Domestic Medicine - Chapters 15-20



CHAPTER XV.
OF AN ACUTE CONTINUAL FEVER.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

IF the patient be afflicted with reaching, or an inclination to vomit, it 
will be right to assist Nature's attempts, by giving him weak camomile-
tea, or luke-warm water to drink.

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

IF about the 10th, 11th, or 12th day, the pulse becomes more soft, the 
tongue moister, and the urine begins to let fall a reddish settlement, 
there is reason to expect a favourable issue to the disease. But if, 
instead of these symptoms, the patient's spirits grow languid; his pulse 
sinks, and his breathing becomes difficult; with a stupor, trembling of 
the nerves, starting of the tendons, &c. there is reason to fear that the 
consequences will be fatal. In this case blistering plasters must be 
applied to the head, ancles, inside of the legs or thighs, as there may be 
occasion; poultices of wheat-bread, mustard, and vinegar may likewise be 
applied to the soles of the feet, and the patient must be supported with 
cordials, as strong wine-whey, negus, sago-gruel with wine in it, and such 
like.

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

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

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

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



CHAPTER XVI.
OF THE PLEURISY.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


Of the BASTARD PLEURISY.

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

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


Of the PARAPHRENITIS.

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

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

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



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

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

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

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

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

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

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

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

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

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

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

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

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

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



CHAPTER XVIII.
OF CONSUMPTIONS.

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

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

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

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

CAUSES. - It has already been observed, that an inflammation of the breast 
often ends in an posthume: Consequently whatever disposes people to this 
disease, must likewise be considered as a cause of consumptions.

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

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

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

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

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

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

--INJURIES done to the lungs, calculi, &c. I lately saw an instance of a 
confirmed phthisis occasioned by a small bone sticking in the bronchae. It 
was afterwards vomited along with a considerable quantity of purulent 
matter, and the patient, by a proper regimen, and the use of the Peruvian 
bark, recovered.

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

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

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

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

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

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

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

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

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

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

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

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

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

THOSE who have strength and courage to undertake a pretty long voyage, may 
expect great advantage from it. This, to my knowledge, has frequently 
cured a consumption after the patient was, to all appearance, in the last 
stage of that disease, and where medicine had proved ineffectual. Hence it 
is reasonable to conclude, that if a voyage were undertaken in due time, 
it would seldom fail to perform a cure. Two things chiefly operate to 
prevent the benefits which would arise from sailing. The one is, that 
physicians seldom order it till the disease is too far advanced; and the 
other is, that they seldom order a voyage of a sufficient length. A 
patient may receive no benefit by crossing the Channel, who, should he 
cross the Atlantic, might be completely cured. Indeed we have reason to 
believe, that a voyage of this kind, if taken in due time, would seldom 
fail to cure a consumption.

SUCH as try this method of cure ought to carry as much fresh provisions 
along with them as will serve for the whole time they are at sea. As milk 
is not easily obtained in this situation, they ought to live upon fruits, 
and the broth of chickens, or rather young animals which can be kept alive 
on board. It is scarce necessary to add, that such voyages should be 
undertaken, if possible, in the mildest season, and that they ought to be 
towards a warmer climate. Though I do not remember to have seen one 
instance of a confirmed consumption of the lungs cured by medicine, yet I 
have known a West-India voyage work wonders in that dreadful disorder.

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

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

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

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

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

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

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

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

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

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

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

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

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

IF the patient's strength and spirits flag, he must be supported by strong 
broths, jellies, and such like. Some recommend shell-fish in this 
disorder, and with some reason, as they are nourishing and restorative. I 
have often known persons of a consumptive habit, where the symptoms were 
not violent, reap great benefit from the use of oysters. They generally 
eat them raw, and drank the juice along with them. All the food and drink 
ought however to be taken in small quantities, lest an overcharge of fresh 
chyle should oppress the lungs, and too much accelerate the circulation of 
the blood.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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



CHAPTER XIX.
OF THE SLOW OR NERVOUS FEVER.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

SHOULD a violent looseness come on, it may be checked by small quantities 
of Venice treacle, or giving the patient for his ordinary drink the white 
decoction. See Appendix, White Decoction.

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

THOUGH blistering and the use of cordial liquors are the chief things to 
be depended on in this kind of fever; yet, for those who may chuse to use 
them, we shall mention one or two of the forms of medicine which are 
commonly prescribed in it. When the patient is low, ten grains of 
Virginian snake-root, and the same quantity of contrayerva-root, with five 
grains of Russian castor, all in fine powder, may be made into a bolus 
with a little of the cordial confection, or syrup of saffron. One of these 
may be taken every four or five hours. The following powder may be used 
with the same intention. Take wild Valerian-root in powder one scruple, 
saffron and castor each four grains. Mix these by rubbing them together in 
a mortar, and give one in a cup of wine-whey three or four times a-day.

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

IF the fever should happen to intermit, which it frequently does towards 
the decline, or if the patient's strength should be wasted with 
colliquative, sweats, &c. it will be necessary to give him the Peruvian 
bark. Half a drachm, or a whole drachm, if the stomach will bear it, of 
the bark in fine powder, may be given four or five times a-day, in a glass 
of red port or claret. Should the bark in substance not sit easy on the 
stomach, an ounce of it in powder may be infused in a bottle of Lisbon or 
Rhenish wine, for two or three days, afterwards it may be strained, and a 
glass of it taken frequently. The bark may likewise be very properly 
administered, along with other cordials, in the following manner: Take an 
ounce of Peruvian bark, orange-peel half an ounce, Virginian snake-root, 
two drachms, saffron one drachm. Let all of them be powdered, and infused 
in an English pint of the best brandy for three or four days. Afterwards 
the liquor may be strained, and two teaspoon-fuls of it given three or 
four times a-day in a glass of small wine or negus.

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



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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

THE most favourable symptoms are a gentle looseness after the fourth or 
fifth day, with a warm mild sweat. These, when continued for a 
considerable time, often carry off the fever, and should never be 
imprudently stopped. Small miliary pustules appearing between the 
petechiae, or purple spots, are likewise favourable, as also hot scabby 
eruptions about the mouth and nose. It is a good sign when the pulse rises 
upon the use of wine, or other cordials, and the nervous symptoms abate; 
deafness coming on towards decline of the fever, is likewise often a 
favourable symptom, as are abscesses in the groin, or parotid glands. 
Deafness is not always a favourable symptom in this disease. Perhaps it is 
only so when occasioned by abscesses formed within the ears.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

FOR preventing putrid fevers we would recommend a strict regard to 
cleanliness; a dry situation; sufficient exercise in the open air; 
wholesome food, and a moderate use of generous liquors. Infection ought 
above all things to be avoided. No constitution is proof against it. I 
have known persons seized with a putrid fever, by only making a single 
visit to a patient in it; others have caught it by lodging for one night 
in a town where it prevailed: and some by attending the funerals of such 
as died of it. The late Sir John Pringle expressed a concern lest these 
cautions should prevent people from attending their friends or relations 
when afflicted with putrid fevers. I told him I meant only to discourage 
unnecessary attendance, and mentioned a number of instances where putrid 
fevers had proved fatal to persons, who were rather hurtful than 
beneficial to the sick. This sagacious physician agreed with me, in 
thinking that a good doctor and a careful nurse were the only necessary 
attendants; and that all others not only endangered themselves, but, 
generally, by their solicitude and ill-directed care, hurt the sick.

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

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

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

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

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