor is this the only 
 fource of error in this cafe ; for there are other di£ 
 eafes, which, being accompanied by thofe fymptoms, 
 which are always obfervable in inflammation of the 
 liver, are liable to be confounded with it, by thofe 
 who are not thoroughly verfed in the knowledge 
 of difeafes. The difeafes here alluded to, are the 
 pleurify, colic, and inflammation of the ftomach 
 and bowels. 
 
 Thofe who poifefs a fanguine temperament, and 
 are of a middle age ; who live freely, indulging in 
 the ufe of fpirituous liquors, and are frequently ex- 
 pofed to the cold air, are particularly difpofed to 
 this difeafe. Violent exercife, expofure of the 
 heated body to the cold air, folid concretions, or 
 collections of liquid matter in the liver, and drink- 
 ing largely of fpirituous liquors, may be the excit- 
 ing caufes of this malady. The cure, as in other 
 internal inflammations, muft be attempted by the 
 timely ufe of bleeding, a ftrict fpare diet, blifters, 
 fomentations, cathartic medicines, &c. 
 
 To deliver in a work of this kind a regular pro- 
 cefs for the cure of this difeafe, would be to occupy 
 the reader's time, without his being likely to derive 
 any benefit from it ; fmce, as has been before ob- 
 ferved, the utmoft fkill is often requifite to dis- 
 cover this difeafe, and diftinguifh it from thofe 
 
 which 
 
MEDICAL ADMONITIONS. 219 
 
 which are accompanied with fimilar fymptoms. 
 This difficulty has been acknowledged by fome, 
 whofe knowledge in their profeffion has been fo 
 eminent, that their precepts have been held in the 
 higheft degree of eftimation by the reft of the med- 
 ical world. If fuch men have found a more than 
 ordinary exertion of their minds neceffary, in the 
 jnveftigation of this difeafe ; furely the informa- 
 tion within the reach of a domeftic practitioner, 
 can never be fufficient to allow him to undertake 
 the cure of fo dangerous a malady. 
 
 Should the difeafe, indeed, appear to be unequiv- 
 ocally pointed out by the fymptoms defcribed in 
 the foregoing hiftory of the difeafe, and regular 
 medical affiftance be not directly obtainable, a large 
 quantity of blood, that is to fay, fourteen or fixteen 
 ounces, if the patient be an adult, mould be directly 
 taken away \ and a mild, but efficacious cathartic, 
 be given. Flannels wrung out of warm fermenta- 
 tions, may be applied to the region of the liver ; 
 after which a large blifter may be applied on the 
 pained part, and, the patient being put to bed, a 
 fweat may be excited by fuch means, as will not 
 caufe any increafe of heat m the fyftem. Warm 
 watery drinks, as barley-water, &c. may be ufed 
 for this purpofe, taking care, that they are not 
 fwallowed in fuch large quantities, as too much 
 to diftend the ftomach j fince that will almoft always 
 occafion an increafe of the pain. Thofe 
 
220 MEDICAL ADMONITIONS. 
 
 Thofe who have once fuffered from this difeafe, 
 ihould be very careful in not expofmg themfelves 
 to cold, moift air, efpecially when heated ; their 
 bowels fliould be kept regular, and their diet Ihould 
 be compofed of fubftances eafy of digeftion, and 
 void of acrimony. Pickles, all kinds of fpiceries, 
 and fpirituous liquors, being carefully avoided. 
 
 Thofe who are fo miferable, as to have devoted 
 themfelves to the deftrucHve habit of drinking to 
 excefs, are particularly liable to difeafes of the liver. 
 Tubercles, fcirrhous hardnefs, and chronic inflam- 
 mations, are tne changes which, in general, are pro- 
 duced in this organ by this pernicious practice. In 
 confequence of the fmall degree of fenfibility, with 
 which the fubftance of this vifcus is endued, it fre- 
 quently happens, that thefe alterations become very 
 confiderable, before either pain, inconvenience, or 
 any fymptoms arife, from which the patient can 
 derive a fufpicion of his calamitous fituation. Too 
 often is a man, boafling of the ftrength and invul- 
 nerablenefs of his conftitution, which he fuppofes 
 repeated exceffes have no way impaired j when fuch 
 changes have actually taken place, as prove the 
 foundation of diftrefsful and incurable difeafes. 
 Several inftances have occurred, where upon dif- 
 fection, large tubercles and abcefles have been 
 found in the liver, a fufpicion of the exiflence of 
 which had never been entertained during the life- 
 time of the patient. This 
 
MEDICAL ADMONITIONS. 22? 
 
 This alarming flatement of the evils refulting 
 from the drinking fpirituous liquors, would not 
 have been made, but with a faint hope of confirm- 
 ing the refolution, of fome one of my readers, who 
 may chance to be wavering between the gratifica- 
 tion of his perverted tafte, and a wifh to free him- 
 felf from a practice productive of fo much evil. 
 Unfortunately, it too frequently happens, that, en 
 thefe occaiions, fear fuggefts, that the conftitution 
 may be already too much injured to allow any 
 hope of returning health ; and inclination prompts 
 the conclufion, that^to oppofe the appetite will be 
 as ufelefs as it will be mortifying. But I muft here 
 remark, with the hope of ftrengthening the refolu- 
 tion, in a conteft where fo much is at ftake ; that,, 
 not only will the animal fyilem fometimes bear 
 thefe attacks for a conliderable time, with fo little 
 ferious injury, that on their being foreborne it will 
 nearly admit of a reftoration ; but that even when 
 the conftitution has been fo harraffed by exceffes, 
 that a morbid affection of the liver has taken place, 
 the return to moderation, and the employment of 
 well adapted medical means, will not unfrequently 
 ficcafion the renovation of health. 
 
 INFLAMMATION 
 
J22 MEDICAL ADMONITIONS. 
 
 INFLAMMATION OF THE KIDNEY. 
 
 Pain in the fmall of the back, pafTmg forwards 
 toward the bottom of the belly, with fever, vomit- 
 ings, and frequent voiding of the urine in fmall 
 quantities ; fometimes very pale, and at other times 
 of a high red colour ; are the fymptoms which, in 
 general, charadterife the inflammation of the kid- 
 ney. 
 
 When it is occafioned by the paffage of a calcu- 
 lous concretion, that circumftance is fuppofcd to 
 be pointed out by a numbnefs of the thigh and leg, 
 and a drawing up, or pain of the tefticle of the 
 fame fide. 
 
 The termination of inflammation of the kidneys 
 may be either in refolution, fuppuration, or gan- 
 grene. The firft is known to have taken place, 
 from the gradual ceffation of all the fymptoms. 
 But when thefe have continued for fome days, 
 without remiilion, the pain becoming throbbing 
 and more acute, and frequent fhiverings take place, 
 it may be known that matter is forming ; which is 
 rendered more certain, by the pain afterwards abat- 
 ing, and the Ihiverings increafmg. The matter 
 thus formed, is, in general, difcharged with the 
 urine. It too frequently happens, that after fup- 
 puration has taken place, a hectic fucceeds, and the 
 patient dies. But when the fymptoms fuffer no 
 
 abatement 
 
ME0ICAL ADMONITIONS. 22J 
 
 abatement, from the means which are ufed, but the 
 vomitings increafe, the pulfe becoming fmaller and 
 quicker, the breathing difficult, the extremities 
 cold, and the ftools are palled without the patient's 
 knowledge ; there is. reafon to fuppofe, that the 
 difeafe will terminate fatally by gangrene. 
 
 Exceflive exertions, external injuries, hard rid- 
 ing, violent" ftrains, expofure to cold when the body 
 is heated, and to a confiderable degree of heat, when 
 chilled, may be reckoned as exciting caufes of this 
 difeafe. But the moft frequent caufe of this malady 
 is, doubtlefsly, calcalous matter impacted in the kid- 
 ney itfelf, or in the pelvis of the kidney at the com- 
 mencement of the ureter. 
 
 The nature of this difeafe, is not pointed out fo 
 clearly by its fymptoms, as to be known by any but 
 fuch as have had frequent opportunities of notic- 
 ing it. The cure, therefore, ought never to be; 
 attempted, by any but thofe who poffefs a requifite 
 degree of fkill. 
 
 But where profeffional aid cannot be obtained at 
 the firft attack of the difeafe, and the nature of the 
 difeafe is rendered evident, a copious difcharge of 
 blood may be obtained from the arm ; and ftools 
 may be procured, by purgative medicines, and 
 emollient clyfters. The external parts, immediately 
 
 over 
 
224 MEDICAL ADMONITIONS. 
 
 over the pained part, may be fomented with hot 
 and {Simulating fomentations ; and if it can be 
 obtained, the patient may be immerfed in a warm 
 bath, being immediately afterwards put into bed, 
 between the blankets, and fupplied freely with 
 cooling and demulcent drinks, as barley-water, 
 with the addition of gum Arabac ; linfeed-tea, 
 decoction of marfhmallows, apple-liquor, &c. with 
 the hope of inducing copious perfpiration. A 
 flannel, four folded, and wetted with fpirits, to 
 which an eighth part of fpirits of hartfliorn is ad- 
 ded, may be applied warm to the fmall of the 
 back, for the purpofe of exciting heat, and a flight 
 degree of inflammation on tne external parts- 
 Over this flannel, a bladder filled with -hot water, 
 may be applied with great benefit. 
 
 Dr. Buchan fays, " If the bladders be filled with 
 " a decoction of mallows and camomile flowers, to 
 " which a little faffron is added, and mixed with 
 " about a third part of new milk, it will be ftill 
 " more beneficial.'* But this opinion is undoubt- 
 edly erroneous, fince none of the medical proper- 
 ties of thefe ingredients can have any effect, through 
 the bladder. Every purpofe will be therefore fully 
 anfwered, by the bladder being filled, with hot 
 water alone. 
 
 Opiates are ferviceable, in fome cafes, when 
 ^iven after the inflammation is fomewhat abated, 
 
 but 
 
MEDICAL ADMONITIONS. 225 
 
 but much judgment is required, to determine 
 when they may be employed with fafety ; fince^ 
 if ufed at too early a period of the difeafe, the in- 
 flammation rnuft necefiarily be thereby inereafed. 
 Of this, however, and of the other circumftances, 
 in the fubfequent management of the patient, it is 
 not neceffary to fpeak, fince thefe will be directed 
 by the phyfician. 
 
 But if medical aid fhould have been too long de- 
 ferred, or, from the ambiguity of the fymptoms, 
 the domeftic practitioner fhould have miftaken the 
 cafe, and, of confequence, treated it improperly, a 
 fuppuration will molt probably take place. Should 
 this happen, and the matter be difcharged with the 
 urine, the great eft care muft be taken, by the pa- 
 tient, that his food coniift of the mildeft and raoft 
 mucilaginous fubftances ; avoiding every thing 
 which is heating, or which is fait and acrid : living 
 chiefly on milk, puddings, broth, vegetables, fruits, 
 butter-milk, &c. Moderate exercife ihould be ufed, 
 and that chiefly in the open air. 
 
 INFLAMMATION OF THE BLADDER. 
 
 The inflammation of the bladder is known by an 
 
 acute pain at the bottom of the belly, which is 
 
 much increafed by prefiure, and is accompanied by 
 
 almoft conftant urgings to void the urine and flools. 
 
 Ee Of 
 
226 MEDICAL ADMONITIONS. 
 
 Of the former, there is fornetimes a total retention, 
 at other times it comes away frequently, but in 
 fmall quantities at a time, and with much pain : 
 the ftools are, in general, obftinately retained like- 
 wife, and when difcharged, it is with pain. This 
 difeafe is accompanied with fever, in proportion to 
 the degree of violence in which it exifts ; but as 
 it feldom occurs as a primary difeafe, a coniidera- 
 ble variety muft be expected in this, and the other 
 accompanying fymptoms. 
 
 The caufes of this difeafe are, calculous concre- 
 tions, fuppreflions of urine from obftructions in the 
 urethra, cantharides taken internally, or applied to 
 the fkin, wounds, bruifes, &c. 
 
 Any admonition as to the admiflion of domeftic 
 quackery in this difeafe, feems to be almoft unne- 
 ceffary ; as the alarm and the diftrefs it excites is 
 generally fufficient, to produce an application to 
 thofe beft qualified to adminifter relief. It will be, 
 however, proper to call the attention to the ill-con- 
 fequences that arife, from delaying, too long, the 
 neceffary oppofition to the difeafe. It fornetimes 
 happens, that, from the patient's having been un- 
 happily too much accuftomed to pain, or from his 
 not attributing the diftrefs he experiences to the 
 true caufe, he neglects the obtaining of afiiftance 
 through the firft ftage of the difeafe. When this 
 happens, there is much reafon to fear, that the moft 
 
 Ikilful 
 
MEDICAL ADMONITIONS. 227 
 
 Ikilful furgeon, or phyfician, will be uriable to pre- 
 vent very difagreeable confequerices. Should the 
 inflammation poflefs that part which is termed the 
 neck of the bladder, or fhould the difeafe be chiefly 
 feated in the pro/irate gland which furrounds this 
 part, there will be great danger of the patient's 
 lofing the power of retaining his urine. 
 
 If, therefore, no doubt remains, as to the nature 
 of the difeafe, and regular medical aid cannot be 
 foon obtained, blood may be taken away plentifully 
 from the arm, ftools procured by fome active puff- 
 gative, avoiding thofe of the faline clafs, and clyf- 
 ters, of the decoction of poppy-heads, may be in- 
 jected every two or three hours. Fomentations, 
 alfo, of the fame decoction, may be kept conftantly 
 applied, over the bottom of the belly ; and, if pof- 
 fible, the patient mould be immerfed in the tepid 
 ;bath, and in other refpects treated as has been juft 
 recommended, in the inflammation of the kidneys j 
 excepting that, where an entire retention of urine 
 exifts, no more muft be drank than is abfolutely 
 neceflary. 
 
 Should the difeafe terminate by fuppuration, the 
 conduct of the patient may, in that cafe alfo, be 
 regulated, by the directions juft given, in the fup- 
 pofed cafe of fuppuration in the kidneys. 
 
 INFLAMMATION 
 
J28 MEDICAL ADMONITIONS. 
 
 INFLAMMATION OF THE SPLEEN. 
 
 This difeafc, which does not often occur, is to 
 be difcovered by fever, with tenfion, heat, fwelling, 
 and pain, of the left hypochondrinna, the pain in- 
 creafing upon preflure. Inflammation of the fpleen 
 requires nothing peculiar in its mode of treatment, 
 nor yields any circumftance, from which I can de- 
 duce any particularly ufeful obfervation. 
 
 INFLAMMATION OF THE PERITONEUM. 
 
 Inflammation of the peritoneum may be fup- 
 pofed to exift, when there is fever, with a confid- 
 erable degree of pain of the belly, which is increafed 
 during an erect pofture, and no fymptom charac- 
 teriflic of inflammation of any particular bowel. 
 
 The treatment of this difeafe, and the manage- 
 ment of the patient, fhould be directed by the rules 
 laid down, when treating of inflammation of the 
 bowels. 
 
 Dr. Baillie, in his moft valuable work, The Mor- 
 bid Anatomy, &c. of tlje Human Body, has this 
 important remark on this moft ferious difeafe : 
 " When the inflammation is flight, I have known 
 the pain to be very inconfiderable, and the pulfe to 
 be little increafed in its frequency, fo that inflam- 
 mation 
 
MEDICAL ADMONITIONS. 229 
 
 mation of the peritoneum had not been fufpe&ed." 
 A difeafe thus infidious muft require all the cir- 
 cumspection and knowledge that fludy can fupply, 
 even to detect it. To the domeftic practitioner, 
 nothing more furely need be faid, to deter him 
 from an improper interference, in cafes marked by 
 fymptoms, fuch as have been juft defcribed. 
 
 RHEUMATISM. 
 
 Rheumatism may be very properly divided in- 
 to two fpecies, the acute and the chronic. Each 
 of thefe I mail fpeak of Separately, beginning with 
 the acute. * 
 
 The acute rheumatifm generally begins with a 
 fenfe of coldnefs pervading the whole body, fre- 
 quently arifing to fuch a degree, as to occaiion Shiv- 
 ering. This is Succeeded by feverifh heat, the 
 pulSe becoming fuller and quicker, and the urine 
 higher coloured, than in health. After thefe Symp- 
 toms have exifted a day or two, the patient feels 
 {harp wandering pains,in various parts oSthe body; 
 Sometimes thefe pains accompany the other fymp- 
 toms, from their firft appearance, and fometimes 
 the pain precedes the febrile fymptoms. The pain 
 chiefly affects the joints of the ankles, wrifts, knees, 
 and elbows, the patient being, in fome cafes, tor- 
 mented with excruciating pains in feveral of thefe 
 
 places. 
 
230 MEDICAL ADMONITIONS. 
 
 places, at the fame time ; in others, this painful 
 affection is produced, in one joint, as it leifens in 
 another ; and often diftrefles the unfortunate fuf- 
 ferer with repeated attacks of the fame joint. Red- 
 nefs and fweliing of the part generally accompany 
 the pain. 
 
 The pain, in general, is fo confiderable, as entirely 
 to deprive the patient of reft j and the night, in- 
 stead of bringing fleep, is generally the time, when 
 the pain and reftlefsnefs are moil excemve. Par- 
 tial vifcid fweats frequently come on, but without 
 any accompanying relief. But fometimes general 
 and copious perfpiration occuring, with a diminu- 
 tion of the pain, affords great reafon to hope for a 
 fpeedy and favourable termination of the difuafe. 
 
 The duration of this difeafe is very uncertain ; 
 but, in general, unlefs very efficacious means are 
 ufed, it will continue, with very little amendment, 
 for two or three weeks, and fometimes even longer. 
 
 This difeafe is much more frequent in cold, than 
 in warm, climates ; and in thofe feafons in which 
 the weather is variable, than even when it is con- 
 stantly cold : thus it is oftener met with in fpring 
 and autumn, than in winter. 
 
 Thofe are moft difpofed to acute rheumatifm, 
 who are of a middle age, and of a fanguine tem- 
 perament. 
 
MEDICAL ADMONITIONS. 23I 
 
 perament. Thofe, alfo, who have once fufTered 
 from this complaint, are more liable to its attacks 
 than others. 
 
 Thofe circumftances, which have already been 
 fpoken of, as rendering the fyftem apt to take on 
 an inflammatory flate, will render the body more 
 fufceptible of injury, from the changes in the ftate 
 of the atmofphere, and thereby more liable to 
 rheum atifm. 
 
 This difeafe requires very great fkill and atten- 
 tion in thofe who attempt its cure ; for although 
 it is evidently of an inflammatory nature, it is alfo 
 very certain, that it is, in many refpects, different 
 from that kind of inflammation, of which we have 
 hitherto treated ; and that it requires a very con- 
 fiderable difference in the mode of cure. 
 
 As in other inflammatory difeafes, fo in this, 
 bleeding is often a very powerful remedy : this 
 ihould be performed to fuch an extent, as its effects 
 may direct, and the ftrength of the patient allow. 
 In fome cafes, the taking away of blood may be 
 highly injurious ; and in other cafes, where it is 
 even advifable, much care muft be taken, left the 
 blood be taken away in too large a quantity. Be- 
 fides, it muft be obferved, that the difcharge by 
 which moft relief is gained, in this difeafe, is that 
 of perfpiration. This, if properly obtained, and 
 
 the 
 
232 MEDICAL ADMONITIONS* 
 
 the patient properly managed, feldom fails of re- 
 moving the difeafe ; especially if it has not long 
 exifted. During the ufe of fudorifics, the bowels 
 fhould be kept regularly open, and the violence of 
 pain moderated by anodyne applications to the 
 part. 
 
 As it is a point by no means eafy to afcertain 
 how far the evacuation of blood may be allowed, 
 fo does it require nicety of judgment to determine 
 how far evacuations, of any kind, may be permit- 
 ted ; fince, it is well known, that there is a period 
 in this difeafe, after which, evacuations, of any 
 kind, not only weaken the patient, but lengthen 
 the difeafe ; and cordial medicines, a reftorative 
 diet, and even the ufe of the bark are indicated. . 
 
 In the acute rheumatifm, the regimen muft be 
 governed by the fame indications which direct the 
 phyfician in his choice of remedies. 
 
 In the chronic rheumatifm, the pains are lefs 
 
 acute, and feldom accompanied with fever ; nor is 
 
 any rednefs difcoverable on the parts affected. The 
 
 larger joints, and the mufcles, are moft commonly 
 
 the feat of this difeafe ; fuch as the hip and moulder 
 
 joints, delloid mufcle, &c. The integuments above 
 
 the pained part are always cold to the touch, it 
 
 being difficult to excite in them either warmth or 
 
 perfpiration. 
 
 Sudden 
 
MEDICAL ADMONITIONS. 233 
 
 Sudden ftrains and exertions may be mentioned 
 here, as a frequent caufe of chronic rheumatifm, in 
 addition to what was faid of the caufes, when treat- 
 ing of the acute kind* 
 
 The remedies Which may be ufed in this difeafe ? 
 are either internal or external. The internal rem- 
 edies are chiefly fuch as act by determining the 
 blood to the furface, and by producing an increafe 
 of perfpiration. Such are, the falts of hartfhorn, 
 the volatile tincture of guiacum, &c. the effects of 
 which may be accelerated by drinking freely of 
 white wine whey, or muftard whey, made by boil- 
 ing the feeds of muftard in milk. The external 
 applications are chiefly fuch ftimulating applica- 
 tions as excite a rednefs in the fkin over the part 
 affected : thefe may be, camphorated fpirits, oppo- 
 deldoc j or, if thefe prove not fufiiciently ftimu- 
 lating, if ufed alone, they may be mixed with the 
 volatile fpirits of hartfhorn, oil of amber, &c. Fric- 
 tion with a flefh brulh renders thefe remedies ftill 
 more effectual. Electricity has been fuccefsfully 
 ufed in many cafes. The wearing a plaifter of 
 Burgundy pitch over the part has alfo often proved 
 ferviceable. 
 
 To prevent the return of either ftate of this di£ 
 
 eafe, the patient fhould defend himfelf by warm, 
 
 but light clothing, from the inclemencies of the 
 
 F f > weather. 
 
^34 MEDICAL ADMONITIONS. 
 
 . weather. Over the parts which are moft particu* 
 larly the feat of the difeafe, fhould be worn flannel, 
 or rather clothing of fleecy hofiery. 
 
 The paffing fuddenly out of one atmofphere into 
 another, differing much in temperature from the 
 former, is very likely to occafion this difeafe. Ex- 
 pofure of the body to a ftream of cold air, is alfo 
 likely to prove very injurious, efpecially if it be apJ 
 plied to one particular part only, and that the body 
 is in a heated ftate. Damp clothing mould be care- 
 fully avoided, as well as the expofure to a moift 
 atmofphere, the ill effects of cold being much in- 
 creafed by the joint action of moifture. 
 
 GOUT. 
 
 The paroxyfms of this tormenting difeafe are 
 moft commonly preceded, by a general uneafmefs ; 
 the feet and legs are affected with numbnefs and 
 coldnefs, and frequently alfo with a fenfe of prick- 
 ling ; the veins on the furface are alfo faid to be- 
 come unufually turgid, and the mufcles of the legs 
 to be affected with the cramp. But the circum- 
 stances which have been obferved, moft particularly 
 to precede the attacks of this difeafe, are the changes 
 which, for fome little time before, take place in 
 the ftomach ; this organ generally fuffers a confid- 
 erable derangement of its functions ; the appetite 
 
 being 
 
MEDICAL ADMONITIONS, 335 
 
 being much impaired, and the ftomach and bowels 
 diftended with wind, the confequence of digeftion 
 jiot being properly carried on ; the appetite becom- 
 ing, however more eager before the attack. 
 
 According to the obfervations of the attentive 
 Sydenham, the paroxyfm generally begins about 
 two o'clock in the morning. The patient, having 
 gone to bed free from pain, is waked about that 
 time with pain poffeffing commonly fome part of 
 the foot. Soon after this, comes on a coldnefs and 
 fhivering, which terminates in fever. The pain 
 increaiing, fometimes refembles that which might 
 be expected to be produced by the ftretching and 
 tearing of the ligaments, or the gnawing of a dog; 
 at others, the parts feem to fuffer the effects of a 
 tight ftri&ure, or confiderable preffure, being fo 
 feelingly alive, as not only, not to bear the weight 
 of the bed-clothes, but not even the heavy tread of 
 any one acrofs the room. In this miferable ftate 
 the patient continues, toffing about the bed, in vain 
 trying the effect of variety of pofture to leflen his 
 Sufferings. At about the fame hour of the follow- 
 ing morning, the patient, in general, experiences a 
 fudden mitigation of the pain, which he com- 
 monly attributes to the laft pofition in which the 
 limb was placed. Soon after this, a moderate fweat 
 coming on, he falls afleep, and, upon waking, finds 
 that the pain is confiderably diminished $ but that 
 
 the 
 
2$6 MEDICAL ADMONITIONS. 
 
 the part \tfhich fufFers is affefted with a red fhining 
 fwelling. The pain fometimes continues two or 
 three days, increafing at night, and becoming more 
 mild towards morning. 
 
 If, after the difeafe has thus completed its courfe 
 in one foot, it difappears entirely, the patient re- 
 gains the ufe of the foot, and experiences a moft 
 .grateful change— ftrength and alacrity having 
 taken the places of debility and languor. But it 
 often happens, that after the violence of the firft 
 attack has fubfided, a fecond will be experienced 
 in the other foot. In more inveterate cafes, both 
 feet, fometimes, are affected at the fame time ; and 
 repeated paroxyfms fometimes extend the fufferings 
 of the patient for fix weeks or two months, or 
 even longer. 
 
 After the firft attack of this difeafe, the patient 
 is, in general, free from it for two or three years j 
 but the intervals becoming fhorter between every 
 paroxyfm, it often happens, that, at laft, the difeafe 
 feldom quits the patient, except for two or three 
 months in the fummer. As the ftrength of the 
 patient becomes leffened, the paroxifms are accom- 
 panied with lefs pain than before ; ficknefs and de- 
 bility fhewing, that the caufe of this confifts, not 
 in a diminution of the gouty difpofition, but of the 
 powers of the fyftem. When the paroxyfms have 
 recurred very often, the joints become ftiff,andthe 
 
 limbs 
 
MEDICAL ADMONITIONS. 237 
 
 limbs enfeebled, and, in many perfons, concretions, 
 refembling chalk, form over the joints, and unite 
 with the circumftances juft mentioned, in depriv- 
 ing the patient of the ufe of the affected limbs. 
 
 The above hiftory contains a defcription of this 
 difeafe, in its moft common mode of appearance ; 
 or in that form which is chara&erifed as regular 
 gout. But it fometimes happens, that inftead of 
 the difeafe proceeding in this regular manner, a 
 variety of anomalous fymptoms arife, unaccompa- 
 nied by thofe affeclions'of the joints, which were 
 wont to appear. This ftate of the difeafe is termed 
 the Irregular Gout. All the various fymptoms 
 which occur in this ftate of the difeafe, cannot well 
 be here particuiarifed : thofe which have been moft 
 frequently obferved,will, therefore, only be noticed* 
 
 When the head is the feat of the difeafe, giddi- 
 nefs, pain, lofs of memory, &c. are the fymptoms 
 which occur,and which generally terminate in fome 
 fatal affe&ion of the brain. Palfy and apoplexy 
 may indeed be, fometimes, the confequence of a 
 fudden tranflation of the difeafe to the brain ; and 
 may therefore happen, without the occurrence of 
 any previous headach, or any other fymptom, from 
 which the fatal termination might be fufpected. 
 
 The lungs, as well as the heart, are alfo fubje& 
 to ti^fe anomalous attacks ; occasioning fliortnefs 
 
 of 
 
238 MEDICAL ADMONITIONS. 
 
 of breathing, afthma, palpitations of the heart, 
 faintings, and fudden death. 
 
 When the ftomach and bowels are affected by 
 this difeafe, a variety of troublefome fymptoms 
 arife ; fuch as lofs of appetite, ficknefs, flatulency, 
 pains in the ftomach or bowels, acid erucations, &c. 
 Frequently at the fame time, the unfortunate fuf- 
 ferer experiences the moft diftreffmg dejection of 
 ipirits, his mind being poffeffed with groundlefs 
 appreheniions and alarms. 
 
 Men are more fubje& to this difeafe than fe- 
 males ; and thofe men are more efpecially liable to 
 it, who are of a full and corpulent habit. A dif- 
 pofition to it feems fometimes to be acquired, and 
 at other times loft, by a difference in the mode of 
 living. It feldom attacks thofe who live on a fpare 
 diet, and who avoid wine and fpirituous liquors ; 
 thofe, alfo, who ufe much exercife, are moftly ex* 
 cmpt from it. 
 
 Many fuppofe, that the attendance of a medical 
 man, is, in this difeafe, entirely unneceffary ; and 
 that this muft certainly be one of thofe cafes, 
 which may with propriety be committed to the 
 care of the domeftic practitioner, whofe knowledge 
 refpe&ing this difeafe is not likely, they fuppofe, to 
 be much exceeded by that of phyficians themfelves. 
 
 Phyficians, 
 
MEDICAL ADMONITIONS. 239 
 
 Phyficians, indeed, do not pretend, either to an 
 accurate knowledge of the nature of this malady, 
 or to the poffeffion of a fpecific, with which they 
 are capable of removing it, with fafety: But, in 
 confequence of their knowledge of the laws by 
 which the animal ceconomy is regulated, and by 
 repeatedly obferving the progrefs of this difeafe, 
 and the changes produced in it, by the various 
 habits and conftitutions in which it occurs, as well 
 as the confequences refulting from the various 
 means, by which its cure has been attempted ; they 
 are often enabled both to palliate the prefent fuf- 
 ferings of a patient, and to give hyn fuch direc- 
 tions for his management, as may not only leffen 
 the frequency, and the duration of future parox- 
 yfms ; but may even, fometimes, entirely prevent 
 their recurrence ; and, at the fame time, fecure 
 the patient from experiencing any ill effects by the 
 change thus induced. 
 
 Thefe directions xmift ever be varied according 
 to the difference of temperaments ; the morbid 
 ffate of the conftitution, which requires to be 
 amended ; and thofe errors in the mode of livings 
 which may have been the exciting caufe of the di£ 
 cafe. Inftru&ions for the condud of patients, in 
 every particular cafe of this malady, would of them» 
 felves make a volume ; it is not intended, therefore^ 
 to attempt more than to offer fome general obfer- 
 \ vations. 
 
240 MEDICAL ADM0N1TI0K3. 
 
 vations, by an attention to which, the ravages of 
 this painful diforder may be fometimes leffened. 
 
 The treatment of the patient, during the parox- 
 yfm, fhould be directed by the medical attendant ; 
 who will be beft able to judge and determine, ac- 
 cording to the variety of circumftances, on the 
 more proper plan. It may not, however, be amifs, 
 to remark here, that the progrefs of the fit fhould 
 be interrupted as little as poflible ; but fhould the 
 pain become exceffively violent, recoiirfe may be 
 had to proper anodynes, the body being at the fame 
 time kept gently open, by fome mild laxative. 
 
 The regimen, during the paroxyfm, mould be of 
 fuch a kind, as will fupport the ftrength, without 
 increafing the heat : broths, puddings, jellies, light 
 meats, &c. "are therefore proper. But fpirits or 
 wines muft be carefully avoided, as well as fait 
 meats, and all highly feafoned food. 
 
 When the fit is entirely gone oft, the patient 
 fhould conlider himfelf as entirely free from the 
 difeafe, and fhould earneftly fet about preventing its 
 return. This may be" done, I am fatisfied, by med- 
 icine alone ; but, unlefs a due attention is paid to 
 the exercife and regimen, another difeafe, and ge- 
 nerally a more fatal one, will be induced. But if 
 due attention be paid to the following admonitions, 
 there is the greateft reafon to believe, that the pa- 
 roxyfm s 
 
MEDICAL ADMONITlONSo " 24I 
 
 toxyfms may be rendered lefs violent, and lefs fre- 
 quent ; and that fometimes their return may be 
 even entirely prevented, and that without occa- 
 fioning any other difeafe. It is alone by a find 
 conformity to regimen, that this difeafe can be 
 lafely checked. To obftrucl: the courfe of the dif- 
 eafe, and prevent the return of the paroxyfms by 
 medicine, whilft exceffes and irregularities are per- 
 mitted, is to create a difeafed flate of the fyftem,, 
 and at the fame time to hinder nature from infti- 
 tutmg that procefs, by which that difeafed ftate 
 may be altered. But by carefully avoiding thofe 
 injurious indulgencies, the difpofition to the difeafe 
 is itfeif removed, and its renewal prevented. 
 
 The victims of this malady are generally thofe 
 who have indulged their appetites with eating 
 highly feafoned animal food, and drinking freely 
 of fermented and fpirituous liquors, particularly of 
 wine ; thofe who lead a fedantary life, who are 
 diftreffed with anxious thoughts, or whofe minds 
 are coniiderably engaged in ftudy. 
 
 The food of thofe who are fubjecl: to this difeafe 
 mould be plain and light. At breakfaft they may 
 take milk, raw or boiled ; and at dinner, puddings, 
 vegetables, and animal food in moderate quanti- 
 ties. Their fuppers ihould be fmall in quantity, 
 ao'd compofed_ of fuch fubftances as are neither 
 G g heating 
 
242 MEDICAL ADMONITIONS. 
 
 heating nor difficult of digeftion. Pickles fhould 
 be entirely refrained from, and acids of every kind 
 fhould be ufed with great moderation. Spirituous 
 liquors mull never be drank, except in the fmalleft 
 quantities, and confiderably diluted. Wines, par- 
 ticularly thofe of foreign production, and even malt 
 liquors, mull be avoided with equal care. 
 
 Regular exercife is of the utmoft fervice, in mod- 
 erating the violence of this difeafe. Such exer- 
 cife fhould be preferred, as being joined with amufe* 
 ment, ferves at the fame time to exhilarate the 
 fpirits ; fuch are rural fports, as hunting, mooting, 
 &c. or any mechanical employment, the execution 
 of which requires fome little attention of the mind. 
 
 Regularity in the hours of retiring to reft, and 
 in rifing, mufl be flriclly adhered to. Late hours 
 being exceedingly prejudicial, mud be carefully 
 avoided ; as well as too long continuance in bed, 
 which, by the debility it induces, is in the higheft 
 degree injurious. 
 
 It is a common obfervation, that the affluent are, 
 in genera!, the fubjecls of this malady ; it feldom 
 happening, that thofe of the inferior clafs of peo-» 
 pie are troubled with it, except they have received 
 it as their reward for copying the follies and vices 
 of their fuperiors in fortune. 
 
 It 
 
MEDICAL ADMONITIONS. $43 
 
 It is however, by no means recommended, raftily 
 to enter on any confiderable change of former nab- 
 its, efpecially if a great degree of debility has been 
 brought on by former exceffes, or by difeafes. In- 
 deed no fuch changes ought to be attempted, with- 
 out due advice, after a full confideration of every 
 attendant circumftance. 3But ihould it be deemed 
 prudent thus to attempt the cure, the patient 
 ihould well confider the advantages likely to be 
 gained by his felf denial, and firmly refolve to give 
 the plan a fair trial, 
 
 The neceffity of a ftricl: attention to regimen, in 
 thofe who are fubjec"t. to this difeafe, is fo well and 
 fo forcibly inculcated by Dr. Cadogan, that I can- 
 not refift the impulfe of recommending theperufal 
 of his treatife,to every one afflided with this difeafe. 
 
 Nor can I here refrain from noticing the obfer- 
 vations contained in a treatife on the Gout and 
 gravel, by Mr. Murray Forbes ; who has moft in- 
 genioufly ihewn, by reafonings upon eftablifhed 
 chemical facts, and by fair chemical deductions, that 
 the gout is a difeafe proceeding from a redund- 
 ancy of acid in the fyftem. — "That acids," he 
 fays, "are greatly inftrumental towards the pro- 
 duction of gout, is an opinion which was founded 
 upon obfervation, and has long been maintained. 
 This difeafe, as well as gravel, has, in many cafes, 
 
 been 
 
244 MEDICAL ADMONITIONS. 
 
 been attributed to an exceffive ufe of acids. It lias 
 likewife been regarded as intimately connected with 
 that {late of the ftomach, in which there is almoft 
 a perpetual generation of acid. At the fame time, 
 however, a variety of circumftances of a different 
 kind have been enumerated as four ces of it. If we 
 examine with attention the condition of many in 
 whom gout makes its appearance, we ihall gene- 
 rally find, that thofe other circumftances have ge- 
 nerally been productive of it, when they have ha4 
 the previous effect of impairing the digeftive facul- 
 ties, and caufing a confequent tendency to the ge- 
 neration of acid. Of this nature are infobriety, 
 luxury, indolence, and voluptuouinefs. The. dif- 
 eafe frequently attends upon a habit of drinking, 
 on account of the acids conveyed into the body by 
 means of it. The tendency of different liquors to 
 produce it, is not fo much in proportion to their 
 ilrength, as to the quantity of acid in their com- 
 pofition. This afferticn is warranted by the expe- 
 rience of ages ; the liquor in which acid predomi* 
 nates having been invariably confidered, by the 
 bed authorities, as peculiarly predifpoiing to gout. 
 Shallow of obfervation muft be the man, who, ac- 
 cuftomed to endure the pains of gout, has not be- 
 come acquainted with the injury of acids. By im- 
 moderate indulgence in intoxicating compounds of 
 any kind, by a life of luxury, by a ftate of indo- 
 lence, and by an inordinate purfuit of pleafures, 
 
 the 
 
MEDICAL ADMONITIONS. 245 
 
 the' powers requifite for the procefs of digeftion 
 are at laft brought into difbrder, and the contents 
 of the ftomach permitted to run into common fer« 
 mentation. Thefe, and other circumftances, which 
 tend to vitiate the a£tion of the ftomach, and con- 
 duce, by reafon of derangement, to the formation 
 of acid, may be looked upon as remote caufes of 
 ' gout and of gravel." 
 
 Dr. WoUaftor., in the Philofophical Tranfaciions 
 for the year 1792, has difcovered, by a feries of in- 
 genious experiments, that the gouty matter con= 
 tains the peculiar (Hthic) acid which Mr. Forbes, 
 in the foregoing paffage, fuppofed to be generated 
 |n the fyftem, and joined to the mineral alkali. 
 
 SMALL POX, 
 
 The fmall pox appears under two very different 
 forms, which are termed the diftincl: and the con- 
 fluent. The mode of treatment of thefe being re- 
 quired to be as different as are their modes of ap- 
 pearance, they will be each treated of feparately. 
 
 The diftincl fmall pox is preceded, for a few 
 days, by a fenfe of languor and wearinefs ; and im- 
 mediately before the coming on of the febrile ftate, 
 frequent cold fhiverings and tranfient glows o£ 
 heat are perceived by the patient. The fever, which 
 . ■ fucceeds 
 
24'5 MEDICAL ADMONITIONS, 
 
 fucceeds to this ftate, is accompanied by violent 
 pain of the head and loins, and frequently with a 
 fevere opprefiive pain at the pit of the ftomach. 
 Thefe fymptoms are much increafed on the fecond 
 evening of the attack, when the patient generally 
 becomes exceedingly reftlefs, and even delirious, 
 through fome part of xhe night ; the fkin burning 
 with an uncommon degree of heat. 
 
 On the following day, the third day of the fever, 
 the eruption is thrown out ; the fkin becoming 
 left hot, and being moiftened with a general per. 
 fpiratiom 
 
 The eruption which takes place on the face and 
 limbs, generally precedes the eruption on the trunk, 
 a few hours. 
 
 The eruptions, at their firft appearance, are fmall 
 red paints, which, upon being clofely examined, 
 and felt by the fingers, will be found to form little 
 eminences in the fkin, which are, from their firft 
 appearance., feparate and diftinct from each other. 
 
 The puftules gradually affume a conical form, 
 and on the fifth or fixth day begin to turn white 
 on their tops ; and by the eleventh day become 
 entirely white, at which time the puftules acquire 
 their greateft magnitude. Their bafes are red and 
 inflamed during the whole courfe of the eruption ; 
 but when the puftules are entirely filled, they affume 
 
 3 
 
MEDICAL ADMONITIONS™ 247 
 
 a browrriih hue, their bafes becoming, at the fame 
 time, paler. The puftules now mrivel, and an; 
 fucceeded by dark coloured crufts. Thefe in a few- 
 days fall off, leaving rednefs of the fkin, and fome- 
 times a fmall pit in thofe parts which they polTe&d. 
 
 A tenfion of the fkin, fwelling of the face, and 
 fome difficulty in fwailowing, generally accompany* 
 even the mildefl fort of this diforder, and fome- 
 times occafion confiderable inconvenience, where 
 the eruption is numerous ; thefe fymptoms being 
 generally proportioned to the number of the puf- 
 tules. The fever, where the eruption is trifling., 
 generally ceafes when that is completed ; but where 
 the eruption is confiderable, it continues during 
 the pr'ocefs of fuppuration. 
 
 The confluent fmall pox is preceded by a much 
 greater degree of fever ; the frequency and fmall- 
 nefs of the pulfe fhewing, that the fever is of the 
 low kind. The eruption appears alfo more ear!y 9 
 is much fmaller, and in greater numbers, the whole 
 face often having the appearance of being poifeiTed 
 by erifypelatous inflammation. , The fpots affume 
 a crimfon colour : they do not rife like the diftinct 
 kind, but, remaining flat, and running into one 
 another, they very much refemble the mealies, dur- 
 ing the firft days of the eruption. As the eruption 
 proceeds, little vefieles form on the top of the pim- 
 ples* A 
 
24° MEDICAL ADMONITIONS. 
 
 A fweliing of the face and neck takes place at 
 the commencement of the eruption, and becomes 
 very considerable ; but fubfides about the tenth or 
 eleventh day. In the diftind kind, the inlide of 
 the mouth and throat fometimes become fwelled, 
 in a flight degree ; but in the confluent kind, this 
 affection is generally very confiderable, and is ac- 
 companied, in children, with a diarrhae ; and in 
 adults, with a copious difcharge of faliva. This is 
 frequently fo acrid, as to excoriate the mouth and 
 throat ; and, as the difeafe advances, becomes fo 
 vifcid,as to be difcharged with the utmoft difficulty. 
 The puftules, inftead of being diflended with whit- 
 ifh matter, as in the diftinct. kind, feldom rife to 
 any height above the Ikin ; and contain only a fe- 
 rious fluid, which in the more malignant cafes, is 
 commonly of a purple colour. This colour is oc- 
 casioned by a mixture with jhe di(folved blood, 
 which, in thefe cafes, efcapes at every outlet : from 
 this caufe alio arife difcharges of blood, by ftool 
 and urine. In this malignant ftate of the difeafe, 
 by the fame caufe are produced purple fpots, refem* 
 bling flea bites, and bladders of dark coloured or 
 limpid feram. Thefe are the appearances diftin- 
 guifhed by nurfes by the names of purple and white 
 hives. When this fpecies of the difeafe terminates 
 favourably, the puflules, filling firft on the face, 
 and foon after on the reft of the body, begin to dry 
 about the fixteenth day ; the contained fluid then 
 
 exuding 
 
r HEt)lCAt ADMONITIONS. 249' 
 
 exuding, and forming a dark coloured cruft, which 
 remains for feveral days. Ulceration generally 
 takes place between them, whence frequently re- 
 fults confiderable lofs of fubftance, and difagreea- 
 
 ble cicatrices. 
 
 The fecondaiy fever, as it is" called, which fre- 
 quently comes on in this confluent kind, makes its 
 appearance, in general, about the period of matura- 
 tion j and is commonly accompanied by fymptoms 
 of a dangerous nature. 
 
 In thofe cafes where the difeafe terminates fa- 
 tally, the fever increafes, the whole furface of the 
 body becomes of a pallid hue, the puflules are flac- 
 cid, and the {welling of the head fubiides, without 
 that of the extremities fucceeding. The patient is 
 harrafled with exceffive anxiety and reftlefsnefs, 
 which is foon fucceeded by a delirious or a com- 
 atofe ftate ; fefpiration* at the fame time, being 
 performed with the greateft difficulty. Suffoca- 
 tion, or violent convulfions, at iaft puts an end to 
 the life and fufferings of the patient. 
 
 The Treatment, In the diftinft kind, where 
 the eruptions are very few, and no particular fymp- 
 toms appear, little more is required, than to regu- 
 late the diet of the patient, and to allow him to re- 
 ceive the benefit of free expofure to pure and cool 
 air* The diet mould confift of vegetable fubftan- 
 H h ces. 
 
25O MED I CAL ADMONITION S« 
 
 ces, as fago, panada, rice gruel, &c. milk, milk pot- 
 tage, rice milk ; and, when the eruption is com- 
 pleted, and fuppuration is taking place, a little broth 
 and light puddings may be allowed. The drinks 
 may be barley-water, toaft and water, and bread 
 tea, rendered grateful to the tafte, by the addition 
 of currant jelly, or the juice of lemons or oranges. 
 Wines and fpirituous liquors, however diluted, 
 muft be very carefully avoided ; as well as all kinds 
 of heating cardiac medicines, which are too fre- 
 quently adminiftered by family dochrefTes, with the 
 intention, as they exprefs themfelves, of throwing 
 out the diibrder, 
 
 The treatment of the confluent kind requires 
 much judgment in the phylician, and even in the 
 attendants. It will be unneceffary to treat, in a 
 work of this kind, of the variety of medicines 
 which will be indicated by the various fymptoms 
 Of this dreadful difeafe. Since no one, who does 
 not poffefs real medical knowledge, ought to be 
 encouraged in attempting the management of a 
 malady fo full of danger. 
 
 The exertions, indeed, of the mofl intelligent 
 phyfician, will be of little or no avail, unlefs the at- 
 tendants are obedient and attentive to his orders. 
 In no difeafe whatever, has ignorance and preju- 
 dice fuch fway, as in that which is the fubject. of 
 
 the 
 

 MEDICAL ADMONITIONS. 25 1 
 
 the prefent fection. In the firfl ftage of this difeafe, 
 it often happens, that the patient is put to bed, un- 
 der a load of bed-clothes, in a room heated with a 
 large lire, the frefh and pure air being, as much as 
 
 I poflible, excluded : and, left this fhould not prove 
 fufficiently efficacious, the febrile ftate of the patient 
 is further incrc'afed, by the heating cordials with 
 which he is conftantly fupplied. Directed by fimx- 
 lar ridiculous prejudices, the patient is not allowed 
 a change, either of his body linen or bed clothes 5 
 but is obliged to wear, to the end of the difeafe, 
 the fame linen, which foon becomes uncomfortable, 
 and even offenfive, from the quantity of putrid 
 matter it has abforbed. Another injurious prac- 
 tice, among practitioners of this defcription, is that 
 of allowing their unfortunate patients to remain 
 feveral days, without any difcharge from the bow- 
 els ; many good women entertaining an idea, that 
 the pock would fill better, if the patient could be ' 
 prevented from having a ftool, even until the ma- 
 turation was complete, or, in their language, until 
 
 - {he pock was turned. 
 
 It is much to be regretted, that thofe who are 
 under the neceffity of employing nurfes, do not 
 confider that care, and exact fubmiifion to direc- 
 tions, are requisites more effential in thefe female 
 attendants, than the molt intimate knowledge of 
 the various recipes of family quackery, Pofleffing 
 
 this 
 
%$% ' MEDICAL ADMONITIONS. 
 
 this kind of information, felf-fufEciency and confi. 
 dence take fuch ftrong pqfTeulon of them, that, un- 
 Jefs they are fuperintended by fome anxious and 
 vigilant friend of the patient, their own defultory 
 £nd deftrucfcive meafures are fubftituted, for thofe 
 which have been dictated by reafon and experience. 
 
 Repeated obfervations have fnewn, that by aug- 
 menting the febrile ftate, either by the application 
 of external heat, or by the administration of inter- 
 nal heating medicines and drinks, the number of 
 the puftules may always be increafed. Apprifed 
 of this circumftance, the celebrated inoculator Sut- 
 ton, ufed to promife, his patient a crop of puftules, 
 numerous, or otherwife, according to their wifhes j 
 well knowing, that, even in good habits, a trifling 
 deviation from the cooling plan he always purfued, 
 was almoft fu^-e to be followed by an increafe in 
 the number of puftules. How injurious, then> 
 muft be that abfurd practice of increafmg the heat 
 of the patient, by every means which folly can fug- 
 geft, when univerfal experience evinces, that the 
 violence of the difeafe keeps pace, with the extent 
 tp which this pernicious mode is adopted. 
 
 The advantages arifing from cleaniinefs of the 
 perfon of the patient, and every thing around him; 
 as well as from frequent ventilation of the bed- 
 chamber, muft be fo obvious in every difeafe, dif- 
 {inguifhed by fymptoms pointing out a putrefcent 
 
 tendency 
 
MEDICAL ADMONITIONS. Z$^ 
 
 tendency in the fluids, that to enlarge on them is 
 unneceffary ; efpecially as this fubject has been 
 already difcuffed, when treating of putrid fever. 
 
 Convulfive fits frequently occur about the time 
 of the eruption. The good women who pride 
 themfelyes on their medical fkill, always predict a 
 favourable termination from the appearance of this 
 fymptom y and too frequently accompany their 
 prognoflic with advifing the friends of the patient, 
 to rely on domeftic aid only, for the cure of a dif. 
 eafe, from which they expect no danger. But 
 unfortunately the prognoflic is often erroneous, 
 and, confequently, the advice improper : for this 
 fymptom being' common to both kinds of the dif* 
 eafe, is fometimes fucceeded by that ftate of the dif- 
 eafe which calls for the utmoft care and fkill ; but 
 f nftead of this being obtained, the life of the unfor- 
 tunate patient is perhaps entrufted to fome opin- 
 ionated and ignorant nurfe. 
 
 An inconteftible proof of the impropriety of per« 
 mitting the management of feverifh complaints to 
 be entrufted tp family practitioners, is derived from 
 confidering, that the utmoft mifchief may be pro* 
 duced by injurious interference, at the firfl appear- 
 ance of this, or of any of the eruptive fevers. Na» 
 ture being difturbed in her procefs, the eruption is 
 often either driven out with fuch violence ; or is 
 fo improperly retarded, as to occafion the patient's 
 fteath, There 
 
2^4 IDICAL ADMONITIONS. 
 
 There is one circumftance, which, as it may affift 
 hi carrying on the above delufion, deferves to be 
 pointed out;. The eruption, even when of a very 
 bad kind, will often, on the firft days, appear Suf- 
 ficiently large and detached, as not to excite alarm, 
 in any but thofe who polTefs real fkill and difcern* 
 ment. In conference of which, proper affiftance 
 Is frequently not called for, until the life of the pa- 
 tient is irretrievably forfeited. 
 
 When the eruption makes its appearance in clus- 
 ters of a dark red colour, danger is to be appre- 
 headed. This is more c&rtainly the cafe, when, as 
 the diieafe proceeds, the puftules remain flat, or 
 even dented, inftead of becoming full and round, 
 and the fkin between the puftules appears pale and 
 flaccid. But when purple fpots, like flea bites, ap* 
 pear between the puftules ; or when the puftuies 
 themfrlves are railed like a blifter, and contain a 
 pale or brownifh coloured fluid, the danger is then 
 in the higheft degree imminent •, especially if ac- 
 companied by bloody urine or ftools. Shiverings 
 happening after maturation is performed, and fub- 
 fidence of the fwelling of the head, without a tume- 
 faction of the hands and feet fucceeding, are alio 
 figns of an alarming nature. 
 
 The eyes are liable to fuffer conftderable injury, 
 during the progrefs of this difeafe 5 it fometimes 
 happening, that total blindnefs is difcovered to be 
 
 the 
 
MEDICAL ADMONITIONS, *53 
 
 the unhappy lot of the patient, when the eye4:ds 
 open, on the fubilding of the fwelling of the face. 
 
 The eyes foon manifeft, in this difeafe, much im* 
 patience of the light ; but the fwelling of the eye- 
 lids, which take? place, as the difeafe proceeds, ge- 
 nerally clofes the eye-lids ; and, by excluding the 
 light from the eyes, renders the patient, in this re- 
 lpecl, much more comfortable than before. Iri 
 children, the relief thus afforded hardly ever efcapes 
 obfervation ; and the parents and attendants be» 
 come, therefore, lefs folicitous id prevent the adhe- 
 fion of their eye-lids from taking place. From 
 this omiffion, I very much fufpecl, thefe injuries to 
 the eyes frequently proceed. The irritation of that 
 membrane which lines the internal part of the eye* 
 lids produces a copious fecretion^ refembling matter ^ 
 which foon fo clofely agglutinates the edges of the 
 "eye-lidsj that very little of this difcharge is allowed 
 to efcape. This morbid fecretion is, therefore ? not 
 only kept conflantly fuffufed over the eyes, but ? be- 
 ing thus detained, is applied to the external menv 
 branes of the eye, with fome degree of preffure, by 
 which its injurious effe&s 'nmft ijdceiTariiy be aug- 
 mented;- 
 
 In thefe cafes, the mode of proceeding is tolera- 
 bly clear, though but feldom adopted. The hard- 
 ened cruft which unites the edges of the eye-lids,, 
 muft be foftened, by laying on it ftrips of lint, or 
 
 of 
 
2$6 MEDICAL ADMONITIONS. 
 
 of fine folded linen, wetted with warm water * 
 when fo much foftened, as to be able to be removed 
 with eafe, this mould be done ; and its future ac- 
 cumulation muft b£ prevented, by frequently warn- 
 ing away the matter, as it exudes, with a piece of 
 wet fponge, or lint. By this treatment, the matter 
 will be allowed to efcape, as raft as it is fecreted; an 
 opportunity may be obtained of afcertaining the 
 real ftate of the eyes ; and of employing fuch lo- 
 tions, as may be thought neceffary. 
 
 When the fmall pox has entirely completed its 
 courfe, yet is the convalefcent, where the difeafe 
 has exifted to a coniiderable degree, far from being 
 entirely exempt from danger : for frequently the 
 habit of body becomes fo changed, and the confti- 
 tution is, at the fame time, fo impaired ; that, to 
 obtain his perfect recovery, much nicety of manage- 
 ment becomes neceffary. It alfo requires great 
 {kill and difcernmcnt, to afcertain the nature of the 
 difeafed ftate which is induced, and the mode of 
 treatment by which it may be removed: 
 
 Dr. Buchan obferves, "As the fecondary fever 
 "is, in a great meafure, if not wholly, owing to the 
 "abforption of the matter, it would feem highly 
 "confonant to reafon, that the puftules, as foon as 
 "they come to maturity, fiiould be opened. This 
 "is every day practifed in other phlegmons which 
 "tend to fuppuration ; and there feems to be no 
 
 caufe 
 
, itolCAL AttMOmTttSiiSi 2$f 
 
 ^caufe why it mould be lefs proper here. On the 
 "contrary, we have reafon to believe, that the fe« 
 "condary fever might always be leffened, and of- 
 "ten wholly prevented." The Doctor farther ob- 
 serves,' that "Opening the puftules hot only pre- 
 " vents the reforption of matter into the blood, but 
 "like wife takes off the tenlion of the fkih, and by 
 "that means greatly relieves the patient. It like- 
 " wife tends to prevent the pitting, Which is a mat* 
 "ter of no fmall importance. Acrid matter, by 
 *« lodging long in the puftules, cannot fail to cof- 
 "rode the tender fkin ; by which many a handfome 
 "face becomes fo deformed, as hardly to bear a re- 
 semblance to the human figure." 
 
 Although the Doctor obferves, that, "it is only 
 "neceffary when the patient has a great load of 
 "fmall pox, or when the matter which they contain 
 "is of fo thin and acrid a nature, that there is rea- 
 "fon to apprehend bad conferences from its being 
 "too quickly reforbed ;*' yet, in eonfequence of 
 his'aflerting, that "this operation can never do harm" 
 there is great reafon to fear, that the hope Of pre- 
 venting deformity, may occafion its too frequent 
 adoption by domeftic practitioners, To prevent 
 this, I have introduced the opinion of a gentleman 3 
 whofe extenfive and fuccefsful practice mult of ne- 
 cehlty give weight to his judgement, and render 
 his obfervations truly valuable^ He fays— "Allow 
 1 1 me 
 
1|8 MEDICAL ADMONITIONS. 
 
 "me to remark on the practice of thofe, who re- 
 "commend the puftules on the face to be opened, 
 "when at the height, that the contained matter 
 "being thereby evacuated, the face may not retain 
 "any difagreeable marks. In a favourable diftinft 
 "pock, this caution feems fuperfluous, there being 
 "little danger of its leaving any deep impreffion ; 
 "and in the confluent malignant kind, when I have 
 "feen it pra&ifed, it has always given fuch intoler- 
 able fmart, as muft wound any perfon not de- 
 prived of humanity itfelf."* 
 
 Parents frequently deceive themfelves, with a 
 confidence that their children are exempt from 
 danger of infection, becaufe they have been in the 
 fame room, or even in the fame bed, with thofe 
 who have had the fmall pox upon them. But left 
 too great a reliance mould be placed on this cir- 
 cumftance, and mould prevent the adoption of ne- 
 celTary meafures, it fhould be generally known, 
 that children, in early infancy, are not fo liable to 
 receive this difeafe, as is commonly imagined ; and 
 that a child, who has been expofed to the influence 
 of this difeafe, without receiving it, or who has 
 even been inoculated without effect, may in a little 
 time become highly fufceptible of infection* 
 
 Purging 
 
 * Obfervations on Epidemical Difeafes, &c. by James Sims, 
 
 m;d. 
 
MEDICAL ADMONITIONS. 259 
 
 Purging is, in general, neceffary after the fmall 
 pox j but when the patient has fuffered under the 
 confluent kind, great care muft be taken, that the 
 dofes are not fo confiderable, nor the intervals be- 
 tween them fo fhort, that exceffiye debility be 
 thereby produced. 
 
 INOCULATION. 
 
 Inoculation is generally performed by the ap^ 
 plication of a fmall quantity of matter, from a 
 fmall-pox puftule, to a flight wound in the fkim 
 
 The advantages derived from this practice are fo 
 confiderable, as to render it deferving of being con- 
 fldered as one of the moft important improvements 
 in medicine. By inoculation, the fhocking rava- 
 ges of this moft difgulHng and alarming difeafe is 
 prevented ; and this, with fo much certainty, that 
 it is almoft in the power of man to choofe, whether 
 the difeafe ihall appear in its ufual difgufting and 
 terrific form j or whether it fhall be produced in 
 fuch a degree, as need not to excite the leaft fhock 
 or alarm. 
 
 This beneficial practice is now become fo fre- 
 quent, and the advantages derived from it are fo 
 well known, that the greateft number of the ob- 
 jections, which have been raifed againft it, have 
 
 loft 
 
%6o MEDICAL ADMONITIONS. 
 
 !oft their power ; at lead on the minds of thole 
 who give themfelves the trouble to obtain any in- 
 formation on this fubject. 
 
 The poflibility of the difeafe being again produ- 
 ced, in one who has already had the difeafe by in- 
 oculation, is not now fufpected by any, except by 
 thofe who obflinately reject the moft pofitive evi- 
 dence, and even the dictate* of common fenfe. 
 
 The chief circumftance which prevents the prac- 
 tice of inoculation from becoming univerfal, is the 
 fufpicion, that as one difeafe may be thus transfer- 
 red, other difeafes, which exift in the perfon from 
 whom the matter is taken, may, at the fame time, 
 be alfo introduced. This fufpicion is the confe- 
 rence of having remarked, that it fometimes hap- 
 pens, that thofe who have been perfectly free from 
 difeafe before, have, immediately after their recov- 
 ery from the fmall pox, by inoculation, been af- 
 fected with cutaneous diforders, and fcrophulous 
 fwellings j and fometimes to fuch a degree, as to 
 have disfigured them, or even to have rendered 
 them cripples, during the reft of their lives. 
 
 That other dxfeafes may be inoculated, in the 
 fame manner as the fmall pox ; and that fcrophu- 
 lous affections have made their appearance after im 
 oculation, are circumftances which undoubtedly 
 may occur. But all this being admitted, ftill it 
 
 muit. 
 
MEDICAL ADMONITIONS. 26j 
 
 iviuft be denied, that fcrophula is ever inoculated 
 with the fmall pox. 
 
 The matter which is contained in the puftule of 
 the fmall pox, conflfis of that particular fpecies of 
 morbific matter, only, which has been formed by 
 thofe difeafed actions, which have been induced by 
 the application of the matter of the fmall pox to 
 the human body.. This matter, thus fecreted, if 
 again applied to the abforbent fyftem, of any one 8 
 who has never had this difeafe, or who has not 
 been rendered infenfible to its influence, will again 
 produce this difeafe, and no other. 
 
 With refpect to fcrophulous tumours, inflamma- 
 tion of the joints, abfceffes, &c. which are by fome 
 Mppofed to be tile confequcnces of particular hu- 
 mours introduce^ into the fyftem, with the variol- 
 ous matter j it mull be obferved, that phyficians 
 have long known, even before the practice of in- 
 oculation was introduced into Europe, that, in 
 fome habits, very confiderable changes take place 
 after the fmall pox. In fome cafes, difagreeable 
 complaints, and thofe even of long continuance 5 
 have entirely ceafed, upon the coming on of this 
 difeafe j whilft in others, it has been fucceeded by 
 various affections of the glands and fkin, to which 
 the patient had never before appeared to be fubject* 
 Ppth thefe effects fucceed much more frequently to 
 
 the 
 
262 MEDICAL ADMONITIONS. 
 
 the fmall pox, which takes place in the natural way, 
 as it is termed, than to that which is produced by- 
 inoculation. It has alfo been obferved to happen 
 more commonly when the eruption has been nu- 
 merous, than when it has been fcanty. - Whence 
 it may be concluded, that thefe circumftances are 
 the remit of the changes induced in certain habits, 
 merely by the difeafed actions confequent to the 
 application of the poifon of the fmall pox to the 
 fyftem : and as thefe circumftances generally feem 
 to be proportioned to the quantity of eruption in 
 the preceding difeafe ; fo the eruption of the inoc- 
 ulated being much fewer, than that of the natural 
 fmall pox, the probability of thefe changes occur- 
 ring, muft be much lefs likely in the former cafe, 
 than in the latter. Inoculation,, therefore, fo far 
 from being avoided on this account, ought the 
 more particularly to be had recourfe to ; fince the 
 chance is much greater of obtaining, by it, an ex- 
 emption from thefe difagreeable and alarming oc- 
 currences. 
 
 The benefits which would refult from the univer- 
 fal practice of inoculation, are fo very confiderable ; 
 and the eafe with which the operation is performed 
 is fuch, that Dr. Buchan, and other benevolent 
 phyficians, have recommended to the nurfes and 
 parents of children to perform the operation them- 
 felves. But were this advice to be followed, I very 
 
 much 
 
MEDICAL ADMONITIONS. 263 
 
 much fufpect that, from the operation being per- 
 formed on improper fubjects ; from the neglect of 
 due preparation ; from the want of proper man- 
 agement, during the eruptive fever ; from the oc- 
 currence of various anomalous fymptoms, which 
 do fometimes happen to the moll Ikilful inocula- 
 tors, and which would excite confiderable alarm in 
 the minds of the ignorant ; that the prejudices 
 againft this practice, would be multiplied, and its 
 adoption, perhaps, become even lefs general, than 
 at prefent. There never would be wanting fome, 
 who would be difpofed to place every thing difa- 
 greeable, that might happen, to the account of an 
 operation, which is feldom performed, without op- 
 polition from the prejudices of fome timid friend 
 or relation. 
 
 Should the wound made by the incifion inflame^ 
 and only fome accidental pimple happen to appear 
 on any part of the body .5 the patient, fatisfied of 
 having paffed through the difeafe, might neglect 
 the neeeffary cautions of avoiding the infection, 
 and in confequence of the poifon not having before 
 really entered the fyflem, he may now become a 
 victim of the difeafe. Such an occurrence would 
 doubtlefsly occalion many to adopt the opinion, 
 that inoculation does not procure an exemption 
 from this difeafe in future. 
 
 Again, 
 
264 MEDICAL ADMONITIONS. 
 
 Again, it may be obferved, that cafes may hap- 
 pen, where the contagious matter may be applied 
 in fuch a manner, as to efcape being taken up by 
 the abforbents of the part to which it is applied j 
 but where, from the patient constantly carrying the 
 virus about him, which has been applied for the 
 purpefe of inoculation, it may occafion the difeafc 
 in the ordinary way. Should this happen, and the 
 difeafe terminate fatally, the cafe would be cited 
 as an inftance of the fatal confequences of inocula- 
 tion. 
 
 For inftance — Dr. Buchan, who ftrongly recom- 
 mends to parents to perform this operation them- 
 felves, defcribes to them the method he took with 
 his own fon. "After giving him two gentle pur- 
 ees, I ordered the nurfe to take a bit of thread, 
 "which had been previoufly wet with frefh matter 
 "from a pock, and to lay it upon his arm, covering 
 "it with a piece of flicking plaifter. This remained 
 "on until it was rubbed off by accident. At the 
 "ufual time the fmall pox made their appearance, 
 "and were exceedingly favourable. Surely this," 
 "the Doctor adds, "which is all that is generally 
 "neceffary, maybe done without any fkill in medi- 
 "cine." — But were fuch a mode of practice to be- 
 come common, is it not very probable that a cafe 
 would fometimes occur, in which, the abforbents 
 of the arm not taking up the matter, the patient 
 
 might 
 
MEDICAL ADMONITIONS* 0.6$ 
 
 might become infected in the natural way, from 
 inhaling the poifon he carries about him ? And 
 mould the fucceeding difeafe prove fatal, there is 
 little doubt but the animadverlions it would occa- 
 sion, would not a, little tend to prevent the future 
 adoption of inoculation. 
 
 From a laudable zeal to promote the wide ex- 
 tenlion of this beneficial practice, Dr. Buchan has 
 endeavoured to render the procefs of inoculation 
 as fimple and eafy as poffible. But I mould much 
 fear, that, from the little ftrefs the Doctor lays on 
 the neceffity of preparation, thofe who are inclined 
 to become inoeulators may be milled 5 and may 
 be induced to place too little reliance on this part 
 of the procefs, on being told, "The fuccefs of in- 
 " collators does not depend on the preparation of 
 "their patients, but on their management of them 
 "while under the difeafe.'* I have long been con- 
 vinced, that from too little attention to prepara- 
 tion, inoculation has produced more considerable 
 crops of puftules, than when it was the cuftom to 
 attend more rigidly to this circumftanee* 
 
 On this point, the remarks of Mr. Daniel Sutton, 
 the celebrated inoculator, are very decided. He 
 fays, "I underftand it has been a practice of late, 
 to give up preparation, medicinal and dietetic, en- 
 tirely, and to rely on the power of medicines, and 
 Kk the 
 
20*6" MEDICAL ADMONITIONS. 
 
 the fkill of the operator, during the eruptive fever*, 
 to keep it in due fubjection. But with fubmiflion 
 to thofe who choofe to practife in this way, I con- 
 ceive that one, at leaft, in eight or ten cafes, may 
 give them more trouble than is either defirable or 
 prudent. — I never yet could difcover any advan- 
 tage from the mere act of inoculation, beyond that 
 of afcertaining the time when the patient would 
 fall ill." 
 
 CHICKEN OR SWINE POX. 
 
 In the chicken or fwine pox, an eruption, much 
 refembling that of a very favourable fmall pox, ap- 
 pears after a flight degree of fever. This eruption 
 foon proceeds to fuppuration, in which itate it re- 
 mains but a little time, before the difeafe termi- 
 nates, by the drying up of the puftules, which fel- 
 dom leave a cicatrix behind. 
 
 The fimilarity which exifts between this difeafe 
 and the fmall pox, not only frequently occadons a 
 difagreeable ftate of doubt and fufpence, in the 
 minds of the patient and his friends, whether the 
 difeafe he has paffed through was the fmall pox or 
 not ; but frequently in other inftances, it occafions 
 an ill grounded hope, that the patient has paifed 
 through the fmall pox, in its milder kind. Hence 
 fucceeds a confidence, which may be produ&ive of 
 
 confequences 
 
MEDICAL ADMONITIONS. 267 
 
 confequences of a ferious nature. The patient, be- 
 ing affured of his future exemption from the ef- 
 fects of the contagion of this dangerous difeafe, he 
 neither avoids thofe Situations in which he knows 
 he may be within the fphere of its influence ; nor 
 does he have recourfe to inoculation, which would 
 either confirm the hopes he entertains, or infure 
 his future fecurity, at the moment it convinced 
 him of the danger of the Situation, in which he had 
 before ftood. 
 
 To prevent, however, an error of this kind, the 
 following circumftances may be attended to. ift f 
 This difeafe feldom comes on with fo much fever, 
 as, 'in general, accompanies a fimilar quantity of 
 variolous eruption. 2dly. The eruption, at its 
 appearance, generally differs from the fmall pox, ijti 
 the pimples being, almoft from the firft, filled with 
 a tranfparent liquor ; the velicle being almoft pel- 
 lucid. 3dly. The eruption appears more early, 
 and paffes through its different ftages more rapidly, 
 than that of the fmall pox : the puftules turning 
 and becoming dry, fometimes in lefs than half the 
 time than what is required in the mildeft kind of 
 the fmall pox. An attention to thefe circumftan- 
 ces will, in general, point out the difference j but 
 when the importance of afcertaining the real nature 
 of the difeafe is confidered, there muft be very few 
 who would not choofe to have the opinion of thofe 
 whofe judgement can be fully relied on. As 
 
268 MEDICAL ADMONITIONS. 
 
 As to the treatment of this difeafe, medicine is 
 very feldom neceffary, it being, in general, fuffi- 
 cient, that the patient be kept, if the weather is 
 cold, from the open air, and be fupplied with cool- 
 ing drinks and light food. 
 
 Sometimes, however, towards the conclufion of 
 this difeafe, matter will form under the hardened 
 fcabs, occafioning deep and troublefome fores, 
 which frequently require, not only the afiiftance of 
 the furgeon, but the ufe of internal remedies alfo. 
 The choice of thefe muft be directed by the pecu- 
 liar habit of the patient, his age, ftrength, &c. 
 
 MEASLES. 
 
 This difeafe depending upon contagion, children 
 are moft generally the fufferers from it ; flnee few 
 pafs their youth without being expofed to, and af- 
 fected by, its influence. 
 
 It moft commonly happens, that, for feveral days 
 previous to the coming on of the difeafe, a child, 
 who has been expofed to the contagion, will droop, 
 lofe its appetite, and become pale and fretful. To 
 thefe fucceeds a fhivering, which frequently in 
 children, r pafTes without being obferved. This is 
 dire£tly followed by fever, accompanied with a 
 quick refpiration j lioarfenefs ; frequent, dry and 
 
 rough 
 
MEDICAL ADMONITIONS* 2.6g 
 
 rough cough ; rednefs of the eyes, fneezings, and 
 a conftant watery difcharge from the eyes and nof- 
 trils. Commonly on the fourth day of the fever, 
 the eruption appears in fmall red points, which 
 are generally firft obfervable around the mouth, 
 then in the other parts of the face, the ftomach, 
 and, at length, on the whole body. The eruption 
 feldom riles much above the fkin ; fo that, except 
 on the face, little or no prominence is difcoverable. 
 After continuing three days, the eruption lofes its 
 bright rednefs, and becomes of a brownifh red 5 
 and, in a day or two entirely difappears, leaving 
 the fkin rough, and as though it had been (lulled 
 with meal. The fever generally declining as the 
 eruption goes off. 
 
 The consideration of the following circumftance 
 will mew how dangerous it is to truft to dom«ftic 
 practice, even in fo common and well known a 
 tfifeafe. 
 
 Tnis difeafe is very likely, at its firft appearance, 
 to be miftaken, by the unexperienced, for the fmall 
 pox ; but this miftake is but of little confequence, 
 when compared with an error to which family 
 practitioners muft be very liable ;— that of miftak* 
 ing the eruption peculiar to the putrid fore throat, 
 for that of the meafles. This miftake is favoured 
 by the mealies itfelf being, fometimes, accompanied 
 
 with 
 
 
270 MEDICAL ADMONITfONS. 
 
 with a forenefs of the throat ; whilft in the difeafe, 
 which, in diis Hate it refembles, the forenefs of the 
 throat does not always particularly call the atten- 
 tion, until the eruption has taken place. Such an 
 error, if not foon difcovered, can hardly fail to oc- 
 canon the death of the patient ; as the mode of 
 treatment which fhould be adopted in the one cafe, 
 is directly oppofite to that which is required in the 
 Other ; plainly evincing the danger of trufting, 
 even in fo common a difeafe, to the precarious 
 practice of domeftic medicine. 
 
 Treatment. When this difeafe is very flight, 
 the fever and cough being moderate, and the 
 breathing eafy, and hardly quicker than natural, 
 little more is neceffary, than to keep the patient's 
 body open, by the afliftance of tamarinds, manna, 
 &c. ; at the fame time fupplying him, frequently, 
 with cooling mucilaginous drinks, fuch as the pec- 
 toral decoction, barley-water, or infufion of linfeed, 
 fweetened with honey. His apartment ihould be 
 but moderately warm, and great care fhould be 
 taken,that he is not expofed to a ftream of cold air. 
 
 To leffen the inconvenience arifing from fre- 
 quent coughing, the patient may frequently hold 
 in his mouth, a mixture of two parts of oil of al- 
 monds, and one of honey ; fwallowing it as flowly 
 as poflible. But ftiould this not prove fufficient to 
 moderate the cough, it will not be right to tamper 
 
 farther ; 
 
MEDICAL ADMONITIONS. 2JI 
 
 farther j but immediate medical advice fhould be 
 obtained, left ferious mifchief be concealed. 
 
 The circumftance which generally occaftons a 
 fatal termination of this malady j and to which, 
 therefore, attention mould more particularly be 
 excited, is an inflammation of the lungs. This dif- 
 eafe, as was more fully demonftrated, when treat- 
 ing exprefsly of inflammation of the lungs, often 
 comes on £o inlidioufly, as to render it difficult of 
 detection, even by the moll Ikilful ; and particu- 
 larly in children. When it accompanies the meafles, 
 the poffibility of its exifting without the knowledge 
 of an ordinary obferver, is very great j and the 
 confequence of its continuance, uninterrupted by 
 the early ufe of proper means, muft be moil proba- 
 bly the death of the patient. 
 
 The likelihood of inflammation of the lungs con- 
 tinuing without detection, when accompanying 
 the meafles, arifes from this caufe. Quicknefs of 
 breathing, the. moft obvious and chara&eriftic 
 fymptdm of inflammation of the lungs, is generally 
 prefent during the greater part of this difeafe ; and 
 •even in thofe cafes where the difeafe terminates in 
 the moft favourable manner. Hence it too fre- 
 quently happens, that fuch an affection of the 
 breathing as calls for immediate recourfe to the 
 moft vigorous meafures, is unnoticed, and the op- 
 portunity of relief tiered to efcape. To 
 
2J2 MEDICAL ADMONITIONS. 
 
 To prevent this, the breathing mould be atten- 
 tively watched. If it becomes very quick, and is 
 performed with a wheezing noife, the fever at the 
 fame time being confiderable, and the cough fre- 
 quent, and evidently occafioning pain to the pa- 
 tient ; every thing is to be feared, and the befl and 
 fpeedieft advice mould be obtained. 
 
 A filiation frequently occurs in this, and indeed 
 in every other difeafe accompanied by inflamma- 
 tion, in which the friends of the patient are very 
 liable to be mifled in the opinion they may form, 
 of the judgment and abilities of the perfon, under 
 whofe care the patient may have been placed. 
 This arifes from the difference of treatment em- 
 ployed whilft there are hopes of removing inflam- 
 mation by refolution, from that which is adopted 
 when fuppuration is taking place. In the former 
 cafe, the furgeon or phyfieian will in general have 
 recourfe to free evacuations, and every other means 
 which may have th£ effect of diminifhing the pow- 
 ers by which the blood is propelled through the 
 fyftem ; but in the latter cafe, it may be neceffary 
 to employ a tolerably full diet, cordial medicines, 
 and every thing which may prove reftorative and 
 invigorating. Suppofe, then, a patient, afflicted 
 with any difeafe, dependent on inflammation j in 
 whofe cafe the moft proper means have been em- 
 ployed for its difperiion, by the medical gentleman 
 
 firft 
 
MEDICAL ADMONITIONS. 273 
 
 firfi employed, but unfortunately with fuch little 
 fuccefs, as to have induced the patient, or his 
 friends, to call in fome other perfon, of whofe char- 
 acter they may have been led to form an higher 
 degree of eftimation. The period in which there 
 was a poffibility of removing the inflammation by 
 difperfion, being now paft, that mode of treatment 
 muft be adopted, which will beft accord with the 
 intention of promoting fuppuration. This plan 
 being of neceflity opposite, almoft in every refpect, 
 to that which has preceded, the comparifon is too 
 often made by the ignorant, to the prejudice of the 
 perfon who had been firft confulted. "Here/* fay 
 they, "was the patient getting daily worfe and 
 worfe ; but now, directly that a different mode of 
 treatment is adopted, he immediately alters for the 
 better. How fortunately we changed our phyli- 
 cian ; he certainly has faved him— under the former, 
 he as certainly would have loft his life." Thus 
 the one is applauded, the other is feverely cenfured 5 
 whilft both have entertained the fame opinion ref- 
 pe&ing the difeafe, and both have been directed^ 
 by exactly the fame principles. 
 
 When purple fpots, and other fymptoms peculiar 
 to a diffolved ftate of the blood, accompany this 
 difeafe, the greateft judgment and attention are 
 required to bring the difeafe to a favourable termi- 
 nation. 
 
 L l An 
 
274 MEDICAL ADMONITIONS. 
 
 An obftinate cough will frequently be found td 
 remain, after all the other fymptoms have fubfided, 
 In this cafe, it would be extremely wrong to truft 
 to the ordinary remedies for coughs, left the cough 
 fhould be fymptomatic of more ferious and latent 
 mifchief. 
 
 To prevent thefe confeqiiences, frequent purging 
 is recommended at the conclufion of the difeafe ; 
 and, in molt cafes, muft prove beneficial, being 
 likely to diminifh the difpofition to inflammation, 
 which is, in general, produced by this difeafe, and 
 which occafions the above mentioned effects. But 
 dependance is not always to be placed On purging 
 alone ; fince, in almoft all thefe Cafes, particular 
 attention mould be paid to the regimen, which is 
 required to be fpare and cooling ; and, in fome 
 cafes, even repeated bleeding may be neceffary. 
 
 I cannot quit this fubject without offering fome 
 advice, which, if attended to, cannot but prove be- 
 neficial. When one child in a family is attacked 
 with this difeafe, let the greateft poffible care be ta- 
 ken, left by expofure to a cold and moift atmof- 
 phere, ;he remaining children become affected by 
 a catarrhal affection j by which the danger of in- 
 flammation of the lungs in the fubfequent difeafe 
 is increafed. It is obvious, that this advice is 
 equally applicable where the difeafe is even known 
 to be in the neighbourhood. SCARLET 
 
MEDICAL ADMONITIONS. . $75 
 
 SCARLET FEVER, 
 
 This fever comes on with cold mivering, pains 
 in the head and loins ; foon after, the throat be* 
 comes uneafy, and the fwallowing difficult, the in* 
 fide of the throat appearing tumid and red. About 
 the third day, a fcarlet eruption takes place, mak- 
 ing its appearance, at firft, in bright red fpots, on 
 the face and neck, and afterwards on the reft of the 
 body, and the extremities. From thefe fpots run- 
 ning together, the whole fkin becomes of a bright 
 fcarlet. Soon after the rednefs appears, white 
 fpecks or Houghs are difcernable on the tonfils j 
 thefe enlarge, after a few days, fall off, and difcover 
 an ulcerated furface underneath ; which, however, 
 in general, foon heals. After continuing about 
 three or four days, this eruption goes off, the fever 
 generally fubfiding at the fame time. 
 
 After this difeafe, the fkin alrnoffc always peels 
 off, and frequently in pretty large portions. It 
 frequently happens, that an anafarcous fwelling of 
 the whole body comes on within a few days after 
 the difappearance of the eruption, and is fometimes 
 difficult of removal. 
 
 Although, in the above hiftory, I have mentioned 
 the forenefs of the throat as one of the fymptoms 
 of this difeafe, yet it muft be remarked, that fcar- 
 let fever fometimes occurs without any affection of 
 the throat. This 
 
2 y6 MEDICAL ADMONITIONS. 
 
 This difeafe is fometimes to be met with, accom- 
 panied with highly inflammatory fymptoms ; and, 
 at other times, with fymptoms marking a fimilar 
 malignity, with the ulcerated fore throat, or putrid 
 fever. 
 
 To attempt to lay down a mode of cure to be 
 adopted by family practitioners, in a difeafe which 
 varies fo much in its mode of exiftence, as to re- 
 quire, at different feafons, and in different fubjecls, 
 the ufe of means entirely of an oppofite nature, 
 would be highly ccnfurable, fince fatal mifchicf 
 might hereby be occafioned. Real benefit may, 
 however, be derived from pointing out thofe dif~ 
 cafes with which fcarlet fever may be confounded, 
 and the confequences that moft probably woul4 
 fucceed to fuch a mjftake, 
 
 At the firft appearance of the eruption, it is by 
 no means unlikely, that a difficulty may be found, 
 by fuch practitioners, in endeavouring to diftin- 
 guifh between that which is characteriftic of this 
 difeafe, and that which is peculiar to the meafles. 
 In thofe cafes of mealies, where the catarrhal fymp- 
 toms are very flight, it may very eafilybe miftaken 
 for fcarlet fever ; and in fcarlet fever, unaccompa- 
 nied by fore throat, efpecially in young fubjeefcs, the 
 probability is great that it may be treated as the 
 meafles, 
 
 Bu* 
 
MEDICAL ADMONITIONS. 277 
 
 But the molt to be feared is, left, on the one hand, 
 a cafe of fcarlet fever, requiring a cooling treat- 
 ment, and, perhaps, even bleeding, be fuppofed to 
 be the putrid fore throat, and an attempt for its 
 cure be made with heating cordials, wine, &c. ; or, 
 on the other hand, that a cafe of putrid fore throat 
 be miftaken for fcarlet fever ; and, inftead of the 
 free ufe of bark, nourilhment, wine, &c. the con- 
 trary mode of treatment be adopted. 
 
 When this difeafe is fucceeded by anafarcous 
 fwelling, the great eft care is demanded; fmce,fhould 
 it be neglected, an incurable dropfy may be the 
 
 confequence. 
 
 ERYSIPELAS, or ST. ANTHONY'S FIRE. 
 
 Erysipelas, according to the accurate defcrip- 
 tion of Dr. Cullen, is an inflammatory affection of 
 the lkin, with hardly any evident fwelling ; of a 
 mixed, and not very bright red colour, readily dis- 
 appearing upon preffure, but quickly returning 
 again ; the rednefs of no regular circumfcription, 
 but extending unequally ; and continuing, mofl 
 conftantly, to fpread upon the neighbouring parts, 
 with a pain like to that from burning ; producing 
 blifters, fometimes of a fmall, fometimes of a larger 
 iize ; always occafioning, as it goes off, a defquam- 
 ation of the fcarf ikin, and fometimes f&rminatmg' 
 fa gangrene, \thea 
 
578 MEDICAL ADMONITIONS. 
 
 When it attacks the face, the patient experien* 
 ces, firil of all, a cold fhivering, fucceeded by a hot 
 ftage, in which there is always more or lefs drowfi- 
 nefs, with, fometimes, a confufion of the head, and, 
 in fome cafes, even delirium. The affection of the 
 (kin appears either on the firft, fecond, or third day 
 of the fever ; frequently pciTenmg, by degrees, the 
 whole of the face ; fometimes the hairy fcalp, and 
 even extending on to the neck. The whole face 
 becomes much fwelled, and the eye lids fo much fo 3 
 that the patient is oftentimes not a,ble to open them. 
 
 The inflammation continues, in general, about 
 eight or nine days, the fever not fuffering any abate* 
 ment from the coming on of the affection of the 
 fldn. In thofe cafes which have a favourable ter- 
 mination, the fever and inflammation, generally, 
 about this time, fubfide together. But in other 
 cafes, the drowfmefs and delirium increafe, as the 
 inflammation proceeds ; and, the external affection 
 being communicated to the brain, the patient is 
 carried off about the fame period, 
 
 Eryfipelas may be produced by the application 
 of heat, or the fudden and partial application of 
 cold, efpecially when the body is in an heated ftate. 
 External injuries of various kinds, as wounds, 
 punctures, and even the flighteft fcratches, are often 
 fucceeded by this affection of the furrounding parts. 
 
 * The 
 
MEDICAL ADMONITIONS. 2J§ 
 
 The application of poifons, more particularly thoft 
 of the animal kingdom, often produces this difeafe. 
 In fome cafes, it has been fuppoied to be the confe- 
 quence of violent paifrons of the mind. 
 
 When eryfipelas exiils only in a trifling degree., 
 and without any, or with but little, affection of the 
 fyftem, or any other alarming fymptom, there may- 
 be no necelEty for calling in profeffional aid ; fince, 
 by .an attention to the following advice, the difeafe 
 may be, in fuch iiight cafes, carried oft with, the 
 utmoft fafety. 
 
 The body mould be kept in a laxative ftate, by 
 the ufe of the gentleft aperitive medicines ; care- 
 fully avoiding thofe medicines, which, from the 
 irregularity with which they act, fometimes pro- 
 duce effects far exceeding the intention with which 
 they were given. Manna, lenitive electuary, faline 
 purgatives, fuch as the Glauber and Rochelle falts, 
 imperial drink, tamarind whey, &c. are remedies 
 which may be ufed with the utmoft fafety. 
 
 The patient, through the day, need not be con* 
 fined to his bed ; it being fnfficient that he avoids 
 expofing himfelf to a cold atmofphere* 
 
 At bed time, the patient may take a few grains 
 of Dover's fudoriiic powder, or, a very fmall dofe 
 of James's powder \ drinking freely of weak wine 
 
 whey. 
 
2&0 MEDICAL ADMONITIONS. 
 
 whey, or warm barley-water, with a fmall quantity 
 of nitre, for the purpofe of procuring a gentle per- 
 fpiration. 
 
 Animal food fliould not be indulged in ; pud- 
 dings, fago, panada, &c. being the moft proper ar- 
 ticles of diet. 
 
 But when erylipelas exifts in a higher degree, or 
 is accompanied by a confiderable affection of the 
 whole fyftem, or by fuch fymptoms as we are about 
 to defcribe ; it not only is of too ferious a nature 
 to be entrufted to domeftic medicine, but even re- 
 quires the greateft care of the medical or chirurgi- 
 cal perfon, whofe attendance is obtained. For the 
 difeafe not being uniform in its appearance, and 
 the variety depending on widely different ftates of 
 the fyftem, as well as of the part affected ; much 
 fkill is required, in determining on the mode of 
 treatment which ought to be adopted. 
 
 When this difeafe exifts in the face to a confid- 
 erable degree, there is great danger of the commu- 
 nication of the difeafe to the brain. The affected 
 parts fometimes become gangrenous, the change 
 often taking place very fuddenly, without being 
 fufpected but by thofe, who, by experience, have 
 obtained an accurate knowledge of the difeafe j and 
 who, by their acquaintance with the laws of the 
 animal oeconomy, are enabled to detect the morbid 
 
 ftate 
 
MEDICAL ADMONITIONS. s8l 
 
 ftate of the fyftem. This difeafe is Very fubjecl: to 
 fudden tranllations from one part to another ; fre- 
 quently from the external to the internal parts } a 
 circumftance which never occurs, without a great 
 degree of danger. 
 
 There is one circumftance, which alone ought 
 to prevent family practitioners, from attempting 
 the treatment of this difeafe, except in the flighteft 
 Cafes. It frequently, when properly conducted, 
 proving a cure to maladies which have long and 
 Obftinately refilled every attempt made for their re- 
 moval. When this difeafe attacks with confidera- 
 ble violence, the life of the patient may often de- 
 pend on timely bleeding. But, of fo much confe- 
 quence is the afcertaining the real ftate of the fy£ 
 tem, that fhould this evacuation be made improp- 
 erly, inftead of faving the life of the patient, a fatal 
 termination of the difeafe might be occalioned. 
 
 As the particular ftate of the fyftem is neceflary 
 to be afcertained, before it can be determined what 
 remedies are moft proper ; fo is it impoffible to give 
 here fuch general directions, for the diet and man- 
 agement of the patient, as may be applicable in all 
 cafes. 
 
 Of the external applications it is not necefiary to 
 
 fay much ; fihce, when the difeafe exifts only in 
 
 M m fuch 
 
582 MEDICAL ADMONITIONS. 
 
 fuch a degree, as to be a proper object, of domeftic 
 medicine, no particular application is neceffary : it 
 being fufficient, that it is defended from the air by 
 any fubftance, which is not allowed to adhere to 
 the part affected. Befides, the felection of external 
 applications, as well as of internal remedies, muft 
 be directed by the ftate of the fyftem, and of the 
 affected part. The following defultory cautions, 
 are, therefore, all that can be introduced on this 
 fubject. 
 
 Greafy applications almoft always feem to aggra- 
 vate the difeafe. Abforbent earths and farinaceous 
 fubftances, which are frequently recommended, 
 form hard and troublefome crufts, by mixing with 
 the liquor which exudes from the part ; the effufed 
 fluid, confined by thefe crufts, irritating the parts 
 beneath. Cooling and fedative applications, fuch 
 as cold water, Goulard's vegito mineral water, &c. 
 are very effectual in leffening the inflammation, and 
 are, therefore, frequently adopted by domeftic 
 practitioners. But it is neceffary to remark, that 
 thefe applications, which, at firft, feem to produce 
 very pleafant and falutary effects ; do fometimes 
 produce, and fuddenly, the molt dangerous confe- 
 quences : a gangrene of the part being very likely 
 to fucceed to the improper employment of them. 
 They fhould never therefore, be ufed in thefe cafes, 
 but under the direction of the phyfician or furgeon. 
 
 Eryfipelas 
 
MEDICAL ADMONITIONS. 283 
 
 Eryfipelas never appears in aged perfons, nor in 
 thofe who have lived freely ^without denoting fuch> 
 a ftate of the fyftem, as mull demand all the aid 
 that can be obtained, from the conjoined powers 
 ©f experience and judgement. 
 
 Its occurrence in youth and middle age is feldom 
 dangerous, except when accompanied with much 
 fever, or when it extends over a confiderable fur- 
 face. 
 
 ERYSIPELAS OF CHILDREN, 
 
 Very young children fometimes are attacked 
 with erysipelatous inflammation, to which it is ne- 
 ceffary moil earneftly to call the attention of par- 
 ents j fince, from the feeming trifling and infigni- 
 ficant appearances which take place on its firft oc- 
 currence ? there is too much probability, that it may 
 be often allowed to attain a confiderable height, 
 before application for affiftance is made. When- 
 ever this does happen, the chance of recovery muft 
 be very flight indeed ; for even in thofe cafes where 
 the utmoft exertions of art are early employed, 
 this difeafe frequently carries off the little fufferer 
 with great rapidity. 
 
 This difeafe begins in fmall red patches, with 
 hardly any elevation, and by no means of fuch an 
 
 appearance^ 
 
384 MEDICAL ADMONITIONS. 
 
 appearance, as to be likely to excite any alarm ; ex- 
 cept in the minds of thofe who are apprifed of the 
 infidious and dangerous nature of this difeafe, 
 Thefe patches, in fome cafes, make their firft ap- 
 pearance on the extremities, and, in others, on the 
 lower part of the belly. They extend themfelves 
 confiderably over the limbs and trunk, becoming 
 hard and more difcoloured, and, if not happily 
 flopped by the adoption of the moft appropriate 
 xneafures, the difeafe foon terminates fatally. 
 
 To excite the attention of parents, fo that, on 
 the firft appearance of this difeafe, they may be ap- 
 prifed of the danger which threatens, and be 
 thereby induced to apply for immediate affiftance, 
 is all that can be attempted here. 
 
 THE MILIARY FEVER. 
 
 The eruption from which this fever derives its 
 name, is formed by feveral little bladders, which 
 rife on the fkin, of the fize and appearance of grains 
 of millet. 
 
 From this eruption having been feen to accom- 
 pany various difeafes, it has been much doubted, 
 whether it is an original and primary difeafe ; or 
 whether it is not merely a fymptomatic diforder, 
 proceeding from the difeafe it accompanies. From 
 
 the 
 
MEE>ICAL ADMONITIONS. 285 
 
 £he circumftance of its having occurred as an epi- 
 demic, having attacked many at the fame time, in 
 the fame neighbourhood, there is hardly a doubt, 
 but that it may exift as a primary djfeafe. But it 
 is not neceffary here to enter farther into this 
 queftion ; fince the determination would not affect 
 the precepts which will be here delivered, refpe&ing 
 its treatment. 
 
 This eruption generally makes its appearance 
 when profufe fweatings have preceded ; but it has 
 fometimes been met with, where no fuch previous 
 fweating has taken place. It attacks* both fexes, 
 and thofe of every age and conftitution j but child-, 
 bed women appear to be moft frequently affected 
 by it. 
 
 When it occurs as a primary difeafe, it begins 
 with a fhivering, which is foon fucceeded by a con- 
 fiderable degree of heat, and pain in the head and 
 loins, attended with great anxiety and lownefs of 
 fpirits, oppreffion on the breaft, and difficulty of 
 breathing. Thefe latter fymptoms, with an itch- 
 ing and prickling in the ikin, in general, imme- 
 diately precede the eruption, which commonly ap- 
 pears between the feventh and fourteenth day of 
 the fever ; but it has not been remarked to make 
 its appearance on any particular day. The erup- 
 tion firfl appears on the neck and cheft, then upon 
 
 the 
 
286 MEDICAL ADMONITIONS. 
 
 the arms ; and at length is diffufed almoft over the 
 whole body, but it is feldom to be difcovered on 
 the face. The fkin has fometimes, but very rarely, 
 continued dry through the whole of the difeafe ; 
 but, in general, the fweating is very profufe. The 
 ftools are, for the moft part, loofe, and the urine 
 pale, and of a particular lightifh green caft. The 
 tongue does not become very foul, and the eyes 
 acquire a more than common brightnefs. About 
 the time of the eruption, there always arifes a pun- 
 gent acid odour, peculiar to this difeafe. In ripen- 
 ing, the eruption becomes of a yeilowifh hue ; and 
 after continuing a few days, the length of time va- 
 rying much in different cafes, it dies off, leaving 
 the fkin covered with branny fcales. Sometimes 
 the eruption is renewed feveral times in the courfe 
 of the fame fever. 
 
 Perfons fweating under febrile difeafes are efpe- 
 cially liable to the miliary eruption, and particu- 
 larly thofe who have been previoufly weakened by 
 large evacuations, particularly of blood. This, 
 Dr. Cullen thought, would explain why it happens 
 to lying-in women more frequently than to any 
 other perfons ; and has remarked it to happen to 
 women not in child-bed, but who had been much 
 fubject to a frequent and copious menftruation, 
 and to an almoft conftant fluor albus. He alfo had 
 occafion to obferve it to happen to men in fevers, 
 after wounds, from which they had fuffered a great 
 lofs of blood. Since 
 
MEDICAL ADMONITIONS. £$J 
 
 Since the feveral varieties in the mode of treat- 
 ing this fever, fhould be the refult of a very nice 
 and accurate inveftigation of all the concomitant 
 circumftances ; and as this talk requires, in the per- 
 fon who undertakes it, a thorough knowledge of 
 the laws of the animal ceconomy, and of the chan- 
 ges induced by difeafe ; it would be very improper 
 to lay down a plan of cure, to be attempted by any- 
 one who does not poflefs that necefiary informa- 
 tion. 
 
 - The fame reafon that prevents the attempt of 
 laying down a regular plan of cure, in a work of 
 this nature, is equally forcible againft the endea- 
 vour to eftablifh any fixed rules for the regimen 
 and management of the patient ; thefe depending 
 on the fame circumftances which have been alluded 
 to, muft be regulated by the advice of the phyfi- 
 cian. 
 
 It may not be amifs to remark here, that this 
 eruption fo generally fucceeds profufe fweating, 
 that it has been fuppofed to be merely a confe- 
 quence of this difcharge. In proportion as the 
 fweating is encouraged or checked, fo may the 
 eruption be augmented or diminifhed; but the pro- 
 priety of either practice cannot be determined, un< 
 lefs it is firft afcertained how far the fweating and 
 eruption is connected with a critical change in the 
 difeafeo 
 
 HEMORRHAGES, 
 
288 MEDICAL ADMONITIONS, 
 
 HEMORRHAGES. 
 
 Hemorrhage may depend on an increafed ac- 
 tion of the blood veffels ; or it may originate in 
 fuch a ftate of them, as is oppofite to that vigour. 
 It may proceed from too great abundance of blood, 
 where there is no error but in quantity ; or it may 
 be the confequence of the blood having acquired 
 fuch a morbid tenuity, as may enable it to pais 
 through openings, by which, in an healthy ftate, 
 it would have been detained. 
 
 Thofe who lead fedentary lives, indulging much 
 at the fame time, in highly nourifhing and ftimu- 
 lating food, can hardly poflible efcape fuch a pre- 
 ternatural fulnefs of the fyftem, as is likely to be 
 productive of haemorrhage ; fince the evacuations 
 not being proportioned to the quantity of nutri- 
 tious matter taken in, a due equilibrium cannot be 
 preferved, between the quantity of the circulating 
 fluids, and the folids which contain them. The 
 diminution or fuppreflion of accuftomed evacua- 
 tions ; whether of thofe which are natural, or of 
 thofe which have been induced by art or previous 
 difeafe, will alfo considerably contribute to the for- 
 mation of that difeafed ftate of the fyftem, in which 
 haemorrhage is likely to occur. In this way much 
 injury is often occafioned, by the frequent bleed- 
 ings which are fometimes had recourfe to, when 
 
 haemorrhage 
 
MEDICAL ADMONITIONS. 289' 
 
 haemorrhage has once occurred; and which actually 
 promote that ftate of the fyfteni they were in- 
 tended to prevent. 
 
 When the abo'v" e deferibed ftate of the fyftem 
 has been induced by the foregoing circumftances, 
 nothing more is required, than the aftion of on£ 
 or- more exciting or occasional caufes, to produce 
 the difeafe. The exciting caufes are, whatever al- 
 ter the regular circulation of the blood ; as exter- 
 nal heat, a confiderable and fudden diminution of 
 the weight of the atmofphere, violent exercife, con- 
 fiderable efforts of the lungs, certain pafiions of the 
 mind, cold externally applied, and fuch poftures of 
 the body and applications of ligatures, as may oc- 
 tafion a determination, or accumulation of the 
 blood in particular parts of the body. 
 
 Dr. Buchan, when treating of this fubjecl, very 
 juftly obferves, that " Involuntary fhixes of blood 
 may proceed from Very different, and often from 
 quite oppofite caufes." Of thefe the Doctor enume- 
 rates no lefs than thirteen ; and then very properly 
 obferves, that " The cure of a hemorrhage muft 
 " be adapted to its caufe." An auertion to which 
 all muft readily aiTent, and heartily regret that any 
 one fhouid ever be induced to attempt the manage-, 
 rhent of a difeafe, dependant oil fuch various cau- 
 fes, with no other information than that which 
 they may have derived from fome treatife on do- 
 meftic medicine. 
 
 N-n If 
 
29© MEDICAL ADMONITIONS* 
 
 If the fyflem has once Differed a lofs of blood, by 
 accident, by art, or by a fpontaneous effufion ; that 
 quantity is not only quickly reftored, but frefh 
 blood is formed fo faft, that a preternatural fulnefs, 
 or plethora, is very foon produced -, which is fre- 
 quently fucceeded by a return of the bleeding. This 
 is again, in like manner, followed by a rapid refto- 
 ration of blood, fulnefs, and haemorrhage. Thefe 
 alternations of evacuation and repletion, being thus 
 repeated, a difpoiition to haemorrhage is, agreeable 
 to a certain law of the animal oeconomy, occafion- 
 ed ; and the dileafe, of courfe, rendered more 
 difficult of removal. Nor is this all, for, in pro- 
 portion to the length of the continuance and fre- 
 quency of recurrence of haemorrhage, will be the 
 danger of its occafioning other difeafes, either by 
 its continuance or fuppreflion. 
 
 The pofitions here advanced, which are founded 
 on the known laws of the animal oeconomy, and 
 are proved by the daily obfervations of every at- 
 tentive medical man ; muft mew clearly the dan- 
 ger of permitting, through neglect, or an ill found- 
 ed timidity, the continuance of haemorrhage : the 
 probability of its inducing future difeafe, having 
 been fhewn to be, in proportion to the quantity 
 of blood which is permitted to now. 
 
 Every fcience, in an age of enquiry, is conftahtfy 
 receiving fome improvement, by the acceffion of 
 
 fomc 
 
MEDICAL ADMONITIONS. 29! 
 
 Ibme new fad, or fome ingenious obfervation. — 
 Thus has the art of healing derived confiderable 
 light, from the obfervations and reafoning of Br, 
 Cullen, on this point. He having clearly evinced 
 the neceiEty of preventing the occurrence of hse* 
 morrhage ; and, in moft cafes, of moderating effu- 
 iions of blood, when they have actually come on. 
 
 The opinions on which the practice of encourag- 
 ing haemorrhage had been founded, were derived 
 from fome fallacious conjectures, refpecting the 
 influence of the foul on the body ; the foul having 
 been fuppofed to direct and occafion fuch changes 
 in the fyftem, as were neceifary to the prevention 
 or removal of difeafe. It was alfo imagined, that 
 the body was, in general, difpofed to a plethoric 
 ftate ; that the greater part of the difeafes to which 
 the human body is fubject, was produced by this 
 caufe ; and that fpontaneous haemorrhage was, al- 
 moft always, the confequence of the efforts of cer- 
 tain powers in the fyftem, exerted for the removal 
 of fome difpofition to difeafe, or of the difeafe itfelf, 
 if already formed. On thefe principles the flow 
 of blood was permitted, until, through the weak- 
 nefs of the patient, it ceafed ; it being fuppofed, 
 that when a fufficient quantity of blood had flowed, 
 to effect the intended falutary change, it would 
 then fpontaneoufly flop. Nor was this the utmoft 
 extent of this mifchievous doctrine, for the fame 
 
 arguments, 
 
5,92 MEDICAL APiMONITlONS. 
 
 arguments, which induced them thus to allow the 
 ravages of the difeafe, in the firft inftance, occa- 
 sioned them alfo to encourage its return. 
 
 It may be eafily conceived, that thefe repeatecl 
 lofles of the blood, on which the formation and 
 nourishment of every part of the body depends, 
 muft render that fluid thin and impoverished ; 
 and occaiion it to pofiefs, after each effufion, lefs 
 and lefs of thofe principles, which are more par- 
 ticularly appropriated to the fupport of the fyftem j 
 although, at the fame time, the circulating fluids 
 jnay exceed their natural quantity. 
 
 Thus, then, by permitting the repetitions of 
 haemorrhage, may fuch a ftate of the fyftem be 
 produced, as will very probably occafion wafting 
 the body, dropfy, or fome other difeafe, which, 
 being founded on general debility, will be very 
 difficult to be removed. 
 
 Dr. Cullen's reafons for -fuppofing that haemorr- 
 hage fhould, in general, be avoided, are, " ift. Be- 
 " caufe it does not always happen in parts where 
 4C it is fafe. sdly. Becaufe often, while it does re- 
 ce lieve a plethoric ftate, it may, at the fame time, 
 " induce a very dangerous difeafe. 3dly. Becaufe 
 " it may often go to excefs, and either endanger 
 a life, or induce a dangerous infirmity. And laftly, 
 i6 becaufe it has a tendency to increafe the pletho- 
 ric 
 
MEDICAL ADMONITIONS. 293 
 
 *? ric ftate it was meant to relieve ; to occafion its 
 " own recurrence ; and thereby to induce a habit, 
 * s which, if left to the precarious and unequal ope- 
 " ration of nature, may, from the frequent errors 
 " of this, be attended with much danger." * 
 
 Having recommended the prevention of plethora, 
 rather than the allowing of the return of haemorr- 
 hage, it is neceffary to defcribe the means by which, 
 this end may be accomplifhed. 
 
 The innumerable fecretions made from the gene- 
 ral mafs of blood, occafions a continual expence of 
 that fluid; and exercife, as it promotes aimoft 
 every fecretion, fo muft it produce an increafe in 
 the confumption of the blood. The quantity of 
 blood thus expended, is reftored by the continual 
 acceffion of new blood, formed from the chyle, 
 which is immediately derived from the various 
 fubftances taken as aliment. The quantity of blood 
 mull, therefore, depend on the quantity of aliment 
 from which it is produced, and the degree of ex- 
 ercife, by which its expence is occaiioned ; in pro- 
 portion as the one or the other of thefc prepon- 
 derate, will a difpofition to plethora, or to the 
 contrary ftate, take place. 
 
 To prevent the quantity of blood from exceed- 
 ing its due proportion, exercife, then, fhould be 
 
 ufed 
 Culien'p Firft Lines, vol. is. p. 301. 
 
294 MEDICAL ADMONITIONS. 
 
 ufed freely, the quantity of food muft be diminifh- 
 ed, and mould be compofed of fuch fubftances, as 
 are nourifhing, only in a moderate degree ; fuch 
 as vegetables, milk, &c. 
 
 Proper means muft, at the fame time, be employ- 
 ed, for keeping the bowels in a laxative ftate ; and 
 the circmnftances which have been before defcrib- 
 ed, as exciting caufes, muft carefully be avoided. 
 
 When haemorrhage has actually come on, and it 
 appears proper that it mould be moderated, the 
 application of every thing heating and ftimulating 
 muft be carefully avoided. The air of the cham- 
 ber fhould be cold, and no malt liquor, wine, or 
 fpirits, permitted the patient. This caution is 
 neceffary, fince it very frequently happens, that the 
 patient is very freely fupplied with thefe pernicious 
 liquors, with the intention of removing the fick- 
 nefs and faintnefs, which accompany the difcharge. 
 The patient mould be kept in fuch a pofture, as 
 may leaft favor the impetus of the blood towards 
 the part from which it flows :-~but this, as well 
 as the other means of cure, will be more fully 
 treated of, when fpeaking of haemorrhage from 
 particular parts. 
 
 Haemorrhages 'proceeding from a dhTolved ftate 
 of the blood, will always require the moft vigorous 
 exertions for their fuppreflion j fince, by their 
 
 continuance, 
 
MEDICAL ADMONITIONS. 295 
 
 continuance, they neceffarily increafe that morbid 
 ftate on which they depend. 
 
 Upon the whole., when we confider how numer- 
 ous the caufes of haemorrhage may be - y and how 
 neceffary it is to afcertain the caufe on which each 
 cafe depends, before a determination is made on 
 io nice a point, as whether the haemorrhage lliall 
 be reftrained or mffered to continue ; it muft be 
 agreed, that no deciiive ftep ought to be taken, 
 until competent advice has been obtained. Until 
 then, little more mould be done than removing 
 any of the circumftances, which are above enume- 
 rated, as likely to become exciting caufes ; and em- 
 ploying fuch means, as may moderate the difcharge, 
 if it is violent, and the patient apparently linking. 
 Skill is required in the treatment of few difeafes 
 more than in thofe of this clafs 5 the cafe being 
 often fuch, as, from its urgency, to require an im- 
 mediate decifion ; and the future health, and even 
 the life of the patient, may depend on the judg- 
 ment with which it is made. 
 
 BLEEDING FROM THE NOSE. 
 
 From the very confiderable number of blood- 
 veffels with which the internal furface of the nof~ 
 trils is furniftied, and the delicate texture of their 
 covering, we may account for the frequency with, 
 which this complaint occurs. This 
 
2^6 • MEDICAL ADMONITIONS. 
 
 This complaint may be met with at every pei 
 of life ; but the changes which take place in the 
 fyftem, juft before puberty, and after the age of 
 forty and fifty, are fuch as to render it more likely, 
 that, at thefe periods, the effufion mould take place 
 from this part, than any other. 
 
 During the exiftence of febrile, or inflammatory 
 complaints, in which the head is much affe&ed, 
 bleeding from the nofe fometimes happens ; in ge- 
 neral proving critical, and being followed by the 
 removal of the prior difeafe. This difcharge alfo 
 often occurs, in fevers which are accompanied by 
 a languid Hate of the fyftem, and a diffolved ftate 
 of the blood. It alfo frequently happens, when 
 there is no reafon to fufpect. it to depend on any 
 particular ftate of the fyftem, but is only produced 
 by fome incidental caufe ; fuch as a violent effort 
 made in fneezing, &c. ; or the application of fome 
 hard fubftance to the internal furface of the nofe. 
 
 Bleedings from the nofe in young people are fel- 
 dom in any confiderable quantity ; generally ceaf- 
 ing fpontaneoufly, after a moderate flow, or yield- 
 ing to the application of cold water to the nofe and 
 furrounding parts ; or to the application of any 
 very cold fubftance, to any part of the furface of, 
 the body : as may be obferved, in the common 
 practice of putting a cold piece of metal, as a key, 
 
 down 
 
MEDICAL ADMONITION^ 2pf 
 
 clown the back, next to the fkin, which induces 9. 
 Ihivering, foori after which the bleeding generally 
 flops. 
 
 Tne infrequericy of this difcharge being directly 
 followed by any evident ill coiifequence, and the* 
 facility with which it is in generally reftrained, con- 
 tribute to miflead the patient and his friends, intci 
 an opinion, that ho harm can be produced by a 
 difeafe fb common, and apparently fo trivial. The 
 patient is therefore, in general, configned to fome 
 good woman, the bleeding ceafes, but ho proper 
 means are adopted to alter the ftate oh which the 
 difeafe depends, and thereby to prevent its return. 
 
 To mew to tho'fe who are tod much difpofed to 
 truft to the vague and dangerous practice of do- 
 meflic medicine, the hecejlity of obtaining the ad- 
 vice of the fkiliul and judicious, in thefe cafes, noth- 
 ing more, furely, can be neceffary, than to point 
 out the ftate of the fyftem, at this time ; and the 
 probable mifchiefs that may fucceed to improper 
 management* 
 
 From attentive obfervations, it appears, that in 
 thofe young people who are fubjed to bleedings 
 from the nofe, there exifts not only a general ful- 
 nefs Of blood ; but alfo an increafed determination 
 Of the blood towards the head. This is a ftate 
 which certainly demands the greatest care and at* 
 O o ,, tention £ 
 
2(}8 MEDICAL ADMOMITIONS. 
 
 tention; fince,ftiould the haemorrhage be retrained, 
 without the adoption of due precautions, the blood 
 might force an opening through fome other vef- 
 fels, fituated, perhaps, in apart, where, as in the 
 brain, it might occafion a fatal injury. And, on 
 the other hand, if, by neglecl: of proper manage- 
 ment, the bleeding mould be fuffered repeatedly to 
 return, and become periodical ; there will be rea- 
 fon to fear, left, when the patient arrives at his full 
 growth, a rupture of a blood-velfel in the lungs, 
 terminating in a confumption, may take place. In 
 confirmation of this opinion, I may here repeat a 
 common obfervation, that thofe, who are moft lia- 
 ble to a difcharge of blood from the lungs, have 
 been fubjecr., when young, to bleeding at the nofe. 
 
 When this difeafe happens to thofe who are ad- 
 vanced in years, the niceft judgement is required, 
 in adopting the mode of treatment. As it certainly 
 often prevents an attack of palfy, apoplexy, &c. 
 there cannot exift a doubt of the impropriety of 
 checking the difcharge, at its firft appearance : on 
 the contrary, it is frequently neceffary to have re- 
 courfe to bleeding, from the arms, and to other 
 means calculated to diminifli the general fulnefs, 
 and to take off the determination to the head* 
 
 A careful attention to the foregoing indications 
 is neceffary, not only at the time when the haemorr- 
 hage 
 
MEDICAL ADMONITIONS. 299 
 
 hage exifts, but mould be affiduoufly perfevered in, 
 for a confiderable time after the hemorrhage has 
 ceafed ; and, in many of thefe cafes, a ftrid regard 
 muft be paid to rules, even cluring the remainder 
 of life. 
 
 The general principles, on which it is neceflary 
 to proceed in thefe cafes, both with refpeft to the 
 treatment of the haemorrhage itfelf, and to prevent- 
 ing its return, are laid down in the preceding chap* 
 ter. But much caution is neceffary, in the appli? 
 cation of thefe principles to particular cafes j £nce 
 an error, on either fide, may be followed by con- 
 fiderable mifchiefs :'on the one fide, by occasioning 
 a rupture of a blood-veffel in f®me vital part ; and, 
 on the other, by laying the foundation for dropfy, 
 or fome one, of the numerous clafs of difeafes, de- 
 pendent on debility. 
 
 Bleeding from the nofe, In febrile or inflamma- 
 tory difeafes, efpecially when preceded by pain in 
 the head, fluflied countenance, and rednefs of the 
 eyes, will, in general, be found to be critical and 
 falutary : and, confequently, muft not be checked, 
 unlefs it becomes profufe, and is likely to exhauft 
 the patient too much, Much caution and fkill is 
 requifite, in forming a right judgement, in thefe 
 cafes ; iince it often happens, that fevers, and va- 
 rious febrile complaints, at their commencement, 
 gnd during fome part of their courfe, are accompa- 
 nied 
 
$00 MEDICAL ADMONITIONS. 
 
 nied with ftrong marks of inflammation, to which, 
 however, eXceflive debility very foon fucceeds. In 
 fuch cafes, this difcharge, although happening at a 
 critical period of the difeafe, will, if not very mod- 
 (ferate, be likely irretrievably to fink the patient. 
 
 When this haemorrhage happens in putrid fever ? 
 Ulcerated fore throat, or any of thofe dileafes, 
 which, from their firft appearance, are accompanied 
 with great debility of the fyftem, the earlieft efforts, 
 muft be exerted to reilrain it ; fince the lofs of even 
 a fmall quantity of blood, may, in thefe cafes, be 
 productive of fatal confequences. The occurrence 
 of haemorrhage, in thefe cafes, is very rarely accom- 
 panied with circumftances which render this adv 
 vice improper. 
 
 Where there is nothing to forbid the fupprei- 
 fion of the haemorrhage, the following means may 
 be employed. Cloths dipped in cold water, vin- 
 egar, or fpirits, may be frequently applied to the 
 nofe and face ; the bocly mould be kept in an erect 
 pofture, and expofed to the free accefs of cold air. 
 If thefe fhould not prqve fufficient, a piece of lint, 
 rolled up in the form of a cone, muft be introdu- 
 ced into the noftrils j no benefit can, however, be 
 expected from this, unlefs it is applied with fufij- 
 cient force to prefs on the orifice of the raptured 
 yeljel. If this mould not fucceed, the lint mav, 
 
 previous 
 
MEDICAL ADMONITIONS. 30I 
 
 jprevious to its introduction into the noftril, be en» 
 ireloped in flour j and, if this fail, the lint may 
 again be introduced, with the addition to the flour 
 of a fourth part of finely powdered allum. It is 
 almoft unneceffary to add, that every thing likely 
 to ftimulate the noftrils mull be carefully avoided. 
 
 Dr. Buchan recommends, that "the garters may 
 pbe tied a little tighter than ufual. Ligatures may 
 * 4 be applied to the arms, about the place where they 
 f'are ufually made for bleeding, and with nearly 
 f'the fame degree of tightnefs. Thefe muft be gra- 
 £' dually ilackened, as the blood begins to ftopj and 
 f s removed entirely, as foon as, it gives over." 
 
 put this practice is pot likely to produce the be- 
 neficial effects, for which it is recommended. Dr. 
 Chapman, in his ingenious Thefes on Hemorrhages, 
 remarks, that ligatures are fometimes applied to 
 comprefs the veins, and thereby to retard the re- 
 turn of the blood from any part to the right ven- 
 tricle of the heart, with the expectation of dimin- 
 ifhing the action of the heart, and of leffening the 
 velocity and force, with which the bloocl circulates. 
 
 But this practice, he obferves, was introduced 
 before mankind had obtained a thorough know- 
 ledge of the circulation of the blood ; and is man- 
 sfeftly liable to objections, which cannot eafily be 
 overturned. 
 
 In 
 
302 MEDICAL ADMONITIONS. 
 
 In the firft place, it is difficult to apply the liga- 
 ture fo as to comprefs the veins, without making 
 a preffure on the arteries alfo ; fo that it may hap- 
 pen, that as much injury may be produced, by in- 
 terrupting the paiiage of the blood from the heart, 
 as benefit can be expected by impeding its return. 
 Secondly, fuppofe that the preffure is even confined 
 to the veins alone, the beneficial effects which are 
 thence expected cannot poffibly laft long ; fince 
 fuch a degree of compreffion muft, in a little time, 
 affect the arteries, to the fame degree, as though 
 the ligatures had been applied to the arteries thenv 
 felves. 
 
 H^IMORRHAGY FROM THE LUNGS, 
 or SPITTING OF BLOOD. 
 
 FLemorrhagy from the lungs, or, as it is com- 
 monly termed, fpitting of blood, is generally pre- 
 ceded by a frequent cough, a fenfe of tightnefs, 
 weight, and anxiety in the cheft ; and, fometimes, 
 by a coldnefs of the limbs, or a general fhivering, 
 A faltifh tafte of the fpittle, and a troublefome 
 tickling of the upper part of the windpipe, fre- 
 quently occur, juft before the difcharge comes on. 
 The quantity of blood fpit, at the firft attack of the 
 difeafe, differs very much, in different cafes ; fome- 
 times only appearing in ftreaks^, mixed with the 
 
 phlegm, 
 
MEDICAL ADMONITIONS. 30$ 
 
 phlegm, and, in other cafes, proceeding in fuch con- 
 fiderable quantities, as even to threaten fuffocation. 
 
 Some judgement is neceffary to diftinguiih, from 
 what part the blood proceeds, which is thrown out 
 of the mouth ; lince it may not only be derived 
 from the lungs, but alfo from the iiomach, the 
 mouth, the back part of the noftrils, or the upper 
 part of the throat. The treatment which thefe 
 latter cafes require, differs fo much from that of 
 an haemorrhage from the lungs, that considerable 
 injury may be produced by an attempt to perform 
 the cure, unlefs the feat of the difeafe is previouily 
 afcertained* 
 
 The difcharge fometimes comes on without any 
 previous notice ; and is then, generally, the con* 
 fequence of fome excellive exertion of the lungs, as 
 in a violent fit of coughing, &c. When this is the 
 cafe, and the habit of body is perfectly free from 
 difeafe, the haemorrhage will fometimes foon ceafe. 
 The fame happy termination may, for the moil 
 part, be expe&ed, when the difeafe is even the re- 
 mit of a plethoric ftate of the fyftem ; but if a dif- 
 pofition to confumption previouily exifted in the 
 habit, there will be the greateft reafon to exped 
 that difeafe may be fpeedily induced. 
 
 But when the difeafe is preceded by the fymp* 
 toms before mentioneeL/and the haemorrhage does 
 
 not 
 
3C4 MEDICAL ADMONITIONS. 
 
 not immediately ceafe, the difeafe will generally' 
 proceed in the following manner. After the di£ 
 charge of blood has taken place, the foregoing 
 fymptoms are, in a great part, relieved ; the cheft 
 becomes more free, the breathing is performed 
 with lefs difficulty, and the cough is lefs frequent. 
 After a little time, more blood oozing from the 
 ruptured vefiel, occaiions a degree of weight and 
 uneafinefs of the lungs, and the return of the irri* 
 tation in the windpipe: to this the cough very foon 
 fucceeds, by which the extravafated blood is again 
 thrown off the lungs. 
 
 It frequently happens, that the patient is enabled 
 to predict the return of the haemorrhage, by the in- 
 creafe of fome of the foregoing fymptoms, which 
 generally takes place after a little refpite. 
 
 In thofe cafes, where the difeafe terminates fa* 
 vourably, the quantity of blood becomes lefs and 
 lefs, in every fpit, the breathing remains eafy, and 
 the cough foon ceafes. The fpit may remain tinged 
 for a little time, but, at laft, refumes its natural ap- 
 pearance. 
 
 But if ulceration of the lungs comes on, as the 
 fpitting of blood difappears, a fpitting of thick yel- 
 low matter comes on ; the breathir.g continues dif- 
 ficult, and the cough frequent. When this unhap- 
 pily takes place, the wafting of the patient, rrequent 
 
 heat 
 
MEDICAL ADMONITIONS. 305 
 
 heat in the palms of the hands, and flumings on the 
 cheeks, will foon point out too plainly the fatal ten- 
 dency of the complaint. 
 
 As this is a difeafe in which there is for the moft 
 part a confiderable degree of danger, and as there is no 
 cafe in which it occurs, in which the greateft care is 
 not neceflary, no one mould think of hazarding in 
 any inftance of it, the practice of domeflic quackery. 
 In all thofe cafes, however, where the difeafe comes 
 onfuddenly, and the aid of the judicious cannot be 
 immediately obtained, it will be neceflary to have re~ 
 courfe to fuch means as may prevent the return of 
 the haemorrhage. With trie hope of accomplifhing 
 this, blood mould be taken away from the arm, efpe- 
 cially if the pulfe be full, or there exifls any degree of 
 fever : the apartment mould be cool, and the patient 
 kept entirely ftill 5 particularly avoiding any exertion 
 of the lungs, as in loud fpeaking, &c. Animal food, 
 and even broths, mull be ftridbly avoided, the diet 
 being allowed to confift only of fuch things as contain 
 but very little nourimment ; and even thefe, only in 
 fmall quantities. Nothing mould be drank warm : 
 the beverage which may be barley-water or toaft and 
 water, either afcidulated with the juice of lemons, or 
 not according to the inclination of the patient, muft 
 be taken as cold as pcfiible ; and {tools may be pro- 
 cured by the ufe of fome mild purgative, as lenitive 
 electuary, manna, &c. By an attention to thefe 
 P p rules, 
 
306 MEDICAL ADMONITIONS. 
 
 rules, and what has been already faid, when treating 
 of haemorrhage in general, the difeafe may common- 
 ly be prevented from increafing, until proper affifl- 
 ance is obtained. 
 
 To prevent the return of this difeafe, the rules 
 already laid down, muft be carefully attended to ; 
 and to thofe may be added, as particularly requiring 
 attention, the injunction, that all exertions be care- 
 fully avoided, which detain, or which hurry, the 
 blood, in its paffage through the lungs ; fuch as ring- 
 ing, loud fpeaking, running, coughing, lifting great 
 weights, &c. 
 
 HEMORRHOIDS, OR PILES. 
 
 The piles are fmall round prominent tumors, 
 formed near the verge of the anus. When blood is 
 difcharged from thefe tumors, they are termed the 
 bleeding piles ; when this is not the cafe, they are 
 faid to be the blind piles ; and when the difcharge, 
 or the unealinefs, proceeds from within the rectum, 
 and no tumor appears externally, the difeafe is term- 
 ed the inward piles. 
 
 The piles fometimes come on without any previ- 
 ous fymptoms ; but, in general, they are preceded 
 by fymptoms, which evidently Ihew a plethoric flate 
 
 of 
 
MEDICAL ADMONITIONS. 307 
 
 of the fyftem ; fuch as giddinefs, pain and weight of 
 the head, and pains in the back ; and when the bleeding 
 takes place, thefe fymptoms generally go off. The 
 quantity of blood varies in different cafes 5 in fome, 
 being very trifling, in others fo coniiderable, as even 
 to threaten the life of the patient. The difcharge 
 frequently, as in other haemorrhages, becomes period- 
 ical. In fome cafes, it feems to confift of pure blood $ 
 but much difference is. obfervable in this refpecl, 
 fince the difcharge is, in other cafes, almoft colour- 
 lefs. 
 
 The piles fometimes come on, and continue fome 
 time, with but little pain, or inconvenience, except- 
 ing heat and itching about the fundament ; but 
 fometimes they are from the firft exeedingly painful, 
 fwelled and inflamed. In thefe cafes, if the means 
 which are had recourfe to do not prove fuccefsful, the 
 pain and inflammation increafe, until the whole fyftem 
 becoming deranged, fever at length enfues. If the 
 inflammation goes on to fuppuration, the patient un- 
 dergoes the-utmoft diftrefs, and mofl excruciating 
 pain j being often prevented from voiding either ftools 
 or urine, until fupuration being completed, a difcharge 
 of the contained matter takes place, accompanied by 
 an alleviating of almoft all the diftrefling fymptoms. 
 In particular habits of body, and in cafes where the 
 inflammation has been very confiderable, they fome- 
 times 
 
308 MEDICAL ADMONITIONS.' 
 
 times terminate, not in fuppuration, but in a gangrene, 
 or mortification of the effected parts. 
 
 This difeafe moft commonly happens to thofe who 
 are beyond the middle flage of life-, and are of a relaxed 
 habit of body, and melancholic temperament. Thofe 
 who have before fuffered repeated lofTes of blood are, 
 for the reafons before affigned, particularly liable to 
 attacks of this difeafe ; and, for the fame reafons, 
 thofe who have been long fubject to other difcharges, 
 fuch as from ulcers, iffues, &c. are frequently troubled 
 with this complaint, upon thofe difcharges cealing. 
 Want of exercife, and exceflive indulgence in eating and 
 drinking, particularly of highly feafoned foods, wines, 
 and fpirituous liquors, are frequent caufes of this 
 malady. But the moft frequent exciting caufe of 
 this difeafe, is the patting of indurated excrement, or 
 the too free ufe of ftrong purging medicines, as aloes, 
 jallap. &c, But whatever circumftances occafion a 
 fulnefs of habit, and diminithes the freedom of the 
 circulation in the inteftines, and in the inferior part of 
 the body, may produce this difeafe. 
 
 In thofe cafes where but little pain or inconveni- 
 ence is produced, no applications will be neceffary to 
 the part, nor any internal medicine required, except- 
 ing fome gentle laxative to be taken occasionally. 
 The fymptoms, however flight, mould ferve to ad- 
 monilh the patient of the neceffity of his adopting 
 
 , the 
 
MEDICAL ADMONITIONS. 309 
 
 the proper regulations in his diet, and mode of living 5 
 left the difeafe be augmented, or fome more danger- 
 ous malady be induced. This is a moment which 
 ought not heedlefsly to be pafled over, fince the difc 
 eafe being once permitted fully to form itfelf, a difpo-? 
 fition to future returns, fucceeds 5 and this difpofition 
 is increafed by each frefh attack. On the other hand 3 
 fhould the progrefs of the fymptoms be checked, and 
 the haemorrhage flopped, without due precautions, a 
 foundation may be laid for fome more alarming ancj 
 dangerous difeafe. 
 
 Since there cannot exift a doubt, but that very 
 confiderable mifchief is often the confequence of pa- 
 tients themfelves, and of domeftic practitioners adopt- 
 ing the opinion, that the hemorrhoidal dicharge is 
 not only innocent, but falutary, and even neceffary ; 
 it cannot but be beneficial to endeavour to {hew how 
 far this opinion is correct, 
 
 A plethoric ftate of the fyftem, in general, accomr 
 panies the firft, as well as every fubfequent attack of 
 the piles. If this is not otherwife reduced, a bleeding 
 from the piles takes place, and the equilibrium is 
 thereby reflored. But if the caufes of this morbid 
 ftate of the fyftem are not removed, the fulnefs re- 
 turns ; the parts affected with the piles having been 
 weakened by the previous distention, more readily ber 
 come again loaded with blood, and the hemorrhage 
 } 1 again 
 
310 MEDICAL ADMONITIONS. 
 
 again takes place. Thus, fucceflive alternations of 
 fulnefs and hemorrhage are produced, until, at laft, 
 the returns of plethora become periodical, and even, 
 in fome meafure habitual. When this is the cafe, if 
 the hemorrhage be prevented, without, the neceflary 
 regulations being adopted, other difeafes, the confe- 
 quence of plethora, may be induced ; and may be 
 removed by the return of the hemorrhage. But 
 here let it be remarked, that thefe difeafes are attri- 
 butable to the permitting of the hemorrhoidal 
 flux, at the firft, inflead of correcting thofe diforders 
 of the fyftem by which it was occafioned. 
 
 When the piles are accompanied with much pain, 
 it is to be feared that fuppuration may take place. 
 Many applications are recommended for the piles, 
 when they are become fwelled and painful ; but to 
 be able to point out which of thefe is preferable, it is 
 neceflary fir ft to know the actual ftate of the parts, as 
 the remedies which may be proper where inflammation 
 has not taken place, may prove highly injurious where 
 that ftate of the parts exifts. Inftead of enumerating 
 thefe, I ftiall, therefore, call the attention to the confe- 
 quences of neglecting to employ the moft proper 
 means in fuch a cafe. 
 
 In moft cafes of painful piles, more or lefs of inflam- 
 mation is prefent. And if this inflammation is not fuc- 
 cefsfully oppofed, it will foon extend itfelf to the ad- 
 joining 
 
MEDICAL ADMONITIONS. 31I 
 
 joining parts, not only producing the moft excruciat- 
 ing pains in the fundament, but alfo in the neck of 
 the bladder ; occasioning almoft an entire fuppreffion 
 of the urine. When this happens, the patient may be 
 allured, that it will be with very great difficulty that 
 a fuppuration in the adjoining parts will be prevent- 
 ed. Should fuppuration take place, the patient 
 ihould confider, that he has now a much more dis- 
 agreeable difeafe to combat with, than before, and that 
 the free and fkilful exercife of the chirurgic art, alone 
 can prevent him from fuffering the inconvenience and 
 pain of a fiftula. • 
 
 Where the inflammation is violent, and continues 
 for fome time, without any appearance of fuppuration, 
 an event may be reafonably feared, by which the life 
 of the patient mull neceiTarily be brought into the 
 moft imminent danger. Hence it muft plainly ap- 
 pear, that where the piles become inflamed, the moft 
 judicious exertions are neceffary, to prevent the moft 
 ferious evils from taking place. 
 
 The regulations of diet, exercife, &c. neceffary 
 for the prevention or removal of that ftate on which 
 this difeafe depends, may be learned from what has 
 been already laid down in the immediately preceding 
 chapters. 
 
 IMMODERATE 
 
'£12 MEDICAL ADMONITIONS. 
 
 IMMODERATE FLOW OF THE MENSES. 
 
 It is not every variation in the period or quan- 
 tity of this difcharge that is to be conlidered as a dif- 
 eafe, fince every healthy female is not exactly alike 
 in thefe refpe&s ; the difcharge recurring, in forne 
 cafes at longer, and in others at fhorter, periods ; in 
 Come cafes in larger, and in others in fmaller quanti- 
 ties ; without the appearance of any circumftance 
 that points out the variation to be unnatural, or un- 
 equal to the neceffities of the conftitution. Slight 
 deviations in thefe refpecls may alfo occur in the 
 fame perfon, without being accompanied by any 
 mark of difeafe. 
 
 But when the difcharge is considerably increafed 
 beyond its accufhomed quantity -, when its returns 
 are at much fhorter periods than ufual ; efpecially if 
 preceded or accompanied by cold chills, fucceeded by 
 heat and thirft, pain in the head and giddinefs, fhort- 
 nefs of breath, and pain in the loins, it may be conclu- 
 ded, that it exceeds the natural and falutary quanti- 
 ty. If the difeafe is not now checked, other fymp- 
 toms, the confequence of exceflive debility, foon 
 come on ; the face becomes pale, the feet are with dif- 
 ficulty kept warm, and become affected with an cede- 
 matous fwelling ; a fluttering and extreme finking is 
 felt in the infide 5 the flomach, inftead of requiring 
 
 food 3 
 
MEDICAL ADMONITIONS. 313 
 
 food, is almoft conftantly afFe&ed with naufea ; the 
 pulfe is fmall and frequent ; the furface cf the body is 
 frequently covered with a cold fweat, and extreme ag- 
 itation or fainting is occafioned, even by the flighieft 
 alarm. When the difeafe has proceeded thus far, a 
 trifling circum fiance may produce an alarming 
 change ; a fudden and copious difcharge may be al- 
 moft immediately fucceeded by fainting, and even 
 death ; or the continuance of a difcharge, not fufn- 
 cient to occafion immediate difiblution, may be pro- 
 ductive of dropfy, and other complaints founded on 
 extreme debility. 
 
 The increafe, both in the frequency and the quan- 
 tity of the difcharge, may take place fo gradually, and 
 the mifchievous confequences be induced in fo in- 
 ildious a manner, that frequently the patient may be 
 reduced to a dangerous ftate of debility, before (he is 
 fufficiently alarmed to feek for affiftance ; or even 
 before fhe is convinced of the exiftence of any dif- 
 eafe. 
 
 Females who lead a life of indulgence and inactiv- 
 ity, and who have been Weakened by frequent mif- 
 carriages, difficult labours, and* immoderate difchar- 
 ges from other caufes, are particularly liable to this 
 complaint ; as well as thofe who have fuffered the 
 fuppreffion of fomelong continued evacuation, or who 
 have fubmitted to frequent bleedings, Diftrefs, and 
 Q^q anxiety 
 
314 - MEDICAL ADMONITIONS. 
 
 anxiety of mind, indulgence in wine, and fpirituous 
 liquors, alio difpofe to this complaint. The exciting 
 caufes of this difeafe, may be the fame with thofe al- 
 ready enumerated, when treating of the other hae- 
 morrhages ; to which may be added, as particularly 
 likely to induce this fpecies of haemorrhage, fudden 
 frights, violent fits of paflion, and the improper ufe of 
 flrong cathartic and forcing medicines ■; particularly 
 of the various pills, advertifed under different titles, 
 but which are almoft wholly compofed of aloes, fcam- 
 mony, and other violent draftic purgatives ; which 
 have the power alfo of determining the blood into the 
 uterine veffels. 
 
 This haemorrhage is not always an original com- 
 plaint, it fometimes being a fymptom of fome other 
 difeafe. Ulcers, polypous concretions, fcirrhous and 
 cancerous affections of the womb, being frequently 
 accompanied with this fpecies of haemorrhage* 
 
 When the various modes in which this difeafe 
 makes its attacks are confidered ; being one while fo 
 violent, as to excite well founded fears of immediate 
 difTolution j at others, fo infidious as entirely to fap 
 the flrength of the conflitution, and bring on difeafes 
 the mofl difficult of cure, before the lead alarm is en- 
 tertained by the unfufpecting patient 5 the neceffity 
 of procuring early help muft be obvious to every one. 
 And when the variety of caufes by which it may be 
 
 produced 
 
MEDICAL ADMONITIONS, » 315 
 
 produced is alfo confidered, not a doubt can be enter- 
 tained of the imprudence and danger of truiling the 
 cure of fuch a difeafe, to the hazardous attempts of 
 domeftic quackery ; efpecially, fince the hemorrhage 
 may, as has been juft obferved, be only the fymptom 
 of fome other difeafe, which maybe entirely overlook- 
 ed and neglected -, whilfl the endeavours made for 
 the removal of the haemorrhage muft neceffarily prove 
 ineffectual, the difeaie on which it depends continuing 
 unabated. 
 
 If an additional argument is neceffary to prove 
 the danger of fuch interference, it may be derived 
 from the confederation, that the neceffity of making 
 that difficult and nice diflinction between hcemorr- 
 hagy depending on increafed vigour, and that which 
 arifes from the contrary date of the fyfters, is more fre- 
 quently required in this than in any other fpecies of 
 haemorrhage. And as the difeafe may depend on either 
 of thefe two oppofite ftates of the fyflem, endeavours 
 for a cure which are made without neceffary ikill, 
 may not only prove ineffectual , but, by promoting 
 that ftate of the fyflem on which the difeafe depends, 
 may increafe every fymptom. 
 
 Directions for the management of this difcharge, 
 when it is not confiderable, as well as for preventing 
 its return, are here unneceffary ; fince, in thefe cafes, 
 there is no preffure of hafte which ought to prevent 
 
 application. 
 
£l6 MEDICAL ADMONITIONS. 
 
 application, for the advice of the regular profeiibr of 
 the healing art. When the haemorrhage is fudden and 
 profufe, the patient fhould, as foon as poflible, be de- 
 prived of every part of her clothing, which may occa- 
 sion the leaft interruption to the free circulation of the 
 blood, and be placed in an incumbent pofture, in a 
 cool chamber, being covered but lightly with bed- 
 clothes. Every thing which is drank mould be as 
 cold as poflible, and cloths dipped in cold water fhould 
 be frequently applied to the loins and neighbouring 
 parts. 
 
 VOMITING OF BLOOD. 
 
 When blood is brought up manifeftly by vomit- 
 ing, there can be no doubt of its proceeding from the 
 flomach. An uneafy flate of the flomach commonly, 
 for fome time, precedes this difcharge. Pain in the 
 region of the flomach, accompanied by anxiety, and 
 a fenfc of oppreffion, is in general experienced, jufl 
 before the coming on of the haemorrhage. 
 
 If this complaint is the confequence of a fuppreffion 
 of the menflrual, or hemorrhoidal difcharge, and is in 
 a (mail quantity, there may not be reafon to appre- 
 hend much danger. But if the difcharge is very con- 
 siderable, and black grumous blood is difcharged, both 
 by vomiting and by floolj the difeafe is really alarm- 
 ing, 
 
MEDICAL ADMONITIONS. 317 
 
 ing, and demands a careful enquiry as to its caufe, and 
 the raoft fkilful exertions to effect its cure. Not a 
 moment mould be loft, but the beft affiftance mould 
 be obtained as foon as poflible. In the mean while, 
 the means recommended in haemorrhage from the 
 lungs, may be employed. Thofe who have fuffered 
 from this diforder, mould, for fome time afterwards, 
 be very careful to take nothing into the ftomach 
 which may be likely to irritate it, or to produce vom- 
 iting. The mode of living Ihould, for fome time 
 afterwards, be fimilar with that recommended after 
 inflammation of the ftomach. 
 
 VOIDING OF BLOOD FROM THE 
 . URINARY PASSAGE. 
 
 Blood difcharged. with the urine may proceed from 
 the kidneys, the ureters, the bladder, or the urethra 
 (the canal which conveys the urine from the bladder.) 
 The part whence the difcharge of the blood proceeds 
 is to be difcovered by attending to the fymptoms 
 which preceded, and which accompany the difcharge. 
 In general, it is a fymptomatic affection of fome dif- 
 eafe, and by the cure of that only can be removed. 
 
 CATARRH. 
 
*lS MEDICAL ADMONITIONS. 
 
 CATARRH. 
 
 At the commencement of this difeafe, the patient 
 generally complains of wearinefs, and diiinclination to 
 move j frequent thrills of cold, fucceeded by tranfient 
 gleams of heat, run through the whole frame ; the 
 head aches, and feems heavy, and the throat feels 
 rough and dry. Soon after this, a flight difficulty of 
 breathing, hoarfenefs, and frequent dry cough, fuper- 
 venes. Oftentimes the difeafe is accompanied with a 
 heat and forenefs of the eyes and noftrils ; a limpid, 
 acrid liquid flowing conflantly, both from the nofe 
 and eyes. 
 
 As the difeafe proceeds, the Ikin becomes hot and 
 dry, the pulfe hard and full, and the urine high colour- 
 ed ; the patient foon lofes all defire for animal food, 
 is reftlefs and thirfty, and much harrafTed with the 
 cough. After a little time, a fmall difcharge of mucus 
 is produced by the cough, which gradually increafes : 
 the roughnefs and forenefs of the throat, the fever, 
 cough, and other fymptoms, leflening, as this dif- 
 charge thickens j foon after which, the difeafe, gene^ 
 rally, goes entirely off. 
 
 The progrefs of the difeafe, as here defcribed, is, 
 however, only to be met with in thofe cafes where 
 feature has been affifted by well adapted means - 3 or, 
 
 at 
 
medical Admonitions. 319 
 
 at leaft, has not been interrupted by improper inter- 
 ference. But where the difeafe, exifting to a con- 
 fiderable degree, has been neglected -, or where trifling 
 cafes have been exafperated by improper treatment ; 
 a variety of fymptoms may arife, by which the real 
 nature of the difeafe may be concealed from an unin- 
 formed practitioner, and the danger, of neceffity, 
 augmented. 
 
 Thofe who have already fuffered from this difeafe^ 
 are particularly liable to future attacks ; thofe alfo, 
 whom previous indifpofitions have rendered it necef- 
 fary to confine themfelves to the houfe, for a time, are 
 very likely to be affected with this difeafe, at their flrfb 
 expofure to the open air. 
 
 This difeafe is fometimes produced by a fpecific 
 contagion ; and when it thus occurs, it is obferved ta 
 fpread to a much greater extent than any other epi- 
 demical difeafe. But the moft frequent caufe of this 
 malady is the too fudden tranfition from one atmof- 
 phere to another, much higher or lower in its degree 
 of temperature. 
 
 When a perfon is affected with what he fuppofes to 
 be a common cold, as it is termed, he generally either 
 neglects it entirely, or attempts its removal by fpiritu- 
 ous and heating drinks, hoping thereby to excite a 
 fweat In the one cafe, the parts affected become Co 
 
 jniured 
 
3 20 MEDICAL ADMONITIONS. 
 
 injured and weakened, by the long continuance of the 
 difeafc, as to be rendered particularly liable to future 
 attacks ; in the other cafe, there is the greateft pro- 
 bability that the difeafe will be immediately aggravat- 
 ed, and perhaps additional diforders occafioned. 
 
 Where the nature of the difeafe is obvious, and 
 where the breathing is perfectly free, the feverifhnefs 
 very flight, the appetite but little impaired, and the 
 cough not very frequent, attempts may be made, by 
 domeflic treatment, to carry off the difeafe at its com- 
 mencement. This may frequently be done, by 
 bathing the feet and legs in lukewarm water, immedi-, 
 ately before going into bed, and drinking freely of 
 fome warm diluting liquor, fuch as barley-water, 
 weak whey, &x. thereby exciting a free perfpiration. 
 
 The patient fhould carefully avoid every circum- 
 ftance which may tend to quicken the circulation of 
 the blood. Animal food, fpirituous liquors, wine, 
 beer, &c. mould be entirely omitted. The food 
 ihould only confifc of milk and vegetables, and their 
 various preparations, fuch as rice-gruel, panada, falop, 
 fago, &c. The drinks may be barley-water, pectoral 
 decoction, infufion of linfeed, bran-tea, 8cc. Thefe 
 may be fvveetened with honey, and rendered plealantly 
 acid by the addition of the juice of lemons or oranges. 
 
 In thofe cafes where the cough is very frequent, 
 the fever confiderable, and the breathing interrupted 
 
 by 
 
MEDICAL ADMONITIONS. 321 
 
 by tranfient pains, or tighfnefs of the cheft, the 
 management of the difeafe will require the uttnoft 
 care and fkill : fince, if a proper mode of treatment 
 is not early adopted, inflammation of the lungs will, 
 very probably, foon fucceed, which, if not fpeedily 
 detected and removed, will be too likely to terminate 
 in a decline. 
 
 In thofe perfons who have previoufly fufFered from 
 fpitting of blood, or who have been at all difpofed to 
 confumption, it is abfolutely neceflary that the mod 
 cautious and vigorous meafures be purfued, at the 
 very onfet of the difeafe ; as there exifts not a doubt, 
 but that, in fuch fubjedts, a common flight cold, as it 
 is termed, frequently proves the exciting caufe of a 
 confumption. 
 
 The probability of confumption immediately fuc- 
 ceeding to inflammation of the lungs, muft be readily 
 conceived by any one, who has even the flighteft 
 knowledge of the functions of that organ. To fuch, 
 then, it muft be fufficient to give them the informa- 
 tion, that this difeafe, the danger of which is fo flightly 
 eftimated, is an inflammatory affection of the mucous 
 membrane which lines the windpipe, and even its 
 ramifications in the lungs. If this be duly confidered, 
 furely the probability of the inflammation extending 
 itfelf to the fubftance of the lungs muft appear fuffl- 
 ciently evident, as well as the neceflity of early adopt- 
 Rr ing 
 
322 MEDICAL ADMONITIONS. 
 
 ing the moft powerful means for the removal of the 
 
 difeafe. 
 
 Nor is it to the firft attacks of this diforder only, to 
 which I would call particular attention. Many cafes 
 may occur, in which the firft fymptoms of the difeafe 
 may be very flight ; and the difeafe may proceed 
 without being characterifed by any marks, which may 
 lead to a fufpicion of danger j but in which the 
 cough may be tedioufly protracted! Frequently, when 
 this is the cafe, the patient and his friends, deceived 
 by the abfence of fever, and the fmall inconvenience 
 otherways experienced, allow the continuance of this 
 injurious fymptom, until fuch mifchief is produced, 
 as no fubfequent care, or exertion, can remove. 
 
 From inattention and improper management, at 
 the commencement of this difeafe, originates that af- 
 fection of the lungs, which has been defcribed as 
 baftard peripneumony ; true inflammation of the 
 lungs, and confumption, alfo frequently proceed from 
 the fame caule. From its frequent recurrence pro- 
 ceed conftant and troublefome accumulation of mucus, 
 or phlegm, and aflhma. 
 
 The frequency with which this difeafe occurs, in 
 this part of the world, and the flight degree of intereft 
 and alarm, which is, in general, excited by the ex- 
 prefiion, catching cold by which thU difeafe is com- 
 monly 
 
 \ 
 
MEDICAL ADMONITIONS. 323 
 
 monly defcribed, to frequently occafion that neglect, 
 by which the foregoing maladies are produced. 
 
 Fully fatisfied that vaft numbers fall victims to the 
 fuppofed infignificance of this infidious enemy, I have 
 been anxious to difplay to your view the danger of 
 not oppofing his attacks, however weak and trifling 
 they may appear. 
 
 It frequently happens, that catarrhal complaints, 
 even when not exifting to an alarming degree, termi- 
 nate, as has been already mentioned, in an affection 
 of the lungs known by the name of baftard peripneu- 
 mony -, a difeafe which differs much from catarrh in 
 its nature, and confequently requires a very different 
 mode of treatment. But this change may come on 
 fo gradually, and in a manner fo little likely to excite 
 the attention of a common obferver, that much mif- 
 chief may arife, from not timely adapting the mode 
 of treatment to the irritation which has taken place. 
 
 That truly dangerous malady, the croup, is very 
 likely, efpecially in the firft ftage, to be miftaken for, 
 and treated as, a fimple catarrh, by thofe whofe judg- 
 ment has not been formed by obfervation and ex- 
 perience. A miftake in this point cannot but prove 
 highly injurious ; fince the ordinary remedies for 
 catarrh, would prove of no effect in checking the rapid 
 progrefs of this dreadful difeafe. 
 
 The 
 
324 MEDICAL ADMONITIONS. 
 
 The cough, which frequently is very troublefome, 
 almoft entirely engrofles the attention of domeflic 
 practitioners, who, omitting the necefTary regulation of 
 diet, as well as the ufe of means likely to correct the 
 febrile ftate of their patients, frequently content them- 
 felves with attempting to put a {top to the cough, 
 by the exhibition of fome opiate, as the Paregoric 
 Elixir ; which, in molt cafes, will not only prove inad- 
 equate to the purpofe for which it is given, but will 
 feldom fail of confiderably augmenting the difeafe 
 itfelf. 
 
 Moft of the noflrums advertifed as cough drops &c. 
 are preparations of opium, fimilar to the paregoric 
 elixir of the fhops ; but difguifed, and rendered more 
 deleterious, by the addition of aromatic and heating 
 gums. The injury which may be occafioned by the 
 indifcriminate employment of fuch medicines, in this 
 difeafe, may be very confiderable ; as is well known 
 to every perfon pofTefling, even the fmalleft fhare of 
 medical knowledge. 
 
 It would undoubtedly be rendering a great benefit 
 to fociety, if fome medical man were to convince the 
 ignorant, of the pernicious confequences of their re- 
 liance on advertifed noflrums : but, unfortunately, 
 the fituation in which medical men ftand, is fuch, 
 that their befl intentioned, and moft difinterefted ex- 
 ertions for this purpofe, would not only be but little 
 
 regarded, 
 
MEDICAL ADMONITIONS. 325 
 
 regarded, but frequently would be even imputed to 
 bafe and invidious motives. Thofe to whom they 
 have to addrefs their admonitions, are, unhappily, 
 thofe, on whom reafon has leaft influence. " Prithee, 
 Doctor," faid an old acquaintance to a celebrated 
 empiric, who was ftanding at his door, " how is it* 
 that you, whofe origin I fo well know, mould have 
 been able to obtain more patients, than almoft all the 
 regular bred phylicians ?" — " Pray," fays the quack, 
 " how many perfons may have pafled us whilft you 
 put your queftion ?" — " About twenty."—" And 
 pray how many of thofe do you fuppofe pofTefTed a 
 competent fhare of common fenfe ?"— *' Perhaps one 
 out of the twenty," — " Juft fo," fays the Doctor, 
 " and that one applies to the regular phyfician ; whilft 
 I and my brethren pick up the other nineteen." 
 
 Thofe who have furTered from this difeafe, are, I 
 have already remarked, very liable to its future at- 
 tacks ; and from what has already been ftated, it 
 cannot but be evident, that mofl ferious mifchiefs 
 may follow its frequent recurrence. The ftri&eft 
 care, therefore, mould be taken, to avoid thofe cir-- 
 cumftances, which, a little confideration will fhew, 
 may, if not properly attended to, become powerful 
 exciting caufes of this difeafe. 
 
 The ill effects of too fuddenly palling into an at- 
 mofphere, confide?ably higher or lower in its degree of 
 
 temperature, 
 
326 MEDICAL ADMONITIONS. 
 
 of temperature, than that which has been juft quitted, 
 have been already defcribed, when fpeaking of the 
 prevention of inflammation in general. To the ad- 
 monitions there given, I muft beg you to revert ; 
 with a confidence, that as this circumftance is one of 
 the moft frequent caufes of catarrh, an attention to 
 what is there delivered may be here of the utmoft 
 importance. 
 
 In guarding againft this difeafe, confiderable advan- 
 tage is to be gained by a due regulation of the cloth- 
 ing. This fhould be neither too thin, nor fo irregu- 
 larly difpofed, as to leave one part of the body naked, 
 whilft the reft is even loaded by warm clothing. 
 In children, and young folks, this error is too 
 frequently obfervable. The former we generally fee, 
 with their legs and arms uncovered 5 and the necks 
 and chefts of the latter are often expofed, unguarded, 
 to the utmoft feverity of the cold. " In every 
 region, we may obferve external warmth to be nearly 
 as neceffary as internal nourifhment, for the young 
 of almoft every animal. Warm rooms and impure 
 air may enervate the body, but warm clothing can 
 never be injurious in cold weather. I am fo tho- 
 roughly convinced, that pure air and a warm fkin are 
 indifpenfibly neceffary for children, that I never be- 
 hold them with naked breafts, legs, and arms, however 
 hardy and robuft, that I do not anticipate the horrid 
 
 confequences 
 
MEDICAL ADMONITIONS. £27 
 
 confeque rices of angina of croup, or of pectoral or in- 
 teftinal inflammations." * 
 
 The remarks of Dr. Beddoes on this point are par- 
 ticularly interefting, as they are properly directed 
 againft a moft filly, but prevailing notion. " In 
 children, it is of the utmoft confequence to keep the 
 body cool, but never to fuller it to be cold. Thus, 
 without being enervated, they may efcape the fatal 
 confequences of heat fucceeding quickly to cold ; for 
 it is not true, as feems, in confequence of an analogy 
 more or lefs diflinctly conceived, to have been fre- 
 quently imagined, that cold hardens children as k 
 hardens fteel." f 
 
 I never witnefs the cruel perfeverance in this pre- 
 tended mode of hardening children, in which the 
 weak and fickly hardly ever efcape, but it calls to my 
 mind the practice of thole nations, who, determined 
 to fecure a hardy race, decree the decriped and infirm 
 to be expofed to perifh, in the woods and deferts. 
 
 The ufe of flannel, and of the fleecy hofiery, cannot 
 be too much urged as a preventive of this difeafe ; 
 but, unfortunately, thofe who think catarrhal affec- 
 tions are of too little moment to call for much 
 trouble in avoiding them, are generally too ready to 
 
 evade 
 
 * Medical Spectator, vol. i. p. 367. 
 i Obfervations, &c. by Dr. Beddoes, p. 16%* 
 
«2& MEDICAL ADMONITIONS. 
 
 evade the adoption of this meafure, on the mofc 
 trifling objections ; the chief of which is, however, 
 the uneafinefs arifing from the irritation it occafions 
 to the fkin. But rather than the important advan- 
 tages to be gained by this mode of clothing mould 
 be loft, the flannel may be worn over the fhirt. In- 
 deed, in thofe cafes where there has been much 
 weaknefs produced by preceding difeafes, or where 
 advantage is not expected to be derived from irritat- 
 ing the Ikin, this mode of wearing flannel is preferable 
 to that of wearing it next the fkin. Remembering 
 that it mould be removed at night, with the other 
 daily clothing ; and that the fame attention be paid 
 to its cleanlinefs, and frequent renewal. 
 
 Thofe who are liable to this difeafe, mould be alfo 
 exceedingly cautious in their mode of living. Their 
 diet fhould be light and fimple, confifbing more of 
 vegetable than of animal fubflances. Milk, in various 
 forms, mould conftitute a considerable part of their 
 food. Spirituous liquors mould be entirely avoided, 
 and wine and beer mould only be taken in fmall 
 quantities 3 by children, thefe alfo fhould be quite 
 omitted. 
 
 The neceffity of avoiding the air rufhing in a ftream 
 from the crevice, or the opening of a door or window, 
 muft be fo obvious, as not ta require to be enlarged 
 upon. Laying in damp beds, and fitting in wetted 
 
 rooms, 
 
M3EDICAL ADMONITIONS. 329 
 
 rooms, are fo well known to be productive of injurious 
 effects, that it can hardly be necefTary to urge the 
 ftrictefl care in avoiding fo open an enemy* 
 
 But there is one negligent, or cruel practice, which 
 cannot be too feverely reprehended 5 fince, from the 
 frequent instances of dangerous dtfeafes, which have 
 been fuppofed to have arifen from this caufe, there is 
 too much reafbn to fear, that inattention, in this re- 
 iped, is too frequent. Lfirge rooms, which, being 
 referved for the purpofe of receiving company, are 
 fhut up for mafiy days, and even fometimes for weeks 
 together, in damp and cold weather, are frequently 
 ufed, with only the precaution of having a fire lighted 
 in them an hour or two before the viiitors arrive. The 
 fire not having yet fufficiently warmed the room ; 
 and the furniture, particularly the curtains, carpeting, 
 and chair-feats, being impregnated with a confidera- 
 ble quantity of moiflure, which begins to evaporate 
 as the room becomes warm, the unfortunate objects 
 of this ceremonious, and dangerous diflinction, are 
 expo fed to the joint action of cold and moiflure. 
 That considerable injury may fohW, there is little 
 reafon to doubt ; efpecially as the dreffes of the* 
 perfons who are thus expofed to the influence of 
 thefe circumftances, are, at thefe times, more light 
 and airy than their ufual clothing $ and are, confe- 
 quently, but little calculated to defend them from 
 fuch powerfully combined adverfaries. 
 
 S s CONVULSIVE 
 
330 MEDICAL ADMONITIONS. 
 
 CONVULSIVE ASTHMA. 
 
 The ingenious Dr. Robert Bree, of Birmingham, 
 was himfelf the object, he fays, of the attacks of this 
 difeafe, and might poffibly, he thinks, have had a 
 ^>rofpect of long complaining of its tyranny, if a de- 
 termined refolution to deviate from the common path 
 of practice had not occafionally yielded inflruction, 
 and given a bafrs for further experiment. From the 
 year 1787,116 examined the forms of afthmawith in- 
 creafed ihduftry,and was fupplied with more numerous 
 opportunities of trying the force of remedies in the 
 paroxyfms (having made experiments in one hundred 
 and thirty paroxyfms) than can generally occur in a 
 practice of ten years, where the motives for enquiry 
 are lefs perfonal to the phyfician-. 
 
 From an attentive confederation of the fubjecl:, he 
 difcovered, that afthma in general is the confequence 
 of irritation of the lungs, and that this may be pro- 
 duced by acrid effluvia in the lungs, but is moft fre- 
 quently occafioned by an efrufion of ferum in the 
 veficulas of the lungs. Other lefs frequent fpecies he 
 alfo enumerates ; but thefe it is unnecefTary to notice, 
 fmce all that is here intended to be done, is to enable 
 you to form fuch an idea of the difeafe, and of the 
 caufes on which it depends, as will enable you to fee 
 the propriety of the directions for the conduce of the 
 
 patient, 
 
MEDICAL ADMONITIONS. 33 1 
 
 patient, which I (hall prefume to extract, for the ad- 
 vantage of afthmatics. It is far from my intention to 
 attempt to furnifh. inftructions to practitioners of both 
 fexes, for the cure of this difeafe, being fully con- 
 vinced, with the author of this valuable treatife, that 
 " No written rules will fupply the defect, which, in 
 this diforder, as well as others, the fagacity and obfer- 
 vation of experience can alone remedy." 
 
 Wherever indigeftion prevails, which may be known 
 by want of appetite, flatulent diftentions and pains of 
 the ftomach, heart-burn, &c. there are we to expect 
 that afthma alfo may occur. Indeed, fo connected 
 are thefe difeafes, that afthma hardly ever takes place, 
 but flatulence, and other fymptoms of indigeftion, 
 are, at the fame time, difcoverable. 
 
 This circumftance, if duly confidered, muft necef- 
 farily imprefs thofe who fuflfer the inconveniences of 
 indigeftion with a ftrong conviction of the necemty of 
 early oppofing it with requifite remedies ; and of fub- 
 mitting to thofe regulations which may be pointed 
 out, left the diftrefles ariling from afthma be fuper- 
 added. Again, from confidering the dyfpeptic. con- 
 dition of patients diftreffed with afthma, and the 
 connection which appears to exift between the two 
 difeafes, the neceflity of correcting indigeftion, and 
 of attending to a proper regimen, muft be very evi- 
 dent to t^e afthmatic. 
 
 Errors 
 
33^ MEDICAL ADMONITIONS. 
 
 Errors in diet, Dr. Bree obferves, are a copious 
 fource of inconvenience to the afthmatic. Under 
 this head lie fpecifies, drinking too much ftrong 
 liquors, or liquors full of carbonic acid, or fixed 
 air, with acefcent materials in the compofition, fweet 
 wines, and new beer. Profufe indulgence in the ufe 
 of tea, and warm watery liquids of all kinds, are ex- 
 citing caufes of afthma. Heavy (uppers, eating be- 
 tween meals, and, generally, all food of difficult 
 digeftion, may produce the fame effecl: ; mch are, 
 fmoked meats, paftry, fat pork or beef, water-fowl, 
 raw vegetables, fallads, and unripe fruits ; alfo boiled 
 cabbage and carrots, rich foups, jellies, and fauces. 
 
 Thefe alimentary fubftances are not readily govern- 
 ed by the flomach. of an afthmatic, but remain, till a 
 fermenting procefs takes place ; and, if purging or 
 vomiting brings no relief, the paroxyfm may be ex- 
 cited ; even when thefe evacuations occur, this 
 confequence is not often prevented. The afthmatic, 
 ht juffcly obferves, muft rigidly believe, that his 
 paroxyfms may be more frequent, or the intermiflions 
 longer ; according as the feductions of the table are 
 too powerful for his prudence, or are refilled by his 
 care. Intoxication and furfeit are fo confpicuous 
 among the word of his enemies, and can have to little 
 allurement where the habit is infirm, that an afthmatic 
 is not to be fufpe&ed of fufferiDg from the excite- 
 ment ot thefe grofs errors. 
 
 The 
 
M ED r CA L ADMONI T IONS". % 3 3 
 
 . The atmofphere produces effe&s on the afthmatic, 
 by feveral changes. When the mercury in the baro- 
 meter flands as high as thirty inches, the denfity of 
 the air is fufficient, ceteris paribus, to preferve the 
 intermiflion of his diforder ; and alterations from 
 this ftandard to a lower, will be, according to circum- 
 fiances, unfriendly. Befides a change from this degree 
 of denfity, the ftate of the air may be cold or warm, 
 cold and moift, or warm and moift j and rain, mow, 
 or froft, ftorms and fogs, may give additional impref- 
 fion ; but flight in comparifon of the ftate. (the 
 diminifhed denfity of the air) which occafions their 
 appearances. When vapours hang low, we have a 
 certain index of the diminifhed denfity of the air, 
 which would otherwife carry them off ; and that the 
 caufe of their low fufpenfion is really a ftate of atmof- 
 phere, producing, at the fame time, the diforder of 
 the reipi ration. 
 
 If to the lightnefs of the air, moifture is added, the 
 operation of its influence may be more injurious ■; and; 
 has frequently been felt in various fituatfcns, when 
 the predifpofition to afthma was not prefent. 
 
 Cold and moijlure check cutaneous perfpi ration, 
 and diminifh the heat of the lungs - 3 and is thereby 
 
 hurtful to the afthmatic. 
 
 - 
 
 Cold alone will not ufually excite the paroxyfm, 
 though there are ftatesof the atmofphere, which are 
 
 very 
 
334 MEDICAL ADM0N1TIQNS, 
 
 very injurious, without the pofitive prefence of 
 aqueous vapour, or moifture. 
 
 The Eaf and North-E^zvinJs, not only chill the 
 lungs, and make their capillaries paflive, and incapa- 
 ble of contracting on their contents ; but they check 
 cutaneous perfpiration, inducing another caufe of 
 althma in catarrh. 
 
 Changes to rain or Jnow affecl: the afthmatic, be- 
 eaufe of the decreafe of weight in the air, which gives 
 occafion to thefe alterations. 
 
 ■S/;;;;^, of any kind, are ufually attended with 
 fudden rarity of atmofphere ; and according to the 
 prevalence of exceflive heat or cold accompanying the 
 change, the afthmatic will be more or Iefs affeded. 
 
 Active motion in a warm air, with frequent refpira- 
 tions, produces great increafe of exhalation from the 
 fuperficial capillaries, and from the lungs. The difli- 
 pation of neat, by this means, is productive of the 
 lTjoft fevere fits of aflhma. Heat may be carried 
 away from the body, by other means, befides exhala- 
 tion ; and this effect takes place in frofty weather, but 
 not ufually with the fame confequences to the afth- 
 matic. 
 
 Profufe bleeding, fpontaneous or artificial, has 
 brought on aflhma, in fome inftances ; and violent 
 purging or vomiting may be an exciting caufe of 'the 
 parody fm. A 
 
MEDICAL ADMONITIONS. $j$ 
 
 A critical attention is neceiiary to the calls of the 
 ftomach, and the power of that organ to perform di- 
 geftion. The firft fhould never be negleded, and 
 the latter never opprefted. If the ilomach is loaded, 
 the fit will be more violent, than after the occafional 
 caufe of failing. The want of foody or an abfurd 
 negleft of regular meals, will as certainly excite the 
 paroxyfm in fome afthmatics, as a moderate and light 
 fupper of tender animal food will alleviate the fymr> 
 toms in others. 
 
 Fafting is not only an exciting caufe of afthma, but 
 it will, according to its extent, increafe the preclilpo 
 fition to the difeafe, by lowering the heat of the body. 
 
 Afudden increafe in the impulfe of the circulation , oae 
 caufe of which may be rapid or violent bodily motion,. 
 may excite the paroxyfm of afthma. 
 
 The fuppr ejjion of the hemorrhoidal cr menflrual flux 
 may occafion dyfpncea, or a paroxyfm of the afthmgl 
 
 Repelled eruptions or g§ut may, according to the 
 habit in which the circumftance occurs, produce 
 either dylpncea afthma, or peripneumony. 
 
 Duft of any kind, metallic fumes and fetid fmells, 
 and ftrong perfumes, fhew their efFe&s on an afthmat- 
 
 xc, by exciting a paroxyfm. 
 
 , 
 
 The frnoh of tobacco is, in moil cafes* offenftve to 
 
 the 
 
336 MEDICAL ADMONITIONS. 
 
 the afthmatic ; and even when the habit of inhaling 
 the fume is purfued, and abfurdly thought to be a 
 remedy for the difeafe, by thofe who miftake the 
 great excretion of faliva for a neceffary evacuation, the 
 patient flrengthens the predifpofition to this difeafe. 
 It is affirmed, that fmokers are afthmatic ; and 
 •piemerbroeck found their lungs dark coloured, ap- 
 proaching to black, and ulcerated. Sir J. Floyer 
 mentions a patient, who fmoked to cure a pain in the 
 ftomach, and by this means acquired the afthma. 
 
 The trial carbonic acid, ox fixed air, is an exciting 
 caufe recorded by Sir J. Floyer. I have known, Dr. 
 Bree fays, the infpiring of the vapour of fermenting 
 fubftances in brewing, to be followed immediately by 
 the paroxyfm. 
 
 The pafiions of the mind may excite a paroxyfm, or 
 flrengthen the predifpofition to it. Severe ftudy 
 affects the digeftive powers, and therefore promotes 
 predifpofition. 
 
 It is not my intention, in a difeafe fo alarming, to 
 pietend to furnifh the domeftic practitioner with a 
 regular plan of treatment, nor even to particularife the 
 feveral remedies which may be demanded in its 
 feveral periods. I mail be fatisfied with making fome 
 remarks on thofe remedies which are particularly de- 
 manded by the diftrefsful ltate of the paroxyfm, and 
 which are generally within the reach and management 
 
 of 
 
MEDICAL ADMONITIONS. Q,2>1 
 
 of domeftic practice ; as well as on fome of thofe 
 which alarm may prompt to the employment of, in 
 defiance of the probability of dangerous mifapplica- 
 iion. 
 
 Emetics are frequently employed with fuccefs in 
 abating the violence of the paroxyfm ; efpecially 
 where the exiftence of indigeiled matter in the ftomacli 
 is pointed out. But much judgment is neceffary to 
 enable any one to determine the extent to which the 
 operation is to be carried. In fome cafes, ftrong 
 vomiting may be neceffary, and in others only naufea ? 
 and flight urgings to reach. 
 
 In fevere fits of the fuffocative afthma, the patienfc 
 Will frequently infift, in fpite of the ftrongefl remon- 
 ftrances, that he may lofe blood, and fometimes with 
 fuch a degree of pertinacity as is impoffible to refift. 
 But the afthmatic mould conllder this point, in the 
 lefs hurried moments of intermiffion ; he mould then 
 reafon with his medical attendant, and carefully at- 
 tend to his arguments, that his mind may be fo 
 armed, as to prevent him from foliciting for, and even 
 infifting on, the performance of that which will have 
 but little chance of rendering him any fervice, but 
 which will, moft likely, occafion an increafe of that 
 debility which helped to conflitute the predifpofition 
 to the difeafe. Dr. Bree, fpeaking of the effects of 
 bleeding in the moft common fpecies of this difeafe, 
 Tc fays, 
 
338 MEDICAL ADMONITION 
 
 fays, " I have repeatedly dire&ed it, but have never 
 " had reafon to think that the paroxyfm was fhorten- 
 « ed an hour by the lofs of blood ; and I have often 
 " been convinced, that expectoration was delayed, and 
 " more dyfpncea remained in the intermiffion, than 
 " was common after former paroxyfms. In old 
 " people, who have been ufed to the diforder, it is 
 * certainly injurious." 
 
 The gum ammoniac and fquills, may be frequently 
 employed with advantage. But the ordinary oily 
 emulfions, and heavy clogging mixtures, are rarely of 
 any ufe -, and indeed, by the interruption they may 
 occafion to the procefs of indigeftion, they muft, more 
 commonly, rather promote than remove the difeafe. 
 
 Bliflers ought not to be employed, in this difeafe 
 fo indifcriminately as is generally the cafe. Their 
 operation is not fumciently rapid to expect much ad- 
 vantage from them, during the paroxyfm j and it 
 (hould be remembered, that in every cafe where either 
 they or iffues are employed to procure a continued 
 difcharge, if the cafe be not fuch as to require evacua- 
 tion, injurious weaknefs, in proportion to the dif- 
 charge, will be produced. 
 
 The experiments and obfervations, of which I hare 
 fpoken when treating of confumption, fhew that con- 
 fiderable advantage may be derived from breathing 
 
 air 
 
MEDICAL ADMONITIONS. 339 
 
 air containing more than the ordinary proportion of 
 
 oxygen. 
 
 The acid of vinegar, diftilled vinegar, or, if that 
 cannot be readily^ obtained, common vinegar, in a 
 dofe of two table-fpoonfuls, with an equal quantity 
 of cold water, is a remedy, from which relief may be 
 frequently obtained in the paroxyfm. Dr. Bree fays, 
 that in afthma proceeding from the irritation of 
 mucus, vinegar is the moft ufeful medicine, in the 
 paroxyfm, which I have tried. 
 
 Warm bathing, he remarks, is hurtful in every 
 ipecies of afthma : but, he afferts, upon numerous 
 trials of its efficacy, that there is no fingle remedy of 
 more value, in all fpecies of the complaint, during the 
 abfence of the paroxyfm, than the cold bath. 
 
 Having already pointed' out the connection between 
 afthma and a weakened ftate of the ftomach, the 
 neceffity of having recourfe to thofe means which 
 may give tone to this bowel, and thereby affift digef- 
 tion, muft be obvious. But the afthmatic mould 
 alfo confider, that to accomplifh this end, a patient 
 and refolute perfevefance in the courfe of medicines 
 which may be prefcribed for this purpofe fiiould be 
 adopted. On nothing lefs can any hopes of benefit 
 be placed. 
 
 With the hope of preventing returns of the difeafe, 
 
 the 
 
34© MEDICAL ADMONITIONS. 
 
 the patient fhould be very ftricc in the diet he em* 
 ploys. From the obfervations on the caufes of this 
 difeafe, above mentioned, the afthmatic will learn 
 what errors of diet mould be avoided : and to the 
 rules he there obtains, he may add the following. 
 His food mould not be generally fluid and poor — . 
 watery gruels and broths are therefore improper, the 
 flomach requiring folids. Vinous drinks alfo mould 
 be avoided. Acidulated water, milk and water, with 
 toafted bread or bifcuit j rice boiled in broth until it 
 is foft, without fat, are fuited to the paroxyfm. Hot 
 liquors are always improper. Cold water is taken 
 with great benefit ; and, if acidulated with vinegar, 
 its good effects are often very confiderable. 
 
 A flrong infufion of coffee was recommended by 
 Sir J. Pringle, as a powerful medicine in the paroxyfm. 
 It was alfo fuccefsfully employed by Floyer. Dr. Per- 
 cival alio recommends its ufe. Dr. Bree alfo advifes. 
 its employment medicinally. 
 
 In juftice to Dr. Bree, I muft here obferve, that the 
 leading points in this article are extracted from the 
 Doctor's valuable obfervations. It may be confider- 
 ed as very advantageous to thofe who labour under 
 any particular difeafe, to have an intelligent phyfician 
 a fellow fufferer. Independent of the nearer and 
 flronger interefl which muft neceflarily impel him to 
 the earnefl confederation of the nature of the difeafe, 
 
 his 
 
MEDIC&L ADMONITIONS. 34I 
 
 his opportunities of investigation are infinitely fuperior 
 to thofe of others, whofe enquiries are always likely to 
 be productive of lefs information, on account of the 
 vague and inconclusive defcriptions contained in the 
 anfwers they receive. He is much better able to con? 
 ned caufe and effect ; and to mark the confequences, 
 beneficial or injurious, which proceed from the feveral 
 kinds of diet, the changes of the atmofphere, and 
 various qjher circumftances. Having the means of 
 experiment always in his power, he is able to employ, 
 on the fpur of the moment, whatever judgment may 
 fuggeft, or neceflity may demand. In a word, his 
 experiments on the difeafe muft be numerous, anc| 
 his obfervations conftant 
 
 Should a phyfician prefent to the world his obferva- 
 tions, made under thefe circumftances, the benefits to 
 his fellow fufferers muft be inestimable : in his pub- 
 lication they find a ufeful itinerary, which points out 
 to them the roads they mould keep, as well as thofe 
 they fhould avoid. It calls their mind from the 
 ufelefs contemplation of objects affording neither in- 
 struction nor pleafure, and directs its attention to 
 thofe which are at once both important and ufeful. 
 Such a publication is that from which I have fo. freely 
 tal^en the chief of the foregoing practical obfervations. 
 
 HOOPING 
 
34a MEDICAL admonitions; 
 
 HOOPING COUGH. 
 
 This infectious difeafe is fufficiently known : a 
 defcription of it is therefore unneceflary. It may be, 
 however, proper to remark, that it often commences 
 with the fymptoms of a common catarrhal cough, or 
 cold, and may exift fome little time before the charac- 
 tereftic hoop is heard. 
 
 There is, perhaps, hardly any difeafe, for which fo 
 many noftrums are recommended. Omitting the 
 mention of thofe which are fo freely recommended by 
 well meaning matrons, I (hall here only allude to thofe 
 advertifed noftrums, which, with fo many alluring 
 promifes of fuccefs, are artfully foifled on the public. 
 From the frequent adoption of thefe, I am well allur- 
 ed, the lives of many children are loft ; but previous 
 to advancing my reafons for this fuppofition, I will 
 make a few remarks on one circumftance, which may 
 occaiion parents to place fo much reliance on thefe 
 dangerous means. 
 
 This difeafe has no determined period for its termi- 
 nation, it difappearing much fooner in fome cafes than 
 in others ; but feldom, however, exceeding three or 
 four months in its duration. Frequently a happy 
 change will take place very fuddenly, and without any 
 obvious caufe : the fits becoming more and more 
 
 flight, 
 
MEDICAL ADMONITIONS. 343 
 
 flight, every day, and the hoop as rapidly declining, 
 A difeafe, thus uncertain in its termination, muft be 
 very favourable to the character of any noftrum, em- 
 ployed with the hope of procuring its removal. 
 
 Suppofe this pretended remedy to be taken by any 
 given number of children, and confider, that it muft 
 be given either towards the beginning, the middle, or 
 the end of the complaint. It muft be fair, then, to 
 conclude, that in one-third of thefe cafes, it will be 
 given near to that period, when the difeafe would of 
 itfelf have gone off. Indeed the proportion might 
 be fuppofed to be much greater than one-third, fince 
 it moft commonly happens, that in the greater num- 
 ber of cafes where thefe noftrum s are had recourfe to, 
 the time employed in the trial of other various means 
 has brought the difeafe near to the period of its con- 
 clufion 3 and the very circumftance of having employ- 
 ed fo many things before, without fuccefs, is employed 
 to arrogate the more merit to the declared fpecific. 
 
 If no injury were the refult of thefe quackeries, they 
 would here have efcaped mention. But during the 
 continuance of this malady, there are feveral circum- 
 ftances which require fuch particular attention, that, 
 if neglected, they will moft probably occafion the 
 death of the patient : and, unfortunately, the parents 
 relying entirely on the infallibility, which the decep- 
 tive advertifement attributes to the mifchievous nof- 
 trum 2 
 
544 MliDlCAL AUMUJNliiuisa. 
 
 trum ; and complying exactly with the terms de- 
 manded, that no other medicine be taken, neglect all 
 lefs notices of danger, until, feeing their child arrived 
 almolt at the point of death, they, too late, apply for 
 regular afliftance. 
 
 It is true, that phyficians do not poffefs a fpecifiCj 
 which will directly remove this difeafe ; and the ac- 
 knowledgment of this, is another inducement to the 
 alarmed parent to fly to noflrums ; but they mult he 
 informed, that fuch a fpecific will be fought with as 
 little fuccefs from the empiric, as from the phyfician. 
 The latter is, however, enabled, by an attention to 
 the different fymptoms which arife, in the progrefs of 
 the difeafe, fo to conduct its courfe, by abating the 
 violence of the fymptoms, that it mail rarely proye 
 fatal. 
 
 The molt dangerous circumltance that arifes in 
 this difeafe, is fhortnefs of the breath ; fince, when- 
 ever, this occurs to any confiderable degree, there may 
 be great reafon to fufpect, that inflammation of the 
 lungs has taken place. In this cafe, bleeding, blifter- 
 ing, and other appofite means, adapted to the age and 
 ftrength of the patient, will generally afford fpeedy 
 relief ; but, on the contrary, fhould any noftrum be 
 here relied on, it is molt probable the child would 
 foon be loft. So alfo the ipafmodic affection, which 
 fo ftrongly marks the difeafe, becomes fometimes fo 
 
 violent 
 
MEDICAL ADMONITIONS. 345 
 
 violent as to threaten fuffocation, during each fit of 
 coughing ; and here the greateft benefit is derived 
 from well adapted antifpafmodics. Thus alfo the ac- 
 cumulation of phlegm, increafe of fever, &c. demand 
 their appropriate remedies ; and common fenfe muft 
 be convinced, that all thefe neceflarily varying proper- 
 ties, are not likely to be found in one boafted noftrum. 
 
 Much reliance has been placed on removing 
 children afflicted with this difeafe into a different air 
 from that which they 4iave been accuflomed to 
 breathe : beneficial effects, it is faid, have proceeded 
 from the change, when even the patient has been re- 
 moved into air lefs pure than that he had left. 
 
 Thefe falutary effects, which the experience of 
 parents and nurfes, unwarped by hypothecs, has fo 
 ftrongly marked, when contemplated by the aid of 
 that light which the late difcoveries in pneumatic 
 chemiftry afford us, furnifh flrong evidence in favour 
 of the employment of airs differing in purity, in feveral 
 of the difeafes incident to the human body. 
 
 I have often been furprifed, that this circumftance 
 lias not been noticed by Dr. Beddoes, Thornton, and 
 other gentlemen, who have made pneumatic medicine 
 particularly their ftudy. It has, indeed, not merely 
 excited my furprife, it has occafioned my regret ; 
 fince the practical deduction I (hall, perhaps, too 
 feebly make, might have proceeded from their pens, 
 U u with 
 
346 MEDICAL ADMONITIONS. 
 
 with fuch clearnefs and force, as might have been 
 productive of much greater good. 
 
 When treating of confumption, I endeavoured to 
 (hew you, that the oxygen, or purer portion of the air, 
 is the beft and mofl natural flimulus to the lungs, and 
 to the whole fyflem, in thofe cafes, where there exifls 
 difficult refpiration, accompanied with a debilitated 
 flate of the fyflem : and that the azotic, or more im- 
 pure portion of the air, has been found to be highly 
 beneficial in the contrary flate of the fyflem ; where 
 too much action, manifefled by inflammation, catarrh, 
 and fpitting of blood, menance a termination in con- 
 fumption. 
 
 In the hooping-cough, both thefe ftates are, at 
 different times, found to prevail ; and furely, it is not 
 at all improbable, that thefe advantages have been the 
 confequence of a fortunate coincidence ; and that, 
 where fuccefs has followed the change of air, it has 
 been when during an inflammatory flate, the change 
 has been for air lefs pure ; and in the contrary Hate, 
 where the removal has been from the clofe air of 
 town, to the purer air of the country. 
 
 From the foregoing premifes, we have certainly a 
 right to conclude, that inflead of indifcriminate 
 changes from one lituation to another, the air mould be 
 chofen, according to the principles jufl laid down — 
 that in thofe cafes where difpofition to inflammation 
 
MEDICAL ADMONITIONS. 347 
 
 is evident, the impure air of a town mould be pre- 
 ferred ; and that, in thofe cafes where a great degree 
 of debility, and of difficulty of refpiration, threaten 
 dropfy of the cheft, &c. the purer air of the country 
 fliould be obtained. 
 
 It can hardly be neceffary to remark, that in thofe 
 cafes where the docility of the patient, and the facility 
 of procuring the neceffary apparatus, and the required 
 air, render the experiment eafy to be made, it will be 
 advifable to try the effects of refpiring the hyperoxyge- 
 nated air in the one cafe, and of the impure, hydro 
 carbonate air in the other. 
 
 That the advice of a phyfician would be defirable, 
 to point out the proper plan to be adopted in thefe 
 cafes, mufl be very obvious ; and particularly fo, 
 when it is confidered, that the medicinal effects of air, 
 differing in purity from the common atmofpheric air, 
 is but a late difcovery ; that phyficians are not yet 
 determined, how much may be fairly attributed to 
 their employment -, and that from the induftry with 
 which this part of the healing art is cultivated, daily 
 information may be expected to be obtained. In 
 the prefent imperfect ftate of pneumatic medicine, 
 much real fcientific information is neceffary in thofe 
 who employ^ el3rfic 
 
 DYSENTERY 
 noitenxflififtfti q% nobilodiib sreriw ^Ab-j siodt m 
 
348 MEDICAL ADMONITIONS. 
 
 DYSENTERY, 
 
 OR 
 
 BLOODY FLUX, 
 
 This difeafe, in general, commences with griping 
 pains about the naval, accompanied with a frequent 
 defire to void ftools. * Sometimes thefe complaints 
 are preceded by cold fhiverings, to which fever fuc- 
 ceeds. The gripings and ftools foon become very 
 frequent ; the functions of the ftomach become cons- 
 iderably impaired ; the appetite is loft; naufea, fick- 
 nefs, and fometimes frequent vomitings, take place. 
 The ftools are in fmall quantities, and compofed 
 aimoft entirely of mucus ; at times mixed with blood, 
 which in fome cafes appears in the mucus, in ftreaks ; 
 and, in others, pure and unmixed. Small pieces of 
 membranous films, and hardened excrement, are alfo 
 obfervable in the flools, which are highly ofTenlive, and 
 of a fmell peculiar to this difeafe. In general, the 
 difeafe is accompanied, through its whole courfe, by 
 a fever of a malignant kind •> but fometimes, the fever 
 foon leffens, although the dyfenteric fymptoms con- 
 tinue. 
 
 Children and aged perfens, and thofe who have 
 been weakened by former difeafes, are much endanger- 
 ed by attacks of this difeafe 5 and even thofe who are 
 
 ia 
 
MEDICAL ADMONITIONS, 349 
 
 in the prime of life, are frequently fo affected by it ? 
 as to give very juft caufe of alarm, 
 
 If the gripings become more fevere, and the ftools 
 more frequent, whilftthe quantity difcharged by them 
 diminishes j efpecially if the fever increafes, the difc 
 eafe may be concluded to be getting worfe. If the 
 gripings ceafe entirely, and the difcharge is of a dark 
 fanious matter, the pulfe becoming exceedingly fmall 
 and quick, and the patient covered with a profufe 
 cold fweat, a gangrene may be fuppofed to have taken 
 place, and aJpeedy diffolution may be expected. 
 
 A favourable termination may be hoped for, when 
 the gripings and ftools become lefs frequent, and the 
 difcharge arTurnes a natural appearance. 
 
 It however frequently happens, that after the diK 
 eafe has aflumed a more favourable appearance, and 
 the patient is fatisfied that his recovery is almoft com- 
 plete, the difeafe will continue without any farther 
 amendment ; inducing a train of difeafes, which, 
 unlefs well adapted means are employed, mull be 
 productive of much ferious mifchief. 
 
 It too frequently happens, that this difeafe is allow- 
 ed to exift for fome time before the patient, who 
 fuppofes it a common loofenefs, acquires a knowledge 
 of the nature of his complaint ; in confequence of 
 which it is permitted to run on until it becomes fo 
 
 inveterate, 
 
350 MEDICAL ADMONITIONS* 
 
 inveterate, and the patient fo much weakened, as to 
 render the cure very difficult to accomplifh. 
 
 To conduct a patient fafely through this difagreea- 
 ble and alarming difeafe, demands much care and 
 fagacity on the part of the phyfician, and the ftricteft 
 attention and moft implicit obedience from the at- 
 tendants. The cure of this difeafe depends in a great 
 meafure, on the removal of the excrements which are 
 morbidly retained in the bowels -, and, confequently, 
 on the producing a faecal difcharge of a natural ap- 
 pearance. To effect this, purgative medicines, with 
 occafional clyfters, mould be employed. But this 
 mode of practice is very little likely to be followed by 
 domeflic practitioners, who cannot be made to com- 
 prehend the principle on which it is founded. To 
 them it will appear, not only incompetent, but even 
 fevere and injurious. They cannot conceive how a 
 purging is to be removed by increafing the difcharge ; 
 or how griping pains are to be leflened, but by the 
 ufe of warm and aromatic remedies. They therefore 
 often take the liberty, not only to fufpend the ad- 
 miniftering of the remedies prefcribed j but to fubfti- 
 tute for them thofe things which, in their opinion, 
 will fooner remove the fymptoms : endeavouring to 
 flop the purging by the moft powerful aflringents, 
 and to lefTen the gi'ipings by aromatic and fpirituous 
 
 drinks. 
 
 So 
 
MEDICAL ADMONITIONS. §J1 
 
 So far is it from being fafe to truft the management 
 of this difeafe, to any one whofe only knowledge 
 refpe&ing it is derived from fome treatife on domcftic 
 medicine, that it is difficult to convey to fuch, infor- 
 mation fufficiently explicit, on the article of diet 
 alone, to enable them to adapt it to the different cafes 
 of this difeafe. The age and ftrength of the patient, 
 the ftate of the fyftem, and the different ilages of the 
 difeafe, all require to be confidered, before a . fit regi- 
 men can be determined on. 
 
 If the difeafe be accompanied by inflammation, the 
 food fhould not only be confined to a liquid form ; 
 but fhould alfo confift of thofe things which are 
 fimple, and are of a cooling nature ; fuch as barley- 
 water, thin panada, or thin gruel, made from flour or 
 rice, &c. &c. Where there are no marks of inflam- 
 mation, the diet may be more nutritive ; but fhould 
 ftill confift chiefly of liquids. To the articles above 
 mentioned may be added broths of various kinds, 
 calves feet jelly, &c. If the fever accompanying the 
 difeafe is of a putrid nature, the patient fhould take 
 freely of ripe fruits, the juice of ripe oranges, and 
 Currant jelly, may be added to the drinks. In gene- 
 ral, the diet may be more nourifhing, after the difeafe 
 has exifled fome time ; and particularly fo, if the 
 patient has been weakened by preceding difeafes, Or 
 is either of a tender or an advanced age. 
 
 The 
 
3£i MEDICAL ADMONITIONS. 
 
 The chamber fhould be frequently fupplied with 
 frefh air, and filled with the fumes of vinegar, he. 
 The clothing of the patient, as well as the bed-clothes, 
 mould be frequently renewed ; and every thing pro- 
 ductive of ofTenhve frnell fheuld be removed as 
 fpeedily as poffible. 
 
 To prevent a return of the difeafe, to which the 
 patient will be liable, moderate exercife may be em- 
 ployed in the open air, in that degree, and in that 
 mode, which his ftrength will permit. A tea-cupful 
 of camomile tea, or of decoction of bark, may be 
 taken three times a day. The diet mould not confift 
 too much of animal food ; and fpirituous and fer- 
 mented liquors mould be entirely avoided. The 
 bowels mould be kept in a ftate of regularity, and 
 fhould be guarded from cold by additional clothing. 
 
 APOPLEXY. 
 
 In this difeafe, the whole of the fenfes, and of the 
 voluntary motions, are in fome degree abolifhed, 
 whilft the actions of the heart and lungs continue. 
 The appearance of the patient is that of one in a deep 
 fleep ; the breathing being moftly accompanied by a 
 loud fnoring. The face is generally fwelled, and of a 
 dark florid colour, every veflel about the head and 
 
 neck 
 
MEDICAL ADMONITIONS. 353 
 
 neck appearing to be diftended with blood. The eyes 
 are bloodfhot, watery, and prominent ; and frequent- 
 ly the head, and the whole body, is bedewed with a 
 cold clammy fweat ; and a paralytic affection of one 
 fide of the body is frequently found, at the fame time, 
 to have taken place: 
 
 Sometimes this difeafe comes on fuddenly ; but 
 moft frequently it is preceded by thefe fymptoms. 
 The face, for fome time before, appears more than 
 ufually florid, and the eyes flightly bloodfhot. The 
 head is giddy, and frequently affected with paim par- 
 ticularly in the back part of it. The extremities alfo 
 are frequently affected with numbnefs, and irregulari- 
 ties, or inability of motion ; and fometimes a little 
 faltering of fpeech may be difcoverable. The patient 
 is almoft conftantly drowfy, and generally fleeps par- 
 ticularly found j but is fometimes affected with fits 
 of the incubus, or night-mare. A troublefome ring- 
 ing noife is frequently perceived in the ears ; tranfient 
 irregularities, both in fight and hearing, are frequent- 
 ly difcovered, and every fenfe appears, at times, to be 
 fomewhat impaired. Recollection, reflection, and 
 every other procefs of the mind, is performed, evident- 
 ly with lefTened power. 
 
 The fubjects of this difeafe, are, generally, perfons 
 
 in an advanced flage of life. Thofe have been ob- 
 
 ferved to be particularly difpofed to it, who are of a 
 
 W w corpulent 
 
354 MEDICAL ADMONITIONS; , • 
 
 corpulent habit, and have a large head and fliort neck.' 
 Indolence, and indulgence in the luxuries of the table, 
 as well as the fuppreffion of any difcharge, which, by 
 its length of continuance, has been fuffered to have 
 become habitual to the con ft i tut ion, contribute much 
 to the forming of a predifpofition to this difeafe. 
 
 Whatever interrupts the return of the blood from 
 the head ; or, by impeding its circulation through the 
 other parts, throws it in too great quantity upon the 
 brain, may prove an exciting caufe of this difeafe 5 
 fmce the moil frequent immediate caufe of apoplexy, 
 is the accumulation of blood in the blood-veffels of 
 the brain, or an effufion of blood, or of fome other 
 fluid, in different parts of the brain, or between it and 
 the bones of the fkull. Every violent exertion, 
 therefore, efpecially if accompanied by a full and long 
 continued infpiration ; a considerable degree of fatigue, 
 exceflive heat, or cold ; a violent fit of coughing ; 
 long continuance in a ftooping pofture, or with the 
 neck in an oblique pofition y any thing worn tight 
 about the neck j intoxication, exceflive diflenfion of 
 the ftomach and bowels, and violent emotions of the 
 mind, may occafion this difeafe. It may alfo be pro- 
 duced by various other changes, which may take 
 place within the cavity of the fkull ; the nature of 
 which cannot be precifely afcertained during life. 
 
 In addition to the caufes of apoplexy here enume- 
 rated^ 
 
MEDICAL ADMONITIONS. ^SS 
 
 rated, feveral others have been mentioned by different 
 authors ; fuch as the receiving the exhalations from 
 newly plaiftered walls, the mephitic air arifing from 
 fermenting liquors, the fumes arifing from burning 
 charcoal, brimftone, &c. from lead, arfenic, and feveral 
 other fubftances ; but the difeafes induced by thefe 
 caufes being very different from apoplexy, and con- 
 sequently requiring a different mode of treatment, 
 will be fpoken of feparately. 
 
 In a difeafe, the caufes of which are fo various, and 
 oftentimes fo difficult to afcertain ; wh'ofe mode of 
 attack is always fo alarming, and whofe termination is 
 generally fo fatal, the earlieft ufe of every effort, pointed 
 out by ftudy and experience, muft be adopted. To 
 attempt to furnifh family practitioners, therefore, with 
 rules for the cure of apoplexy, would be abfurd and 
 dangerous : all that with propriety, therefore, can be 
 attempted in a work of this kind, is to manifefl the 
 neceffity of obtaining the earlieft medical aid ; to 
 recommend the fafeft mode of treating the patient, 
 until that is obtained ; and to point out the moft 
 proper plan to be adopted, to prevent the return of 
 the difeafe. No time, then, mufl be loft .: the beft 
 medical afliftance mould be obtained, as foon as 
 poffible ; fince, in every moment that is wafted, 
 the difeafe is, moft probably, more firmly eftablifhing 
 itfelf. In the interim, no ram experiment, nor any 
 
 violent 
 
356 MEDICAL ADMONITIONS. 
 
 violent endeavours, fhould be employed. The appln 
 cation of irritants to the noftrils, as volatile falts, 
 fnufT, &c. with the hope of routing him from his 
 flate of infenfibility, muft be particularly forborne, as 
 well as any attempts to force him to (wallow any h> 
 ritating liquors. 
 
 The patient fhould immediately be raifed into an 
 elevated pofture, and his head, in particular, mould 
 be kept erect ; fmce, otherwife, an angle being form- 
 ed by the bending of the neck, the blood will be the 
 more likely to be detained in the blood-vefTels of the 
 brain ; which, of neceflity, muft occafion an augmen- 
 tation of the difeafe. The neckcloth, and whatever 
 is likely to occafion a ftricture on any part of the 
 body, muft be removed, 10 that no interruption to the 
 free circulation of the blood may exift. The air of 
 the room fhould be moderately cold ; and the cloth- 
 ing fo difpofed, as to allow the patient to breathe the 
 cool air, at the fame time that the body itfelf may be 
 iuiflcicntly defended from the action of the cold on its 
 furface. In removing the patient to his chamber or 
 bed, great care mould be taken, that he be ftirred no 
 more than is abfolutely neceflary ; and that an erecl; 
 polition be preferved as much as poflible. Should the 
 patient have been feized foon after eating a hearty meal, 
 and fhould frequent urgings point out a difpofition to 
 retch, the difcharge of the contents of the ftomach 
 
 may 
 
MEDICAL ADMONITIONS. 357 
 
 may be procured, by irritating the throat and fauces 
 with the end of a feather ; iupplying him, as foon as 
 he is able to fwallow, with camomile tea, fait and 
 water, warm water, &c. until the ftomach is quite 
 emptied. This mould, however, be performed with 
 caution : if the eyes are very red, and the face exceed- 
 ingly florid and turgid, it ought not to be attempted, 
 until fome blood has been taken away. 
 
 From a confidence in ics utility, in every cafe of this 
 difeafe, bleeding is almoft always immediately pro- 
 pofed, by thofe who happen to be prefent at the firfb 
 onfet of the difeafe ; and is generally adopted, if any 
 one can be found who can wield a lancet. And, in- 
 deed, not only in this difeafe, but in every other, 
 which menaces the fpeedy extinction of life, is this 
 operation too generally had recourfe to. To prevent 
 the rath and dangerous adoption of this practice, it 
 may be fufficient to inaprefs on the mind, that thefe 
 alarming fituations may oftener depend on a depletion 
 of the blood-venels, and an exhauftion of the vital 
 powers, than on too great fulnefs, or on too powerful 
 action. Even in the difeafe, which is the fubject of 
 the prefent fection, in which it muft be acknowledg- 
 ed, that bleeding is more frequently demanded than 
 in any other difeafe, which has for its characteriftic 
 fymptoms the deprivation of fenfe and motion, the 
 
 obfervation? 
 
358 MEDICAL ADMONITIONS. 
 
 obfervations of the moft celebrated phyficians have 
 proved, that bleeding is fometimes highly injurious.* 
 
 The heft advice, therefore, that can be here given, 
 with refped to bleeding, as a rule of conduft in thefe 
 diftrefsful cafes, is, perhaps, to abftain from this 
 operation, until the opinion of the intelligent can be 
 obtained. 
 
 This delay will be efpecially necefTary, if the coun- 
 tenance appears to be funk and pallid, rather than 
 tumid and florid ; if this attack has occurred at the 
 clofe of long continued labours, either of the mind or 
 body ; and in fubjecls who have not been devoted to 
 indolent or luxurious indulgences. 
 
 A fimilar caution is necefTary, with refpect to the 
 employment of blifters, which, from an opinion of the 
 iafety with which they may be ufed on all occafions, 
 are often had recourfe to in thefe cafes. But, it mult 
 be here remarked, that their employment is admiffible 
 only in feme cafes ; in others, every alarming fymp- 
 tom may be increafed by their application. 
 
 It has been already remarked, that there is a certain 
 peculiarity of make, which very much difpofes to this 
 
 difeafe'j 
 
 * Heberden. Medical Tran factions, vol. i. p. 471. 
 Fothergill. London Obf. & Inq. vol. vi. p. 680. 
 'Kirkland's Commentary en Apople&ic and Paralytic 
 Affections, p. 46. 
 
MEDICAL ADMONITIONS. %$$ 
 
 djfeafe ; this was faid to confift chiefly in a fhortnefs 
 of the neck, and a largenefs of the head, accompanied 
 by a full habit of body, and a florid countenance, 
 I muft here digrefs, for the fake of leflfening unnecef- 
 fary uneafinefs and alarm, which may be excited, in 
 thofe who may conceive they poflefs, in fome degree, 
 this peculiar form. 
 
 This peculiarity, it muft be obferved, then, only 
 gives a greater fufceptibility of this difeafe ; and this 
 by no means to the extent which has been generally 
 fuppofed. The difeafe itfelf, and even a difpofitioa 
 towards it, muft be produced by a concurrence of 
 various circumftances, the greater number of which 
 may be removed^ or prevented, by a little care and 
 refolution. 
 
 When it is recollected, that a frequent caufe of 
 apoplexy is a mechanical preffure on the brain, the 
 confequence of the accumulation of blood in the 
 blood-veflels of the brain ; or of the extravafation of 
 blood, or of fome other fluid, in or upon the brain 5 
 it is obvious, that, to prevent fuch a fulnefs of blood 
 arifing, as may deftroy the equilibrium between the 
 blood-venels and their contained fluid, mould be the 
 confiant endeavour of every one who has reafon to 
 fear an attack of this diforder. 
 
 To effect this, it will be neceflary that a due pro- 
 portion 
 
*6b MEDICAL ADMONITIONS* 
 
 portion be preferred, between the quantity of nourim- 
 ment which is taken, and the wafle which is occafioned 
 by exercife. The patient ihould therefore be very 
 fparing^n his meals ; of which animal food mould 
 form but a very fmall part. Spirits, wine, and the 
 ltronger kinds of malt liquor, as porter and ale, mould 
 be ftridtly avoided. The beverage ihould chiefly 
 confift of lemonade, flierbet, whey, butter-milk, &c< 
 and, where fome indulgence to long eftablifhed habits 
 is infifted on, weak negus, or a glafs or two of port, 
 or of the lighter French wines, may be allowed after 
 dinner. 
 
 The clothing mould be light and loofe ; and par- 
 ticular care mould be taken, that nothing the leafl 
 tight be worn about the neck. 
 
 Exercife mould be employed to a confiderable ex- 
 tent, and no more fleep indulged in, than is jufi fuf- 
 ficient to recruit the ftrength. Sleeping immediately 
 after a full meal mould be carefully avoided : efpeci- 
 ally fleeping in a chair, which is particularly danger- 
 ous ; fince, in confequence of the mufcles which 
 fhould fupport the head lofing their power, during 
 fleep, the head falls on one fide, by which, the blood- 
 velTels in the neck being compreffed, the return of the 
 blood from the head may be impeded, and a rupture 
 of fome of the veffels in the brain be thereby pro- 
 duced. 
 
 A 
 
MEDICAL ADMONITIONS. 361 
 
 A confiderable number of thofe.who fall victims to 
 this difeafe, are attacked during the night ; this 
 may be accounted for, by confidering, that the hori- 
 zontal pofition impedes the return of the blood 
 through the jugular veins ; its motion being no 
 longer aided by its gravity, which was the cafe whilft 
 the body was in an ered pofture. For this reafon, 
 the beds of thofe who have caufe to fear an attack 
 of this diforder fliould be coniiderably higher at the 
 head than at the feet. This rifing of the bed fhould 
 be gradual, fuch as would be occafioned, by fhorten- 
 ing the fupporting polls at the foot of the bed j fince 
 if it be attempted only in the ufuai way, by three or 
 four pillows, in addition to thofe ufually employed to 
 raife the head, the chin will be thrown forward on the 
 cheft, and the neck bent at fo acute an angle, as may 
 be very likely, during'the hours of fleep, by interrupt- 
 ing the paflage of the venal blood, in the neck, to 
 bring on thofe very effects which it was intended to 
 prevent. 
 
 The man of bufinefs, who for his cares and exer- 
 tions has obtained the reward of eafe and competence, 
 is particularly fubjed to this malady. In him we find 
 the concurrence of many circumftances, which mufl 
 have a tendency to produce this \fifeafe. In the days 
 of his induftry, when conftantly labouring, perhaps 
 literally- fo, to obtain the gains of his bufinefs or pn> 
 X x feffion, 
 
362 MEDICAL ADMONITIONS. 
 
 feflion, the necetfary exercife, both of body and mind,, 
 muft, from the great expence of the vital fluid, 00 
 cafion the demand of conliderable fupplies of nourifh- 
 ment ; and we, in general, find, that men of the above 
 defcription are favoured with organs of digeftion in a 
 found and vigorous ftate, and are confequently well 
 difpofed towards the luxuries of the table. 
 
 Such a man feldom quits the pleafing buftle of a 
 fuccefsful bufinefs, until he difcovers, that he has fo 
 far paiTed the acme of his life ; that his abilities are 
 not what they were, and that his exertions are no 
 longer productive of that fuccefs which he has hither- 
 to experienced. However difpofed he may be, at firft, 
 to attribute this to other caufes, it will not be long 
 before he discovers the true caufe, in the diminifhed 
 vigour, perhaps both of body and of mind. 
 
 He retires, therefore, from the bufy world, with 
 the intention, either of freely indulging himfelf with 
 that reft, to which his purfuits, followed with avidity, 
 have hitherto rendered him a ftranger ; or, at leaft, 
 of exchanging his exercife and his employments, for 
 fuch as may be more agreeable, and better fitted to 
 his declining years and flrength. 
 
 If we follow him in his retirement, we fhall moft 
 probably find him indulging in almoft a ftate of ab- 
 iblute indolence - 3 or, at leaft, in a ftate comparative- 
 ly 
 
MEDICAL ADMONITIONS. 363 
 
 ly {o y if the adive fituation from which he has been 
 removed, be recollected. 
 
 Although he may, for his health's fake, being aware 
 of the ill confequences of the omiffion, make a point 
 of taking fome exereife -, yet it is moft likely that 
 this will not be employed to that extent, which is 
 neceffary to prevent the evils intended to be avoided. 
 This may arife from his varying his modes of exereife, 
 when he changes his fituation of life. Thus, whilffc 
 engaged in his former purfuits, we may fuppofe him 
 to be almoft conftantly on foot, hurrying to wherever 
 he may be fummoned, by the various calls of his 
 bufinefs or profemon. But after his retirement, he 
 will moft probably adopt, for his amufement, fuch 
 exercifes as will confiderably differ from that to which 
 he has hitherto, in fome meafure, been impelled. 
 The culture of a flower-garden, riding on horfe-back, 
 or even the regular ringing of dumb bells, may be 
 adopted ; but without anhVering the propofed inten- 
 tions. To understand the reafon of this failure, I 
 muft beg you to confider, that if any {tt of mufcles 
 are employed, in a different manner, and in a different 
 combination, from that to which they have been ac- 
 cuftomed, a fenfe of wearinefs and pain is foon ex- 
 perienced in them. Bend but the neck flrongly to 
 one fide, and retain it there a few minutes, this fact 
 will be foon fufneiently evident. Thus, though the 
 
 gardener 
 
364 MEDICAL ADMONITIONS. 
 
 gardener may delve from morning till night, with little 
 or no inconvenience ; and the veteran fportfman may 
 follow the longeft and hardeft chace, with delight ; he 
 who has been unaccuftomed to thefe modes of exer- 
 cife, would, by employing them, not only foon become 
 inexpreflibly wearied ; but would probably not get 
 rid of the painful affection of the mufcles, for feveral 
 days. In this way, an important deception may take 
 place ; for reckoning his exercife by the quantity of 
 fatigue he experiences, he may fuppofe it to be equal 
 to that which ufed to be afforded, by fo much of his 
 former amufements, as was productive of a fimilar 
 degree of wearinefs. Whereas, on the contrary, al- 
 though his fatigue may be confiderable, his exercife 
 may have been fo trifling, as to have yielded no bene- 
 ficial effect. 
 
 But mould he, after his retirement, even perfevere 
 in a limilar mode of exercife, with that to which he 
 has been accuiiomed (of walking for inftance,) it is 
 very likely, that for want of an object fufficiently im- 
 portant and interesting to engage his attention, he 
 will too acutely feel the many little inconveniences 
 and troubles, which continually arife, to teize a mind 
 which is too little occupied. In confequence of 
 which, he will foon yield to a fenfe of wearinefs 3 and 
 will endeavour to convince himfelf, that he has taken 
 the full quantity of exercife, which had been allotted 
 him. Were 
 
MEDICAL ADMONITIONS. $6$ 
 
 Were he to leffen the quantity of his food, in the 
 fame proportion as he diminifhes his exercife, little or 
 no evil might arife ; but, unfortunately it fometimes 
 happens, that the mere habit of eating plentiful 
 meals, may continue the cuftom ; even when the ap- 
 petite itfelf does not demand them : and long after 
 the various modes of exercife have been given up, by 
 which the neceffary balance mould be preferved. 
 
 In a word, then, perfons of the above defcription 
 ihould change their modes of living gradually, and 
 with the greateft circumfpe&ion : their minds mould 
 be almoft conftantly engaged, in lome purfuit or 
 amufement, which may keep off the attacks of languor 
 and liftlefTnefs ; and the utmoft care Ihould be taken, 
 that a due proportion be preferved between the food 
 they take, and the exercife they employ. 
 
 But it is not the fuccefsful and high fed citizen 
 alone, that is obnoxious to the attacks of this difeafe- 
 It frequently marks for its victims, objects of a very 
 different defcription — thofe who devote their hours 
 to the moft fevere and obftrufe ftudies ; and particu- 
 larly thofe who may have long ftruggled with adverfity 
 and difappointment ; and whofe minds have been 
 conftantly harraffed with anxious attention to fpecula- 
 tions 5 which at laft have involved them in ruin. 
 
 PALSY, 
 
366 MEDICAL ADMONITIONS; 
 
 PALSY. 
 
 ~"~ """""" 
 Palsy confifts in a lofs of the power of motion, 
 but affecting certain parts of the body only. 
 
 The different forms in which this difeafe appears, 
 are diftinguimed by different names, according to the 
 parts which are affected : thus, if the lower part of the 
 trunk, as well as the inferior extremities, are affected, 
 the difeafe is termed paraplegia :• if one fide of the 
 body is affected, with the limbs on that fide, the dif- 
 eafe is then named hemiplegia. 
 
 Such perfons as have been already defcribed, in the 
 preceding chapter, as predifpofed to attacks of apo- 
 plexy, are alfo very liable to paralytic affections. 
 Thofe who lead fedentary and luxurious lives -, who 
 have been much engaged in night ltudies, and watch- 
 ings ; and have fuffered much diftrefs and anxiety, 
 are frequently the victims of this malady. It feldom 
 comes on before the middle ftage of life is paft, and 
 has been thought to happen more frequently to fe- 
 males, than to men. Extreme coldnefs and dampnefs 
 of the atmofphere, appear to be favourable to the 
 production of this difeafe ; fince attacks of palfy, 
 as well as apoplexy, are very frequent at the nrfl 
 fetting in of winter. The immoderate ufe of fpiritu- 
 ous liquors, tobacco, coffee, and tea, will be likely to 
 
 promote 
 
MEDICAL ADMONITIONS. 367 
 
 promote the production of this complaint. Similar 
 effects may be alfo produced by quickiilver, lead, ar- 
 fenic, and other mineral fubftances $ either by the 
 unfkilful employment of them as medicines, or by the 
 neceffary expofure to their action, in the various arts 
 in which they are employed, fuch as gilding, the 
 fufing of metals, painting, &c. Sudden and violent 
 guffs of paffion, and other considerable affections of 
 the mind, may alfo induce this difeafe. 
 
 The difeafe fometimes comes on without any pre- 
 vious fymptoms, the patient having appeared, but juft 
 the minute before, as in perfect health ; but it more 
 frequently happens, that, for feme time before, the 
 patient has complained of pain, and of giddinefs and 
 weight of the head ; and frequently of a general lan- 
 guor and liftleflhefs 1 the powers of the mind alfo 
 feeming, in fome meafure, to be impaired. 
 
 When the difeafe has taken place, the pulfe, as in 
 the apoplexy, becomes, in general, hard and full, and 
 moderately quick ; fometimes it is flower than natu- 
 ral, and fometimes very irregula^and even intermit- 
 ting. The limb affected drops ufelefs, and becomes 
 pale and cold ; and is almoft always, at the firft, in a 
 clammy fweat j fometimes a painful prickling fcnfa- 
 tion is felt, exactly refembling that which occurs when 
 the leg is faid to be afleep ; and in other cafes, the 
 parts, affected are deprived of the fenfe of feeling, as 
 
 well 
 
,68 MEDICAL ADMONITIONS. 
 
 well as of the power of motion. Apoplectic fymp- 
 icms frequently accompany the diieafe at the firft 
 attack ; but thefe fometimes fubfide, and leave the 
 patient affected with the paralytic fymptoms only. 
 
 When a fenfe of tingling is felt in the parts affect- 
 ed, and the parts regain a final 1 degree of motion, a 
 hope may be reaibnably entertained, that a considera- 
 ble change for the better may yet take place. This 
 expeftation may be the more indulged, if no giddi- 
 nefs, head-ach, or preternatural fleepinefs, remain ; 
 cfpecially if the patient feems to be regaining the 
 powers of recolledion, thought, &c. 
 
 The danger with which this diieafe is known always 
 to be accompanied, and the formidable manner in 
 which its attacks are generally made, cannot fail but 
 imprefs the mind of the patient, and his attendants, 
 fo ftrongly, as to render it entirely unnecefiary here, to 
 ufe any arguments againft the folly of having recourfe 
 to the futile, or dangerous attempts of domeflic 
 medicine. 
 
 On the firft onfet of the difeafe, and before proper 
 medical aid can be obtained, the cautions laid down 
 in the preceding fe&ion will be very proper to direft 
 the management of the patient. 
 
 A* foon as the difeafe is fu&ciently leiTened, to 
 allow of the patient's making ufe of exercife, it mould 
 
 be 
 
MEDICAL ADMONITIONS. 369 
 
 be cautioufly and regularly employed 5 but great care 
 mould be taken, that it be of that kind, which is bell 
 adapted to his ftrength and former habits. 
 
 Electricity is almoft always had recourfe to, in this 
 malady, and too often without firft obtaining the 
 neceffary information, from thofe who alone are capa- 
 ble of giving it, as to its propriety or impropriety. 
 It is too generally fuppofed, that, although electricity 
 may produce no beneficial effects by its application, 
 in cafes of <3ifeafe, yet it cannot be productive of any 
 injury to the patient. But the contrary of this is the 
 truth ; for electricity, it is well known, is capable of 
 producing very confiderable, and very different effects 
 on the animal fyftem ; for at the fame time that it is 
 one of the moft powerful ftimulants that can be em- 
 ployed, it is alfo pofTeffed of the power of rapidly 
 deftroying the mobility of the nervous fyflem. 
 
 In cafes, therefore, where the difeafe depends on a 
 furcharge of the veifels of the brain, how dangerous 
 muft be the ralh employment of fo powerful a ftimu- 
 lant ! Again, when its debilitating effects are confider- 
 ed, how evidently it appears, that in cafes of debility, 
 it muft: of neceflity occafion the farther diminution of 
 the vital powers ; and thereby produce an increafe of 
 the difeafe it was meant to remove, and perhaps the 
 fpeedy death of the patient. Cafes are not wanting, 
 where the increafe of jpaliy has been manifestly the 
 Y y confequence 
 
370 MEDICAL ADMONITIONS. 
 
 confequence of employing electricity, with the hope 
 of its removal. 
 
 " That the electric fluid acts as a ftimulus upon 
 the animal iyftem, muft, I believe be allowed j but 
 that its ftimulant effects are more tranfient, and the 
 fucceeding ftate of debility confequentfy more rapidly 
 produced, than what remits from the application of 
 any other known ftimulus, muft, I think, be alfo 
 allowed." * 
 
 Dr. Falconer, in the fame work, obferves — " Elec- 
 tricity has often been recommended as a remedy ia 
 palfy, and much cried up by fome that pretend to 
 fecrets in the mode of adminiftering this remedy. 
 But the medical faculty have, I believe, nearly loft all 
 faith in it, from experience of its general inefEcacy to 
 be of fervice, and in fome inftances, of its mifchievous 
 effects. I am more certain that a ftrong electric fhock 
 pofleffes the power of caufing a palfy, than I am of its 
 having any power to cure it. We have lately had 
 two inftances in the Bath hofpital, of perfons who had 
 paralytic attacks after being ftruck with lightning." -J» 
 
 Dr. Falconer alfo obferves, that it is a frequent 
 
 practice 
 
 * An Account of the Effects of Lightning, by j. Parkin- 
 fon, Hoxton. Memoirs of the Medical Society of London? 
 vol. ii. p. 493. 
 
 t Ibid. p.2ou 
 
MEDICAL ADMONITIONS; 37 1 
 
 practice to lap up paralytic limbs in many folds of 
 flannel, and to keep the perfon fo affe&ed, very warm 
 an every refpect. But this is, undoubtedly, a very 
 noxious practice, as it generally induces a ten- 
 dency to fweat on the paralytic part; which always 
 weakens it. 
 
 FAINTING. 
 
 In this difeafe, the circulation of the blood, and 
 the action of the lungs, become fo much weaker than 
 natural, as in feme cafes, to give reafon to fufpect 
 that they are entirely fufpended. 
 
 When the difeafe does not come on fo fuddenly as 
 to deprive the patient, at once, of his fenfes, he ex- 
 periences a fenfe of pain and oppreflion, about the 
 region of the heart ; accompanied with exceffive lan- 
 guor, and frequently with ficknefs. He fees very 
 imperfectly the objects which furround him, which all 
 ieem to be polTeffed with a rotatory motion, and at 
 the fame time his ears are affected, with a confuied 
 ringing noife. Every part of the body, but particu- 
 larly the face and extremities, become cold and pale ; 
 and are frequently covered with a profufe cold fweat. 
 The powers of fenfe and motion are always impaired 
 in fome degree, and fometimes entirely fufpended for 
 a time : the pulfe, as well as the breathing, being, at 
 
 the 
 
37 2 MEDICAL ADMONITIONS. 
 
 the fame time, fcarcely, if at all, to be perceived. 
 After the fymptoms have thus continued a few min- 
 utes, they gradually difappear ; a difcharge of the 
 contents of the ftomach fometimes comes on, and 
 fometimes the fainting is fucceeded by convulfions. 
 In moft cafes, if proper means are not had recourie to, 
 a recurrence of the difeafe may take place. 
 
 Of the numerous caufes of fainting, the more fre- 
 quent, need only be enumerated ; thefe are, fudden 
 and profufe haemorrhages, irregular diftributians of the 
 blood, immoderate difcharges of various kinds, violent 
 exertions, exceflive pain, fudden or violent paffions 
 or emotions of the mind, difgufling fights, difagreea- 
 ble odours, long continuance in heated rooms, de- 
 bauches, &c. 
 
 A difpofition to this difeafe may take place where- 
 ever debility exifts ; but when this difeafe frequently 
 recurs, without any obvious caufe, a morbid ftate of 
 the heart or brain themfelves is to be fufpedled. 
 
 The treatment of the patient reflects either the 
 fhortening of the paroxyfm, or the preventing of its 
 recurrence. 
 
 The firfl of thefe intentions may, in general, be ac- 
 complifhed, by adopting the following means. The 
 patient mould be placed in a reclined pofture, and 
 every part of the clothing, which, by its tightnefs, is 
 
 likely 
 
MEDICAL ADMONITIONS. 373 
 
 likely to interrupt the free circulation of the blood, 
 /hould be immediately loofened. No more perfons 
 mould be allowed to be in the room, than are abfo- 
 lutely neceffary, from the affiftance they may yield ; 
 and thefe mould fo difpofe themfelves, as not to in- 
 terrupt the free accefs of the air to the patient. The 
 doors and windows of the room, efpecially if the 
 weather be warm, mould be kept open ; or, if the 
 room be fo fituated, as not to allow of fuiiicient air being 
 thus obtained, the patient may then be removed into 
 the open air. The face may be fprinkled with cold 
 vinegar, or water. The fmoke of burnt linen cloth, 
 vinegar, and any pungent vapour, particularly that of 
 volatile falts, may be applied to the noftrils ; but in 
 doing this fome management is neceffary ; fince, 
 without care, the intended effects will not be pro- 
 duced. 6 A 
 
 If the patient retains fenfe enough to experience 
 any inconvenience from the application of pungent 
 vapours to the noftrils, but not fufHcient judgment 
 to be aware of the neceffity of inhaling them, the ut- 
 moft exertions will be made by him to infpire through 
 the mouth only ; excluding the air thus impregnated, 
 as much as poffible, from the noftrils. It is ulual to 
 qbferve patients, in this ftate, thus bear the applica- 
 tion of fmelling bottles filled with the moft pungent 
 and volatile remedies, for a long time together, with- 
 out 
 
574 MEDICAL ADMONITIONS.' 
 
 out feeming to be at all affected by them. In thefe 
 cafes the mouth is to be clofely flopped, by holding a 
 handkerchief forcibly againfl it, but leaving the 
 noflrils perfectly free. The patient being now under 
 the neceffity of breathing through the noflrils, the 
 effluvia which are employed, are impelled againfl the 
 membrane which lines the cavities of the noflrils, and 
 on which are difpofed the fentient extremities of thp 
 olfactory nerves. Frequently it will be obferved, 
 when recourfe is had to this mode, that the patient 
 will for a long time refrain from breathing at all ; 
 but at laft, being under the neceffity of infpiring, and 
 deeply, the pungent particles, imbibed in great quan- 
 tity, and with confiderable force, will occafion fo con- 
 siderable a degree of irritation, as will fuddenly and 
 mofl effectually aroufe the patient from his ftate of 
 infeniibility. 
 
 To haflen the termination of the fit, as well as to 
 prevent its return, the occafional or exciting caufc 
 fhould be afcertained and carefully removed. 
 
 But to prevent the recurrence of this difeafe, 
 fomething more is required ; for too frequently fo 
 flrong a difpofition to fainting fits exifls, that the 
 mofl trifling circumflance may prove fufncient to 
 occafion them. Whenever this is the cafe, there can- 
 not be a doubt but that fo confiderable a degree of 
 debility is induced, as will be likely to terminate in 
 
 fome 
 
MEDICAL ADMONITIONS. $J$ 
 
 ibme dangerous malady. The caufes by which this 
 ftate of extreme debility may be produced 7 are fa 
 numerous, and various, that to detect them, and ap- 
 propriate the fitteft modes of cure, is a talk only to 
 be undertaken by the fkilful and experienced. 
 
 APPARENT DEATH. 
 
 Reason and humanity demand, that a knowledge 
 of the proper mode of treatment of perfons apparent- 
 ly dead, from drowning, &c. or brought to the brink 
 of the grave by famine, or exceflive cold, mould be 
 as generally diffufed as poflible. 
 
 The leading principle of our conduct, in every 
 cafe where a near approach to death is occafioned by 
 long failing, or expofure to extreme cold, is to yield as 
 gradual a fupply as pojjible of thai stimulus, 
 from the deprivation of which life appears to be about 
 to ceafe. 
 
 . Where life appears to be nearly extinguished by 
 long expofure to extreme cold, the greatefl caution is 
 neceffary in restoring the defective ftimulus heat. 
 Its application fhould be at mil in the lowefl degree, 
 and fhould be gradually increafed. Imitating the 
 practice of the inhabitants of the cold countries, who, 
 when any part of the body is frof -bitten, immediately 
 
 thaw 
 
3)6 MEDICAL ADMONITIONS. 
 
 thaw it, by rubbing it with fnow ; and very gradual* 
 ly expofe it to the influence of a warmer temperature, 
 well knowing, that by a fudden approach to the fire 
 the frozen part would foon be entirely deftroyed. 
 
 When from long faffing the vital powers feem to be 
 nearly exhaufted, the fupply of the defective ftimulus, 
 food, fhouid alio be made in the moft gradual and 
 cautious manner. Weak broths fhouid be firft given, 
 barely warm, and in very fmall quantities at a time ; 
 and afterwards gruel, milk porridge, milk enriched by 
 the addition of an egg, wine whey, &c. may confti- 
 tute the nourilhment with which the reftoration may, 
 by the gentiefl gradations, be completed. 
 
 The directions given by the Royal Humane Society 
 are fo clear and explicit, as to put it in the power of 
 any one, to employ the moft powerful means for the 
 recovery of the apparent dead. As no opportunity 
 mould be omitted of promoting the diffufion of 
 knowledge fo important to the deareft interefts of 
 humanity, I have taken the liberty to introduce the 
 procefs recommended by the fociety.* 
 
 RESUSCITATIVE 
 
 *The Editor of the Reports of this Society eloquently 
 remarks — " What an exalted tranfport muft it afford every 
 companionate breaft, to be inftrumental in recalling our 
 helplels fellow-creatures from apparent death ; — to witnefs 
 the heartfelt paflions of anguifh and defpatr, of hope, fur- 
 
 prife; 
 
MEDICAL ADMONITIONS, 377 
 
 RESUSCITATIVE PROCESS. 
 
 What thou doeft, do quickly. 
 
 THE DROWNED. 
 
 i. Convey carefully the body, with the head raif- 
 ed, to the neareft receiving houfe. 
 
 2. Strip, dry the body 3 clean the mouth and 
 noftrils. 
 
 3. Young Children to be put between two perfons 
 in a warm bed. 
 
 4. An Adult — Lay the body on a bed, and in cold 
 weather near the fire. 
 
 In fummer, expofe the body to the rays of the fun 5 
 and, in warm feafons, air mould be freely admitted. 
 
 id 3 5. The body to be gently rubbed with flannel 
 fprinkled with ipirits or flour of muflard. The 
 
 Z z proper 
 
 i 
 
 prife, and joy, which alternately agitate the human frame ; — 
 to mark the lively traits of gratitude, painted in the counte- 
 nances of the mother, fitters, brothers, &c. of the reftored 
 object !— What epicure could ever yet boaft fo refined, 
 fo exquifite a luxury, as the benevolent deliverer from fuch 
 a fcene — a fcene far beyond what any pen has yet been abl& 
 to defcribe, or pencil to exprefs !" 
 
$>]$ MEDICAL ADMONITIONS. 
 
 proper fubftances to be fprinkled on flannels, and a 
 heated warming-pan, covered, may be lightly moved 
 over the back and fpine — Salt never to be employed. 
 
 6. The breafl to be fomented with hotfpirits. Hot 
 bricks or tiles, covered, &c. to be applied to the foles 
 of the feet and palms of the hands. 
 
 If no figns of life appear, the body to be put into 
 the warm bath. 
 
 7. To rejlore breathing — Introduce the pipe of a 
 bellows (when no apparatus is at hand) into one 
 noftril ; the other, and the mouth, being clofed, 
 inflate the lungs, till the breaft be a little raifed ; the 
 mouth and noftrils mull then be let free. Repeat 
 this procefs till life appears. 
 
 8. Tobacco fmoke is to be thrown gently into the 
 fundament, with a proper inftrument, or the bowl of 
 a pipe covered, fo as to defend the mouth of the 
 affiftant. - 
 
 9. Eleclricity to be early employed, either by the 
 medical afliftants, or other judicious practitioners. 
 
 INTENSE COLD. 
 
 Rub the body with /now, ice, or cold water. 
 
 Reftore warmth by flow degrees ; and after fome 
 
 time, if there be no appearance of life, the refufcitative 
 
 procefs for the drowned mull be employed. 
 
 suspension 
 
VlTIMOM'QA ,TA3K. 
 MEDICAL ADMONITIONS. 379 
 
 SUSPENSION BY THE CORD. 
 
 i . A few ounces of blood may be taken from the 
 jugular vein ; cupping-glaffes applied to the head and 
 neck ; leeches alfo to the temples. 
 
 2. The other methods of treatment the fame as 
 recommended for the apparently drowned. 
 
 SUFFOCATION EY NOXIOUS VAPOURS. 
 
 Cold water to be repeatedly thrown upon the 
 face, &c. drying the body by intervals. 
 
 If the body feels cold, employ gradual warmth ; 
 and the plans for reftoring the drowned. 
 
 INTOXICATION. 
 
 The body to be laid on a bed, with the head a little 
 raifed : the neckcloth, &c. removed. 
 
 Obtain immediately medical affijlance, as the modes 
 of treatment muft be varied according to the circum- 
 stances of the patient. 
 
 GENERAL OBSERVATIONS. 
 
 I « On Jtgns of returning life, a tea-fpoonful of 
 warm water may be given ; and, if fwallowing be re- 
 turned, warm wine, or diluted brandy. The patients 
 muft be put into a warm bed ; and, if dilpofed to 
 fleep^they will generally awake perfectly reftored. 
 
 2. The 
 
380 MEDICAL ADMONITION!. 
 
 2: The plans of refufcitation are to be ufed for 
 three or four hours. 
 
 Jt is an abjurd and vulgar opinion, to fuppofe perfons 
 irrecoverable, becaufe life does not foon make its ap- 
 pearance. 
 
 3. Bleeding never to be employed } unlefs by the di~ 
 retlion of the medical ajftftants, 
 
 CONVULSIONS. 
 
 By convulfions are here meant thofe epileptic con- 
 vulfive fits, to which children are fubject ; and which 
 from the fuddennefs with which they occur, and the 
 fhocking appearances they exhibit, are truly fubjects 
 of alarm to a parent. 
 
 To prove how much circumfpection and fkill is 
 required in the treatment of this difeafe, it may be 
 only necefTary to point out the various caufes from 
 which it may proceed. The difficulty which muft 
 generally occur in afcertaining, on which of thefe 
 caufes the convulfions may depend, mull be then 
 fufficiently obvious. 
 
 Among the moft frequent caufes of convulfions 
 may be enumerated painful dentition ; the accefs of 
 fmall pox, meafles, and other eruptive fevers ; the 
 
 irritation 
 
MEDICAL ADMONITIONS. 38 1 
 
 irritation from worms, in the inteftines ; exceflive 
 diftenfion of the ftomach, with even food proper in 
 quality ; the irritation from the employment of crude 
 and indigeftible fubftances for food ; the retroceflion 
 of eruptions on the ikin ; the incautioully drying up 
 of fome difcharge \ the diftenfion of the ftomach or 
 inteftines with wind - 9 fudden and violent noife; 
 acute pain ; and breathing too long a vitiated air. 
 
 Should it not be likely that medical advice can 
 foon be obtained, as ftrict an enquiry as pomble 
 fhould be made, by the parents of the child, to 
 afcertain the exciting caufe ; fo that an appropriate 
 method of treatment may be adopted. 
 
 In the firft place, the ftate of the ftomach and 
 belly mould be enquired into. If the region of the 
 ftomach feems diftended ; if the child has, either 
 before the fits, or in the intervals between them, made 
 exertions to vomit -, and efpecially if the child has 
 been fed plentifully not long before, an emetic of the 
 tartarifated antimonial wine fhould be given as foon 
 as it can be fwallowed, in a dofe proportioned to the 
 age of the child. 
 
 If there be an evident diftenfion of the belly ; 
 efpecially if the child have appeared to fuffer pain in 
 the bowels, the caufe of the mifchief may juftly be 
 fufpected to exift there. Information muft then be 
 
 obtained, 
 
382 MEDICAL ADMONITIONS. 
 
 obtained, as to the previous flate of the child's bowels. 
 When coftivenefs has preceded, a clyfler mould be 
 exhibited, compofed of thin gruel, coarfe fugar, and 
 caftor oil ; a powder may be alfo given, with a grain 
 or two of calomel, and fix or eight grains of jallap ; 
 repeating the clyfter every hour until ftools are ob- 
 tained. But if the child have been reduced by a 
 long continued loofenefs, the diftenfion of the bowels 
 may be attributed to confined air -, and a clyfter, 
 made by boiling carraway or annifeeds in thin gruel, 
 fhould be directly given. A tea-fpoonful of fome 
 carminative mixture, made by adding two tea-fpoon- 
 fuls of fome aromatic cordial, fuch as annifeed, juniper, 
 or carraway, with as many table-fpoonfuls of water, 
 in which has been diflblved a fmall quantity of fugar, 
 may be occasionally given. The belly mould be alfo 
 rubbed with fuch a degree of preflure, as will be 
 likely, without giving much pain to the child, to oc- 
 cafion the difperfion of the confined air. Both in 
 this, and in the laft cafe, the belly may be fomented 
 with flannels wrung out of a ftrong decoction of 
 camomile flowers. The camomile flowers themfelves, 
 wetted with any fpirits, and made hot, may be alfo 
 applied, in a flannel bag, to the belly. 
 
 If the fymptoms which have previoufly occurred 
 give reafon to fufpect the prefence of worms, a calo- 
 mel purge may be given as foon as the child can 
 
 fwallow j 
 
MEDICAL ADMONITIONS. |S| 
 
 fwallow i and a clyfter may be thrown up, made by 
 diffolving a few grains of aloes in water or milk, to 
 which a fmall portion of oil may be added : the 
 quantities, of courfe, depending on the age of the 
 patient. 
 
 In thofe fits, where the exciting caufe cannot be 
 afcertained, and in the above-mentioned cafes, where 
 fuch of the foregoing means as appeared moft appro- 
 priate have not fucceeded, and regular affiftance can- 
 not yet be obtained, the following meafures may be 
 adopted. If the blood- veffels of the face be turgid, 
 the eyes red, and the countenance of a crimfbn hue, 
 blood may be taken away from the arm, or, by 
 leeches, from the temples. The feet and legs may 
 be bathed in warm water, and, where no confiderable 
 determination to the head appears, fpirits of hart (horn, 
 or fal volatile, may be held to the noftrils, and rub- 
 bed on the temples, &c. 
 
 Should the remedies employed prove fuccefsful, 
 ftill confiderable attention will be required, in dis- 
 covering on what caufe the difeafe depends, that the 
 moft effectual: means may be adopted to prevent a 
 relapfe. Here I mufl take notice of the abfurd 
 opinion, that a phyfician is not required in the dif- 
 eafes of children — an opinion which, unfortunately 
 for the little fufferers, is too generally embraced. But 
 furely the occurrence of circumftances/o ambiguous; 
 
 as 
 
384 MEDICAL ADMONITIONS. 
 
 as are perceived in the difeafes of children, demand 
 the clofeft inveftigation, of even the mod intelligent 
 phyfician. Often will, in other refpecls, a confiderate 
 parent fay, " the poor child is unable to defcribe its 
 complaints — therefore a phyfician can be of no ufe." 
 Inftead of concluding, that in proportion as the cafe 
 is involved in obfcurity, are knowledge and the power 
 of difcernment required. Dr. Underwood, in his 
 Treatife on the Difeafes of Children, juftly remarks, 
 " that although infants can give no account of their 
 complaints, in the manner we receive information 
 from adults, their difeafes are all plainly and fufficient- 
 ]y marked by the countenance, the age, the manifeit 
 fymptoms, and the faithful account given by the 
 parent, or an intelligent nurfe. This I am fo confi- 
 dent of, that I never feel more at my eafe, in prefcrib- 
 ing for any diforders, than thofe of infants -, and never 
 fucceed with more uniformity, or more agreeably to 
 the opinion I may have adopted of the feat and the 
 nature of the difeafe. Every diftemper may be faid, 
 in fome fenfe, to have a language of its own, and it 
 is the bufinefs of a phyfician to be acquainted with it ; 
 nor do thofe of children fpeak lefs intelligibly. 
 Limited as is human knowledge in every department, 
 there are yet certain principles and great outlines, as 
 well in phytic as in other fciences, with which men of 
 experience are acquainted, that will generally lead 
 them tafely between the dangerous extremes of doing 
 
 too 
 
MEDICAL ADMONITIONS. $85 
 
 too little, or two much ; and will carry them fuccefs- 
 fully, where perfons who want thofe advantages cannot 
 Venture to follow them. Let me afk, then, is it ob- 
 fervation and long experience, that can qualify a 
 perfon for the fuperintendance of infants, or the treat- 
 ment of their complaints ? Surely all thef© fall 
 eminently to the (hare of regular practitioners, to the 
 Utter exclufion of nurfes and empirics." 
 
 EPILEPSY, 
 
 OR 
 
 FALLING SICKNESS. 
 
 In thefe fits, the perfon falls, fuddenly deprived of 
 fenfe and motion. During the fit, the limbs, the 
 mufcles of the face, and every part of the body, are 
 violently agitated by convulfive ftruggles - 3 a frothy 
 liquor iffues from the mouth, and, if great care be 
 not taken, the tongue is thruft out of the mouth 
 between the teeth, and wounded by their convulfive 
 clofing. 
 
 During the fit, the greatelt care mould be taken 
 that the patient does not injure himfelf by the violence 
 of his ftruggles : he therefore fhould be directly 
 placed on a bed. From neglect of this caution, it 
 often happens, that the poor Tufferer fuftains very 
 A a a confiderable 
 
3S6 MEDICAL ADMONITIONS, 
 
 confiderable injuries. The clothing (hould be ever/ 
 where loofened, and the head moderately elevated. 
 As foon as poflible, fome fubftance mould be intro- 
 duced and held between the teeth to prevent their 
 clofing on the tongue ; and even when fenfe appears 
 to be a little returned, no vefTel of any fragile fub- 
 ftance, as earthen -ware or glafs, mould be ufed for 
 the purpofe of offering drink ; left, from the delirious 
 ftate which occurs in the interval of the convulfion, 
 or from the convulfion itfelf fuddenly coming on, 
 he mould bite out a piece of the edge of the cup, or 
 glafs, and thereby get the iharp and broken fragments 
 within his mouth. 
 
 Should it appear that the patient has been drinking 
 too freely of fpirituous liquors, or has loaded his 
 itomach with indigeftible and ofTenfive matters, the 
 firft opportunity ihould be feized of getting a pretty 
 ftrong emetic into the ftomach. In thefe cafes, it 
 generally happens, that as foon as the ftomach is 
 cleared of its injurious contents, the convulfions en- 
 tirely luDiiae. 
 
 With refpect to the other caufes of this fhocking 
 difeafe, they are fo numerous, and, in general, fo 
 difficult of detection, that the aid of fome medical 
 man mould be always, if poflible, obtained immedi- 
 ately on the fits taking place. To prevent the return 
 of the fit, the domeftic pharmacopeia teems with re- 
 cipes } 
 
MEDICAL ADMONITIONS, 387 
 
 opes ; but, previous to the adoption of any of t:hefe, 
 $muft entreat you, and my other readers, to attend 
 to this fad — That this difeafe may arife from caufes 
 almofl innumerable ; and many of thefe not only 
 much differing from, but even fometimes directly 
 oppofite to, each other. A due attention to this 
 circumftance muft certainly, not only fhew that a 
 medicine ought not to be thus matched at random ; 
 but alfo that much patient inveftigation will be re- 
 quired to be employed, even by the moil intelligent 
 phyfician, before he can venture to determine on the 
 means to be ufed for the cure. 
 
 ====================== 
 
 WORMS. 
 
 sol z&d 'lO <E\ . 
 
 As epileptic or convulfive fits are very frequently 
 occafioned by the prefence of worms in the inteflines, 
 it may not be improper to fpeak of them here. 
 
 Palenefs, irregular appetite, and pains of the flomach 
 and bowels, are generally fuppofed to be marks, by 
 which the exiftence of worms in the flomach or 
 bowels may be known ; but thefe fymptoms are 
 equivocal, fince they generally accompany a debili- 
 tated ftate of the fyftem, proceeding from any caufe 
 whatever. Indeed, it is by no means fo eafy, as^yi 
 general imagined, to determine whether worms 4p 
 . gcvai-v really 
 
388 MEDICAL ADMONITIONS. 
 
 really exift in the bowels, or not. It would be eafy 
 to recite, in this place, the figns which are ufually 
 faid to denote the prefence of worms ; moft, or indeed 
 all, of which accompany debility arifing from various 
 other caufes : but the point is only to be determined, 
 by a judicious and careful confideration of all the 
 fymptoms that are prefent, as well as of former illneffes, 
 on which fome of thefe fymptoms may depend. 
 
 The neceffity of determining, with fome degree of 
 accuracy, whether the complaints of a child depend 
 on worms, or not, is much greater than may at firft 
 appear. The fymptoms which are faid to mark their 
 prefence, I have already obferved, are thofe which 
 like wife accompany debility from any other caufe. 
 If, therefore, this debility proceed not from worms, 
 and the means generally recommended for their re- 
 moval, particularly fmart mercurial and fcammoniate 
 purges, be adopted, they will not only fail of produc- 
 ing beneficial effects ; but, by increafing the weaknefs 
 of the patient, occafion very dangerous confequences. 
 
 Within thefe few months, I witnefled the defiruc- 
 tion of a young woman, who, enfeebled by a weak 
 ftate of the ftomach and bowels, could not be diffuad- 
 ed from believing that her complaints were occahoned 
 by worms. She therefore procured and took, without 
 acquainting her friends, a noflrum advertifed ns a fafe 
 and Ipeedy cure for worms. After a little time, fhe 
 
 perceived 
 
MEDICAI. ADMONITIONS. 389 
 
 perceived a little forenefs of her mouth : this fhe 
 little noticed. It became worfe, and this (he con- 
 cealed as long as ihe could, afhamed of having 
 fecretly employed thofe means to which fhe attributed 
 her prefent complaints. At lafl fhe informed her 
 friends of her diflrefs and its caufe, and, upon exami- 
 nation was now found to be in a deep falivatiori. 
 By a proper treatment the falivation was, after fome 
 time, flopped j but fo much was fhe reduced by the 
 feverity of her fufferings, by the quantity of faliva 
 dif charged, by the deprivation of her food, &c. that, 
 although placed in the country, under the care of an 
 attentive and afliduous mother, fhe foon died, 
 
 .. 
 
 WEAKNESS OF THE STOMACH. 
 
 The fymptoms which evince a weak date of the 
 flomach are lofs of appetite ; fqueamimnefs, fome- 
 times arifing to fuch a degree, as to be fucceeded by 
 vomiting ; heart-burn ; coflivenefs ; diflenfions of 
 flomach, particularly upon taking even a very fmall 
 quantity of food ; frequent rifings into the throat of 
 a fharp acid liquor 5 and eructations of imperfectly 
 digefled matter. 
 
 The evils arifing from this difeafe, are by no means 
 confined to the flomach ; but generally extend over 
 
 the 
 
390 MEDICAL ADMONITIONS. 
 
 the whole fyftem. From the fympathy which exifts 
 between the brain and the ftomach, the patient is 
 alfo affected with giddinefs, and pain of the head. 
 
 In confequence of the functions of the ftomach not 
 being duly performed, a fufficient quantity of aliment 
 is not taken into the ftomach j and what little is 
 taken in, does not undergo a proper digeftion. The 
 blood, therefore, becomes foimpoverifhed, that the 
 body no longer receives its due quantity of nourifh- 
 ment ; hence arifes a palenefs and coldnefs of the 
 whole furface of the body, and particularly of the 
 extremities ; the patient becoming weak and emaci- 
 ated, his lips white, his tongue foul, and his counte- 
 nance bloated and unhealthy. A confiderable degree 
 of languor and dejection of fpirits alfo take place, his 
 nights are difturbed with frightful dreams ; and in 
 the day time his mind is diftrerTed with a variety of 
 ill-grounded alarms, and apprehenfions. If the dif- 
 eafe is not timely oppofed by proper means, the feet 
 and legs will be perceived to fwell ; plainly (hewing 
 that excefiive debility has taken place, and that a 
 collection of water may be foon formed in fome of 
 the larger cavities, by which death itfelf may be in- 
 duced. 
 
 Errors, and irregularities in the mode of living, are 
 the moft frequent caufes of this malady. Thofe who 
 indulge in the immoderate ufe of tea and coffee, are 
 
 particularly 
 
MEDICAL ADMQNITX0N3, ££* 
 
 particularly liable to it ; as well as thofe who ar^ 
 habituated to the conflant ufe of tobacco, and opium. 
 Even bark and bitters, than which few things are 
 more ferviceable in curing this complaint, will fre- 
 quently increafe it, or even produce it, if exhibited 
 improperly. Thofe who are much expofed to cold 
 and moifl air, and thofe who lead fedentary lives, and 
 apply themfelves too clofely to bufinefs, or to intenfe 
 fludy, as well as thofe who fuffer from anxiety, and 
 diftrefs of mind, are often victims to this difeafe. 
 Diftending the ftomach frequently, with excefHve 
 quantities of either folid or fluid aliment, is likewife 
 injurious. But the moil frequent caufe of weaknefs 
 of the ftomach is, perhaps, the conflant ufe of fpiritu- 
 ous and flrong fermented liquors. Nor is it neceflary 
 to the production of this difeafe, that thefe liquors 
 fhould be taken in fuch quantities as will produce 
 intoxication ; fince thefe effects fucceed to the fre- 
 quent drinking of them, in fmall quantities, and even 
 when highly diluted. 
 
 i 
 There are few difeafes, if any, over which the phy^ 
 fician has fo little power ; unlefs aided by the refolute 
 efforts of the patient, as in this. In vain may he 
 prefcribe the beft adapted remedies, and in vain may 
 they be fwallowed, unlefs the ftricteft attention be 
 paid to thofe rules, which every phy fician mufl think 
 neceffary to deliver to patients in this difeafe. Thefe 
 
 injunctions, 
 
J$$ MEDICAL ADMONITIONS. 
 
 injunctions, indeed, mud too frequently be of fuch A 
 kind, as very few will be difpofed to fubmit to ; fince 
 they will enjoin, perhaps, the yielding up of habits, 
 which, in confequence of long indulgence, have taken 
 fuch poffeffion of the will, as to require the moft 
 fedulous, and unremitting endeavours to overcome 
 them. They may perhajps require a courfe of life to 
 be purfued, totally oppofite to that in which the 
 patient has placed his greateft delight and enjoyment. 
 
 There exifls but little chance that a phyfician wiil 
 be able to convince his patient, that any ill effects 
 can be produced by the continuance of practices, in 
 which he has fo long perfevered - 3 and in which fa 
 many perfifc, and, as he fuppofes, for want of fuffici- 
 ent enquiry, with entire impunity. Or fnould a 
 phyfician prove fo fuccefsful, with the arguments he 
 may adept, as to convince his patient of the peini- 1 
 cious confequences of any farther indulgence ; how 
 little probability is there, that the neceflary reflric- 
 tions will be complied with. Rather will it happen, 
 and, in fact , fo it daily does happen ; that the patient, 
 foured by the long continuance of his difeafe ; angry 
 with the phyfician, for having pointed him out, as 
 the caufe of his own fufferings ; and vexed with him- 
 felf, for his weaknefs, and want of refolution ; will 
 rail at the inefBcacy of the art, and perhaps at the 
 ignorance of its profefTors , afferting, that the admo- 
 nitions 
 
Medical admonitions. 393 
 
 nitions he has received, are fuch leflbns of aufterity, 
 as his monitor himfelf, has neither the power, nor the 
 inclination to follow. 
 
 If a phyfician takes upon himfelf the honelt part 
 of mewing to his patients* that the greateft number 
 of difeafes are the refult of indulgence in indolence 
 and luxuries, he may expect, to a certainty, the fate 
 of having his lectures but little attended to ; and 
 may even efleem himfelf fortunate, if he efcape both 
 abufe and ridicule, " Who is this,'* the multitude 
 cries, " who prefumes thus to preach ? 'Tis fome 
 " fatiated epicure, or fome rigid melancholic. It 
 * c health and life are only to be pilrchafed at the price 
 " of all our enjoyments, they are not worth the price. 
 " If our lives are thus to confifl of a perpetual ftate 
 <s of warfare and toil, hourly ftruggling between the 
 * £ dictates of our habits and inclinations, and the 
 " denunciations of our phylicians, let us take our 
 " chance — A fhort life and a merry one." Were 
 phj'ficians to expect, that the prefent race of bon vi- 
 vants would be reformed by their writings, and would 
 immediately fet about to correct their irregularities, 
 and abridge themfelves of their* indulgences, they 
 might perhaps deferve to be told, that their plan was 
 chimerical and abfurd. But thofe who venture to 
 inveigh againft idlenefs and intemperance, prefume 
 not to hope for the accomplifhment of fuch wonders - 9 
 B b b they 
 
394 MEDICAL ADMONITION*. 
 
 they cannot expect that their doctrine fhould oftes 
 procure the facrifice of favourite, and long indulged 
 habits : they will be amply rewarded, with the pleaf- 
 ing idea of having made fome converts, to their 
 opinions ; who, though they may not poffefs resolu- 
 tion enough to quit the paths in which they have fo 
 long trodden, will not be inclined to fuffer their 
 children to be enflaved by habits, the ill effects of 
 which they have themfelves fo much experienced. 
 
 This difeafe, however, as you will perceive by re- 
 verting to the enumeration of its caufes, is not the 
 lot only of the luxurious liver 3 fince it too often 
 forms an addition to the diftrefTes of the unfortunate ; 
 but never more certainly, than when he feeks a 
 refpite from his miferies, in the temporary exhilara- 
 tion arifing from the abufe of fpirituous liquors. 
 
 The fymptoms accompanying this malady, mark 
 it fo distinctly, that there are very few who fuffer from 
 it, but are enabled to judge of the nature of their 
 complaint. The inconveniences they experience 
 evidently pointing out a . weakened ftate of the 
 flomach. 
 
 When the fymptoms have become fo considerable 
 as to force the patient to feek for relief, he in general 
 has recourfe to fome heating aromatics, or bitters 
 fteeped in fpirits : the ftomach being Stimulated by 
 
 thefc 
 
MEDICAL ADMONITIONS. 395 
 
 thefe means, a trifling amendment will take place ; 
 fome of the fymptoms becoming more moderate, 
 whilft others are even fufpended. This truce will be, 
 however, but of very fhort duration, unlefs more 
 effectual means be employed. To procure an entire 
 removal of the difeafe, the ftomach muft be cleanfed 
 of the fordid and ill digefted matters with which it is 
 loaded ; and proper regulations muft be adopted, both 
 as to diet and medicine, to prevent their future accu- 
 mulation. If thefe be carefully attended to, the 
 Peruvian bark, bitters, preparations of fteel, &c. may 
 be adminiftered with great probability of efTential 
 
 benefit. 
 
 sibb& flfi e/rnol 
 The infufion of camomile flowers is a medicine 
 which is frequently employed, with a considerable 
 degree of fuccefs, in this difeafe j but owing to a 
 miftake, fometimes made in the mode of adminifter- 
 ing it, effects are produced, quite oppofite to thofe 
 which were hoped for : the error confifls in the in* 
 fufion being drank warm, and in a large quantity ; 
 by which naufea, and even vomiting, is produced ; 
 whereas if taken in the quantity of a tea-cupful, and 
 quite cold, it lefTens fkknefs, and increafes the 
 
 :3odaoD ol smoDsc nodYf' 
 
 I To furnifh a plan of regimen, adapted to every 
 confutation and habit, is by no means aa-eafy.-tafk;'; 
 fince fome variation will be always required, according 
 ateril to 
 
396 MEDICAL ADMONITIONS. 
 
 to the age and ftrength, as well as the former habits 
 of the patient. But, in general, by fiddly regarding 
 the following rules, the cure of the difeafe will be ac- 
 celerated, and future attacks of it prevented. 
 
 The greateft attention fhould be exerted by the 
 patient, in endeavouring to dilcover what circum- 
 flances prove beneficial, and what injurious , regulat- 
 ing his mode of living, in future, by the information 
 he thus obtains, The circumftances which have 
 been already enumerated, as productive of this difeafe, 
 muft, of courfe, be carefully avoided. 
 
 The food fhould be taken in fmall quantities at a 
 time, but with frequency ; carefully avoiding the dif- 
 tendir g of the flomach, efpecially with liquids. Fat 
 of meat, butter, and all oily fubftances, fhould be 
 taken very fparingly ; and if at all rancid, abftained 
 from entirely. Broths, &c. with all liquid food, 
 (hould be fully impregnated with nutritive matter ; 
 and fhould be taken only lukewarm. Fruits, and 
 vegetables of all kinds, fhould not be ufed, until a 
 confiderabie progrefs is made in the cure. The vege- 
 table acids, fuch as vinegar, lemon-juice, &c. fhould 
 be employed with a confiderabie degree of caution. 
 
 Early rifing, and moderate exercife in the air, par- 
 ticularly riding on horfeback, will prove exceedingly 
 ferviceable, giving ftrength and tone to the flomach, 
 
 as well as to the whole fyftem. 
 
 But 
 
MEDICAL ADMONITIONS. 397 
 
 But when it is considered, that this difeafe may, if 
 pot timely removed, produce hypochondriacal, and 
 other moft ferious and diftrefling complaints, no one, 
 furely, who has it in his power, will hefitate, as to 
 obtaining the advice of the intelligent and friendly 
 phyfician. 
 
 nohi 
 
 HYPOCHONDRIAC AFFECTION, 
 
 The hypochondriac is diftinguifhed, in the words 
 of the celebrated Cullen, by — A languor, liftleffhefs, 
 and want of refolution and activity with refpeft to all 
 undertakings 5 a difpofition to ferioufnefs, fadnefs, 
 and timidity ; as to all future events, an apprehenfion 
 of the wOrft, or moft unhappy ftate of them ; and 
 therefore, often upon flight grounds, an apprehenfion 
 of great evil. Such perfons are particularly attentive 
 to the ftate of their own health, to every the fmalleft 
 change of feeling in their bodies ; and from any un- 
 ufual feeling, perhaps of the flighteft kind, they appre- 
 hend great danger, and even death itfelf, 
 
 Thofe who are unhappily afflicted by this malady, 
 too frequently become the fubjefls of raillery and 
 reproof. The ftrange capricioufnefs of their com- 
 plaints induce thofe around them to fufpedt them all 
 to be imaginary. This is, however, very far from 
 
 being 
 
g9$ MEDICAL ADMONITIONS.' 
 
 being the cafe. It is true, indeed, that from the con- 
 stant attention they are difpofed to pay to every 
 trifling change which arifcs in their bodies, and from 
 the appreheniions with which they are tormented, 
 their account of their feelings may be rather exagge- 
 rated and hyperbolical. But allowing this to be the 
 fact, and even that the moft ridiculous and chimerical 
 diftreffes are imagined by them j even in that cafe, 
 their fufferings are fuch, that no confiderate perfon 
 will regard them in any other point of view, than as 
 demanding all the iolace and relief that friendfhip, 
 attention, and judgment, can bellow. 
 
 It muft be conferTed, indeed, that much depends 
 on the patient himfelf, and that feveral circumftances 
 imperiously require of him a confiderable degree of 
 exertion. A fondnefs for frequent and various 
 medicines, he fhould carefully ftrive to reprefs ; he 
 mould feek for a phyfician to whom he can entruft 
 himfelf and his complaints, with friendly confidence, 
 and to whofe advice he can pay implicit obedience ; 
 guarding himfelf againfb fufpecting neglect, becaufe 
 his medical friend honeltly avoids to load his ftomach 
 with more drugs than are necelTary. But the grand 
 point, on which all muft turn, is his ready acquiefcence 
 in thofe other meafures which may be dictated 
 to him, as elfential to his recovery. He muft 
 aroufe himfelf from his diftreffing ftate of liftlefmefs, 
 
 and 
 
MEDICAL ADMONITIONS. JQ^ 
 
 and allow himfelf to be difpofed of as his friends may 
 advife, for the purpofe of diverting his attention to 
 other objects than his own feelings. His propee 
 avocations fhould be attended to, fuch arrangements 
 being formed, as mail prevent him from being expofed 
 to too much anxiety or fatigue. 
 
 His amufements mould always be fuch as will af- 
 ford a fufflcient degree of intereft ; fuch are games 
 of ikill, as cards, draughts, backgammon, and evert 
 chefs ;. for although the latter demands almoft pain- 
 ful attention, yet it thereby prevents a much more 
 injurious attention to certain other obje&s. Thefe 
 fedentary amufements mould not wholly engrofs his 
 hours, but mould be interrupted by various exercifes 
 in the open air - 3 fuch as failing, riding on horfeback,, 
 driving a carriage, &c. 
 
 I cannot quit this fubjec"t without again noticing 
 the folly, nay cruelty, of considering- this complaint 
 as dependent on the will of the fufferer ; and remark- 
 ing, that fo far from this being the cafe, this difeafe 
 particularly depends on the original temperament of 
 body. As well, therefore, may the peculiar make of 
 the patient be afcribed to him as a crime, as the dif- 
 treffing feelings he experiences be attributed to his 
 
 •-■\rf -vprrt fitodj fit 
 
 caprice. 
 
 ftum >H *Yi3V0D3i COLIC, 
 
 mfl grull 
 
4.00 MEDICAL ADMONITIONS. 
 
 COLIC. 
 
 To the treatment of this malady, domeflic do&ref- 
 fes have long laid an exclusive claim : family phar- 
 macopoeias teeming with colic tinctures and elixirs, 
 which, except when compofed of too fiery ingredients, 
 will frequently produce a mitigation of the fymptoms, 
 and fometimes a cure; 
 
 To produce this defirable effect, however, thefe 
 
 medicines mud be employed in pure colic ; and where 
 
 no inflammation of the inteftine has taken place. 
 
 But, unhappily, it is extremely difficult to determine, 
 
 whether inflammation be come on, or not : and there 
 
 is very little doubt, that if this mould be the cafe at 
 
 the time of the administration of thefe medicines, con- 
 
 fiderable injury may be occafioned. Dr. Alexander 
 
 Monro obferves, " The common practice of taking 
 
 fpirituous liquors, or the warm carminatives, when 
 
 people feel colic pains, is often unlucky, and public 
 
 warning fhould be given againft it ; for though relief 
 
 is found from fuch things in the windy or fpaf "odic 
 
 colic, which is not a deadly difeafe ; yet they hurry 
 
 on the inflammatory diieafes io fait, that they foon 
 
 prove mortal." * 
 
 Much 
 
 * Observations, &c. by Dr. A. Monro. Medical and 
 Literary Eilays, Vol. I. 
 
MEDICAL ADMONITIONS. 40 1 
 
 Much mifchief may indeed be the confequence ot 
 niiftaking the fymptoms of pure inflammation of the 
 bowels, or of ilrangulated rupture, for thofe of colic. 
 It is not to be wondered at, that domeftic practition- 
 ers (hould be very liable to fall into this error ; fince 
 confiderable attention is required in the exercife of 
 the judgment, in fimilar cafes, by thofe who are well 
 ikilled in the nature of thefe difeafes. This arifes 
 from the fimilarity of the fymptoms belonging to 
 thefe feveral difeafes. 
 
 In colic, the chief fymptoms are, frequent vomit- 
 ings, obftinate coftivenefs, fevere griping pains over 
 the whole of the belly, but chiefly about the navel, 
 accompanied by a painful fenfation of diftenfion j the 
 external part 6f the belly being, at the fame time, 
 drawn irregularly inwards. If thefe fymptoms be 
 compared with thofe which were defcribed as the 
 fymptoms of inflammation of the bowels, and with, 
 thofe which belong to ftrangulated rupture, treated 
 of in the next article, the refemblance will be found 
 to be fo great, as plainly to mew the danger of at- 
 tempting even the alleviation of fuch fymptoms, 
 without judgment fufScient to difcover their true 
 origin. 
 
 In thofe cafes where other affiftance cannot be ob- 
 tained, and where, from the former occurrence of the 
 fymptoms, or from other circumftances, the difeafe is 
 C c c clearly 
 
402 MEDICAL ADMONITIONS. 
 
 clearly afcertained to be colic, a clyfter may be given, 
 compofed of a pint of warm fat broth, to which may 
 be added a table-fpconful of common fait ; or the 
 fame quantity of gruel with two table-fpoonfuls of 
 caftor oil, and a table-fpoonful of feft fugar. If (tools 
 are not thereby obtained, a lpoonful or two of caftor 
 oil may be taken. The belly mould be fomented 
 with flannels wrung out of hot water, and between 
 the times of fomenting may be covered with one of 
 the flannels wrung out as dry as poflible, over which 
 may be laid a large oxes bladder, nearly filled with 
 hot water. 
 
 If thefe means fail, much circumfpecrion is re- 
 quired, before any determination is made, as to the 
 next meafure to be adopted ; it being neceflary to 
 afcertain, with as much precifion as poflible, whether 
 inflammation has taken place or nor. For mould 
 the complaint be merely colic, without inflammation, 
 the cure may be accomplished by fome carminative 
 purging remedy, fuch as fena tea, warmed by the 
 addition of a little fpirits of annifeed ; but fhould 
 inflammation have come on, not only will every thing 
 irritating be productive of farther injury, but it will 
 even be neceflary to employ bleeding, and that with 
 a confide rable degree of freedom, 
 
 RUPTURES, 
 
MEDICAL ADMONITIONS. 403 
 
 RUPTURES, OR HERNLE. 
 
 The term rupture was adopted when it was fup- 
 pofed, that the difeafe was always the confequence of 
 a rupture of fome of the parts which form the cavity 
 of the abdomen or belly. But anatomical examina- 
 tion has fhewn, that this difeafe, as it moil commonly 
 appears, takes place in confequence of the protrufion 
 of fome of the contents of the abdomen, through 
 openings which are natural to the human body ; and 
 without any rupture, or violent feparation of parts. 
 It will not be neceffary to defcribe particularly, the 
 feveral kinds of ruptures which may occur. It will 
 be fufficient to obferve, that ruptures generally appear 
 in the groin, in the upper and fore part of the thigh, 
 and at the navel : but they alfo may occur in any 
 point of the fore part of the belly. Thofe which ap- 
 pear, at firft, juft above the groin, will, in general, if 
 neglected, foon defcend into the fcrotum, in men, and 
 into the labia pudendi, of women. The tumor, in 
 this difeafe, is mcft commonly formed by a part of 
 the inteftinal canal, or of the omentum or caul, or 
 of both. 
 
 In thofe ruptures which are capable of eaiy re- 
 duction, as foon as preffure is properly made, the 
 protruded interline generally flips up, all at once, 
 with a kind of guggling rioife. and the tumour imme- 
 diately 
 
404 MEDICAL ADMONITTOKS. 
 
 diately fubfides : where the tumour has chiefly been 
 formed by omentum, that paffes up more ilowly, and 
 without that particular noiie which accompanies the 
 return of the interline. 
 
 In thofe cafes of rupture, where ftricture has taken 
 place en the protruded parts, and the reduction is 
 thereby rendered difficult, the belly becomes tenfe 
 and painful, the pain of the belly, as well as of the 
 tumour itfelf, being much increafed by the leaft ex- 
 ertion ; a total ltoppage ot difcharge by iiool takes 
 place, and the patient is diftreffed by a ficknefs at the 
 ftomach, which increafes, until almofl conflant retch- 
 ings add to his fufferings-. 
 
 Having called your attention to thefe two ftates of 
 ruptures, with or without ftriclure, I will now point 
 out that information refpecting them, of which I am 
 convinced that every one ought to be poiTeffed. 
 
 In thofe ruptures which are eafily reduced, the 
 mind of the patient mould be imprelTed with the 
 conviction, that, in general, and particularly where 
 the difeafe is recent, it will depend entirely on his own 
 choice and refolution, whether he ever fuffer from it 
 any ferious inconvenience, or not. He may affure 
 himfelf, that from the moment the parts are reduced, 
 he has it in his power conftantly to retain them in 
 their natural fituation ; and that, if he neglects to do 
 
 this. 
 
MEDICAL ADMONITIONS. 403 
 
 this, he may expect the difeafe to increafe daily ; 
 and, not only that the tumour may attain an incon- 
 venient, and even enormous fize, but that he will be 
 alfo momentarily liable to have a ftri&ure induced on 
 the protruded parts, which never happens without 
 the greateft degree of danger, 
 
 To prevent all thefe evils, it is only neceffary, that 
 fuch a preffure be kept on the opening, through 
 which the part protruded, as may prevent its again 
 falling out : the preffure of the fingers (hews how 
 effectually this may be done, and if, at the time this 
 preffure is made, the patient but gently coughs, he 
 will difcover how forcibly the protruding parts are 
 driven outwards, and how neceffary it is to guard 
 againft their future propuliion. The ingenuity of 
 artifts has devifed a mode, by fpring truffes, of apply- 
 ing a conflant and properly adapted preffure - ? requir- 
 ing little or no exertion, or even attention, of the 
 patient himfelf. No perfon, therefore, in the fitua- 
 tion thus defcribed, iliould fuffer a day, more than is 
 abfolutely unavoidable, to pafs, without obtaining 
 the comfort and fecurity which will follow the appli- 
 cation of a trufs ; lince, if it be adopted at the firft 
 appearance of the difeafe, not only will the malady be 
 flopped in its progrefs ; but, if employed with con- 
 flancy and fteadinefs, a radical cure may be gained. 
 To thofe whofe circumftances will render the acquisi- 
 tion 
 
406 MEDICAL ADMONITIONS. 
 
 tion of this inftrument eafy, nothing further need be 
 faid ; but the poor induftrious labourer, whofe 
 month's earnings would hardly fuffice to make the 
 required purchafe, fhouid be apprifed of the vaft im- 
 portance of the early application of a trufs : his better 
 informed neighbour fhouid inftruct him, that after 
 the firft appearance of this difeafe, no confideration 
 ought to induce him to make one more laborious ex- 
 ertion, until provided with this fecurity againft future 
 mifchief ; — that, if neglected, it will, in confequence 
 of his exertions, increafe with rapidity ; and may even 
 foon deftroy him : and laftly, that there can be no 
 little luxury, or convenience, which he ought not to 
 give up ; nor any facrifice of delicacy, which he 
 ought not to make, that prevents his application for 
 benevolent and charitable aid, in procuring this im- 
 portant and neceffary inftrument.* 
 
 If 
 
 * It is with much pleafure I perceive an inflitution is 
 formed, under the chirurgical direction of Mr. W. Turnbull, 
 for fupplying the ruptured poor with trufles. It is much 
 to be wifhed, that fimilar charitable eftablifhments may be 
 formed in every part of the kingdom, for the relief of the 
 poor afflicted with this malady. Miferable indeed is the 
 ftate of him, who is under the neceffity, either, for the fake 
 of retarding the progrefs of this diforder, of totally abftain- 
 ing from the lahour which fumifhes his family with bread ; 
 or of rapidly increafing this (hocking evil, and even of hasten- 
 ing his death, by perfevering in his employments. His 
 
 claims 
 
MEDICAL ADMONITIONS. 4O7 
 
 If it be difcovered that the return of the rupture is 
 become difficult, and that a ftriclure on the protruded 
 part has perhaps taken place, the perfon fhould place 
 himfelf on his back, inclining to the fide oppofite to 
 that difeafed, with the head low, and the breech raif- 
 ed high, the knees being drawn upwards, and a little 
 outwards. Whild laying in this pofture, he mould 
 endeayour, by fuch preflure as he has been accuftomed 
 to employ for its redu&ion, to return the protruded 
 part. Should he not fucceed in this attempt, he may 
 lay on the part a piece of folded linen dipped in cold 
 water, and repeat his attempts. If theie be alio un- 
 fuccefsful, he may then be allured that a ftridure has 
 taken place, and that on the speedy removal 
 
 OF THIS HIS LIFE DEPENDS. 
 
 This affertion is by no means made to occafion 
 unneceflary alarm. One moment's consideration of 
 the flate of the parts, muft be fufficient to (hew the 
 
 neceffity 
 
 claims on the affluent are furely too juft and powerful to be 
 evaded ; efpecially by thofe who have themfelves experien- 
 ced the great advantages derivable from the ufe of thefe in- 
 ftruments. Mr. Blizard, in his Suggeftions for the Improve- 
 ment of 'Hofpitahf &c. when enumerating the cafes of diftrefs 
 in hofpitals, which call upon humanity forconfideration, but 
 which cannot be brought within the provifions of thofe 
 valuable inltitutions, particularly mentions " Cafes of rup- 
 ture, from fudden catifes, which frequently require trulTes, 
 for preventing relapfe, and even confequent death." 
 
403 MEDICAL ADMONITIONS, 
 
 neceffity of immediate regular aid, and the danger of 
 trufting to domeftic tamperings. Let it then be 
 confidered, th?it part of the contents of the abdomen, 
 and probably a fold of the inteftine, is thruft out of 
 the cavity, and confined by the clofe preflure of the 
 fides of the aperture, through which it has paffed ; 
 that whiiit in this flatc no faxes can poflibly pais be- 
 yond the protruded part, a circumftance which of 
 itfelf mult occafion death ; that, almoft from the 
 moment of its being thus incarcerated, inflammation 
 begins to take place j and proceeds, if the ftricture 
 be not removed, until it terminates in mortification ; 
 and that the mod expert and judicious furgeons are 
 fometimes unable to reduce the protruded part, with- 
 out an operation. Surely, when thefe circumflances 
 are confidered, no one will hefitate in determining, 
 that not a moment fhculd be loft ; but that the bed 
 chirurgical affiftance that can be had, mould be di* 
 redly obtained. 
 
 From want of knowledge of thefe circumflances, 
 
 alarm is, in general, not excited diffidently foon to 
 
 allow of benefit being derived, even from the beft 
 
 adapted means - 3 and very frequently, as is known 
 
 to almoft every furgeon, in that time which is loft, in 
 
 following the routine defer ibed in fome treatife on do- 
 
 medic medicine, do thofe mifchiefs occur, which 
 
 place the recovery of the patient beyond the reach 
 
 of art. 
 
 But 
 
MEDICAL ADMONITIONS* 409 
 
 But it is not the lofs of time merely, of wrhich we 
 have here to complain ; fince it muft too often hap- 
 pen, that the attempts to reduce the rupture, made 
 by one who is not porTefled of any anatomical know- 
 ledge, muft increafe the difficulty of the reduction. 
 Force, in moll cafes, muft be employed ; but if this 
 be not done moft carefully, and in a proper mode and 
 direction, no advantage will be derived from it ; but, 
 on the contrary, the fold of the interline, which, in 
 confequence of the ftricture, is already conliderably 
 inflamed, will fuffer an increafe of inflammation, and 
 the total ftrangulation of its veflels, and the death of 
 the patient, muft be accelerated. 
 
 Should every other means have been employed 
 without fuccefs, the reduction of the rupture, by 
 operation, mould be had recourfe to. By this the 
 furgeon obtains accefs to the protruded part, and is 
 then enabled, not only to adopt effectual means for 
 its reduction, but even for a radical cure. The 
 horror excited by the idea of fuch an operation, as 
 mall expofe a part of the inteftinal canal, frequently 
 determines the patient to fubmit to the certain lofs 
 of life, rather than thus receive immediate relief. His 
 terrified imagination conceives the operation to be 
 painful and dangerous in the higheft degree. His 
 alarm prevents him from fairly attending to the argu- 
 ments employed to induce him to fubmit ; and he 
 D d d concludes, 
 
410 MEDICAL ADMONITIONS. 
 
 concludes, that the chance of relief is fo little, as not 
 to be worth the additional torments, he imagines he 
 lhall fuffer from the operation. But every man's 
 mind mould be impreifed,. previous to the moment 
 of alarm and confuilon, with thefe important truths — 
 that the pain of this operation but little exceeds that 
 which the patient is already fuffering, or that which 
 would be experienced by opening a moderate fized 
 abfcefs ; and that fo little danger attends the opera- 
 tion itfelf, that in almolt every cafe where it terminates 
 fatally, it may be fairly attributed to its having been 
 too long deferred. 
 
 Before I conclude this article, juftice to the afflict- 
 ed demands, that I mould fhte the claims a patient 
 has on his furgeon, in this cafe. When once a ftric- 
 ture has taken place, no temporifing can be admitted ; 
 nor ought the patient to be left, a moment, with the 
 fallacious hopes of a cure, by the fpontaneous efforts 
 of nature : inftances of relief having thus occurred 
 are too rarely met with to be allowed to influence our 
 practice. Firmnefs, perfeverance, and decifion, muft 
 mark the conduct of the furgeon -, not a fingle mea- 
 fure that can be adopted with fafety, and that affords 
 the leafl hope of preventing the operation, fhould be 
 omitted ; but when thefe have failed, the operation 
 fhould be performed, without a moment's longer 
 delay. 
 
 RUPTURE 
 
MEDICAL ADMONITIONS. 411 
 
 RUPTURE AT THE NAVEL IN 
 CHILDREN. 
 
 This is a complaint of very common occurrence, 
 and but feldom excites that attention and intereft 
 which it has a right to demand. Mothers obferve a 
 flight protrufion at the navels of children, and witnefs 
 its very gradual increafe without alarm. They mould 
 therefore be informed, that if proper means for its 
 cure be not adopted, it may become of a moft enor- 
 mous fize, and even occafion the lofs of life. To 
 this information it is moll pleafing to add, that the 
 means of cure are in every one's reach ; and will be 
 almoft always fuccefsful, if employed early, and at- 
 tended to conftantly. 
 
 The means to be adopted are fimply thefe — The 
 protruded parts are to be returned, which may be 
 eafily done by flight preflure with the finger ; and 
 retained in their proper fituation, by a conical piece 
 of very foft fponge, thoroughly cleared, by rubbing 
 between the thumb and finger, of fand and minute 
 fhells, which may be lodged in its cavities. This 
 being kept to the part, by the point of one finger, is 
 to be fecured by feveral flips of flrongly adhefive 
 plaifter, three inches in length, crofling each other in 
 a ftellated form. 
 
 It 
 
412 MEDICAL ADMONITIONS. 
 
 It is proper, however, again to enforce the necefiity 
 of a conftant attention in this cafe. It is not by 
 keeping the parts confined for a few days, and then 
 permitting them to remain unreftrained for a day or 
 two, before the means are again employed, that a cure 
 can be expected. Real advantage can only be ob- 
 tained by conftant and uniform preflure. Should, 
 therefore, any difficulty arife in this very necefTary 
 procefs, application mould immediately be made to 
 thole who are in the habit of performing this and 
 fimilar operations. 
 
 The difficulty of retaining the parts in their natural 
 fituation may indeed be produced, by the nature and 
 extent of the protrufion, and the advice of a furgeon 
 may therefore be necefTary to determine whether it 
 will be fafe to depend on this mode, or whether it will 
 not be required to employ a well adapted elaflic trufs. 
 
 ULCERATION OF THE NAVEL IN 
 CHILDREN. 
 
 A soreness of the navel fometimes occurs in 
 newly bcrn children, fome weeks after the navel has 
 appeared to be healed - s which feldom heals, even 
 under proper treatment, in lefs than five or fix weeks. 
 
 Bat parents fhould be apprifed, that an ulceration 
 
 of 
 
MEDICAL APMONITIONS. 413 
 
 of this part, much more dangerous and ungovernable, 
 jbmetimes takes place, in children where a conlidera- 
 bte degree of debility is manifeft. In thefe cafes, if 
 the moft effectual means are not early employed, the 
 child will moft probably be loft ; and, indeed, in 
 many cafes witnefled by Dr. Underwood, in which, 
 of courfe, all that fcience could fuggeft was adopted, 
 the ulceration fpread over a great part of the belly, 
 and even mortification enfued. 
 
 CHOLERA. 
 
 In the difeafe thus named, the patient is harralTed 
 by almoft conftant vomiting and purging - 3 bile ap- 
 pearing to exift in a considerable proportion, in the 
 matters thus difcharged. In general, the patient is 
 alfo diftreffed with fevere griping pains of the bowels, 
 fpafmodic contractions of the mufcles of the belly, 
 and extremely painful cramps in the mufcles of the 
 extremities. 
 
 In thofe cafes where the difeafe is only in a mode- 
 rate degree, where the patient is ftrong, and of a 
 middle age, and no very considerable diminution of 
 his ftrength takes place, there exifts little or no 
 danger. The free ufe of diluting drinks, as gruel, 
 broths, &c. will, in general, prove fumcient to procure 
 
 the return of health. 
 
 But 
 
414 MEDICAL ADMONITIONS. 
 
 But when the difeafe comes on with great violence ; 
 occafioning faintings, cold fweats, coldnefs of the ex- 
 tremities, and a fudden exhauftion of ftrength, the 
 patient may be concluded to be in a mod perilous 
 fcate : life depending on the immediate adoption of 
 the mod vigorous meafures. Young children, per- 
 fons advanced in years, and thofe who have been re- 
 duced by preceding difeafes, muft be attended to 
 with the utmoft care and vigilance - 3 fince, in the 
 courfe of two or three hours, the difeafe, if unreftrain- 
 ed, may fink them fo low, as hardly to leave a poffi- 
 bility of their recovery. When marks of leffening 
 ftrength are evident, the moft flrenuous exertions 
 mufc be made for their fupport ; by freely adminif- 
 tering, in fmal-1 quantities at a time, flrong beef, 
 chicken, or mutton broths, deprived of their fat ; 
 gruel, made into white caudle, by the boiling in it 
 ginger, allfpice, and whole pepper, and adding to it a 
 proper quantity of fpirits : and procuring that medi- 
 cal aid which fymptoms fo imminent muft require. 
 
 DIARRHCEA, OR LOOSENESS. 
 
 It may be fufficient, for the purpofe of (hewing 
 the impciiibility of giving fuch directions, as may 
 enable domeftic practitioners to take on themfelves 
 the cure of this difeafe, to point out the various cir- 
 
 cumftances 
 
MEDICAL ADMONITIONS. 415 
 
 cumftances on which it may depend. A diarrhoea 
 may be occafioned by too great a quantity of aliment 
 being taken into the flomach ; by the peculiar nature 
 of the food which has been taken ; by the digeflion 
 of the food having been impeded in confequence of 
 the weaknefs of the flomach and bowels ; by various 
 paffions of the mind ; by difeafes of other parts, or of 
 the general fyftem. Many other caufes might be 
 enumerated, but thefe are furely fufficient to fhew 
 the propriety of not attempting to lay down here, a 
 plan of treatment applicable to every cafe. 
 
 One caution is however neceffary, again{l the too 
 prompt and indifcriminate employment of purgative 
 medicines, in the onfet of the difeafe. Believing it 
 never to originate, but in the irritation occafioned by 
 lome matter, which, they fuppofe, cannot be too 
 rapidly removed, thofe who fufFer from this difeafe, 
 generally, have immediate recourfe to fame active 
 purgative, to expedite the falutary procefs which 
 they fuppofe nature to have inflituted. But it will 
 frequently happen, that fo far from accelerating the 
 cure of this malady, fuch medicines will, by their 
 additional irritation, prove highly pernicious. 
 
 Nutritive drinks fliould be taken freely, fuch as 
 broths, gruel, &c. : but beyond the employment of 
 thefe the patient fliould not proceed ; unlefs he is 
 able clearly to af certain the caufe on which his com- 
 plaint depends. DIABETES. 
 
4-l6 MEDICAL ADMONITIONS. 
 
 DIABETES. 
 
 . The fymptoms of this difeafe are here enumerated 
 merely to excite thofe who fuffer from it, to attend 
 to it in its early flages, when, of courfe, it muft be 
 mod likely to be within the reach of medicine. 
 
 In this difeafe, the urine is voided in a quantity 
 unulually large, the tongue is white and foul, and the 
 patient is tormented with exceffive third. The 
 urine, when viewed in a certain direction, has a green- 
 ilh hue ; and, on being evaporated, yields a large 
 proportion of faccharine extract. 
 
 A powerful inducement to thofe who are fubject 
 to this malady, to make early application for relief 
 mull ariie from the knowledge that an ingenious 
 phyfician, who has particularly attended to the nature 
 of this difeafe, which has hitherto been efteemed fo 
 d .icult of cure, concludes that it is now " Jo Jar 
 underfiood, as to be fuccefsfully cured.'" * 
 
 HYSTERICAL 
 
 * An Account of two Cafes of Diabetes Mellhus. By 
 John Rollo, M. D. 
 
 33 - 
 
MEDICAL ADMONITIONS. 417 
 
 HYSTERICAL AFFECTIONS. 
 
 As thefe are, in general, fymptomatic of fome 
 other difeafe ; and moft commonly, perhaps, of fome 
 particular affection of the uterine fyftem, the rules 
 for their treatment can only be formed, upon a 
 knowledge of thofe particular circumftances to which 
 they owe their origin. 
 
 The management of the patient during the ftrug- 
 gles of an hyfteric fit, or paroxyfm, may be directed 
 by the principles laid down when treating of epilep- 
 tic convulfions. 
 
 Suppreflion, or irregularity of the menftrual dis- 
 charge, is very frequently the caufe of hyfterical 
 affections^ Indeed, fo obvious is this caufe, that a 
 cure for thefe morbid affections is generally fought 
 for in fome noftrum, celebrated for its powerful ef- 
 fects. But a few words on this practice cannot but 
 be beneficial. 
 
 That the moft injurious confequences may follow 
 from the indifcriminate ufe of thefe violently forcing 
 remedies, muff plainly appear, from ftating only one 
 aflumed cafe. A delicate female, from fome acciden- 
 tal caufe, fuffers a fuppreffion of the accuftomed dis- 
 charge, the whole fyftem foon becomes affected, 
 E e e neither 
 
I 
 
 418 MEDICAL ADMONITIONS. 
 
 neither digeftion of the food, nor the ufual converfion 
 of aliment into chyle and blood, takes place to the 
 required degree ; and hence a flate of extreme debili- 
 ty enfues, plainly marked by a deadly palenefs, dejec- 
 tion of fpirits, and a conflant difinclination to motion ; 
 or rather, I inould fay, for the fake of lefTening the 
 too frequent, falfe imputations of indolence, in thefe 
 cafes, almoft a deprivation of the powers of motion. 
 In fuch a cafe, what muft be the confequence, mould 
 thefe medicines, by their violence, occafion a reftora- 
 tion of the menftrual difcharge, without, at the fame 
 time, producing an augmentation of ftrength ? Moil 
 certainly an increafe of weaknefs and of all its atten- 
 dant evils. 
 
 DROPSY. 
 
 In Anafarca, a ferious fluid is collected in the 
 cellular texture under the fkin. By Jfcites, is meant 
 dropfy of the lower belly. And by Hydrothorax, a 
 preternatural collection of ferous fluid in the cheft. 
 
 So numerous are tne caufes on which this difeafe 
 may depend, and fo various are the difeafes from 
 which it may originate, as to preclude a hope of ren- 
 dering any fervice by their enumeration, and to render 
 the laying down a general plan of cure impoffible. 
 A detached obfervation or two on the noftrums 
 
 generally 
 
MEDICAL ADMONITIONS. 419 
 
 generally employed in this difeafe, is all that appears 
 to be neceflary here. 
 
 To cure the dropfy without tapping, is the promife 
 of many pretenders, to whom the lives of perfons af- 
 flicted with this malady are fubmitted. But, in 
 general, fo violent are the remedies they employ, and 
 fo rafli is their mode of a'dmimftering them, that 
 fliould they even make good their promife of remov- 
 ing the dropfy, it is moft probable that fo much 
 weaknefs may be produced, that the patient will not 
 long furvive. 
 
 1 very lately witneffed a cafe of confirmed droply 
 of the belly, in which the patient was perfuaded, by 
 a domeftic practitioner, to take a ftrong inflation of 
 the fox-glove ; much flronger than any phylician 
 would have dared to prefcribe. The dropfy was re- 
 moved, for a time ; but the difeafe of the vifcus, 
 from which the dropfy proceeded, ftill remaining, the 
 water again collected ; and inceffant vomitings and 
 purgings, produced by the fox-glove, added considera- 
 bly to his fufferings, and at length deftroyed him. 
 
 HYDROCEPHALUS, or WATERY HEAD. 
 
 No one, furely, can hefitate for a moment, in be- 
 lieving that the treatment of this melancholy difeafe 
 
 ought 
 
420 MEDICAL ADMONITIONS. 
 
 ought only to be confided to the moft judicious and 
 experienced. I fhall, therefore, only mark out thofc 
 fymptoms which ought to aroufe the attention of the 
 parent, and occafion him immediately to call in the 
 moil powerful aid ; and point out fome circumftances, 
 by an attention to which this malady may, perhaps, 
 be fome times prevented. 
 
 This difeafe generally occurs within the firft ten 
 years of life. Sometimes the complaint comes on 
 fuddenly, but in general it commences with a flow 
 fever, and is indeed accompanied, in its beginning, by 
 fuch fymptoms as to render it very likely to be mif- 
 taken for an attack of the flow nervous fever. Soon, 
 however, the difeafe is rendered more manifeft, by a 
 difinclination to employ the mufcles on which volun- 
 tary motion depends. The arms and legs are moved 
 with reluctance, and the fatigue of preferving the 
 body in an erect pofture is fuch, that the patient is 
 always defirous of being laid down : the pain in the 
 head is more conftant than in the low nervous fever ; 
 and the heavinefs and dulnefs more evident : the 
 pulfe is alfo ufually very flow and irregular. As the 
 difeafe proceeds, the pulfe becomes quicker ; the 
 child's fenfes and faculties become evidently impaired, 
 the fight particularly fails him, objects appearing ex- 
 ceedingly indiflinct, and the pupils of the eyes are 
 conflantly dilated. Towards the clofe of this melan- 
 
MEDICAL' ADMofcltlONS. 42 1 
 
 choly fcene,the urine and {tools are palled involunri- 
 i-ily ; total blindnefs comes on, and a fatal termination 
 takes place while the patient lays in a comatofe ftate, 
 or whilft agitated with fevere convulfions. 
 
 This difeafe may be the confequence of an original 
 weak habit of body, of various other affeclipns of the 
 brain, and of other difeafes which have induced a 
 confiderable degree of debility of the whole fyftem. 
 But one caufe, and that perhaps a very frequent one, 
 more particularly demands here a few words. 
 
 This caufe is a violent concumon or jar of the head 
 from blows or falls. When the numerous accidents, 
 to which children are expofed, are confidered, to- 
 gether with the delicate texture of the brain, it 
 becomes really a fubjecl: of furprife that this (hocking 
 calamity does not more frequently occur. It however 
 happens with fufficient frequency to warrant the moll 
 zealous exertions for its prevention, 
 
 . 
 On this head it will not be fumcient 'to "fay, that 
 care mould be taken that children mould not be 
 
 unnecefTarily expofed to injury. Parents mufl 
 
 excufe the fuggeftion, as it is made with a hope that 
 it may prove beneficial. The correction of chil- 
 dren, performed in the moment of paffion, is not 
 always within thofe bounds which the parent would 
 the moment before, or after the inflidion of the 
 
 punifhment, 
 
42 % MEDICAL ADMONITIONS. 
 
 punifhment, himfelf have defcribed. A box on the 
 ear, as it is termed, or a fevere blow on the head 
 with the open hand, is the moft ready punifhment, 
 and therefore moil generally adopted, when petulence 
 or paffion impels to an immediate correction. But 
 when I confider the tender fabric of the brain, and 
 alfo that a blow fufncient to give the intended degree 
 of pain to the delinquent cannot be inflicted without 
 giving a confiderable jar to the head, I mud fufpect 
 it to be a mode of correction highly improper, and 
 which may poffibly occafion this dreadful malady. 
 
 The obfervation I now mail make, I am aware 
 may appear to many to be bordering on frivolity ; 
 but fatisfied of its real importance, I mall, without 
 apology, introduce it. To endue children with 
 hardinefs and caution, it has been recommended, 
 rather than fmooth the way for them, to render it 
 more replete with obftacles ; and rather than fhield 
 them from the little injuries they would fuffer from 
 their trips and flumbles, to let them feel their con- 
 fequences ; that the difficulties they overcome, and 
 the pain they fuffer, to-day, may furnifh them with 
 courage and circumfpection to-morrow. The princi- 
 ple is certainly good, therefore I propofe not to com- 
 bat with it, but with a practice which has arifen 
 from its improper extenfion. I mean that of neg- 
 lecting to guard the head from the injuries to which 
 
MEDICAL ADMONITIONS, 423 
 
 it is fubject, from thofe accidents to which child rea 
 are fo frequently fubject. It was the good practice 
 of parents, a few years back, to furround the head 
 with a circular quilted pad, covered with filk, which, 
 though not very ornamental, had no very forbidding 
 appearance, and mull frequently have faved children 
 from confiderable injuries of the head. I am fo con- 
 fident pf this fact, that I cannot refift the impulfe of 
 moll: earneflly propofing their adoption to the affec- 
 tionate parent. 
 
 THE BITE OF AN HYDROPHOBIC 
 ANIMAL. 
 
 When the mocking effects fometimes refulting 
 from this injury are considered, and the uncertainty 
 of fuccefs arifihg from the employment of fuch 
 medicines as have hitherto been tried is alfo contem- 
 plated -, the propriety of endeavouring, in this place, 
 to excite every one to the prompt adoption of the 
 only means of obtaining fecurity, will, I think, be 
 manifeft. 
 
 From the abforption of the faliva, conveyed by the 
 teeth of the animal into the wound he inflicts, is the 
 hydrophobia fuppofed to proceed. The more fpeedy 
 and the more complete its removal, the lefs chance 
 
 is 
 
424 MEDICAL ADMONITIONS. 
 
 is there for abforption. Confequently, in every cafb 
 of bite from an animal, in which there is reafon to 
 fuppofe hydrophobia exifts, the piece fliould be im- 
 mediately cut out -, fo carefully including, even the 
 parts immediately furrounding the wound, both at the 
 bottom and fides, that a probability (hall not exift of 
 the knife's coming in contact with the wound made 
 by the animal. For mould this be the cafe, not 
 only would the excifion be incomplete, but the knife 
 itfelf, imbued with the poifon, would ferve to multi- 
 ply the infection. 
 
 The carefully warning the wound by repeated ab- 
 lutions with warm and cold water, and the application 
 of a cauftic to the part, have been recommended ; 
 but when our endeavour is to obtain an exemption 
 from fuch a terrific difeafe, no apprehenfion of mo- 
 mentary fuffering mould induce us to adopt thofe 
 meafures which obvioufly do not rank as firft, in the 
 probability of being fuccefsful. 
 
 SCALD HEAD 
 
 Is a difeafe in which little ulcers form in the fkin, 
 at the roots of the hair, pouring out a difcharge, 
 which generally dries on the part in a hard white 
 cruft. Sometimes the difeafe fpreads over great part 
 of the head, and the dilcharge is fo confiderable as to 
 
 keep 
 
medical Admonitions. 425 
 
 keep the difeafed parts in a moift ftate. When this 
 is the cafe, the fcalp aflumes an honeycomb appear- 
 ance. 
 
 This difeafe is communicable by contact, and it is 
 often the confequence of want of attention to clean- 
 linefs. It is alfo fuppofed to be a fymptom of fcro- 
 fula. 
 
 The cure of this difeafe mould be attempted in 
 this manner. The hair mould be removed freely by 
 fhaving ; if the difeafe ihould be extenfive, the whole 
 head fhould be fhaved ; but if it is fo flight that the 
 removal of a part is lufricient, the remainder mould 
 be carefully cleanfed by warning with ftrong foap-fuds. 
 The fores themfelves may be rubbed with the unguen- 
 ium hydrargyri nitrati of the (hops ; or with an oint- 
 ment compofed of one part of the powder of white 
 hellebore, two parts of flour of fulphur, and as much 
 tar as will make it into a due confidence. When the 
 hairs feem to be loofened, they Ihould be pulled out 5 
 and this appears to be beft done by the application 
 of fome ad hell ve plaifler, which, on its removal, will 
 bring the hairs with it. A fubmiffion to this un- 
 pleafant -and painful procefs is often neceffary to 
 obtain a cure. 
 
 Although I have here flightly Sketched a mode of 
 
 cure of this dilagreeable malady, I jiiu'ft yet remark, 
 
 Fff that 
 
426 MEDICAL ADMONITIONS. 
 
 that it is a difeafe fo important in itfelf, and fo mucii 
 more fo in its coniequences, as to render its early re- 
 moval highly neceffary : regular chirurgical affiflance 
 mould therefore, if poffible, be obtained. I have 
 already mentioned its being efteemed one of the 
 fymptoms of fcrofula ; but I fhall trouble you with 
 one or two obfervations more on this point. 
 
 When the unfortunate fufferers under this malady 
 have been fubjected to it for a little time, an enlarge- 
 ment of the glands on the fides of the neck generally 
 takes place. This alfo being efteemed one of the 
 fymptoms of fcrofula, it is in general fuppoled that 
 the patient was originally fcrofulous, and that the 
 icald head was the firft manifeilation of the difeafe. 
 But here I venture, with the utmofl deference to the 
 authorities I oppofe, to fuggeft, that fcald head may 
 not be a fymptotn of fcrofula ; and that, in many of 
 thefe cafes, the enlargement of the cervical glands 
 may be only the confequence of the irritation of the 
 abforbents originating in the difeafed parts ; and 
 that fcrofula may only fucceed where this irritation is 
 long permitted, and where the fubject. is unfortunate- 
 ly predifpofed to this difeafe. 
 
 I mould not have agitated this queftion, in fuch a 
 work as this, a work pretending to no originality, but 
 with a hope of drawing fuch a conclufion as may 
 prove of real ufe. From the foregoing obfervations, 
 
 then.. 
 
MEDICAL ADMONITIONS. %t| 
 
 then, it mufl appear, that if the difeafe be removed 
 at its fiiii appearance, the fwellings of the glands of 
 the neck, the more ftrong chara&eriftics of fcrofula, 
 may not appear > that if thefe even have appeared., 
 they will difappear if the original difeafe be timely 
 removed j and that, on the contrary, where the 
 original difeafe has been allowed to exift long, the 
 glands of the neck will become difeafed, and this 
 fecondary affection may extend itfelf through the 
 greater part of the lymphatic fyftem : the fcald-head, 
 in confequence of neglect, having become the cauie, 
 at leaft the exciting caufe, of fcrofula. 
 
 The importance of an early and judicious oppofi* 
 tion to this difeafe, muft, from the above considera- 
 tions, be obvious. I have, therefore, only to repeat, 
 that it is a contagious difeafe ; and to recommend, 
 that, on its appearance, thofe whom it attacks fliould 
 be carefully feparated from other children. 
 
 THRUSH, 
 
 Aphthous ulcers in the mouth itldoiii happen to 
 grown perfons, except fome considerable diforder of 
 the fyftem exifts at the fame time, or has juft pre- 
 ceded. In children they occur very frequently, and 
 even at times when the child appears, in Other re- 
 
428 MEDICAL ADMONITIOK$. 
 
 fpec~b, perfectly well. Improper food is perhaps a 
 principal caufe of their occurrence, fince thofe children 
 who are robbed of their natural food, and crammed 
 with mixtures of bread and water, &c. which are often 
 given much too hot, feem much more difpofed to this 
 complaint, than thofe children, whofe mothers have 
 it in their power, and are difpofed, to fupply them 
 with the food which nature has appointed for them.* 
 
 Breathing 
 
 * The thrufh almofl always afFe£is thofe children who 
 are attempted to be dry-nurfed. Gripings, conftant diarr- 
 hea, rapid wafte of ftrength and of flefh, are almoft the 
 certain harbingers of fpeedy death to the poor little vi£lim, 
 doomed to perifh for want of that nutriment which nature 
 had defigned and bounteoufly provided. 
 
 " Connubial Fair ! whom no fond tranfport warms, 
 
 To lull your infant in maternal arms ; 
 
 Who, blefs'd in vain with tumid bofoms, hear 
 
 His tender wailings with unfeeling ear ; 
 
 The foothing kifs and milky rill deny 
 
 To the fweet pouting lip, and glift'ning eye ! — 
 
 Ah ! what avails the cradle's damafk roof, 
 
 The cider bolfter, and embroider'd woof ! 
 
 Oft hears the gilded couch unpitied plains, 
 
 And many a tear the tafTal'd cufhion ftains ! 
 
 No voice fo fweet attunes his cares to reft, 
 
 So foft no pillow as his mother's bread !" Darwin. 
 
 To fuch of my fair readers who are difpofed to liflen to 
 Oie voice of admonition, on this important fubjeft, I earneft- 
 ly recommend the perufal of the charming poem of The 
 Nurse, by Mr. Rofcoe. 
 
MEDICAL- ADMONITIONS. 429 
 
 Breathing the confined and impure air of the bed and 
 ,bed-room, during the month, where due attention 
 to cleanlinefs and ventilation is not attended to, may- 
 be another caufe of this difeafe. A .difordered ftatc 
 of the ftomach and bowels may alfo be coiifidered as 
 a caufe of the thrulh. 
 
 Unlefs the caufe of the difeafe can be afcertained, 
 there will be very little probability of adopting a fuc- 
 cefsful mode of treatment. Enquiry, therefore, mud 
 be made into the kind of food with which the child 
 is fupported. In general, this will be found tobe 
 improper, and not fufficiently nutritious : this fault 
 muft be therefore corrected ; the child muft be al- 
 lowed to breathe a purer air, and particular regard 
 muft be paid to the date of the bowels. As this dif- 
 order may depend on fo many different circumftances, 
 it is not poffible to point out here the medicines 
 which will be required. But I cannot allow this 
 opportunity to pafs without calling the attention of 
 parents to the cruel practice, frequently adopted by 
 nurfes, of cleanfing the mouths of children afflicted 
 with the thrum, by rubbing the infide of their mouths 
 roughly, with a piece of linen cloth wrapped round a 
 piece of flick, and dipped in a mixture of Armenian. 
 bole and honey. Whoever has witneffed this opera- 
 tion, muft have perceived that it has occafioned the 
 little fufferer very considerable pain ; and a very Iktb 
 
 consideration 
 
430 MEDICAL ADMONITIONS. 
 
 confederation will ferve to convince, that the pain 
 thus inflicted is unnecefiary. The aphthous fores 
 which conftitute the thrufh are filled by gangrenous 
 floughs, theie either adhere to the living parts, or are 
 feparated from them. If the former be the cafe, there 
 is very little likelihood that the floughs will be re- 
 moved by friction, however feverely employed : if, on 
 the other hand, a feparation have taken place, no 
 force is necelTary for their removal. In both cafes, it 
 is entirely fufneient, that whatever applications are 
 refolved on, (hould be of a tenacious confidence, and 
 be put into the child's mouth from the end of a tea- 
 fpoon ; the action of the child's tongue, which 
 neceflfarily follows, being quite fufficient for the dif- 
 fufion of the remedy, and for its application to the 
 affe&ed parts. 
 
 SWALLOWING OF PINS, &c. 
 
 Children, from their being playfully difpofed 
 to put various fubftances in their mouths, are liable 
 to have hard and fnarp pointed fubftances pafs into 
 the gullet, and even into the ftomach. By the filly 
 practice of putting pins, &c. into their mouths, adults 
 are alfo expofed to the iame mifchiefs. Pieces of 
 bones, griftle, &c. fometimes flop in the gullet, and 
 afford confiderable diftrefs ; but thefe may in general 
 
 be 
 
MEDICAL ADMONITIONS. 43" I 
 
 be fpeedily removed by a piece of whalebone, to one 
 end of which is affixed a button of fponge. 
 
 If a pin, or any other fharp-pointed fubflance,- 
 fhould flick in the gullet, beyond the reach of the 
 foreceps or nippers, it is indeed a cafe which calls for 
 the utrnoft exertions of patience from the unfortunate- 
 fufferer, fince it will in general be found much better 
 to wait the fpontaneous loofening of the fubftance, 
 which may happen much fooner than could be ex- 
 pected, than torifque additional injury, by employing- 
 the means ufually recommended, which are the palling 
 of the fponged probe, and the adminiflering of a 
 vomit. Unhappily the petition of the pin, for in- 
 fiance, cannot be known, and it is not at all unlikely- 
 that the prefTure of the fponge, or the urgings to 
 vomit, may more deeply infix the point. Farther, it 
 may be obferved, with refpect to an emetic, that 
 mould the patient unhappily, during the firft. urgings 
 to vomit, experience excefiive pain, from which it is 
 concluded that the pin laying acrofs the throat, every 
 exertion ferves to fix it deeper, we are obliged to wit- 
 nefs this addition to his fu&rings without affording 
 relief, not having it in our power to flop the vomit- 
 ing, until the flomach is cleared of the emetic. 
 
 It is too prevalent a practice, when any fubftance' 
 of this kind has paffed into the flomach, to endeavour 
 to haften its paffage through the bowels, 'by giving 
 
 fome 
 
432 MEDICAL ADMONITIONS. 
 
 ibme opening medicine. Juft the contrary conduct 
 to this fhoiild be adopted. Milk, alone, or mixed 
 with eggs unboiled, fliould be immediately taken, as 
 by the coagulation which takes place, the fubftance 
 may become To involved, as to prevent its doing 
 injury to the ftomach ; and on the lame principle 
 fliould opening medicines, which render the feces 
 thin, be avoided ; as, by allowing the faeces to obtain 
 iome firmnefs, there will be the greater probability of 
 the pointed parts of the fubftance being fo Eheathed, 
 as to prevent them injuring the inteftines. 
 
 BOIL. 
 
 A boil is a circumfcribed hard tumour, exquifitely 
 fenfible, fpreading below the furface, and riling very 
 little above the level of the fkin. Its fize is in 
 general about that of a pigeon's egg. After it has 
 exifted a few days, a trifling difcharge of matter hTues 
 from a fmall opening in the moil prominent part of 
 the tumour, a Hough remaining at the bottom, which 
 is, in general, a considerable time before it is fepa- 
 rstcd. 
 
 Boils, unlefs they are very large, and happen in 
 debilitated conftitutions, although productive of con- 
 ficferabie pain and inconvenience, are without danger, 
 
 and 
 
MEDICAL ADMONITIONS. 433 
 
 and will often do well without chirurgical aid -, but, 
 in general, the cure Will be accompliihed much 
 fooner, and the patient fpared much inconvenience, 
 by a free opening, and other affiftance, which cannot 
 be well obtained but from the hands of a ftirgeon. 
 
 In general they may be brought into a good ftate, 
 by the application of warm fomentations, and emolli- 
 ent cataplafms : when a tolerable opening is obtained, 
 the ulcer may be drafted with any mild digeftive 
 ointment > and in general the cure will be completed 
 without much difficulty. Attention muft alfo be 
 paid to the general ftate of the fyftem ; fince if that 
 particular ftate on which they depend is not changed, 
 the patient may be harraffed for a confiderable time, 
 by their making their appearance in different parts of 
 the body. With the hope of producing this change, 
 domeftic practitioners, in general, adopt a practice 
 which muft often prove very injurious : that of put- 
 ting the patient under a long courfe of draftic purga- 
 tives. That this practice muft often be fucceeded 
 by ill cOnfequences, muft be evident, when it is con- 
 lidered, that the great eft benefit to be obtained in 
 fuch cafes is from the ufe of tonic and ftrengthening 
 remedies, fuch as the bark, fea bathing, 8cc. 
 
 G g g ANTHRAX, 
 
434 MEDICAL ADMONITIONS. 
 
 ANTHRAX, OR CARBUNCLE. 
 
 At its commencement, anthrax has much the ap- 
 pearance of a common boil, but it foon puts on ap- 
 pearances which point out the malignity of its nature : 
 the rednefs and hardnefs extend themfelves very wide, 
 although the tumour is raifed but very little above 
 the level of the fkin ; fmall puflles come out on the 
 furface, which have the appearance of being only 
 fuperficial, but the openings which they leave evident- 
 ly reach to the large fphacelated bafe which pofTelTes 
 the place of the cellular membrane ; about the middle 
 of the tumour the colour is of a deep crimfon, inclin- 
 ing to purple, becoming paler and mottled toward 
 the circumference ; the furrounding integuments are 
 generally found by preffure to be in an cedematous 
 ftate. Several of thefe fometimes appear at the fame 
 time ; but moft commonly a fingle one occurs, 
 which fpreads to a great extent. 
 
 The Cure of Anthrax. By the exertion of 
 a fkilful furgeon, and the moft fcrupulous exactnefs 
 in purfuing his directions, this terrible difeafe is iome- 
 times cured -, but the ftate of the body which exifts 
 is fuch as mud always render the event highly to be 
 feared. To treat, in this work, of the chirurgical 
 treatment of this difeafe, would be prefumptuous and 
 
 ufelefs ; 
 
MEDICAL ADMONITIONS. 435 
 
 ufelefs ; fince it is of too ferious a nature to admit of 
 the triflings of family pra&ice. A confiderable op- 
 portunity, however, always offers itfelf for the friends 
 of the patient to evince their zeal, and affift in the 
 cure : for fo much affiduity is required, in adminif- 
 tering proper cordials and nourifhment, that it ought 
 hardly ever to be entrusted to the care only of an 
 hired attendant. 
 
 From their great fimilitude at their firft appearance, 
 there is much reafon to fear, that the carbuncle, at 
 its commencement, is often miftaken for a common 
 boil — a miftake which may be productive of the moft 
 dangerous confequences, fince in carbuncle the ex- 
 ertions for faving the patient mull be very confidera- 
 ble and unremitting : the treatment which is ordi- 
 narily adopted for a common boil, would, therefore, 
 allow the difeafe to make fuch a progrefs, that art 
 might afterwards be of no avail in endeavouring to 
 fave the patient. 
 
 INFLAMMATION AND ABSCESS GF THE 
 BREAST. 
 
 Inflammation of the bread may be judged to 
 have taken place from heat, rednefs, and pain, pofTeff- 
 ing a part or the whole of the breaft. When the 
 
 difeafe 
 
436 MEDICAL ADMONITIONS. 
 
 difeafe is confiderable, it is ufually preceded by a miver- 
 ing, and accompanied by fever. The milk continu- 
 ing to be fometimes fecreted into the bread, without 
 any difcharge of it being obtained, the breaft necefTa- 
 rily becomes tenfe and heavy. 
 
 The inflammation of the breaft may happen without 
 being able to afcertain any caufe. But, in general, it 
 may be traced to one or the other of thefe caufes — 
 expofure to cold, repreffing the difcharge of the milk, 
 or external violence. 
 
 To remove this difeafe by refolution, the means 
 mould be had recourfe to in the early part of the 
 difeafe. When, if the difeafe exifts in a very con- 
 fiderable degree, blood may be taken from the arm, 
 in a quantity proportionate ; but, in general, large 
 bleedings are not required in the cure of this difeafe, 
 the lofs of fmall quantities by topical bleedings 
 generally proving fufficient for the intended effect. 
 Gentle purgatives are proper, and a preference mould 
 be given to fuch as contain fome of the neutral falts in 
 their compofition, fince thefe will alfo tend to increafe 
 the difcharge of urine. To leffen the fecretion of 
 milk, no more aliment mould be taken, than may be 
 juft fufficient to fupport the ftrength of the patient. 
 To promote the abforption of that which is fecreted, 
 the breaft may be frequently bathed with camphorat- 
 ed oils, ufmg, at the fame time, a moderate degree of 
 
 prefTure. 
 
MEDICAL ADMONITIONS. 437 
 
 preflure. To lefTen the ill effects refulting from its 
 fenfion and weight, the milk may be drawn at proper 
 intervals, and the breaft fufpended by means of proper 
 bandages, and the increafed action of the inflamed 
 part be leflened by the ufe of proper cooling appli- 
 cations. 
 
 If the inflammation does not feem likely to be 
 difperfed, but fuppuration appears to be advancing, 
 recourfe muft be had to warm and emmollient fer- 
 mentations and cataplafms. AbfcelTes, in the breaft 
 in general do very well, when allowed to break fpon- 
 taneoufly ; but there . are many cafes, where the 
 afliftance of the furgeon prevents numberlefs incon- 
 veniences, and very much accelerates the cure of the 
 difeafe. 
 
 The inflammation may be either outwardly, in the 
 integuments, or it may poflefs the centre of the breaft. 
 Much need not be faid to make it believed 3 that the 
 latter is much the worft cafe, and requires the greateft 
 exertions for its removal.- 
 
 Frequently, however, in thofe cafes where the 
 patient has been fatisfled with the afliftance of fome 
 family pra&itioner,, (lie will be under the necefiity, at 
 the conclusion of the difeafe, to have recourfe to a 
 regular furgeon, for the removal of a dilagreeable 
 hardne£ 5 which often continues for fome time after 
 
 the 
 
438 MEDICAL ADMONITIONS. 
 
 the inflammation has ceafed ; which, although it is 
 not of the fame nature with fcirrhus and cancer, will 
 often require the greateft fkill to afcertain its moft 
 proper mode of treatment. 
 
 CHILBLAINS. 
 
 A chilblain is an itching and painful fwelling, 
 produced by the action of cold, fometimes terminat- 
 ing in ulceration. 
 
 Tumefaction, rednefs, and itching of the part, are 
 the firft marks which denote the coming on of chil- 
 blain. The fwelling afterwards extends beyond the 
 rednefs to the furrounding parts, which, upon preffure, 
 will generally be found to be in an cedematous ftate ; 
 the redneis gets darker, until at laft it becomes of a 
 deep crimfon, or even of a livid colour ; the itching 
 increafes to fuch a degree, as to become almoft intole- 
 rable, and is accompanied with aching pain. If the 
 mode in which the complaint is treated does not 
 prove equal to the removal of the difeafe, it may con- 
 tinue, nearly in the fame ftate, for a confiderable time, 
 or may terminate in ulceration. Before this happens, 
 the complaints increafe, and a blifter filled with 
 bloody water arifes, after the breaking of which, a foul 
 painful ulcer fucceeds, which, if not properly treated, 
 
 will 
 
MEDICAL ADMONITIONS. 439 
 
 will extend itfelf, both in depth and width, affecting 
 the tendons, and even the bones themfelves. 
 
 Children, and young perfons who ufe but little 
 exercife, are moft difpofed to this complaint, which 
 generally comes on with the winter, and, if powerful 
 remedies are not had recourfe to, will continue until 
 the return of mild weather. Thofe who have once 
 fuffered from this difeafe are obferved to be much 
 difpofed to a return of the complaint in the fucceed- 
 ing winter. 
 
 When this difeafe is only in a trifling degree, there 
 is no neceflity for application to a furgeon : the reme- 
 dies afforded by domeftic medicine are here frequently 
 fufficient. 
 
 To flrengthen the veifels of the part, fo that by 
 their action the blood, which feemed to be ready to 
 ftagnate, may be propelled through them, is the chief 
 principle which fliould regulate the mode of treat- 
 ment. With this view, the parts affected mould be 
 frequently rubbed with the naked hand, or with 
 flannel ; as much exercife mould be ufed, as the ftate 
 of the difeafed parts will allow ; and if there be no 
 fore, ftimulating medicines, fuch as camphorated 
 fpirits, fpirits of turpentine, warm fomentations, plaif- 
 ters, &c. fhould be applied to the parts affected. 
 Sudden and confiderable changes from cold to. heat 
 
 iliould 
 
446 MEDICAL ADMONItlONS. 
 
 ihould be avoided ; and, laflly, the parts (hould be 
 defended from the action of cold by coverings of fuch 
 fubftances as are known to have but little power in 
 conducting heat, fuch as fiightly woven woollen and 
 cotton, warn leather, which is loofe in its texture, 
 and downy on each fide. 
 
 When the chilblain becomes ulcerated, the ulcer 
 muft be treated according as its appearances may 
 indicate, it being impoiTible to lay down a mode of 
 treatment which ought to be adopted in every cafe, 
 fince the part affected is capable of putting on all the 
 varieties of ulcers from other caufes, and confequent- 
 ly may demand, in fome cafes, a different, or even an 
 oppofite treatment, to what it may require in others. 
 
 To prevent this difeafe, early recourfe may be had 
 to the means above recited for its cure, efpccially io 
 far as refpedte exercife, friction, and preventing the 
 ad ion of cold. 
 
 WHITLOW. 
 
 The whitlow is an extremely painful inflammatory 
 tumour, poffelTmg the end of the finger. 
 
 One fpecies of this complaint begins with a con- 
 fiderable burning pain ; but the &in fc-on becomes 
 
 elevated 
 
MEDICAL ADMONITIONS. 441 
 
 elevated around the nail, and the whole end of the 
 finger, and becomes filled with a famous liquor - 3 the 
 cuticle and contained fluid appearing almoft tranf- 
 parent. 
 
 Another fpecies has its iituation much deeper than 
 the former, the inflammation attacking the tendons 
 and ligaments, and the intervening cellular membrane. 
 The pain, at the commencement, and during the 
 progrefs of this fpecies, is much more violent and 
 throbbing than that of the former fpecies ; the pain 
 being felt over the whole hand, and oftentimes even 
 along the arm ; both the hand and arm, in fuch cafes, 
 becoming conliderably fwelled. The fuppuration. 
 proceeds extremely flowly ; and when the matter is 
 formed, it is fo deep feated as to be a confiderable 
 time before it makes its way to the furface. By the 
 violence of the pain, fever, delirium, and convulfions 
 are fometimes produced ; the whole nervous fyftem 
 fuffering fuch a derangement, that inftances are 
 known where death itfelf has been occafioned by this 
 malady. 
 
 AbfcefTes frequently form along the courfe of the 
 lymphatics, even as far as the arm-pit. The tendons 
 fuffer frequently fo much, that the fingers become 
 ftiff and immoveable ; the bone alfo fometimes fuf- 
 tains fo great a degree of injury, as to render the 
 Hhh amputation 
 
442 MEDICAL ADMONITIONS. 
 
 amputation of at lead the laft joint of the finger, 
 neceffary. 
 
 Whitlows may be produced by external injuries, 
 fuch as a puncture, bruife, or flight wound. There 
 have been many inflances of the worll kind of this 
 difeafe immediately fucceeding to the moll trifling 
 and fuperficial punctures ; but they happen mod fre- 
 quently from fome internal caufe, or, at leaft, from 
 caufes that cannot be afcertained. 
 
 In the firft fpecies, no application is preferable to 
 that of a bread and milk poultice : the tumour be- 
 ing opened, when in a proper (late, a continuance of 
 the fame application will generally fcon complete the 
 cure. 
 
 In the other fpecies, as early an application as poffi- 
 ble mould be made to a furgeon, fince this malady 
 will require every poffible exertion to prevent the oc- 
 curring of thofe evils above mentioned. Sometimes, 
 indeed, when the difeafe is feated in thofe parts 
 which are in immediate contact with the bone, the 
 injury is communicated to the bone itfelf, in fo 
 early a ftage of the difeafe, that it may be imporlible 
 for the raoft ikilful furgeon to fave the difeafed bone. 
 
 SCIRRHUS 
 
MEDICAL ADMONITIONS. 443 
 
 SCIRRHUS AND CANCER. 
 
 The parts which are moft commonly affected by 
 this difeafe are the breads of women, the arm-pits, 
 noftrils, tefticles, uterus, rectum, fcrotum, &c, 
 
 A fcirrhus in the breaft commences with a very 
 fmall, hard, and moveable kernel, which often re- 
 mains a •conliderable time, without pain, and without 
 increafe of magnitude ; but, after fome time,,it in- 
 creafes, both in fenfibility and fize. A flight tingling 
 alfo takes place in the parr, and this gradually in- 
 creafes, until it terminates in a painful fenfation, 
 which at length becomes acute and lancinating. The 
 tumour, as it increafes in magnitude, becomes more 
 fixed, and more irregular in its figure. The veins 
 which run juft under the fkin, are enlarged, and the 
 fkin itfelf gets difcoloured in feveral parts ; a fluid is 
 difcoverable underneath thefe difcolourations, which 
 exudes, when ulceration takes place. The ulcerations 
 which fucceed are very irregular in their figure, and 
 but why proceed in the defcription of this dread- 
 ful calamity ? Sufficient muft have been faid, to have 
 furnifhed information to fecure its detection at its firft 
 appearance ; and but little more, I hope, need be 
 faid, to fully prove the neceffity of a refolute fubrnif- 
 fion to its early removal. 
 
 The 
 
444 MEDICAL ADMONITIONS. 
 
 The hope of exciting in the unfortunate fufferer 
 the degree of courage required to get rid, at firft, of 
 an evil, which becomes dreadful by fufferance, will 
 induce me to employ the greater part of this article 
 on that important object. 
 
 This difeafe I have already defcribed as commen- 
 cing with a very [mall kernel. If, upon a proper ex- 
 amination, which, immediately on its difcovery, Ihould 
 be obtained, this fmall kernel be afcertained to be a 
 true fcirrhus, the patient fhould confider, that nothing 
 but its fpeedy removal, by the knife, can be depended 
 on, to prevent its termination in cancer. It mould 
 alfo be confidered, that during this ftate of the difeafe, 
 the operation is comparatively trivial, and requires 
 but very little time for its performance ; that the 
 pain which accompanies it is very far fhort of that 
 which is imagined ; and that the exemption from 
 future difeafe is rendered, by it, almoft certain. 
 
 It is worthy of remark, that the oppofition to this, 
 and indeed to every operation, does not proceed fimp- 
 ly from the dread of pain ; but from an aflbciation 
 of the moft horrid ideas of every minute circumftance, 
 refpecting the operation, which can be fancied. The 
 affemblage of the furgeons, the preparation of instru- 
 ments, and many other circumftances, the enumera- 
 tion of which would be oppofite to the prefent pur- 
 pofe, are all reprefented in a colouring fo fombre, and 
 
 with 
 
MEDICAL ADMONITIONS. 445 
 
 with touches fo mafterly and impreffive, that the 
 mind is filled with the utmoft horror at the picture 
 the imagination has drawn. Reafon has no longer 
 power to exert its influence ; and the unfortunate 
 fufferer, thus becoming the Have of terror, attempts 
 not to argue and combat with the hofl of terrific 
 Spectres which fancy is conftantly placing before the 
 eyes. 
 
 When I confider how powerfully the dread of an 
 operation affects the mind, I cannot indeed expect to 
 effect much by argument. Some little good may 
 however, perhaps, follow, from this analyfis of the 
 ordinary procefs of the mind in this and fimilar cafes. 
 Since it thus plainly appears, that the dreadful appre- 
 hension of the operation is formed, in a great meafure, 
 by the mind's dwelling on objects entirely vifionary, 
 and that the fear of Suffering pain has, perhaps fome- 
 times, the leaft influence in directing the oppofition 
 to the operation recommended. Thus, we often fee 
 men who can bear pain with the greateft fortitude, 
 declare, that although they well know the pain of the 
 operation does not exceed that occasioned by the 
 fcratch of a pin, yet they can with difficulty bring 
 themfelves to confent to fuffer the operation of— 
 bleeding. Nor can it hardly be doubted, if the mod 
 timid female, Suffering under this difeafe, was aflured, 
 that if fhe would permit the pain of the part to be 
 augmented exactly to the fame degree, and for the 
 
 fame 
 
446 MEDICAL ADMONITIONS. 
 
 feme period of time, as it would by any propofed 
 operation, fhe fhould obtain an entire removal of the 
 diieafe, and even indeed of the part itfelf, and this 
 merely by an incantation, but that her content would 
 eafily be obtained. But, indeed, it is not neceflary 
 to imagine a cafe, to fhe;v th,at the dread of opera- 
 tions does not depend merely on the fear of pain, as 
 this is fufnciently evident from the much more ready 
 fubmiffion to the application of cauflics ; even under 
 the ftrongeft conviction of their producing a much 
 greater degree of pain, and of their affording a con- 
 iiderable lefs chance of a cure. 
 
 The mode of thinking which mould therefore be 
 adopted, by thofe to whom fuch an operation has 
 become neceiTary, is to let the mind dwell only on 
 the abfolute pain of the operation, abftracted from all 
 foreign circumftances and vifionary terrors ; and to 
 confider, that a cure may be obtained by only a few 
 minutes increafed pain ; and this pain very far fhort 
 indeed of what is mod probably anticipated by ima- 
 gination : but fuppofe it ever fo violent, let it be 
 remembered, that it is but fuffering, even fay ! the 
 moft excrutiatiating pain, for a few minutes, to pro- 
 cure an entire liberation from mifery and defpondence. 
 
 But, unhappily, there are many, whofe dread of 
 chirurgical operation is fo great, that no argument or 
 confideration can overcome. To thefe it is proper 
 
 to 
 
MEDICAL ADMONITIONS. 447 
 
 to addrefs all the confolatory language that truth will 
 allow ; and, therefore, to affure them, that this mala- 
 dy, although perhaps incurable, and accompanied by 
 moft difireffing circumftances, is yet, in general, not 
 attended with thofe excruciating pains which are fup- 
 pofed always to belong to this malady. If, indeed, 
 the poor fufferer is induced, by the miftaken zeal of 
 fome fympathifing friend, to place herfelf under the 
 care of fome of thofe impoftors who have acquired 
 the character of cancer- curers, this may not be the 
 cafe, but the pains may become cruelly aggravated, 
 and the progrefs of the dileafe rapidly accelerated. 
 
 1 am well aware, that many of my readers will be 
 ready to afk, But do not thefe, whom you have thus 
 fbgmatifed, frequently effect cures, even in thofe cafes 
 which have been deemed cancerous ? It is therefore 
 neceflary to obferve, that tumours in the bread fre- 
 quently fucceed to the inflammation of the bread, 
 arifing from retention of the milk, which, although 
 they are certainly not of a cancerous nature, do often 
 poflefs thofe appearances which render it very dim- 
 cult to make the neceflary diftin&ion, and will con- 
 tinue under that form for feveral months, and at lafl 
 refolve, perhaps, by the application of a bread and 
 milk poultice. Thefe are the cafes which prove fo 
 favourable to the character of this clafs of practitioners. 
 From their fize, hardnefs, and length of duration, 
 
 they 
 
448 MEDICAL ADMONITIONS* 
 
 they commonly gain from the patient and her friends 
 the epithet cancerous ; and fhould any profefiional 
 man, deceived by an imperfect hiftory, drop a fufpicion 
 of an unfavourable termination of the cafe, the foun- 
 dation is laid, on which the reputation of fome igno* 
 rant pretender may be railed. 
 
 When the furface of the fkin is attacked by cancer, 
 it generally begins with a fmall excrefcence of the 
 warty kind, which becomes a cancerous ulcer on fuf- 
 fering even a flight irritation : fuch are the cancers 
 which appear in the face. The. extirpation of thefe, 
 at their firft appearance, may be accomplifhed by an 
 operation by no means remarkable for its feverity. 
 
 Cancer of the womb is commonly preceded by a 
 very confiderable difcharge ; much pain is felt at the 
 bottom of the belly, darting in different directions, 
 but chiefly down the thighs. As the complaint pro- 
 ceeds, the pains become more pungent and forcing, 
 and at length ulceration taking place, a profufe dif- 
 charge of varioufly coloured matter, very acrid and 
 offenfive to the fmell, enfues - y the general ftate of 
 the f\ ftem fympathifing with the local injury, hectic 
 fever is induced. 
 
 SCALDS 
 
 -, - 
 
MEfelfe&t AiMoinfiotfs. 4-49 
 
 SCALDS AND BURNS. 
 
 ■JDr» Underwood obferVes, thar>— A ftrong {blution 
 ©f foap in water has long been in ufe with artificers* 
 employed in any bufinefs expofing workmen to very- 
 bad fcalds 5 and is a very excellent remedy. But -as 
 the foap would take fome time in diflolving, and the 
 folution fome time in cooling, the do&Or recommends 
 a mixture of fix ounces of oil to ten of water, with 
 two drachms of the ley of kali, Or pof-afh. This 
 quantity may be furlicient for a burn on the hand or 
 foot, which is to be immerfed, and kept about half 
 an hour in the liquor, which will remove the injury, 
 If had recourfe to immediately ; but muft be repeat- 
 ed,.^ the pain may require, if the fcald or burn be of 
 fome ftanding. Should a perfon be fcalded all over, 
 and immediately put into a cold bath of this kind, 
 and the head, at the fame time, be frequently im- 
 tnerged, or well wafhed with the liquor, I believe, 
 the Dodor fays, very little injury would enfue. 
 
 The mcfb ufeful application, I think, with Which 
 families can be provided, againft the moment of 
 emergency, is a ftrong brine, made by placing Hiced 
 potatoes and common fait in alternate layers in a pari, 
 allowing them to remain until the whole of the fait is 
 liquified ; which muft be then drained off, and kept 
 iii bottles, properly labelled, ready for immediate ufe. 
 I i i Linfeed 
 
450 MEDICAL ADM0KITI0NS. 
 
 Linfeed oil, fo frequently recommended, mould 
 never be the firft application ; fince it poflefles little 
 or no power in preventing the inflammations of the 
 parts, and by greafing the fkin, defends it entirely 
 from the action of thofe remedies which would prove 
 beneficial, if applied immediately in contact with the 
 ikin. 
 
 The ulcerations which fucceed to fcalds and burns 
 demand fo much nicety in their management, as to 
 require the care of a fkilful furgeon. Without this, 
 the patient may be .diflreffed by inconveniences for 
 the reft of his life, which no fubfequent endeavours 
 may be able to remove : the moft unfufpected adhe- 
 fions of parts naturally feparatcd, and the moft rigid 
 contractions of parts, which before were flexile, will 
 frequently take place, ncceflarily occafioning the moft 
 diftreffing deformities. 
 
 Extraordinary inflances fometimes occur, of thofe 
 whofe clothes have by accident taken fire, efcaping in 
 a wonderful manner, by adopting the ufe of fuch 
 means as have been dictated by an extraordinary 
 prefence of mind. But rather than truft to that 
 which is fuggefted in the moment of terror and con- 
 fuflon, by a mind totally unfurnilhed with any fixed 
 mode of proceeding, it will perhaps be better to lay 
 down certain rules, which being ftrongly imprinted on 
 the mind, will ferve to direct to the moft fafe and 
 beneficial line of conduct. To 
 
MEDICAL ADMONITIONS. 45I 
 
 To call for help 'presents itfelf to the mind fo in- 
 stinctively, that it would not be mentioned here, but 
 to remark, that this mould be done, if poflible, by 
 ringing the bell,. &c. without opening the door o£ 
 the apartment, as the external air ruftiing in, would 
 immediately increafe the rapidity of the progrefs of 
 the flames. 
 
 The firft attempt mould be to tear off that part of 
 the clothing which is in flames ; and, if in a parlour, 
 to feize the water decanter, and which, even for this 
 reafon alone, Ihould be large, and kept always full ; 
 or any other veffel of water, which may be in the 
 room where the accident has happened, mould be 
 recollected and flown to. 
 
 If unfuccefsful in thefe inftantaneous exertions for 
 relief, the unfortunate fufferer mould feat himfelf on 
 the floor, remembering, that in this pofture (he will 
 fee better enabled to fmother the flames of her lower 
 garments, and that an upright pofture will render the 
 communication of the flames to the upper part of her 
 drefs more probable. 
 
 In this fituation, fhoujd these be a hearth carpet 
 (which even for this ufe, in this moment of emergen- 
 cy, fhould form part of the furniture in every room,) 
 it will, from the materials of which it is compofed, 
 prove highly ufeful in extingui thing the flames, laid 
 over the burning clothes, or wrapped tight round 
 them. Females 
 

 4$2 MftVtCAh AT>MONITX0»K 
 
 Females' are mofl commonly the fubje&% o£ tiiis 
 terrible accident,, owing to their clothing being of a 
 more combuftible kind than thofe of men. Wooden 
 clothes not only burning much flower than liB^n Q* 
 cotton, but giving an alarm much fooner, by the. 
 fmell their burning occafions. Females, therefore, 
 whole age or infirmities almofl confine them to their, 
 lire -fide, and prevent the hope of any adlive exertions, 
 .fhould be perfuaded to wear gowns and aprons of 
 filk, or of fluffs of force fabric in which worfted and 
 fiik are blended, inftead of muflin and fine linen ^ 
 which not only will catch fire almoft with a fpark, but 
 will burn with the utmoft rapidity. 
 
 c 
 
 — 
 
 EFFUSIONS OF BLOOD FROM RUPTUR- 
 ED OR WOUNDED VESSELS. 
 
 "Were the knowledge of the fituation of the 
 biood-vefiekof the extremities., fo far as isneceffary for 
 checking dangerous erTufions of blood, and the ufe of 
 the tourniquet, more general ; not confined to the 
 navy and arrriv, but extended to colleges and fchools, 
 particularly military and nautical academies, manu- 
 factories, h'ofpitals of every defcription, prifons, plan- 
 tations, fire-offices, the clergymen of parifhes in which 
 no fur^eens are refident, commanders of merchant- 
 
l»en,- miners, &c. it coul4 not tail of proving- highly 
 beneficial tQ mankind"* 
 
 Convinced, witli the benevolent author of the put?- 
 
 ■ ■. 
 
 lication from which this and the lucceeding quotations 
 
 are taken, of the advantages to be derived from the 
 
 wide diffufion of fuch knowledge, I have inferted the 
 
 following paragraphs : but at the fame time muft exr 
 
 prefs a wifh, that they may incite my readers to £ 
 
 perufal of the little work itfelf, as the lefions it teaches 
 
 cannot be too plainly imprinted on the mind. 
 
 *' The veffels, or tubes, which proceed from the 
 heart, to convey the blood to all parts of the body ? 
 are called Arteries. From the power with which 
 the heart propels the blood through {his fyftem of 
 veffels, it happens, that,, whenever they are wounded, 
 the blood flows rapidly, and in jerks, from the wound* 
 ed part. They divide, to be diflributed to parts ? 
 from trunks, like the branches of a tree from th$ 
 body ; fo that,- 'on preffing together the fides of any 
 trunk, the flow of blood into the branches beyond jth© 
 comprefled part is prevented, 
 
 ** The veffels, which return the blood to the heart, 
 arc named Veins. In them the blood receives but 
 little of the impelling, force of the heart, and, there - 
 
 ■ :. ; ........ & re » 
 
 * A Left Ore on the Situation of the large piood-VefTels 
 fefOje Extremities, &c. &c. by Williarm Blizard, F. R. S. 
 
454 MEDICAL ADMONITIONS. 
 
 fore, moves not with a ftrong tide, or current, but 
 glides evenly and gently on, like the ebbing water j 
 and, of confequence, wounds of thefe veflels are. not 
 of much importance ; a fmall degree of refiftance, by 
 a finger, or fome folded linen, applied to the wounded 
 part, will generally flop the bleeding. 
 
 " It is very plain, then, that if a bandage or liga- 
 ture be made fufflciently tight around any limb, the 
 flow of blood into all the parts below mud be pre- 
 vented. But, to render this certain, theprefiure muft 
 be very great in the whole circumference of the limb ; 
 and, in fome cafes, from the fituation of arteries be- 
 tween bones, the effect cannot be obtained. To 
 perform this procefs, therefore, fuccefsfully, in cafes 
 of wounds and operations, and, at the fame time, to 
 prevent the confequences of an exceedingly ftrong 
 general preflure, furgeons have fixed on certain parts 
 of the trunks of arteries, before their ramifications, 
 for the application of a pad, or Compress. 
 
 " The Pulse is the beating or diflending of an 
 artery, from blood propelled into it by the beait. 
 The fpaces of time between the pulfations are periods 
 when the heart itfelf is filling with blood returned to 
 it by the veins. 
 
 " Now it is evident, that there can be no pulfa- 
 tion when the flow of blood and pulfation of an artery 
 
 are 
 
MEDICAL ADMONITIONS.' 4££ 
 
 are prevented. Where, then, a pulfe can be conve- 
 niently felt, as in the wrift, the ceafing of it, from a 
 preffure being made on the trunk above, will prove 
 tjiat the preffure is made effectually. To illuftrate 1 
 this by experiment — Let a friend feel the pulfe in 
 your wrift ; then apply two or three fingers in the: 
 little pit immediately below the collar-bone, clofe to the 
 flioulder. Prefs ftrongly, and the pulfe will ceafe, 
 becaufe the artery that fupplies the upper extremity 
 pajfes under the collar- bone, over the firjl and Jecond 
 ribs, along this part, and will now be preffed againfl 
 one of thefe ribs. Remove the fingers, and again 
 apply them, and the pulfe will be found to alternate 
 with the preffure. 
 
 " Suppofe, then, a wound to be received, an artery 
 of confiderable fize to be cut or torn, and a copious 
 bleeding, in confequence, to happen, in any part of 
 the arm below the place juft defcribed : it appears 
 manifeft, that, by making a preffure with the fingers, 
 in the manner defcribed, or afiifted by a pad between 
 the fingers and the part, the bleeding would inftarYtly 
 ceafe. 
 
 "The arteries of the upper extremity, or arm, 
 proceed from the trunk after this manner : the trunk 
 pajfes into the arm-pit, deeply filiated ; it then proceeds 
 along the fide of the arm* next the body, obliquely to- 
 wards the fore part of the joint or bend y and here di- 
 vides 
 
vides into thtf t branches. In this courfe to m divifidB 
 it lies near the bone, and may therefore be fttcdefeftiVi 
 ly comoreffed* ■ - - • 
 
 " The diflribution of the veitels of the lower ex- 
 tremity is in this way : the artery paffes from the 
 cavity of the belly to the Groin, where, in thin 
 perfons, the pulfation of it may be felt. 
 
 " At this place, in cafe of wound and cffufioti ofr 
 blood very high in the thigh, effectual comprefiioft 
 may "be made, by fome fingers preffed very ftfongly, 
 an the manner defcribed for compre&on below the 
 collar-bone ; though it were better to have fome kind 
 of ftrong pad, or firm body, fuch as will be described, 
 interpofed between the fingers and the part. From 
 the groin, the artery proceeds in an oblique direction, 
 downwards and inwards, and at about the middle of 
 the infide of the thigh it lies clofe to*the bone. This 
 is the moft favourable part for making a prefture 
 upon it, becaufe of the refiflance of the thigh-bone 
 behind. And, where there are opportunities of choice, 
 as in cafes of rounds, or operations below this part, 
 this is the place which furgeons fix on for the appli- 
 cation of the compretTing body j it therefore deferves 
 particular attention. 
 
 '" The courfe of the veffe) is then downwards and 
 backwards to the Ham ; in the hollow ofzvkich, againfi 
 the IcwerJltU end cf the thigh-bone, compreffion may 
 
 again 
 
MEDICAL ADMONITION 457 
 
 lift be very fuccefsfully made, in all cafes of wounds 
 or operations below the knee joint. But beyond this 
 part, compreffion muft not be depended on ; for, 
 immediately below the joint, the artery divides, like 
 that of the upper extremity, into three veffels, which 
 are fituated between the bones of the leg. 
 
 " And now — fuppofe a wound to have happened 
 by a pen-knife, or other thing, in the thigh, leg, or 
 arm, and, a large artery being punctuated, a violent 
 bleeding mould enfue— You have no tourniquet, but 
 you clearly underftand what has been taught on this 
 fubject. — How, then, would you ad? — Undoubted- 
 ly you would inflantly pull off your garter, or take 
 the firfl piece of firing or cord you could find ; roll 
 up your handkerchief hardly, and lay it on the trunk 
 of the artery above the wounded part ; pafs the gar- 
 ter, or cord, over the handkerchief round the limb ; 
 tie a knot, leaving a proper fpace -, and then twill 
 the ligature by a piece of flick or cane, or any other 
 firm body you could procure." 
 
 BLEEDING. 
 
 The art of opening a vein, and the neceffary cau- 
 tions refpeding the operation mould be learned by 
 every one j fince cafes of emergency may, happen, 
 where the neceffity of its. being performed is evident* 
 "k and 
 
45& MEDICAL ADMONITIONS. 
 
 and where life may be loft before a furgeon can be 
 obtained. 
 
 Another qualification neceflary to be pofieffed fo> 
 that of being able to flop the flow of blood from a 
 vein thus opened. Obvious as are the means to be 
 employed on fuch an occafion, I will rifk the afTertion, 
 that there is no medical man who has witnefied a 
 moderate fhare of practice, but who has met with an 
 inflance or two, where, if life itfelf has not been en- 
 dangered, considerable injury has been occafioned by 
 a wafte of blood, from the orifice opening afrefli, alter 
 the departure of the furgeon ; no one of the by- 
 ilanders having prefence of mind and intelligence 
 fumcient to prevent the farther efFufion. But a little 
 attention to a few words will enable any one to per- 
 form the office of furgeon in this cafe. 
 
 The fimple principle, with which the mind mould 
 be fully pofTefled, is,, that the blood muft ceafe to 
 flow, if the orifice be clofed. To accomplish this, 
 let the thumb be flid on to the orifice, fo as to bring 
 its fides together, ?nd to prefs it with a moderate 
 force. The flow of blood will be now flopped, and 
 the operator, now confident of the. power he porTeffes, 
 with the other hand cleanfes the arm, while a little 
 bolder of linen is folded by feme by-ftander, which 
 he artfully introduces between the orifice and his 
 thumb : over this he places another comprefs, of a 
 
 thicknefs 
 
MEDICAL ADMONITIONS. 45^ 
 
 tlikknefs fufficient to fill up the hollow of the bend 
 of the arm, confining the whole with a ribband or 
 tape paffcd over the comprefs, and above and below 
 the elbow, in the form of a figure of eight, finifhing 
 with a knot over the comprefs. 
 
 LEECHES. 
 
 Leeches may be employed in every cafe where 
 topical bleedings are thought necefifary 3 or where 
 vensefe&ion cannot be performed. 
 
 As thefe little animals are depended on for the re- 
 moval of very dangerous difeafes, and as they often 
 feerh capriciouily determined to refrrl; the endeavours 
 made to catjfe them i o adhere, I fhall give a few 
 directions, by which their afflftance may, with more 
 certainty, be obtained. 
 
 This ufeful ally to the phyfician, it may be remark- 
 ed, is as little fond of the tafte of phytic as the phyfi- 
 cian can be himfelf. The introducing a hand > to 
 which any ill flavoured medicine adheres, into the 
 water in which they are kept, will be often fufficient 
 to deprive them of life ; the application of a fmall 
 •quantity of any faltne matter to their ikin, immedi- 
 ately occafions the expulfion of the contents of their 
 ftomach j and,< what rs mod to our prefent purpofe, 
 
 the 
 
40fi MEJMCAL ADMONITIONS: 
 
 the Jeaft flavour of any medicament that has been 
 applied, remaining on the ikin, or even the accumu- 
 lation; of the matter of perfpiration, will prevent them 
 from fattening. The Ikin ihould therefore, previous 
 to their application, be very carefully cleanfed from 
 any foulnefs, and moifteried with a little milk. 
 
 The beft mode of applying them is by retaining 
 them to the fkin in a fmall wine glafs, or the bottom 
 of a large pill box, when they will, in general, in a 
 little time, faften themfelves to the ikin. On their 
 removal, the rejection of the blood they have drawn 
 may be obtained by the application of fait external- 
 ly ; but here, for the fake of thofe to whom we are 
 fo much indebted, I fhall remark, that a few grains 
 of fait are fuffkient for this purpofe - 9 and that cover- 
 ing them with it, as is fometimes done, generally 
 deftroys them. It fometimes happens, that the blood 
 will continue to flow from the Orifice made by a 
 leech longer than is defirable ; and fometimes children 
 have been nearly loft from the inability'of the attend- 
 ants to fupprefs the discharge. A few words, there- 
 fore, defcriptive of the method in which this mould* 
 be done, cannot but be ufeful. The blood fhould 
 be warned' off clean, and the point of the finger preflT- 
 ed- moderately hard on the orifice, when the blood 
 wSll ceafe to flow. A fronll comprefs may then be 
 applied to the wound, which may be retained by the 
 point of the finger, as long as. the blood appears upon 
 
 withdrawing 
 
MEDICAL- ADMONITIONS. 461 
 
 .wRbdrawing the preffure. Remembering, that no 
 xrtore blood need be fuffered to flow, than is thought 
 neceffary ; fince all that is required to prevent it, is 
 patiently to perfevere in the neceffary preffure. 
 
 SCROFULA. 
 
 
 e For reafons fufficiently obvious, I (hall not pretend 
 to detail the various fymptoms of this difeafe, or to 
 lay down a plan of cure. I (hall, with the confidence 
 of being much more ufefully employed, point out 
 the injury which arifes from neglecting to adhere 
 ftriclly to the advice of the furgeon, as to one par- 
 ticular circumftance, in the mod dreadful forms of 
 the difeafe. 
 
 ! 
 The curvature of the spine, which is ac- 
 companied by a carious ftate of the vertebrae, and 
 which, if not timely remedied, is Succeeded by palfy 
 of the lower extremities, is a calamity over which the 
 furgeon has. fuch confiderable power, as frequently to 
 effect a cure, in cafes of a moft deplorable appearance. 
 But in hardly any cafe whatever does the furgeon 
 more require the auxiliary aid of parental attention. 
 and refolution ; fi-ncey let him be ever fo well allured 
 ©f the effects of the remedies he employs, he cannot : 
 exped a favourable: termination of the difeafe, unlefs 
 
 the 
 
4$g MftfclCAL ADMONITIONS. 
 
 the difeafed parts aie prefer ved in an abfolute ftate of 
 reft daring the whole of the cure. Let it be recol- 
 lected, that the fpine or back bone forms the grand 
 prop or ftay of the animal machine ; that the verte- 
 bra of which it is compofed bear the weight of all 
 the parts which are luperiof to them ; and that, in 
 this difeafe, thefe component parts of this chief flip- 
 per ting pillar of the ftructure is in a foft, crumbling 
 Hate— Common ienfe will then lay— If you attempt 
 a cure, never permit the weight of the body to be 
 thrown on the lpongy, diftempered parts, either in an 
 upright or fitting pofture, but let the patient be con- 
 iiantly kept in an incumbent pofture, on a bed or 
 rnattrefs. F:om want oi attention to this injunction, 
 as every furgeon knows, the failure of relief in thefe 
 cales, may frequently be attributed. 
 
 INFLAMMATION OF THE HIP AND 
 KNEE JOINT. 
 
 These dreadful calamities, known by the names 
 of Hip Cafes and White Swellings, might frequently 
 be prevented, if parents were but aware that they 
 may in general be traced back to fome painful affec- 
 tion of the part which may have occurred fome weeks 
 before any lamenefs was perceived. Painful affections 
 of thele parts, therefoie, mould be ferioufty attended 
 
 to, 
 
MEDICAL APMQNITIpNS, j£* 
 
 tq, as by the early and vigorous employment of appro- 
 priate means, the diieafe may t?e removed i|> this, iu 
 firft ftage. 
 
 But fhoutd thefe have been neglected, or have bees 
 unfuccefsfully employed, dill a cure may be hofjed 
 for, but not unlefs, as in the former cafe, the difeafed 
 parts are kept conftantly refted. What expectation 
 of cure can be entertained, whilft the difeafed part;| 
 are forcibly grated together ? Who, to make ufe of 
 a homely comparifon, would fet the wheels of a 
 watch in motion, whilft in a ftate requiring the Kelp 
 oftheartift? 
 
 FRACTURES OF THE LIMBS, AND IN- 
 JURIES OF -THE HEAD- FROM " > 
 EXTERNAL INJURIES. 
 
 Presuming that the injurious interference of 
 domeftic practitioners in thofe cafes which belong to 
 this feclion, is not to be expected, I (hall here con- 
 fine my admonitions to thofe points which are necef- 
 fary to be attended to by the patient and his friends, 
 during the Brit moments of the. accident. { 
 
 If, in confluence of a fall from forae high place, 
 or by any other accident, a confiderabie degree of 
 injury appears to have been received j the fuilerer 
 
 being; 
 
464 MEDICAL ADMONITIONS. 
 
 being unable, in confequence of the deprivation of 
 his ienfes, to point rut the injured part j fome con- 
 fideration and attention is neceflary, before any at- 
 tempts are made, even to raife him from the ground. 
 Should a fracture of one of the bones, either of the 
 upper or lower extremity, have happened, and not be 
 fufpected by his amftants, their exertions to raife 
 him, and to place him on bis feet, might force the 
 fractured ends of the bone through the foft parts, and 
 convert a mere fimple fracture into a very dangerous 
 compound one. The limb^, therefore, with a view to 
 this circumflance, mould be carefully examined -> but 
 even if they feem to have fuftained no material injury, 
 yet fliould the patient not be precipitately raifed, until 
 fomething be provided, on which he may be placed : 
 as thereby unneceffary, and perhaps injurious, exer- 
 tions are avoided. As it will be fair to conclude, 
 from the deprivation of the fenfes, that the brain 
 may have fuftained fome injury, great care fliould be 
 taken, that whilfl he is conveying to his apartment, 
 and whilft laying in the bed the head be kept moder- 
 ately raifed, and. that on no fuggefticn whatever, any 
 fpirituous drinks be given to him. 
 
 The neceffity of the latter caution, from the diffi- 
 culty it may occafion in forming an opinion of the 
 nature of the injury, will be made evident by the 
 following cafe. A lad of twelve years of age fell 
 
 from 
 
MEJDICAL ADMONITIONS. 4t>| 
 
 from a bay-loft about twelve, feet from the ground,, 
 and was brought to his parents about an hour after 
 the accident, almoft infenfible : it was with difficulty 
 he was roufed to anfwer a queftion, and then immedi- 
 ately relapied into a fenfelefs flate, ; after having laid 
 in this flate about ten or twelve hours, the furgeon 
 firft faw him : he then complained of extreme pain in 
 his head, and ficknefs at his ilomach, relapfing be- 
 tween whiles into a ftate approaching to infertility,. 
 
 Here appeared to be prefent feveral of the rhoflj 
 tcbaracteriftic fyrhptoms of ferious injury to the head ; 
 the furgeon 3 thereforej had begun to apprife his 
 parents of his apparent danger, when the boy threw at 
 little matter off his ilomach, which fmelt ftrongly of 
 fpirits. He was immediately well drenched with 
 warm water, until what he rejected no longer fmelt of 
 fpirits. He then fell afleep, and awoke perfectly well 
 in a few hours, the brain having fuflaihed ah injury, 
 not from the fall, but from a bumper of brandy, 
 which had been given to him by one of the by -flank- 
 ers, as a cordial^ when he was firft taken up. 
 
 > But mould it be difcovered that a leg or thigh is 
 broken, the aid and directions of a furgeon thould, if 
 poffible, be obtained, for his removal j but if this 
 cannot be the cafe, the following rules fbould be 
 
 obferved; 
 
 , ... - • ; 
 
 Lil %. That 
 
466 MEDICAL x\DMONITIONs: 
 
 i. That he be not ftirred until a proper vehicle 1* 
 procured, on which he can be placed. 
 
 2. This, if nothing more proper can be had, may 
 be a door, a mutter, or two or three planks well fe- 
 cured together. 
 
 3. To place him on this, two perfons may raife 
 him, by means of a iheet Hid under his hips, whilft 
 one or two raife him by the flioulders ; one perfon 
 railing the found leg, and one, the mod intelligent of 
 his friends, conducting the fractured limb. 
 
 4. In moving the fractured limb, the object which 
 mould poflefs the mind, ihould be, that the divided 
 pieces of the bone be kept as much as pofiible in the 
 fame line, left the fractured ends pierce through the 
 foft parts. 
 
 5. If a pillow can be obtained, the broken limb 
 mould be placed on it ; and, if it appear to be pre- 
 ferable, previous to his being raifed. ' 
 
 6. When placed on the litter, he mould be a little 
 inclined to the fame fide of the injured limb, which, 
 if circumftances will admit, mould alfo be laid on 
 
 the fide, and with the knee a little bent. 
 
 f 
 
 7. The bef! mode of conveyance is undoubtedly 
 by two or four men, in the manner in which a fedan 
 chair is carried. A cart, or even a coach, fhould 
 
 never 
 
MEPICAL ADMONITIONS. 467 
 
 never be employed, where the mode juft recommend- 
 ed can be adopted. 
 
 8. As the patient will be under the neceflity of 
 laying fome time without getting up, a matrafs fhould 
 be laid on his feather-bed, or, if that cannot be had, 
 two or three long and wide boards, joined together, 
 maybe placed under the feather-bed. If this can 
 be done before he is firfl laid down, much fubfequent 
 pain and exertion will be prevented. 
 
 If the arm be broken between the elbow and the 
 wrift, the arm fhould be bent at the elbow, railing the 
 palm of the hand to the breaft, with the fingers 
 moderately bent ; the thumb being fuperior, and the 
 little finger inferior. In this ftate it may be retained 
 by a fling or handkerchief, fupporting it from the 
 elbow to the fingers ends. 
 
 When the arm is fractured between the wrift and 
 moulder, the fore arm may be placed in the fame 
 pofition as already defcribed y but the fling, inftead 
 of fupporting the whole length of the arm, fhould 
 only fupport the hand, which fhould be raifed higher 
 than in the former cafe, the elbow being allowed to 
 link ; its motion, however, being prevented, by a 
 handkerchief paffed moderately tight round the trunk, 
 including the fractured arm; 
 
 I HERE 
 
468 MEDICAL ADMONITIONS. 
 
 I here conclude the talk allotted mc, hoping that, 
 notwithstanding its imperfections, this little work may 
 prove of real utility. ' 
 
 Your candour will, I truft, prevent you from in- 
 ferring from my philippics againft domeftic quackery, 
 that it is my wifh to leffen the diffufion of ufeful 
 knowledge. Indeed, on the contrary, I am confident 
 that the beft, and moil: effectual mode of checking 
 the career of empiricifm would be, by more frequent- 
 ly admitting the fludy of anatomy, phyfiology, patho- 
 logy, and chemiftry, as part of a liberal education. 
 
 PofTefTed of fome knowledge of the ftructure, of 
 the ufes, and of the laws of action, of the various parts 
 of the human' body ; and apprifed of the confiderable 
 difference between difeafes of fimilar appearance, few 
 could be difpoied, except where error feemed impof- 
 fible, to prefer! be for themfelves, and lofe the advan- 
 tage of that aid which they might expect from thofe 
 who had palled their lives in the fludy of the healing 
 art. In farther recommendation of the ftudy of thefe 
 fciences, I muft obfeive, that, independent Of the ad- 
 vantages juft mentioned, anatomy and chemiftry 
 would furnifti the inquifitive mind with the moft 
 curious and interefting facts ; and would prove a 
 fource of rational and inftructive entertainment. So 
 cbvious, indeed, is this, as to render it furprifing that 
 
 gentlemen^ 
 
MEDICAL ADMONITIONS. %6tJ 
 
 f entlcmen, not of the profeffion, fhould not more 
 frequently avail themfelves of the opportunities of 
 acquiring this kind of knowledge, in the pleafant and 
 expeditious manner in which it is offered them, by 
 the public lectures on thefe various branches of fci- 
 ence. Nor is fo much previous knowledge. neceffary 
 as is in general fuppofed, the perufal of Dr. Gregory's 
 (Economy of Nature, and of the Medical Extracts, 
 would fupply all the information necefiary to render 
 the comprehension of the doctrines laid down in fuch. 
 lectures perfectly eafy. 
 
 To thofe who may wifh to obtain more accurate 
 ^knowledge reflecting diet and regimen, the lectures, 
 published on thefe fubjects, by Dr. A. F. M. Willich 
 will be found highly ufeful. And it is with pleafure 
 I ftate, that very ample directions to nurfes for the 
 management of the fick, in thefe refpects, may be 
 expected foon from Dr. Hamilton, Phyfician to the 
 General Difpenfary. 
 
 From a fear left what I have faid againft indifcrect 
 attempt to harden children, as it is termed, fnould 
 not appear fumciently convincing, I cannot refrain 
 irom earneftly recommending to parents the perufal 
 of Dr. Darwin's excellent Effay on the Education of 
 Females- 
 
 As 
 
47° MEDICAL ADMONITIONS. 
 
 As the exemption from the fmall-pox by the inocu- 
 lation of the matter of the cow-pox, may Hill be con- 
 fidered as a fubject of experiment and mveftigation,it 
 cannot with propriety be dwelt on in a work of this 
 kind. The farther experiments of Dr. Jenner and 
 Dr. Pearfon, with thofe which, I truft, will enrich 
 the fecond volume of Dr. Woodville's excellent 
 Hiflory of Inoculation, will, I hope, clearly fhew how 
 much may be expected from this moft important 
 difcovery. 
 
 I am, 
 
 Your's, 
 
 J. P, 
 
 OBSERVATIONS 
 
o- 
 
 OBSERVATIONS 
 
 ON THE,' 
 
 Excejfive Indulgence of Children ', 
 
 PARTICULARLY INTENDED TO SHOW- 
 ITS INJURIOUS EFFECTS ON. THEIR HEALTH, 
 
 AND THE 
 
 DIFFICULTIES IT OCCASIONS IN THEIR. .TREATMENT 
 DURING SICKNESS. ' 
 
 Theft ftall the fury paffior.s tear, 
 The vultures of the mind ; 
 
 Difdainful anger, pallid fear, 
 And fliame that fkulks behind^ 
 
 A 
 
 SLIGHT and tranfient view of the duties of 
 parents to their children, during the fiat e of infancy y \ 
 might favour the opinion, that little more is required 
 of them than that care for their prefervation which 
 the brute parent inftincYively bellows on its offspring. 
 But when it is confidered that the human parent 
 poffefTes reafoning powers, and that the mental ener- 
 gies of the child begin to be evolved in the early 
 days of infancy, it muft be obvious that the duties 
 are much more numerous and much mure important : 
 Vol. II. of 
 
472. M£DICAL ADMONITIONS* 
 
 Of a degree of importance indeed proportioned to trMj 
 elevated place a child pofTefles in the fcale of animated 
 beings. Nor is this obfervation unneceffary j no 
 caftle is here creeled merely for the purpofe of being 
 levelled ; fince there are too many inflances where the 
 minds of children are no more attended to, than if 
 they were really the offspring of brutes ; and where 
 even the necerTary care for their health and exiiience 
 is exceeded by almofl the whole of the brute creation. 
 
 That children are born with various difpofitions is 
 undoubtedly true - } but it is alfo true, that by due 
 management, thefe may be fo changed and meliorated 
 by the attention of a parent, that not only little blem- 
 ifhes may be fmoothed away ; but even thofe circum- 
 flances which may more offenlively diftinguifh the 
 child* may, by proper management, become the 
 chara&eriftic ornaments of the man. But, alas ! too 
 often do we fee, from the want cf this care, the charm- 
 ing blofToms of virtue and happinefs .blighted. 
 
 On the treatment the child receives from his parents, 
 during this flage of his life, will, perhaps, depend 
 much of the miiery or happinefs he may experience, 
 not only in his palTage through this, but through the 
 other iiages of his exiiience. If, on the one hand, 
 every little Tally of pailion and impatience is immedi- 
 ately controuled ; if that which is admiffible is regu- 
 larly permitted, and that which is improper as regu- 
 larly 
 
MEDICAL ADMONITIONS* 473 
 
 forty withheld, the wily little creature will foon learn 
 to diftinguifti that which is allowed of, from that which 
 is prohibited. He will* indeed, urge his claim, for 
 that to which he has been taught he has a right, with 
 manly boldnefs ; but will not harafs hjmfelf and his 
 attendants, with ceafelcfs whinings or ravings, to ob- 
 tain that which uniform prohibition has placed beyond, 
 expectance. But a melancholy reverfe appears, if, on 
 the other hand, no confiflency is obferved in his 
 management j if, at one time, the flightefr indulgence 
 is refufed, and at another the moft extravagant, and 
 even injurious cravings, are fatisfied, juft as the caprice 
 of the parent may induce him to gratify his ill hu- 
 mour, by thwarting another ; or to amufe his moments 
 of ennui, by playing with his child as a monkey, and 
 exciting it to thofe acls of mifchief and audacity for 
 which, in the next moment, it may fuffer a fevere cor- 
 rection. Continually undergoing either difappoint- 
 ment or punifliment ; or engaged in extorting grati- 
 fications, which he often triumphs at having gained 
 by an artful difplay of paffion ; his time paries on, 
 until at laft the poor child manifefts ill nature fufficient 
 to render him odious to all around him, and acquires 
 pride and meannefs fufficient to render him the little 
 hated tyrant of his playfellows and inferiors. Can 
 the duties of a parent have been fulfilled in this cafe ? 
 Can the child owe any duty, in return for fuch con- 
 duel: ? Certainly not. What may be the natural 
 M m ra obligations 
 
474 MEDICAL ADMONITIONS. 
 
 obligations of a child to a parent is not intended to 
 be here dwelt on, it is only meant to be aiTerted, 
 that they muft be lefTened by treatment Co abfurd 
 and injurious. 
 
 The mortifications which the parent muft repeated- 
 ly endure, from perceiving his darling child render 
 himfelf obnoxious to all around him, by the enormity 
 of his conduct, muft awaken a lufpicion that fome 
 error has been committed in his management ; and 
 muft, at times, excite a tranfient inclination to adopt 
 a more firm and rational mode of conduct. But fup- 
 pofe this child of humour and indulgence to be over- 
 taken by llckncfs, then muft the unhappy parent find 
 conviction ftafh ftrong on his mind, and he becomes 
 his own harfh, unforgiving accufer. When life itfelf 
 depends on a peaceful ferenity, and an exact compli- 
 ance with various regulations, he fees his froward 
 darling fevered by the exertions of paflion ; and ex- 
 haufted by petulant rejections of the means of relief, 
 and by inceffant cravings for thofe things which, being 
 noxious, are prohibited, and which, by the perverfenefs 
 of temper, are thereby rendered more defirable. 
 Generally does the poor little fufTerer pay with his life 
 the purchafe of his early indulgencies ; or, at beft, 
 efcapes with an enfeebled conftitution, prefenting a 
 conftant memorial to his parent, that — the temper 
 
 OF A CHILD IS FORMED IN TH£ EARLY DAYS OF 
 INFANCY. 
 
 Every 
 
MEDICAL ADMONITIONS. 475 
 
 Every one who has had opportunities of obfervation, 
 muft have remarked how diftreffingly the fufferings of 
 the child, the perplexity of the phyfician, and the 
 diftrefs of the parents are augmented by frowardnefsof 
 difpofition. To particularife the various injuries 
 which the exceffive indulgence of the caprices of chil- 
 dren may occafion to their health, and the feveral 
 impediments it is productive of to their proper treat- 
 ment, when opprefled with difeafe, (hall be the en- 
 deavour of the fucceeding pages. _ In making this 
 attempt, it is eagerly hoped, that very powerful 
 arguments will offer themfelves to the affectionate 
 parent, in favour of a ftri& regulation of the difpofi- 
 tions of children, even during their early infancy. 
 
 The difeafes of children are, in general, involved 
 in fo considerable a degree of obfcurity, as to demand 
 the exercife of much ingenuity, and acutenefs of dif- 
 crimination in the phyfician, whilft engaged in difcov- 
 ering the nature of the difeafe he is required to remove. 
 But when his enquiries are impeded, by exceffive 
 wailings ; when the expreffions of impatience magnify 
 one particular fymptom, and conceal the reft j the 
 niceft invefligation may prove infufficient to obtain 
 the necefiary information. 
 
 Not only is the phyfician fometimes, thus prevented 
 from forming a juft opinion of the nature of the dif- 
 eafe j but even when, by dint cf earneft attention and 
 
 enquiry, 
 
476 MEDICAL ADMONITIONS. 
 
 enquiry, he has fatisfied his mind j and is difpofed to 
 employ thofe means which his judgment may dictate, 
 it too frequently happens that infuperable difficulties 
 arife of another kind. The medicines he fhall pre- 
 scribe, he will, very likely, be told, muft not only not 
 be ill-flavoured, but, if he expe&s they (hall be gotten. 
 down his patient, they muft be abfolutely without 
 any tafte. 
 
 In thofe cafes, in which bleeding by leeches is re- 
 quired, he will often be told that however neceffary 
 their application may be, it is a remedy which muft 
 be declined ; for mould the child ever fee them, he 
 would be immediately thrown into convulfions ; and 
 as to a blifter, although they, the parents, might be 
 difpofed to fubmit to have their child expofed to the 
 infliction of this torture ; they are fatisfied that as 
 foon as he mould experience pain from its action, he 
 would directly tear it off. Placed under fuch limita- 
 tions it cannot be expected, however anxious the 
 phyfician may be to procure relief to his patient, that 
 much advantage can be obtained by his prefcriptions. 
 He therefore, either declines his attendance ; or acting 
 within the bounds to which he is limited, he does 
 little more than alleviate fome of the more diftreiTing 
 fymptoms, whiift he has the mortification to witncfs 
 the alm'cfl uninterrupted pronrefs of the difeafe. 
 
 : 
 
 Thofe. children who are allowed to conduct them- 
 
 felves, 
 
MEDICAL ADMONITIONS. 477 
 
 felves, entirely as their humour happens to prompt 
 them ; and who have unhappily been taught, by 
 their parents' imprudence, to regard their d. dates as 
 nugatory j are not only more expofed to the attacks 
 of difeafe ; but have the chance of its removal leffen- 
 ed by not allowing the employment of the rnoft 
 efficacious means. Frequently, alfo, iheir diibrder is 
 augmented, by the violent exertions confequent to 
 the irritation of the mind, pruduced by the pain, and 
 the various inconveniences, accompanying the flace of 
 difeafe. 
 
 IMPROPER INDULGENCES. IN FOOD. 
 
 Unlimited indulgence of children in the article 
 of food, is a fource from which a multitude of difeafes 
 .arife.' The child is placed at a table, where variety 
 of meats, and the ingenuity of the cook, tempt the 
 flomach to take food, beyond the calls of natural ap- 
 petite. From extreme kindnefs, he is helped from 
 almoft every difh, until the ftomach has received fo 
 much as to occafion an injurious diftenfion of its coats, 
 in confequence of which, the performance of digeftion 
 is confiderably impeded. 
 
 This procefs being daily repeated, probably, the 
 digeflive powers become fo much impaired, that lofs 
 of appetite, fqueamimnefs, and even frequent vomit- 
 ings 
 
478 MEDICAL ADMONITIONS. 
 
 ings fucceed. The child, inflead of acquiring ftrength, 
 evidently becomes weaker, the eyes appear funk, the 
 complexion aflumes a waxy palenefs, and fo great a 
 degree of emaciation takes place, as plainly (hows, that 
 but little nourifhment is derived from the great quan- 
 tity of food which is employed ; and that the kindly 
 meant indulgences have produced effects, directly op- 
 pofite to thole which were intended. 
 
 But mould even thefe effects not take place, to the 
 degree here defcribed, and the flomach efcape this 
 fpecies of injury j an evil of another kind, of no fmall 
 magnitude, will very probably occur. In confequence 
 of thefe repeated diftenfions of the flomach, its capa- 
 city becomes actually enlarged, and the habit of 
 •taking large quantities of fond is induced. Although 
 the appetite becomes fo depraved as to demand the 
 confumption of even an enormous quantity of food, 
 the flomach, however, not having its faculties increaf- 
 ed, in the fame proportion as its capacity, the fyflem 
 does not derive, even the fame quantity of nutriment, 
 as is afforded by the ordinary quantity of food, acted 
 en by a flomach in its natural (late. Hence will it 
 be often feen, that children who feed even rapacioufly, 
 are thinner, and have a lefs healthful appearance than 
 tliofe, who k^d with more regularity and moderation, 
 
 From thefe inordinate gratifications, another disa- 
 greeable circumftance frequently arifes : as the child 
 
 experiences 
 
MEDICAL ADM0NITI0N5. 47.9. 
 
 experiences a lofs of appetite for proper food, he be- 
 comes fubject to the moft unnatural cravings. The 
 ftomach fatiated, and even forfeited, with fweets and 
 delicacies, folicits for fubftances which are, to others, 
 the moft fordid and difguftful. 
 
 The foundation of all thefe evils is often laid in th£ 
 firft months of the child's life, by repeatedly diftend- 
 ing its ftomach with the various mixtures, employed 
 as fubflitutes for that food which nature has prepared 
 for it, and, of which it never fuffers a deprivation, 
 without danger of the moft diftrefsful confequences 
 enfuing. 
 
 In early infancy, therefore, where unhappily the 
 child is obliged to fubmit to this cruel deprivation, 
 the food which is fubftituted mould be Ample, and 
 approaching as nearly as poffible to the nature of 
 the mother's milk. Goats milk, afles milk, and cows 
 milk are probably the beft fubflitutes ; but thefe 
 fhould be given frefhly drawn from the animal, {light- 
 ly warm, unmixed with vegetable fubftances, and in 
 frequent, but moderate quantities. Too frequently 
 is the paffive infant feen laying acrofs the lap of its 
 Uurfe, who pours into its ftomach, one boatful after 
 another, as warm as it can be fwallowed, a mixture 
 of water thickened with bread, the acefcent fermenta- 
 tion of which is promoted by the addition of fugar, 
 this being often allowed to begin to take place, in the 
 
 fpace 
 
480 MEDICAL ADMONItlOU*. 
 
 fpace of time between its being mixed, and its being 
 given to the infant. 
 
 As the child advances in age, frill muft it be remem- 
 bered, that its health will depend on the fimplicity of 
 its diet. The variety in its chief meal mould never 
 be extended beyond two dimes ; the one, confifting 
 of vegetables, drefled in the moft fimple mode, or of 
 fruits drefled in the form of pudding or pie ;• and 
 the other, of animal food drefled as plainly as poilible. 
 Pickles and fpices mould be entirely avoided. 
 
 When this is dove, and children are not teized 
 with repeated urgings, to try to take a little bit more, 
 they wiii be ieldom roui.d to eat inordinately ; or to 
 lejcct capiirioufly that food which is fitted for them. 
 Id thole cafes, where either of thefe circumftances oc- 
 curs, it will, in general, be found to depend on injuri- 
 ous habits, induced by thofe improper modes of 
 feeding, during infancy, which have been jufl par- 
 ticularifed. 
 
 NERVOUS 
 
 • This permifTion will to fome appear objectionable, as 
 paftry has been repeatedly declared to be among thofc articles 
 of food which are moft injurious to the ftomach. But al- 
 though this may be true of thofe kinds of paftry which are 
 made to contain a large quantity of butter, it docs nor fecm 
 that pie-cruft of the plainer kinds can be fo hurtful as to 
 authorife its prohibition. 
 
MEDICAL ADMONITIONS. 48 1 
 
 NERVOUS AFFECTIONS, AND MADNESS. 
 
 Those parents will often find themfelves egregi- 
 ouily deceived, who Hatter themfelves into a confident 
 expectation, that the early indulgence of the humours 
 and caprices of children, will not be fucceeded by any 
 injurious confequences 3 and that, as they advance in 
 years, reafon will aflume her empire, and correct every 
 improper propenfity. But when the period arrives at 
 which the reafoning powers are, in general, ftrong, it 
 will, too frequently, be found that the pafiions have, 
 by long indulgence, become flrengthened, and are 
 too turbulent to fubmit to the dictates of reafon. 
 
 When the child of indulgence attains this period-, 
 judgment, ill formed, and exercifed only by ftarts, 
 ferves merely to chequer his actions with inconfiftency 9 
 whiifl reflection torments him, by mowing to him 
 the folly and extravagance of paft conduct, and by 
 pointing out to him as his duty, the adoption of that 
 path into which he is unable to enter, fince inclina- 
 tion, the abfolute directrefs of all his actions, leads him 
 the contrary way* 
 
 Accuflomed to yield to no oppofition, and taught 
 
 that the bufinefs of life is not to endure, but only to 
 
 enjoy j he is but little able to brook thofe rubs, which, 
 
 in the ordinary courfe of things, jnuft fall to his lot. 
 
 N n n Every 
 
4&2 MEDICAL ADMONITIONS. 
 
 Every circumftance which tends in the leafl to dimin- 
 ifh the confequence he afiumes, is felt mod poignant- 
 ly ; and from this principle, even the fuccefTcs of thofc 
 around him yield him pain. 
 
 When he mixes with the world, he is mre to find 
 thofe of a fimilar difpofkion with his own, who will 
 be ready to harrafs and thwart him at. every turn - y 
 whilft others, who know the facility of overreaching 
 one who is full of confidence in his own judgment, 
 but who, at the fame time, bends like a reed before 
 the breath of adulation,, will not fcruple to accommo- 
 date themfelves to his humours, the more eafily to 
 cajole him, and render him their dupe. 
 
 It having been hitherto the employment of thofe 
 around him, to fhield him from the mortification of 
 difappointment, by procuring the exact correfpon- 
 dence of events with his wiflies, he comes into a trick- 
 ing world, with a dangerous confidence of expectation 
 and hope. His mind dwells with a deceptive ,afTu- 
 rance of fuccefs, on the termination of every fpccuiative 
 fcheme ; and failure feems, to him, to be impoffible. 
 Thus deceiving himfeif, he looks forward only for fun- 
 fhine ; and makes no preparation for thofe florms, 
 againfl which, thofe bleft with more caution carefully 
 guard. When difappointment does break upon him, 
 every thing confpiresto render his diftrefs moft pungent 
 and intolerable. His fphere cf dominion, as it were, 
 
 is 
 
MEDICAL ADMONITIONS^ 483 
 
 is contracted. As his expectation of increafed fuperi- 
 ority has been indulged, the dread of humiliating de- 
 preffion is augmented. The fuffering mind foon 
 marks its influence on the whole nervous fyftem : 
 his nights are palled, almofl without fleep ; his ap- 
 petite, and confequently his ftrength, foon fail him ; 
 and not only is the Stomach impaired, but the bowels 
 alfo become difordered. Frequent head-ach, tre- 
 mors, palpitations of the heart, and dejection of fpirits 
 foon follow ; until his mind, morbidly irritable, is 
 constantly tormented with imaginary evils. Every 
 action of thofe he made feel his fuperiority, .whilft 
 profperity bewildered him, feems now to be intended 
 for retaliation : and even the manifestations of com- 
 panion are regarded by him, as the molt cruel of all 
 infults. Thus fuffering under an accumulation of 
 real and fancied ills, his mifery becomes fo great and 
 infupportable, that fullen or furious infanity, or dread- 
 ful fuicide may foon be expected to fucceed*. 
 
 EPILEPTIC FITS. 
 
 The fondly indulgent parent muft alfo be inform- 
 ed, that long before the age of maturity, the brain 
 may become ferioufly affected in confequence of thofe 
 paffionate exertions which unlimited gratifications 
 teach an infant to difplay. 
 
 "The 
 
484 MEDICAL ADMONITIONS. 
 
 The child who is accuftomed to conftant fubmif- 
 lion from all around him, feldom experiences oppo- 
 iition to his moft extravagant and dangerous requefts, 
 without manifefting his refentment by the moft violent 
 and outrageous fits of pamon. To thefe may frequent- 
 ly be attributed the occurrence of epileptic fits, and 
 other convulfive affections, which often continue, 
 through life, the dreadful lot of the fubject of indif- 
 criminate indulgence. 
 
 A remarkable inftance of epilepfy being thus pro- 
 duced, and of its cure, I once witnefTed in a girl about 
 feven years of age. The leaft refiftance to the willies, 
 of this. little favourite was almoft fure to be followed, 
 by the moft violent gufts of paffion, which generally 
 terminated in an epileptic fit. After applying for 
 relief to feveral phyficians, and employing, without 
 the leaft appearance of fuccefs, every meafure which 
 had been recommended - 3 although, perhaps, not with 
 lb much regularity and perfeverance as the cafe re- 
 quired, her parents concluded the difeafe to be in(u- 
 perable, and declined any further attempts at a cure. 
 
 At this period, a friend recommended a remedy, 
 which he afferted would, if employed with a ftrict 
 attention to every circumftance enjoined in the pre- 
 fcription, infallibly effect a cure. The prefcription 
 was as follows : — 
 
 Take 
 
\ MEDICAL ADMONITIONS. 485 
 
 Take two ounces of blood, about the time of the 
 moon becoming full, from the arm of the 
 patient, and ftir into it a tea fpoonful of fait. 
 This mixture muft be fwallowed whilft ftill 
 warm. If the patient experiences any return 
 of the fits, the bleeding muft be repeated, and 
 the blood again drank on the ninth morning, 
 mixed with the fait as before. 
 
 The blood was taken away, and the horrid potion 
 drank ; but neither the one nor the other was accom- 
 plifhed, without exciting in the unfortunate fubject 
 of the experiment the flrongeft figns of repugnance 
 and horror. Indeed, the experiment would not have 
 been made, fo great a degree of averfion was manifeft- 
 ed by the patient, had not the parents placed great 
 reliance on a remedy which, beiides being fo ftrongly 
 recommended, was by its uncornmonnefs, and by the 
 attention required to be paid to the ftate of the moon, 
 and to certain days, well calculated to infpire an ex- 
 traordinary degree of expectation. Complete fuccefs 
 was the reward of their refolution, for not only was 
 the return of the fit prevented ; but a moil unexpect- 
 ed event took place, the child was no longer prone to 
 thofe violent gufts of pafEon to which fhe had hither- 
 to been fubjecl. 
 
 To account for the operation of this extraordinary 
 remedy is, perhaps, not very difficult. With the 
 
 hope 
 
4-86 MEDICAL ADMONITIONS^ 
 
 hope of inducing the child to reprefs its violent failles 
 of pafiion, the dependence of the fits on thefe had been 
 frequently and ftrongly inculcated -, and well knowing 
 that thefe means were employed to prevent the return 
 of the fits, and that they were again to be repeated 
 fhould the fits return j the child could not avoid 
 making the conclufions, that to avoid this terrific and 
 difgufting procefs, it was abfoluteiy necefiary that fhe 
 fhould reprefs her pafftonate exertions ; and that it 
 tvas much better to fubmit to the will of her parents, 
 than be again forced to fvvallovv her own blood. 
 
 RUPTURES. 
 
 Among the caufes of ruptures, in children, may be 
 undoubtedly mentioned, the exertions which accom- 
 pany violent fcreamings and crying. This is a fact 
 which muft be fo well known, as to require to be 
 mentioned only, for the fake of reminding the fond 
 parent, that this complaint, which may continue 
 through life, is very likely to be one of the melancholy 
 confequences of that violence of temper which ex- 
 treme indulgence too often creates. But even without 
 considering the exertions juft mentioned as equal to 
 the effect of producing this malady,* the impediments 
 they will place in the way of a cure are fo considerable, 
 and {o obvious, as to demand but very little reflection 
 
 to 
 
MEDICAL ADMONITIONS. 4$^ 
 
 to convince the parent, that, in this cafe, no tempo- 
 rary gratification can atone to a child, for the pain 
 and inconvenience to which he is thus fubje&ed. 
 
 FRACTURED LIMBS. 
 
 When a child, who in temper and difpofition is 
 rather intractable, has the misfortune of fuffering 
 under this accident, the pain and inconveniences lie 
 will endure muft be confiderably greater than thofe 
 of a patient, in whom conformity to the injunctions 
 of the furgeon, and fubmillion to the Decenary con- 
 finement and reltraints can be obtained. In the one 
 cafe, nature proceeds uniformly and regularly to the 
 completion of that procefs, by which the bone is 
 united : the parts being fo retained by the art of the 
 furgeon, and the attention of the patient, that the 
 union is generally accompli (lied, without injury either 
 to the functions, or the appearance of the injured 
 limb. But, in the other cafe, where the injunctions 
 of the furgeon are not obeyed by the patient ; and 
 where, yielding to impatience, he is conflantly moving 
 the injured limb, nature is interrupted in her work, 
 and the utmoft care of the furgeon may be infuhicient 
 to prevent his patient from fullering from deformity 
 and lamenefs, through the remainder of his life. 
 
 FEVERS 
 
4oS. i MEDICAL ADMONITIONS. 
 
 FEVERS IN GENERAL. 
 
 In fever, and indeed, in every febrile complaint, 
 the want of iufficient influence over children to obtain 
 a compliance with neceflary regulations, may be con- 
 fidered as a circumftance likely to place them in a 
 fituation of great danger. 
 
 In the commencement of fever, when its fpeedy 
 cure, or its tedious protraction, will depend on the 
 almolr entire removal of external irritation, and on 
 obtaining a copious flow of perforation, the hopes of 
 the phyfician will be proportioned to the degree of 
 fubmiffion he difcovers in his patient, whofe continu- 
 ance in an irkfome and unpleafant fituation, for feveral 
 hours, mud often be required. If the body is not 
 kept flail, and the arms, and even, perhaps, the face, 
 are not kept underneath the bed-clothes ; and if 
 proper drinks are not taken freely, and of a due degree 
 of temperature, little chance will exifl of any benefit 
 being derived from the remedies employed. But in 
 thofe children, whom faulty indulgence has rendered 
 too irafcible, the neceflary fubmiffion is with difficulty, 
 if even at all obtained. As the heat and inconveni- 
 ences increafe, fo alfo will the agitations of the child 
 increafe : the body will be thrown from one fide of 
 the bed to the other, and the arms continually toiTed 
 out of the bed ; the head ach at the fame time being 
 
 augmented 
 
MEDICAL ADMONITIONS. 489 
 
 augmented by inceffant waitings, and the oppofition to 
 thofe injunctions to which he is not difpofed to fubmit, 
 
 As the difeafe proceeds in its progrefs, the difficulties 
 arifing from want of a due government of the child 
 will be found to increafe. Medicines, and thofe, of 
 neceffity, not very pleafant, fhould be taken ; drinks, 
 not exactly of that degree of temperature, nor quite 
 agreeable to the tafte of the patient, may be required 
 to be drank ; and oftener, perhaps, than he is inclin- 
 ed to. A quiet fubmiflion to all this might be too 
 much to expect in almoft any child ; and in a child 
 who has not been habituated to fubmit to the dictates 
 of its parents, his oppofition will, mod probably, be 
 fuch as to prevent the neceflary means from being 
 employed with the leaft probability of fuccefs. 
 
 INFLAMMATORY AFFECTIONS IN 
 GENERAL. 
 
 Indulgence in too high living, by taking too 
 freely of animal food, of highly fealoned dimes, and 
 of wine, frequently creates, in children, a difpofition 
 to difeafes of the inflammatory kind. 
 
 Were the operations of inftinct allowed to direct a 
 
 child in the choice of its food, this fpecies of excefs 
 
 would but rarely happen ; but unhappily parents, led 
 
 away by fanciful reafonings refpecting the food of their 
 
 O o o children., 
 
49<=> MEDICAL ADMONITIONS. 
 
 children, often vitiate their tafte, and overpower the" 
 impulfes of inftind, by intruding on them that kind 
 of diet which is oppofite to that which nature de- 
 mands. Frequently, thinking that a child cannot be 
 too highly nouriihed, will a fond mother be feen urg- 
 ing a fine, full, healthy child, to eat more meat, whilft 
 the child turns with difguft from the morfel which 
 is forced upon him. 
 
 In fuch a cafe, either the inftin&ive appetite of the 
 child will prevail, and his difrelim for animal food will 
 be increafed, by its being repeatedly forced upon him 3 
 or, in confequence of perfeveringly continuing to 
 oblige him to take animal feed, the flomach becomes 
 ib far accuftomed to the meal, that he, at laft, eagerly 
 craves, with a depraved appetite, for that food which 
 he before rejected. In this way may be brought on 
 the habit of taking animal food beyond the demands 
 of the fyftem, by which confidtrable danger will arife, 
 of fuch a difpofition to inflammation enfuing, as may 
 require only a very flight occafional caufe to produce 
 a dileafe, of a very alarming nature.* 
 
 THE 
 
 * It is proper to obferve here, that parents fometimes run 
 into an error of an oppofite kind ; but, perhaps, not lefs in- 
 jurious to their children. Alarmed by fome little appear- 
 ances of eruption or fcurfinefs of the fkin, they fufpeft fome 
 particular grolTnefs of the humours, and, with the hopes of 
 correcting this fiate, the child is flridly prohibited from 
 taking any animal food, butler, &c. fuch a regimen being 
 
 infifted, 
 
MEDICAL ADMONITIONS. 49 1 
 
 THE CROUP. 
 
 Without dwelling on the poflibility of this dread- 
 ful difeafe being actually produced, by the long con- 
 tinued and violent fcreamings, which children, who 
 have been much humoured, fometimes employ to 
 obtain thofe things of which they are defirous, or to 
 manifefl their diflike to thofe things they wifh to 
 avoid, it may be fufficient to remark, that this difeafe, 
 always formidable, will hardly ever yield where the 
 unhappy fufferer is of a petulent and froward difpo- 
 fition. 
 
 The frequent fcreamings by which children of this 
 defcription manifefl the diftrefs they endure, cannot 
 but increafe the inflammatory ftate of the windpipe ; 
 befides that the reflleflhefs, and frequent agitation of 
 the limbs, mufl entirely prevent that ftate of the fkin 
 from being produced, on which the cure will materi- 
 ally depend. i 
 
 INFLAMMATION OF THE LUNGS. 
 
 This inflammation of the lungs becomes, in fuch 
 fubje&s, a difeafe truly formidable. The poor little 
 
 fufterer, 
 
 infifted on, confiding of puddings made without eggs, dry 
 bread, milk thinned with water, &c. as cannot but increafe 
 that debility which already too much prevails. 
 
492. MEDICAL ADMONITIONS. 
 
 fufferer, to whom the patient endurance of even 
 trifling inconveniences has not yet been taught, will 
 mod probably, under the didrefsful fenfations accom- 
 panying this difeafe, employ exertions fo violent, as 
 may be likely to augment every alarming fymptom. 
 
 By fuch incefTant agitations, the heat of the blood 
 is increafed, the circulation is hurried on through the 
 inflamed lungs, the perfpiration is checked, and the 
 febrile date is neceflarily increafed. 
 
 PLEURISY, 
 
 The remarks jud made mud apply with dill more 
 force, in cafes of pleurify, the urgency of the pain 
 neceflarily occafioning, even in the mod patient, that 
 degree of agitation which mud confiderably counteract 
 the meafures employed to effect the cure. 
 
 INFLAMMATION OF THE STOMACH 
 AND BOWELS, 
 
 In this difeafe, where the agonies of the patient 
 are fo vehement, the mod patient fufferer will hardly 
 poffefs the power of reprefling his exertions, fo as to 
 give to the remedies employed thofe advantages which 
 are neceflfary for fecuring their effectual operation. 
 
 Much 
 
MEDICAL ADMONITIONS." 493 
 
 Much lefs mull it be expected then from thfrpoor 
 Child who has been permitted, and even taught to 
 difplay his refentment and anger upon every inciden- 
 tal infli&ion of pain. 
 
 Children who are unlimitedly gratified with every 
 thing they capricioufly demand, may alfo be reafona- 
 bly expected to be more prone than others to this dif- 
 eafe. The various articles of indigestible train, which 
 fuch children are conftantly taking into their ftomachs, 
 mull, by the irritation they occafion to the bowels, be 
 likely to produce this difeafe. 
 
 INFLAMMATION OF THE EYE, AND 
 EYE LIDS. 
 
 The termination of this difeafe, in children, will 
 frequently depend on the degree of docility with which 
 the little fufTerer is endued. When he is unhappily 
 of an untoward difpolition, a diflrefsful termination 
 may be apprehended. The inflamed eye, from which 
 every flimulus fhould be abltracted as carefully as 
 poffible, is by fretting kept continually fuffufed with 
 briny tears. To be convinced how much injury this 
 mull occalion, it is only neceffary to recollect, that 
 rednefs and tendernefs of the eyes and eyelids are ef- 
 fects which always fucceed to this mode of expreffing 
 diftrefs. Children who are not under due restraint, 
 
494 MEDICAL ADMONITIONS. 
 
 will alfo always confiderably aggravate the evils under 
 which they fuffer, by conflantly rubbing the inflamed 
 eyejwith their hands -, a practice which children of 
 this defcription generally have recourfe to, expecting 
 thereby to remove the pain and inconvenience they 
 fuffer. In addition to thefe circumftances it is to be 
 confidered, that in children of the defcription of 
 which we are fpeaking, the greateft difficulty exifts in 
 obtaining the employment of the neceffary means of 
 cure. Not only is the furgeon perhaps prevented, 
 from adminiflering proper internal remedies ; but he 
 is alfo moft certainly precluded, from having the ex^ 
 temai applications duly employed. 
 
 These are impediments to the cure of this malady, 
 in children of a violent and petulant temper, which 
 every furgeon muff, have had reafon lepeatedly to la- 
 ment. Indeed, I doubt not but that all thole who 
 have had the opportunities of obfervation, will concur 
 with me in thinking, that blindneis is, in thefe cafes, 
 not unfrequently the confequence of parents lofing, 
 by their mifmanagement the neceffary fway over the 
 minds of their children. 
 
 l 
 
 THE MALIGNANT, ULCERATED, 
 SORE THROAT. 
 
 Life mull frequently depend, in the malignant 
 ulcerated fore throat, on the degree of compliance and 
 
 manageablenefs 
 
MEDICAL ADMONITIONS. 495 
 
 manageablenefs which the little patient evinces during 
 its progrefs. Meafures are necefTary to be adopted 
 in thefe cafes which muft not only be difagreeable, 
 but which are productive of an increafe of fuffering, 
 for a time. Nutritious drinks, although occafioning, 
 by the mere action of fwallowing, confiderable pain, 
 muft be taken freely, or the ftrength of the child will 
 not be fufficiently fupported. Wine, which from its 
 fharpnefs muft occafion ftill more pain in being fwal- 
 lowed, muft alfo be occafionally employed. Prepara- 
 tions of bark and other medicines, not perhaps agreea- 
 ble to the palate, muft in moft cafes be required ; and 
 gargles, from the ufe of which fome inconvenience, 
 and even fome pain muft arife, will often be indifpen- 
 iibly necefTary. 
 
 But when the unhappy fubject of this difeafe has 
 been in the habit of permitting that only which ac- 
 cords with his inclination, and of obtaining an exact 
 fubmiffion to all his little caprices, little hopes can be 
 entertained, if the cafe be dangerous, of any real ad- 
 vantage from medical advice of even the higheft 
 eftimation ; fince in a child thus educated, no hopes 
 can be entertained, that fuch a compliance with the 
 prefcriptions will be obtained as will give a chance of 
 its recovery. 
 
 THE 
 
49^ MEDICAL ADMONITIONS! 
 
 THE HOOPING COUGH. 
 
 In the hooping cough, the paroxyfms are always 
 likely to be brought on by any pamonate exertions. 
 A confiderable difference is always to be perceived, in 
 the number of the paroxyfms in the fame child, on 
 thofe days in which but little has occurred to ruffle its 
 mind ; and on thofe days, when fome little oppofition 
 has been made to its inclinations. In thofe children, 
 whofe minds have been duly regulated, the little fuf- 
 ferer will be feen, when the fit is threatening, to retire 
 filently to any part of the room, and there patiently 
 wait the attack ; or, clinging to the knee cf its mother, 
 quietly endeavour fo to regulate its breathing, as its 
 hopes may defer, or moderate the violence of the ap- 
 proaching convulfion. On the other hand, the un- 
 fortunate darling, whofe indulgence has taught him a 
 leffon, which painful experience muft correct, that he 
 has a right to expect to meet with every thing accord- 
 ing to his wifhes ; and who, therefore, does not feel it 
 a duty to fubmit to that which is unpleafant with fomc 
 degree of refignation, not only brings on the paroxyfm, 
 by his petulance occafiooed by various other cauies ; 
 but difplealed, and even angered at feeling the fit 
 approach, his refiflance is of that violent and empaf- 
 fioned kind, as to occafion the attack of the difeafe to 
 come on, with increafed rapidity and violence. 
 
 DISEASES 
 
MEDICAL ADMONITIONS. 497 
 
 DISEASES OF THE SKIN, 
 
 Children are fubject to eruptive difeafes of vari- 
 ous parts of the body, the difcharge occafioned by 
 which is of fuch a nature, that being applied even to 
 the found fkin of the neighboring parts it will fooa 
 effect a morbid change in the veflels of tttofe parts, in 
 confequence of which they will fecrete a matter pof- 
 feffing firnilar powers, with that by which their difeaf- 
 ed action was produced. In thofe children therefore* 
 who are not under a certain degree of reflraint, the 
 irritation they experience in the fein occafions their 
 frequent application of the nails, both to the difeaf- 
 ed parts* and to the furrounding ikin ! the healthy 
 ikin is therefore abraded by the nails, imbued with this 
 morbid poifon, and the difeafe is hereby multiplied. 
 In thofe cafes where this difeafe occurs in the face, 
 the difFuiion of the exuding matter* by the frequent 
 rubbing with the child's hands, is frequently fucceed- 
 ed, in confequence of its application to the eye, by a 
 very fevere and alarming inflammation of this part, 
 which is with confiderable difficulty fubdued,. fince 
 every thing is done, on the part of the patient, which 
 is likely to encreafe and prolong the difeafe* 
 
 THE MEASLES. 
 
 A pronenefs to inflammation in the lungs, appears 
 
 to be almofl characteriftic of this difeafe : and on the 
 
 degree in which the inflammation of the lungs takes 
 
 P p p place, 
 
493 MEDICAL ADMONITIOSr-S." 
 
 place, will, in general, depend the degree of danger 
 which accompanies the mealies. In this difeafe, there- 
 fore, there can exift but little doubt, that a happy 
 termination, can only be reafonably expected, where a 
 moderate degree of conformity with the prefcribed 
 rules, and a due moderation of the temper, can be ob- 
 tained. 
 
 Where this is not the cafe confiderable danger rauft 
 arife. From thofe agitations and exertions which will 
 accompany impatient endurance, an increafe of the 
 difpofition to inflammation ; and even inflammatory 
 action will probably proceed : and when this does 
 take place, the difficulty of checking its progrefs rauft 
 be obvious. 
 
 THE SMALL POX. 
 
 The difeafe in which a want of fufficient influence 
 over the mind of a child is likely to occafion moft 
 fuffering to the patient, and diilrefs to its relatives and 
 attendants is the fmall pox. 
 
 As the quantity, and even, in fome meafure, the 
 degree of refinance of the fubfequent eruption will de- 
 pend on the violence of the eruptive fever, the greateft 
 care is necelTary that every thing be carefully avoided 
 in the firft moments of the difeafe, which by irritating, 
 may be likely injurioufly to augment the febrile ftate. 
 But thofe only who have witneffed it can be judges of 
 the difficulty with which this can be accompli fhed, in 
 a child of a froward and crofs difpofition. General 
 
 obfervation 
 
MEDICAL ADMONITIONS. 499 
 
 obfervation will, however, point out the fact, that 
 children of this defcripiion will, in confequence of 
 their impatience and violent agitations, be loaded 
 with the eruption to a much greater degree, than 
 thofe children whofe pliability of temper renders 
 them more eafily managable, 
 
 " Nor is it merely in the commencement of thedif- 
 eafe, that mifchief is liable to be produced by the 
 /allies of impatience and petulence ; fince through 
 the whole of the eruptive period, excefiive augment- 
 ation of the febrile heat will mofr. frequently be fol- 
 lowed by a fuperabundant crop of puftuies. 
 
 In the more advanced ftages of this loathfome dif- 
 eafe, the /cenes which the parent mufl witnefs will be 
 dreadfully cqnyincing, that exceffive indulgence of 
 children is generally productive of tenfold diftrefs and 
 iuffering. As the eruption proceeds, a troublefome 
 heat and itching of the fkin takes place ; and where 
 this is not borne with a tolerable lhare of patience, the 
 nails of the poor child are employ ed to overpower the 
 irritation of the fkin .j but with fo much vehemence, 
 that the fkin becomes more inflamed, being in parts 
 even abraded, by which the number of puftuies muft 
 of neceffity be confiderably multiplied. 
 
 But when the maturation of the pock takes place, 
 the mifchiefs proceeding from inability to reftrain the 
 impatience of the poor tormented child become too 
 
 t obvious 
 
£00 MEDICAL ADMONITIONS. 
 
 obvious. His little hands are conftantly employed 
 in rubbing the face, or fome part of the body, and 
 oftentimes with fo much violence as to cnum almoft 
 every puftule. The part which in general fuffers 
 mofl from this fpecies of injury, is the face, which 
 will frequently be mockingly lafcerated, and covered 
 with the blood, and the contents of the ruptured 
 puftules.* 
 
 INOCULATION. 
 
 The remarks which have been jufl; made, are alfo 
 applicable to thole children who derive the fmall pox 
 from inoculation ; fince ic too frequently happens 
 that many of the advantages deriveable from the pro- 
 eels of inoculation are counteracted, by the evils 
 
 which proceed from exceilive indulgence. 
 
 Children 
 
 * In thofe cafes in which fach nn event is to be apprehended, parents 
 mould confider that no reliance for its prevention can be placed on 
 the mofl vigilant attention of the nnrfe ; fince in a moment of time, 
 whilll her head is turned, the mifchief may be accomplifhed. The 
 child mould therefore, by an appropriate and eafy contrivance, have 
 its hands fo fee u red as to render their approach to the face impoffible. 
 Parents frequentl) object to this practice, on the fufpicion that by the 
 ftrugglh which the child will make to obtain a releafe hum his con- 
 finement, he will injure himfelf more than he would v\ere his hands 
 and arms left at liberty. But in almofl e»cry cafe where the hands 
 of a child are properly fecured, a dcy or two before the maturation 
 of the pock, he will indeed ftruggle lor a while ; but when he finds 
 his exertions ineffectual, and that he is as it were conquered, be of 
 neceffity yields to his confinement : and indeed it is often aflon'fhing 
 to fee how foon, and how quietly, children ci even violent difpofi* 
 tions fubra'it to this fpecies of coercion. 
 
MEDICAL ADMONITIONS. £OX 
 
 Children who have been faultily indulged, are un- 
 doubtedly the worfl fubje&s for inoculation that can 
 be found. During that period, in "which fome de- 
 gree of caution is neceffary, as to their food, it is 
 much to be feared, from the eager requifitions of the 
 child, and the habitual promptnefs of compliance on 
 the part of the parent, that a fufticiently Arid atten- 
 tion to the prefcribed regimen will not be paid. 
 When the very ferious evils which in general follow 
 fuch tranfgreffions are confidered, it is aftonifhing that 
 they are ever committed ; but it too frequently hap- 
 pens, that judgment is made to fubmit to the fug- 
 geftions of overweening fondnefs. A celebrated fur- 
 geon, fome years ago, inoculated two or three child- 
 ren of one family in the metropolis. Each child was 
 loaded with a confluent eruption, and, in fpite of 
 every exertion on his part, they all died. His 
 mortification may be eafily conceived to i*ave been 
 very great ; nor, perhaps was it much leffened upon 
 learning that, on the night preceding the fever, the 
 children were allowed to fit at the fupper table, and 
 partake freely of roaft fowl, wine, &c. &:c. 
 
 It feldom happens that during the period of erup- 
 tion the child is entirely free from fome degree cf in- 
 convenience and pain : fome times indeed, very acute 
 pain will be felt in the head, loins, or pit of the fto- 
 mach. When in confequence of this producing a, 
 ftrong degree of impatience, the child is incefiantly 
 
 crying 
 
£02, MEDICAL ADMONITIONS. 
 
 crying and rubbing his hands with violence over his 
 eyes, and indeed the whole of his face ; the eruption, 
 provoked by this irritation, will fly in considerable 
 quantity to the face, and particularly to the eyelids, 
 which from the friction, and the conftant application 
 of the briny tears, become generally afTe&ed with 
 fome flight degree of inflammation. 
 
 CASES REQUIRING CHIRURGICAL AID. 
 
 Children who have been thus imprudently edu- 
 cated, muft be more expofed to accidents than oth- 
 ers, in confequence of the little attention they gene- 
 rally pay to the directions and remonflrances of their 
 attendants ; but independent of this, cafes will ne« 
 ceflarily arife, in which chirurgical aid will become 
 jieceffary. 
 
 Thefe are cafes, which mud too painfully convince 
 the parent of the error of allowing parental influence 
 to be loft. Frequently from the unconquerable tem- 
 per of a child are his fufferings redoubled, and the 
 mind of the fond parent more cruelly tormented. 
 Ill applied tendernefs often allows the critical mo- 
 ment to pafs in which, by fome trifling opera- 
 tion, accompanied with a little temporary increafe of 
 pain, certain relief might have been obtained ; whilft 
 obftinate and violent refiitance entirely prevents the 
 performance of that, by which alone, perhaps, health 
 
 can 
 
MEDICAL ADMONITIONS. $Q$ 
 
 can be reftored ; or allows it only to fuch an extent 
 that the propofed intention is by no means fulfilled. 
 
 From what has been faid above, it is hoped that 
 parents will plainly perceive that the eafe, the health,, 
 and even the life of their children, mud frequently 
 depend on the due regulation of their paffions and 
 temper, in even their infantile days, — in other words,, 
 that the obtaining of fuch a degree of influence over 
 the mind of a child as may procure its prompt lub- 
 mimon to the will of its parents, either in yielding up 
 that which may be injurious, or in acceding to that 
 which, though not pleafant, may be abfolutely necef- 
 fary, will greatly contribute to the prefent, as well as. 
 the future comfort and tranquility, both of the par- 
 ent and the child. The fond parent cannot, even 
 with a little attention, avoid difcovering, that the 
 object of his affection will, when thus educated, be 
 the lefs likely to fall the victim of difeafe ; that 
 by having been rendered thus manageable, when difr 
 cafe does unavoidably occur, he will not deprive him- 
 felf of the chance of recovery, by obflinately oppofing 
 the efforts of art ; and that, (hould even a fatal ter- 
 mination take place, his mourning relatives will not 
 have to accufe themfelves with having occafioned his 
 death, by having, in fact, excited that oppofition 
 which the lamented object has made to every ration- 
 al endeavour for his recovery, 
 
 Other 
 
'£04 MEDICAL ADMONITIONS. 
 
 Other effects on the health are produced by excef- 
 five indulgence, which, though highly injurious, are 
 not (o obvious as thofe which have been already 
 part iculari fed. A conftant fretful nefs is generated, 
 which, even during the moments that it does not 
 actually break into expreflions of violence and paf- 
 fion, is conftantly torturing the mind and peace j the 
 digeftive powers become affected, the procefs of nu- 
 trition is impeded, and the child pines under a wafting 
 hectic. " Paffions," fays an elegant writer,* " arc 
 " quick and ftrong emotions, which by degrees fub- 
 " fide. Temper is the difpofition which remains 
 " after thefe emotions are paft, and which forms 
 " the habitual propenfity of the foul. The one are 
 "like the ftream when it is fwoln by the torrent, and 
 tc ruffled by the winds ; the other refembks it when 
 *' running within its bed, with its natural force and 
 " velocity. The influence of temper is more filent 
 " and imperceptible than that of pafiion ; it operates 
 " with left violence ; but as its operation is conftant, 
 " it produces effects no lefs confiderable." 
 
 * Dr. Elair. 
 
 FINIS. 
 
CONTENTS- 
 
 I 
 
 Page 
 
 NTRODUCTION •.**-— 3 
 
 Table of Symptoms — — , .i „., 7 
 
 Prefatory Obfervations ■ » 46 
 
 Fever, Defcription of •• • ■■ < > S 51 
 
 * Difficulty of making the neceffary Diftin&ions of 53 
 
 Intermittent Fevers or Agues, 
 
 Defcription of ■■ ~' . v ■ • ■ $6 
 
 Ambiguity, from firft Appearance of 58 
 
 — 1 from commencing in a continued form 59 
 
 from fuddenly changing to a continued Fever 60 
 
 Obfervations on the Ufe of Peruvian Bark 6 1 
 
 Remarks on popular Remedies — — 62 
 
 --■— Regimen and Prevention s-a 64 
 
 Inflammatory Fever, 
 
 Defcription of — — — - "■ "■ 66 
 
 Danger of being milled by the firft Symptoms 67 
 Neceflity of ftri<3 Attention to the Orders of thePhyfician 68 
 
 Slow Nervous Fever, 
 
 Defcription of ■ ■> ■ " 70 
 
 Infidious Mode of Attack ■> > 7 1 
 
 Perfeverance in the Endeavours for a Cure enjoined, 
 
 as long as Life remains 7 6 
 
 Obfervation of Dr. Buchan, Remarks on 77 
 
 Putrid Malignant Fever, 
 
 Defcription of ■ ; « 78 
 
 Danger of Error in Domeflic Practitioners 80 
 
 Q^qj*. Mifchiefs 
 
506 CONTENTS. 
 
 Page 
 Mifchiefs arihng from Bleeding, James's Powders, heat- 
 ing Regimen, &c. 82 
 
 Regimen and Management of the Patient, 83 
 
 Cautions refpefting the Ufe of Wine 87 
 
 Neceffity of ventilating the Bed- Room 89 
 
 Directions for the Management of the Patient, whilft 
 
 delirious — — 90 
 
 Quotation from Dr. Blane on this Subject 91 
 
 The Patient not to be abandoned, on the Appearance 
 
 of thofe Symptoms ufually denoting fpeedy Death 93 
 •Seeming Incapability of Swallowing accounted for, and 
 the pioper Mode of adminiftering Nourifiimcnt 
 
 pointed out — — 94 
 
 Alarm unneceflarily excited by that which is termed 
 
 The Rattles 95 
 
 Prevention ■■ ■ ■ ■ 97 
 
 Obfervations on Effluvia -■ - -- ~ 98 
 
 Remarks on a Quotation from Dr. Gregory, adopted 
 by Dr. Buchan, — — — — 99 
 
 Cold favourable to Infection icJo 
 
 Fumigation of Apartments 101 
 
 Mode of employing the nitrous, marine, and acetous 
 Acid, as recommended by Dr. J. C. Smyth and 
 Mr. W. Blizard 101 
 
 Danger of Infection from foul Clothing 102 
 
 Cautions neceffary on the Return of Appetite, and on 
 
 the Expofure to cold Air 
 
 Mode to be adopted on the fir ft Appearances of In- 
 fection 
 
 Vital or Oxygenated Air, Benefit from 104 
 
 Study of Chemiftry recommended — ic>4 
 
 Infants not fo liable to Fever as Adults 105 
 
 Remitting- 
 
 103 
 103 
 
CONTENTS. 507 
 
 Remitting Fever, 
 
 Defcription of » ' ■■■■ 
 
 Neceffity of early attention t.o . ~~— rr- 
 
 Page 
 
 ; 106 
 - 708 
 
 Hectic Fever, 
 
 
 Defcription of 
 
 Importance and Neceffity of d:te<Sting ks Gaufa 
 
 109 
 110 
 
 Inflammation, 
 
 Defcription of ■ m 
 
 Care necefTary in felecling the Means of Cure, and in 
 eftimating the Degree to which they fhould be em- 
 ployed 113 
 Particularly in different Stages of the Difeafe, and 
 whilft the Difeafe is gliding from one Stage to 
 another 11 $ 
 Prevention -— — 122 
 Avoiding the too fudden Tranfition to an Atmof- 
 phere differing much in its Degree of Temperature, 
 from that to which a Perfon has juft been expofed 124 
 Danger of ufing fpirituous and heating Drinks, .ei- 
 ther before, pr after Expofure to extreme Cold 1 25 
 Proper Mode of Conduct fhewn 126 
 Maxim — In every cafe in which pain occurs with 
 fever, to obtain immediately the beft advice 127 
 
 Inflammation of the Brain, 
 
 Defcription of *•?<-*- 129 
 
 Inflammation of the Eye, 
 
 Defcription of ■ . 1 3 1 
 
 Confequences of Neglect 132 
 
 Blindnefs may be produced in a few Hours, if proper 
 
 Means are not adopted — — 133 
 
 Children, newly born, frequently blinded through im- 
 proper Treatment or Inattention 136 
 
 Th* 
 
508 CONTENTS. 
 
 Page 
 The Inflammatory Sore Throat, 
 
 Defcription of 138 
 
 Only to be removed by proper Means, employed in 
 
 the early Stages of the Difeafe 139 
 
 Danger of Error in Domeftic Practitioners 140 
 
 Neceffity of frequently lubricating the Fauces 143 
 
 The Putrid or Malignant Ulcerated Sore Throat, 
 
 Defcription of 145 
 
 Danger of Interference with Domeftic Medicine 146 
 
 Regimen, and Rules for the Management of the 
 
 Patient -— — 147 
 
 Neceffity of Refolution and Perfeverance in the Treat- 
 ment of Children 148 
 
 The Croup, 
 
 Defcription of 149 
 
 Abfolute Neceffity of immediate Aid 152 
 
 Dr. Ferriar's Remarks on this Difeafe 153 
 
 Utility of anatomical Examinations of thofe who fall 
 
 Victims to ambiguous Difeafes 154 
 
 Remarks on the Objections to this Practice 155 
 
 Prevention of the Difeafe 156 
 
 Expofure of Children to extreme Cold highly dan- 
 gerous 157 
 
 Erroneous Calculations made on the Appearances of 
 
 Cottage Children 159 
 
 Two cafes mentioned, where the Difeafe feemed to be 
 caufed by violent fcreaming and holloing 160 
 
 The Mumps, 
 
 Defcription of 161 
 
 Fatal Termination of 16* 
 
 Danger of Domeftic Practice, even in a Difeafe appar- 
 ently trifling ■—■ — I0 "» 
 
 Inflammation 
 
CONTENTS. 509 
 
 Page 
 
 Inflammation of the Ear., 
 
 Defcription and Treatment of » ■* .. . 1 — 162 
 
 Tooth Ach — ! 163 
 
 Errors in Domeftic Practice, from confidering Tooth -ach 
 
 as a Term expreflive of one particular Difeafe 1 64 
 
 Tooth- Jch, the Symptom of various Difeafes of the 
 
 Teeth, requiring different Modes of Treatment 165 
 
 Impropriety in the ordinary Domeftic Praclice, and in 
 
 the immediate Extraction of the Tooth — 166 
 
 More rational Mode propefed 166 
 
 Teething ■ 167 
 
 NeceiTary Cautions during Dentition — — 167 
 
 Lancing the Gums, the Neceffity of pointed out 1 68 
 
 Tooth Necklaces a cruel Impofition 170 
 
 Remarks on Dr. Buchan's Opinion of the Inutility of 
 
 this Operation — — ■ 171 
 
 Objections to the Modes of performing it recom- 
 mended by Dr. Buchaa — — — • 172 
 
 Sorenefs behind the Ears, the Treatment of — 173 
 
 Inflammation of the Lungs 174 
 
 Symptoms of 175 
 
 111 Confequences arifing from an Oppofition to the 
 
 Prefcriptions of the Phyfician 1 79 
 
 Dr. Duplanil's Remarks on Dr. Buchan's Advice in 
 
 this Difeafe 181 
 
 Infidious Nature of the Difeafe ; fometimes highly dan- 
 gerous without caufing Alarm 182 
 
 When the Breathing is altered in Quicknefs, a morbid 
 State of the Lungs may be fufpecled — 183 
 
 Inflammation of the Lungs in Children, 
 
 Defcribed _~ — a*i** 184 
 
 The 
 
5I<5 CONTENTS. 
 
 Page 
 The Attention of Parents called to this Difeafe 1 85 
 
 Alarming Symptoms, and the proper Mode of Con- 
 
 duft pointed out 186 
 
 Dire&ions for the Ufe of the Warm Bath — 1 86 
 Cautions refpecting the Mode of applying Blifters 187 
 111 Confluences of deferring the Application to Med- 
 ical Men until Evening — 1 187 
 
 Pulmonary Consumption, 
 
 Characteri flics defcrihsd — — 189 
 
 Regimen and Diet 191 
 
 Remarks on Dr. Euchan's Advice as to leaving off 
 
 Animal Food and ftrong Liquors 194 
 
 > Dr. Cadogan's Opinion on the fame 
 
 Subject - ■■■■ - . ■ 195 
 
 Obfervations on the various Modes of Exercife 198 
 
 Atmofpheric Air, compofed of oxygen and azotie Air— 
 
 their fuppofed medicinal Powers explained 201 
 
 Clothing, Remarks en • — — - 204 
 
 Inflammation of the Stomach, 
 
 Defciibed 205 
 
 Important Remark of Dr. Crichtojj , 206 
 
 Danger from the adoption of Domeftk Medicine 208 
 Regimen, Diet, and Prevention 208 
 
 Fatal Confequences of the Mifemployment of fpirituous 
 
 and aromatic Drinks 208 
 
 Probability of Family Practitioners being mifled by the 
 
 Vomiting -r-»— 209 
 
 Inflammation of ths Bowels, 
 
 Defcribed —- — 2 1 1 
 
 Danger of mi (taking it for Colickly Pains — 213 
 
 Symptoms of Recovery and of Danger 2 1 g 
 
 Dr. Duplanil's Remarks on Dr. Buchan's Opinion 214 
 
 Inflammation 1 
 
CONTENTS* 512 
 
 Page 
 
 INFLAMMATION OF THE LlVEE, 
 
 Symptoms of — — 216 
 
 Difficulty of detecting by a Domeftic Practitioner 219 
 Admonitions to the Intemperate 220 
 
 Inflammation of the Kidney, defcribed 222 
 
 Inflammation of the Bladber *— i 225 
 
 Symptoms of 226 
 
 111 Confequences arifmg from Delay 226 
 
 Inflammation of the Spleen ,»—_»__= ft2 8 
 
 Inflammation of the Peritoneum — 228 
 
 May occur without exciting necenary Alarm in Do- 
 meftic Practitioners — -— 238 
 
 Remark of Dr. Baillie - — 228 
 
 Rheumatism — - — ^ — 229 
 
 Gout, - — ** — — 234 
 
 Advantages derivable from the Attendance of a Phy- 
 fician in this Difeafe ----- — --- 239 
 
 Obfervations on Regimen and Diet - 2-4.0 
 
 Opinion of Mr. Forbes on the Nature of Gout — 243 
 
 Small Pox, — =— — — - — — 
 
 Defcribed -■>—* — — 245 
 
 Neceffity of real medical Knowledge in treating this 
 Difeafe 250 
 
 Numerous ridiculous Prejudices noticed 251 
 
 Advantage of Attention to Regimen and Cleanlinefs 252 
 
 Symptoms of Danger 254 
 
 Danger of Blindnefs— Conduct neceffary to be adopted 255 
 Opening the Puftules recommended by Dr. Buchan 256 
 Remarks on this Practice by Dr. Sims — — 257 
 
 Ill-founded Confidence of Exemption from Danger of 
 Infection- ........ ....... 2 58 
 
 I N O e V L A T i.O K 
 
511 CONTENTS. 
 
 Page 
 Inoculation > — -•**- 259 
 
 Objections to it anfwered - 259 
 
 Confequences of its being performed by Nurfes and 
 
 Parents 262 
 
 Obfervations on the Mode recommended by Dr. 
 
 Buchan 264 
 
 Remarks of Mr. Daniel Sutton 265 
 
 Chicken or Swine Pox, 
 
 Defcribed 266 
 
 Neceflky of afcertaining the real Nature of the Erup- 
 tion 267 
 
 Marks by which it is diftinguifhable from Small Pox 267 
 
 Measles — — 268 
 
 Precarious Practice of Domeflie Medicine not to be 
 
 trufted to in this Difeafe 269 
 
 Inflammation of the Lungs—Danger from it— Diffi- 
 culty of Detection 271 
 
 Undeferved Cenfure of Phyficians, whence arifing 272 
 
 Scarlet Fever, 
 
 Defcribed — 275 
 
 Necefiky of a nice Difcrimination in determining 
 the real Nature of the Difeafe ■ 276 
 
 Erysipelas, 
 
 Defcribed 277 
 
 Proper Treatment of flight Cafes 278 
 
 More ferious Cnfes demand confiderable Judgement 280 
 Mifchiefs arifing from the Employment of Goulard's 
 Vegito Mineral Water — - ■ 282 
 
 Erysipelas of Children 
 
 The Attention of Parents called to the firft Appear- 
 ances of this Difeafe ' 283 
 
 Miliary 
 
CONTENTS. 513 
 
 Page 
 
 Miliary Fever, Obfervations on ■ 284. 
 
 Hemorrhages, From Internal Caufes ■ ■ " ■ 288 
 
 Dependent on numerous Caufes 289 
 
 Dr. Cullen's Reafons for preventing the Recurrence 
 
 of Hemorrhage ■ - 292 
 
 Bleeding from the Nose 295 
 
 Danger, by permitting its frequent Recurrence, of pro- 
 ducing Confumption ■ 297 
 The niceft Judgement neceiTary in moft Cafes when it 
 
 happens ■ — 298 
 
 Remarks on Dr.^Buchan's Recommendation of Liga- 
 tures ©n the Limbs • 301 
 
 Spitting of Blood — — — «—- 302 
 
 Neceflity of diftinguifhing from what Part the Blood 
 proceeds ■ 303 
 
 Degree of Danger pointed out 303 
 
 The Treatment of this Difeafe in no inftance to be 
 trufted to Domeftic Quackery 305 
 
 Diet, Prevention, &c. - — 305 
 
 Hamorrhoids, or Piles, 
 
 Defcription of -■ .. ■ 306 
 
 Symptoms pointing out their probable Termination 
 
 in Abfcefs and Fiftula 307 
 
 Neceflity of Regulation in the Mode of Living 308 
 
 111 Confequences of allowing their Progrefs, and of not 
 
 preventing their Return 3°9 
 
 Erroneous Opinions refpe&ing their beneficial Effecls 
 
 on the Syftem — > 309 
 
 Fiftulae frequently produced by negle&ed Piles 3 1 1 
 
 Immoberate Flow of the Menses 318 
 
 Immediate Danger and future ill Confequences fiiewn 3 1 3 
 
 Sometimes the Symptom of fome other Difeafe 315 
 
 R r r Vomiting 
 
cl± CONTENTS. 
 
 54 Page 
 
 Vomiting ot Blood — — 316 
 
 Voiding of Blood from the Urinary Passages 317 
 
 CaTAPvRH, 
 
 Symptoms of ■ 3 l8 
 
 Dinger arifing from Neglect, or Improper Treatment 319 
 Proper Mode of 1'reatment pointed out 320 
 
 Danger of producing Inflammation of the Lungs 
 
 and Confumption 3 21 
 
 A Common flight Cold, a frequent Caufe of Confumption 321 
 111 Confequences from attending to the Cough only 322 
 Cough Dropr, Elixirs, and other Nojlrums 324 
 
 Too fudden Changes of the Atmofphere 325 
 
 Clothing, in general too light, and irregularly difpofed 326 
 Folly of expofmg Children too much to exceffive Cold 327 
 Flannel and Fleecy Hofiery, Directions refpecling 327 
 Rules for preventing Catarrh 328 
 
 111 Confequences of receiving Company in cold and 
 damp Rooms • 3 2 9 
 
 Convulsive Asthma — — 330 
 
 Excellent Remarks on by Dr. Bree 33° 
 
 Diet, Obfervations on ■ 33 2 
 
 Effects of the Atmofphere, Cold, Eaft and North- 
 
 Eaft Winds, Storms, &c on the Afthmatic 333 
 
 Treatment neceffary during the Fit 335 
 
 Emetics and Bleedings, Obfervations on 337 
 
 Blifters and Warm Bathing 33 8 
 
 Smoke of Tobacco, its Effects 339 
 
 Rules for the Prevention of this Difeafe 34* 
 
 Hooping Cough — 34 2 
 
 Obfervations on the Noftrums recommended in this 
 
 Diforder ' — 34* 
 
 Change of Air, beneficial EfFefts 345 
 
 Principles 
 
CONTENTS. 515 
 Page 
 
 Principles fuggefted, on which this Change may be 
 
 made ■ 346 
 
 Dysentery, or Bloopy Flux —__ — « g^g 
 
 Symptoms of Recovery, or of Danger 549 
 
 Danger from permitting its too long Continuance 350 
 
 Mode of Cure contrary to common Opinion 351 
 
 Treatment of the Patient, 352 
 
 Apoplexy ■ *w- 352 
 
 Conduct to be adopted in the firft Moments of Attack 355 
 Bleeding and Blifters, Obfervations on 357 
 
 Peculiarity of Make fuppofed to predifpofe to this 
 
 Difeafe • - • 359 
 
 Mode of preventing the Difeafe 360 
 
 Sleeping after a full Meal, in a Chair, Remarks on 361 
 Apoplectic Fits occur during Bed-time from horizon- 
 tal Poflure — — — * 363 
 Apoplexy too often the Lot of the retired Citizen 364 
 Deception as to the quantity of Exercife employed 365 
 
 Palsy — . 366 
 
 Symptoms and Caufes enumerated . 367 
 
 Electricity, Obfervations on its Effects 369 
 
 Fainting ■ 371 
 
 Mode of Treatment - - 372 
 
 Obfervations on the Mode of applying pungent O- 
 dours to the Noftrils 373 
 
 Apparent Death, - ■ 375 
 
 From long Fading, Treatment of 375 
 
 From Expofure to extreme Cold >— 375 
 
 Refufcitative Procefs —— - 377 
 
 In 
 
$l6 CONTENTS. 
 
 Page 
 
 In Cafes of Sufpenfion by the Cord 37g 
 
 ■ Suffocation by Noxious Vapours 
 
 1 ■ — Intoxication . 
 
 379 
 379 
 
 380 
 
 Convulsions 
 
 Numerous Caufes of ., ^8o 
 
 Conduct to be adopted on the fir ft Attack 381 
 
 Convulfions in Children, Remarks on 382 
 
 Remarks »n the Opinion of the Inutility of Phyficians 
 in Difeafes of Children 383 
 
 Epilepsy, or Falling Sickness 385 
 
 Treatment during the Fit 386 
 
 Worms, Symptoms of — -■ 387 
 
 Ambiguity of the Appearances fuppofed to denote 
 
 their Prefence 388 
 
 Mifchiefs arifing from Error 388 
 
 Danger of having recourfe to advertifed Noftrums 388 
 
 Weakness of the Stomach 389 
 
 Symptoms and Caufes of enumerated 390 
 
 Spirituous Liquors, injurious Effects of 391 
 
 Remonltrances of Phyficians but too little attended to 391 
 Conduct proper to be adopted 395 
 
 Hypochondriac Affection, 
 
 Defcribed 397 
 
 Attention required from the Friends of the Patient 398 
 Confiderable Exertions demanded of the Patient himfelf 398 
 Cruelty of treating the Hypochondriac as a Subject of 
 Raillery and Reproof 399 
 
 Colic 
 
 Colic Tinctures and Elixirs, Remarks on 400 
 
 Danger of miftaking Symptoms of Strangulated Rup- 
 ture and of Inflammation of the Bowels for thofe 
 of Colic ■ 4 01 
 
 Difficulty 
 
CONTENTS. 515? 
 
 Page 
 
 Difficulty of making the neceiTary Diftin&ion 402 
 
 Mode to be adopted when regular Aid is not to be 
 obtained — — — — -— =- 402 
 
 Ruptures, or Hernia 
 
 Defcribed - — — - 403 
 
 Their Increafe dependent on the Will and Refolution 
 
 of the Patient > 404 
 
 May be conftantly retained 404 
 
 TruiTes, Remarks on ■ ■ ■« 405 
 
 Strangulated Rupture — — 407 
 
 Life depends on immediate Reduction 407 
 
 Danger of Exertion improperly made, and of wafting 
 
 a Moment in domeftic Quackery 408 
 
 Operation thereby rendered neceffary 409 
 
 The operation much lefs painful than is generally 
 
 imagined, and in itfelf void of Danger 410 
 
 Duty of a Surgeon in this Cafe 410 
 
 Rupture at the Navel ,^____„ 411 
 
 Neceffity of early and conftant Attention 411 
 
 Mode of treatment — — — — 413 
 
 Ulceration of the Navel in Children 412 
 
 Demanding the utmoft Care 412 
 
 Cholera, Defcribed — — ■> 413 
 
 Treatment of flight Cafes — — - 4 1 3 
 Cautions refpe&ing violent Attacks in very young 
 
 or old Perfons 414 
 
 Diarrhoea, or Looseness 
 
 General Mode of Treatment, Remarks on 414 
 
 Diabetes, 
 
 Attention called to its firft Appearances 416 
 
 Succefsfully treated — — 4 I<5 
 
 Hysterical 
 
51S CONTENTS. 
 
 Hysterical Affections 
 
 Danger of having recourfe to violent forcing Nof- 
 
 trums, as Deo'oftruents a\j 
 
 Indolence often unjuftly imputed to the Subjects of 
 
 this Difeafe 417 
 
 Dropsy 
 
 Obfervations on the Employment of Noftrums in this 
 Difeafe 418 
 
 Hydrocephalus, or Watery Head, 
 
 Symptoms defcribed — 419 
 
 Caufes enumerated 42 1 
 
 Cautions refpecting the Correction of Children 42 r 
 
 Danger from Blows on the Head 422 
 
 Mode of Defence in Cafes of Falls fuggefted 423 
 
 The Bitb of an Hydrophobic Animal, 
 
 Neceflity of immediate Excifion pointed out, and 
 Directions refpe&ing it 423 
 
 Scald Head, 
 
 Defcribed ■ .„ 424 
 
 Early affiftancc neeefTary — — - — 425 
 
 111 Confequences of Neglect 426 
 
 Scrofulous Swellings in the Neck produced by it 427 
 
 Thrush, in Children, generally proceeding from impro- 
 per Diet ' 427 
 
 Dry-nurfing the moil frequent Caufe 428 
 
 Cautions refpecting the violent rubbing affected Parts 429 
 
 Swallowing of pins, &c. 
 
 Proper Mode of Conduct to be adopted 43 c 
 
 Boil, often improperly treated, and the Conftitution 
 
 thereby injured — — 434 
 
 Anthrax 
 
CONTENTS. 519 
 
 Page 
 Anthrax, or Carbuncle, 
 
 Defcribed — *— 434- 
 
 Danger of miftaking for a common Boil — - 434 
 Importance of the early Adoption of efficacious Means 434 
 
 Inflammation and Abscess of the Breast ■ ■ 435 
 
 Cure may be much accelerated by furgtcal Aid — 
 
 Hardnefs fometimes produced refembling Schirrhus 436 
 
 Chilblains, 
 
 Treatment of propofed, Prevention, Sec. — — 438 
 
 Whitlow, 
 
 Danger from — — . 440 
 
 Neceflity of immediate Application to the fkilful Sur- 
 geon — — 44 2 
 
 Schirrhus and Cancer, 
 
 Defcribed ■< — — 443 
 
 Early Removal earneftly recommended 444 
 
 Repugnance to the Operation not merely from the 
 
 Fear of Pain 444 
 
 Coafiderations fuggefted as likely to diminifh the dread 
 
 of the Operation — — 444 
 
 Cancer Cureri, pretended, Injuries they occafion — 
 
 Remarks on the Cafes, ©n which their Fame is built 445 
 
 Scalds and Burns, 
 
 Applications recommended to be kept in Readinefs 449 
 Linfeed Oil, improper — — — •■ .. 450 
 
 Meafures fuggefted for Adoption, by Females, whofe 
 Clothes have by Accident taken Fire — — 450 
 
 Effusions of Blood from ruptured or wounded 
 
 Vessels — — — ■ 452 
 
 Situation of the large VefTels, &c. defcribed by Mr. 
 
 Blizard — — 453 
 
 Meafures 
 
/*v. 
 
 
 520 TENTS. 
 
 
 ■ r 7-7 J r, 
 
 Meafures to be adopted m Cafes of Accidents of this 
 
 Nature . 
 
 454 
 
 Bleeding ■ 457 
 
 Wafte of Blood from the Orifice opening afrefh 458 
 
 Directions for its Prevention 4.58 
 
 Leeches 
 
 Directions for their Application and Management 459 
 
 Curvature of the Spine 
 
 Neceffity of abfolute Reft 461- 
 
 Inflammation of the Hip and Knee Joint 
 
 Caution refpecling Attention to the earlieft Symptoms 461: 
 Reft enjoined 462 
 
 Fractures of the Limbs, and Injuries of the Head 
 from External Injuries. 462 
 
 Treatment at the firft Moments of the Accident 463; 
 
 Directions lefpe&ing the Removal of the Patient 464 
 
 Obfervations on the improper indulgence of Children 465 
 
 P*K 
 
022 169 843 5