Domestic Medicine - Chapters 35-40



CHAPTER XXXV.
OF WORMS.

THESE are chiefly of three kinds, viz. the taenia or tape-worm; the teres, 
or round and long worm; and the ascarides, or round and short worm. There 
are many other kinds of worms found in the human body; but as they proceed 
in a great measure from similar causes, have nearly the same symptoms, and 
require almost the same method of treatment, as these already mentioned, 
we shall not spend time in enumerating them.

THE tape-worm is white, very long, and full of joints. It is generally 
bred either in the stomach or small intestines. The round and long worm is 
likewise bred in the small guts, and sometimes in the stomach. The round 
and short worms commonly lodge in the rectum, or what is called the end 
gut, and occasion a disagreeable itching about the seat.

THE long round worms occasion squeamishness, vomiting, a disagreeable 
breath, gripes, looseness, swelling of the belly, swoonings, loathing of 
food, and at other times a voracious appetite, a dry cough, convulsions, 
epileptic fits, and sometimes a privation of speech. These worms have been 
known to perforate the intestines, and get into the cavity of the belly. 
The effects of the tape-worm are nearly the same with those of the long 
and round, but rather more violent.

ANDRY says the following symptoms particularly attend the solium, which is 
a species of the tape-worm, viz. swoonings, privation of speech, and a 
voracious appetite. The round worms called ascarides, besides an itching 
of the anus, cause swoonings and tenesmus, or an inclination to go to 
stool.

CAUSES. - Worms may proceed from various causes, but they are seldom found 
except in weak and relaxed stomachs, where the digestion is bad. Sedentary 
persons are more liable to them than the active and laborious. Those who 
eat great quantities of unripe fruit, or who live much on raw herbs and 
roots, are generally subject to worms. There seems to be a hereditary 
disposition in some persons to this disease. I have often seen all the 
children of a family subject to worms of a particular kind. They seem 
likewise frequently to be owing to the nurse. Children of the same family, 
nursed by one woman, have often worms, when those nursed by another have 
none.

SYMPTOMS. The common symptoms of worms, are paleness of the countenance, 
and at other times, an universal flushing of the face; itching of the 
nose; this however is doubtful, as children pick their noses in all 
diseases: starting, and grinding of the teeth in sleep; swelling of the 
upper lip; the appetite sometimes bad, at other times quite voracious; 
looseness; a sour or stinking breath; a hard swelled beIly; great thirst; 
the urine frothy, and sometimes of a whitish colour; griping, or colic 
pains; an involuntary discharge of saliva, especially when asleep; 
frequent pains of the side, with a dry cough, and unequal pulse; 
palpitations of the heart; swooning; drowsiness; cold sweats; palsy; 
epileptic fits, with many other unaccountable nervous symptoms, which were 
formerly attributed to witchcraft, or the influence of evil spirits. Small 
bodies in the excrements resembling melon or cucumber seeds are symptoms 
of the tape-worm.

I LATELY saw some very surprising effects of worms in a girl about five 
years of age, who used to lie for whole hours as if dead. She at last 
expired, and, upon opening her body, a number of the teres, or long round 
worms, were found in her guts, which were considerabIy inflamed; and what 
anatomists call an intus susceptio, or involving of one part of the gut 
within another, had taken place in no less than four different parts of 
the intestine canal. That worms exist in the human body there can be no 
doubt; and that they must sometimes be considered as a disease, is equally 
certain: but this is not the case so often as people imagine. The idea 
that worms occasion many diseases gives an opportunity to the professed 
worm-doctors of imposing on the credulity of mankind, and doing much 
mischief.They find worms in every case, and liberally throw in their 
antidotes, which generally consist of strong, drastic purges: I have known 
these given in delicate consttutions to the destruction of the patient, 
where there was not the least symptom of worms.

MIEDICINE. - Though numberless medicines are extolled for killing and 
expelling worms, a medical writer of the present age has enumerated 
upwards of fifty British plants, all celebrated for killing and expelling 
worms, yet no disease more frequently baffles the physician's skill. In 
general, the most proper medicines for their expulsion are strong 
purgatives; and to prevent their breeding, stomachic bitters, with now and 
then a glass of good wine.

THE best purge for an adult is jalap and calomel. Five and twenty or 
thirty grains of the former with six or seven of the latter, mixed in 
syrup, may be taken early in the morning, for a dose. It will be proper 
that the patient keep the house all day, and drink nothing cold. The dose 
may be repeated once or twice a-week, for a fortnight or three weeks. On 
the intermediate days the patient may take a drachm of the powder of tin, 
twice or thrice a-day, mixed with syrup, honey or treacle.

THOSE who do not chuse to take calomel may make use of the bitter 
purgatives; as aloes, hiera picra, tincture of senna, and rhubarb, &c.

OILY medicines are sometimes found beneficial for expelling worms. An 
ounce of sallad oil and a table-spoonful of common salt may be taken in a 
glass of red port wine thrice a-day, or oftener, if the stomach will bear 
it. But the more common form of using oil is in clysters. Oily clysters, 
sweetened with sugar or honey, are very efficacious in bringing away the 
short round worms called ascarides, and the teres.

THE Harrowgate water is an excellent medicine for expelling worms, 
especially the ascarides. As this water evidently abounds with sulphur, we 
may hence infer, that sulphur alone must be a good medicine in this case; 
which is found to be a fact. Many practitioners give flour of sulphur in 
very large doses, and with great success. It should be made into an 
electuary with honey or treacle, and taken in such quantity as to purge 
the patient.

WHERE Harrowgate water cannot be obtained, sea-water may be used, which is 
far from being a contemptible medicine in this case. If sea-water cannot 
be had, common salt dissolved in water may be drunk.

I HAVE often seen this used by country nurses with very good effect. Some 
flour of sulphur may be taken over night, and the salt-water in the 
morning.

BUT worms, though expelled, will soon breed again, if the stomach remains 
weak and relaxed; to prevent which, we would recommend the Peruvian bark. 
Half a drachm of bark in powder may be taken in a glass of red port wine, 
three or four times a-day, after the above medicines have been used. Lime-
water is likewise good for this purpose, or a table-spoonful of the 
chalybeate wine taken twice or thrice a-day. Infusions or decoctions of 
bitter herbs may likewise be drank; as the infusion of tansy, water 
trefoil, camomile-flowers, tops of wormwood, the lesser centaury, &c.

FOR a child of four or five years old, six grains of rhubarb, five of 
jalap, and two of calomel, may be mixed in a spoonful of syrup or honey, 
and given in the morning. The child should keep the house all day, and 
take nothing cold. This dose may be repeated twice a-week for three or 
four weeks. On the intermediate days the child may take a scruple of 
powdered tin and ten grains of aethiops mineral in a spoonful of treacle 
twice a-day. This dose must be increased or diminished according to the 
age of the patient.

BISSET says, the great bastard black hellebore, or bear's foot, is a most 
powerful vermifuge for the long round worms. He orders the decoction of 
about a drachm of the green leaves, or about fifteen grains of the dried 
leaves in powder, for a dose to a child betwixt four and seven years of 
age. This dose is to be repeated two or three times. He adds, that the 
green leaves made into a syrup with coarse sugar is almost the only 
medicine he has used for round worms for three years past. Before pressing 
out the juice, he moistens the bruised leaves with vinegar, which corrects 
the medicine. The dose is a tea-spoonful at bed-time, and one or two next 
morning,

I HAVE frequently known those big bellies, which in children are commonly 
reckoned a sign of worms, quite removed by giving them white soap in their 
pottage, or other food. Tansy, garlic, and rue, are all good against 
worms, and may be used various ways. We might here mention many other 
plants, both for external and internal use, as the cabbage-bark, &c. but 
think the powder of tin with aethiops mineral, and the purges of rhubarb 
and calomel, are more to be depended on.

BALL'S purging vermifuge powder is a very powerful medicine. It is made of 
equal parts of rhubarb, scammony, and caiomel, with as much double refined 
sugar as is equal to the weight of all the other ingredients. These must 
be well mixed together, and reduced to fine powder. The dose for a child 
is from ten grains to twenty, once or twice a-week. An adult may take a 
drachm for a dose. A powder for the tape-worm resembling this, was long 
kept a secret on the Continent; it was lately purchased by the French 
king, and will be found under the article Powder, in the Appendix.

PARENTS who would preserve their children from worms ought to allow them 
plenty of exercise in the open air; to take care that their food be 
wholesome and sufficiently solid: and, far as possible, to prevent their 
eating raw herbs, roots, or green trashy fruits. It will not be amiss to 
allow a child who is subject to worms, a glass of red wine after meals; as 
every thing that braces and strengthens the stomach is good both for 
preventing and expelling the vermin.

WE think it necessary here to warn people of their danger who buy cakes, 
powders, and other worm medicines, at random from quacks, and give them to 
their children without proper care. The principal ingredients in most of 
these medicines is mercury, which is never to be trifled with. I lately 
saw a shocking instance of the danger of this conduct. A girl who had 
taken a dose of worm powder, bought of a travelling quack, went out, and 
perhaps was so imprudent as to drink cold water, during its operation. She 
immediately swelled, and died on the following day, with all the symptoms 
of having been poisoned.



CHAPTER XXXVI.
OF THE JAUNDICE.

THIS disease is first observable in the white of the eye, which appears 
yellow. Afterwards the whole skin puts on a yellow appearance. The urine 
too is of a safron hue, and dies a white cloth of the same colour. There 
is likewise a species of this disease called the Black Jaundice.

CAUSES. - The immediate cause of the jaundice is an obstruction of the 
bile. The remote or occasional causes are, the bites of poisonous animals, 
as the viper, mad dog, the bilious or hysteric colic; violent passions as 
grief, anger, &c. Strong purges or vomits will likewise occasion the 
jaundice.

SOMETIMES it proceeds from obstinate agues, or from that disease being 
prematurely stopped by astringent medicines. In infants it is often 
occasioned by the meconium not being sufficiently purged off. Pregnant 
women are very subject to it. It is likewise a symptom in several kinds of 
fever. Catching cold, or the stoppage of customary evacuations, as the 
menses, the bleeding piles, issues, &c. will occasion the jaundice.

THE patient at first complains of excessive weariness, and has great 
aversion to every kind of motion. His skin is dry, and he generally feels 
a kind of of itching or pricking pain over the whole body. The stools are 
of a whitish or clay colour, and the urine, as was observed above, is 
yellow. The breathing is difficult, and the patient complains of an 
unusual load or oppression on his breast. There is a heat in the nostrils, 
a bitter taste in the mouth, loathing of food, sickness at the stomach, 
vomiting, flatulency, and other symptoms of indigestion.

IF the patient be young, and the disease complicated with no other malady, 
it is seldom dangerous; but in old people, where it continues long, 
returns frequently, or is complicated with the dropsy or hypochondriac 
symptoms, it generally proves fatal. The black jaundice is more dangerous 
than the yellow.

REGIMEN - The diet should be cool, light and diluting, consisting chiefly 
of ripe fruits and mild vegetables: as apples boiled or roasted, stewed 
prunes, preserved plums, boiled spinage, &c. Veal or chicken broth, with 
llght bread, are likewise very proper. Many have been cured by living 
almost wholly for some days on raw eggs. The drink should be butter-milk, 
whey sweetened with honey, or decoctions of cool opening vegetables; or 
marsh-mallow roots, with liquorice, &c.

THE patient should take as much exercise as he can bear, either on 
horseback, or in a carriage; walking, running, and even jumping, are 
likewise proper, provided he can bear them without pain, and there be no 
symptoms of inflammation. Patients have been often cured of this disease 
by a long journey, after medicines have proved ineffectual.

AMUSEMENTS are likewise of great use in the jaundice. The disease is often 
occasioned by a sedentary life, joined to a dull melancholy disposition. 
Whatever therefore tends to promote the circulation, and to cheer the 
spirits, must have a good effect; as, dancing, laughing, singing, &c.

MEDICINE. - If the patient be young, of a full sanguine habit, and 
complains of pain in the right side about the region of the liver, 
bleeding will be necessary. After this a vomit must be administered, and 
if the disease proves obstinate, it may be repeated once or twice. No 
medicines are more beneficial in the jaundice than vomits, especially 
where it is not attended with inflammation. Half a drachm of ipecacuanha 
in powder will be a sufficient dose for an adult. It may be wrought off 
with weak camomile-tea, or lukewarm water. The body must likewise be kept 
open by taking a sufficient quantity of Castile soap, or the pills for the 
jaundice recommended in the Appendix.

FOMENTING the parts about the region of the stomach and liver, and rubbing 
them with a warm hand or flesh brush, are likewise beneficial; but it is 
still more so for the patient to sit in a bath of warm water up to the 
breast. He ought to do this frequently, and should continue it as long as 
his strength will permit.

MANY dirty things are recommended for the cure of the jaundice; as lice, 
millepedes, &c. But these do more harm than good, as people trust to them, 
and neglect more valuable medicines; besides, they are seldom taken in 
sufficient quantity to produce any effects. People always expect that such 
things should act as charms, and consequently seldom persist in the use of 
them. Vomits, purges, fomentations, and exercise, will seldom fail to cure 
the jaundice when it is a simple disease; and when complicated with the 
dropsy, a scirrhous liver, or other chronic complaints, it is hardly to be 
cured by any means.

NUMBERLESS British herbs are extolled for the care of this disease. The 
author of the Medicina Britannica mentions near a hundred, all famous for 
curing the jaundice. The fact is, the disease often goes off of its own 
accord; in which case the last medicine is always said to have performed 
the cure. I have sometimes however seen considerable benefit, in a very 
obstinate jaundice, from a decoction of hempseed. Four ounces of the seed 
may be boiled in two English quarts of ale, and sweetened with coarse 
sugar. The dose is half an English pint every morning. It may be continued 
for eight or nine days.

I HAVE likewise known Harrowgate sulphur-water cure a jaundice of very 
long standing. it should be used for some weeks, and the patient must both 
drink and bathe.

THE soluble tartar is a very proper medicine in the jaundice. A drachm of 
it may be taken every night and morning in a cup of tea or water-gruel. If 
it does not open the body, the dose may be increased. A very obstinate 
jaundice has been cured by swallowing raw eggs.

PERSONS subject to the jaundice ought to take as much exercise as 
possible, and to avoid all heating and astringent aliments.



CHAPTER XXXVII.
OF THE DROPSY.

THE dropsy is a preternatural swelling of the whole body, or some part of 
it, occasioned by a collection of watery humour. It is distinguished by 
different names, according to the part affected, as the anasarca, or a 
collection of water under the skin; the ascites, or a collection of water 
in the belly; the hydrops pectoris, or dropsy of the breast; the 
hydrocephalus, or dropsy of the brain, &c.

CAUSES. - The dropsy is often owing to an hereditary disposition. It may 
likewise proceed from drinking ardent spirits, or other strong liquors. It 
is true almost to a proverb, that great drinkers die of a dropsy. The want 
of exercise is also a very common cause of the dropsy. Hence it is justly 
reckoned among the diseases of the sedentary. It often proceeds from 
excessive evacuations, as frequent and copious bleedings, strong purges 
often repeated, frequent salivations, &c. The sudden stoppage of customary 
or necessary evacuations, as the menses, the haemorrhoids, fluxes of the 
belly &c. may likewise cause a dropsy.

I HAVE known the dropsy occasioned by drinking large quantities of cold, 
weak, watery liquor, when the body was heated by violent exercise. A low, 
damp, or marshy situation is likewise a frequent cause of it. Hence it is 
a common disease in moist, flat, fenny countries. It may also be brought 
on by a Iong use of poor watery diet, or of viscous aliment that is hard 
of digestion. It is often the effect of other diseases, as the jaundice, a 
scirrus of the liver, a violent ague of long continuance, a diarrhoea, a 
dysentery, an empyema, or a consumption of the lungs. In short, whatever 
obstructs the perspiration, or prevents the blood from being duly 
prepared, may occasion a dropsy.

SYMPTOMS. - The anasarca generally begins with a swelling of the feet and 
ancles towards night, which for some time, disappears in the morning. In 
the evening the parts, if pressed with the finger, will pit. The swelling 
gradually ascends, and occupies the trunk of the body, the arms, and the 
head. Afterwards the breathing becomes difficult, the urine is in small 
quantity, and the thirst great; the body is bound, and the perspiration is 
greatly obstructed. To these succeed torpor, heaviness, a slow wasting 
fever, and a troublesome cough.This last is generally a fatal symptom, as 
it shews that the lungs are affected.

IN an ascites, besides the above symptoms, there is a swelling of the 
belly, and often a fluctuation, which may be perceived by striking the 
belly on one side and laying the palm of the hand on the opposite. This 
may be distinguished from a tympany by the weight of the swelling, as well 
as by the fluctuation. When the anasarca and ascites are combined, the 
case is very dangerous. Even a simple ascites seldom admits of a radical 
cure. Almost all that can be done is to let off the water by tapping, 
which seldom affords more than a temporary relief.

WHEN the disease comes suddenly on, and the patient is young and strong, 
there is reason however to hope for a cure, especially if medicines be 
given early. But if the patient be old, has led an irregular or a 
sedentary life, or if there he reason to suspect that the liver, lungs, or 
any of the viscera are unsound, there is great ground to fear that the 
consequences will prove fatal.

REGIMEN. - The patient must abstain, as much as possible, from all drink, 
especially weak and watry liquors, and must quench his thirst with mustard-
whey, or acids, as juice of lemons, oranges, sorrel, or such like. His 
aliment ought to be dry, of a stimulating and diuretic quality, as toasted 
bread, the flesh of birds or other wild animals roasted, pungent and 
aromatic vegetables, as garlic, mustard, onions, cresses, horse-raddish, 
rocambole, shalot, &c. He may also eat sea-biscuit dipt in wine or a 
little brandy. This is not only nourishing, but tends to quench thirst. 
Some have been actually cured of a dropsy by a total abstinence from all 
liquids, and living entirely upon things as are mentioned above. If the 
patient must have drink, the Spaw-water or Rhenish wine with diuretic 
medicines infused in it, are the best.

EXERCISE is of the greatest importance in a dropsy. If the patient be able 
to walk, dig, or the like, he ought to continue these exercises as long as 
he can. If he is not able to walk or labour, he must ride on horseback, or 
in a carriage, and the more violent the motion so much the better, 
provided he can bear it. His bed ought to be hard, and the air of his 
apartments warm and dry. If he lives in a damp country, he ought to be 
removed into a dry one, and, if possible, into a warmer climate. In a word 
every method should be taken to promote the perspiration, and to brace the 
solids. For this purpose it will likewise be proper to rub the patient's 
body, two or three times a-day, with a hard cloth, or the flesh-brush; and 
he ought constantly to wear flannel next his skin.

MEDICINE. - If the patient be young, his constitution good, and the 
disease has come on suddenly, it may generally be removed by strong 
vomits, brisk purges, and such medicines as promote a discharge by sweat 
and urine. For an adult, half a drachm of ipecacuanha in powder, and half 
an ounce of oxymel of squills, will be a proper vomit. This may be 
repeated as often as is found necessary, three or four days intervening 
between the doses. The patient must not drink much after taking the vomit, 
otherwise he destroys its effect. A cup or two of camomile-tea will be 
sufficient to work it off.

BETWIXT each vomit, on one of the intermediate days, the patient may take 
the following purge: Jalap in powder half a drachm, cream of tartar two 
drachms, calomel six grains. These may be made into a bolus with a little 
syrup of pale roses, and taken early in the morning. The less the patient 
drinks after it the better. If he be much griped, he may take now and then 
a cup of chicken-broth.

THE patient may likewise take every night at bed-time the following bolus: 
To four or five grains of camphor add one grain of opium, and as much 
syrup of orange-peel as is sufficient to make them into a bolus. This will 
generally promote a gentle sweat, which should be encouraged by drinking 
now and then a small cup of wine-whey, with a tea-spoonful of the spirits 
of hartshorn in it. A tea-cupful of the following diuretic infusion may 
likewise be taken every four or five hours through the day.

TAKE juniper berries, mustard-seed, and horse-radish, of each half an 
ounce, ashes of broom half a pound; infuse them in a quart of Rhenlsh wine 
or strong ale for a few days, and afterwards strain off the liquor. Such 
as cannot take this infusion, may use the decoction of seneka-root, which 
is both diuretic and sudorific. I have known an obstinate anasarca cured 
by a an infusion of the ashes of broom in wine.

THE above course will often cure an incidental dropsy, if the constitution 
be good; but when the disease proceeds from a bad habit, or an unsound 
state of the viscera, strong purges and vomits are not to be ventured 
upon. In this case, the safer course is to palliate the symptoms by the 
use of such medicines as promote the secretions, and to support the 
patient's strength by warm and nourishing cordials.

THE secretion of the urine may be greatly promoted by nitre. Brookes says, 
he knew a young woman who was cured of a dropsy by taking a drachm of 
nitre every morning in a draught of ale, after she had been given over as 
incurable. The powder of squills is likewise a good diuretic. Six or eight 
grains of it, with a scruple of nitre, may be given twice a-day in a glass 
of strong cinnamon-water. Ball says, a large spoonful of unbruised mustard-
seed taken every night and morning, and drinking half an English Pint of 
the decoction of the tops of green broom after it, has performed a cure 
after other powerful medicines had proved ineffectual.

I HAVE sometimes seen good effects from cream of tartar in this disease. 
It promotes the discharges by stool and urine, and will at least palliate, 
if it does not perform a cure. The patient may begin by taking an ounce 
every second or third day, and may increase the quantity to two or even to 
three ounces, if the stomach will bear it. This quantity is not however to 
be taken at once, but divided into three or four doses.

TO promote perspiration, the patient may use the decoction of seneka-root, 
as directed above; or he may take two table-spoonfuls of Mindererus's 
spirit in a cup of wine-whey three or four times a-day. To promote a 
discharge of urine, the following infusion of the London hospitals will 
likewise be beneficial.

TAKE of zedoary-root, two drachms; dried squills, rhubarb, and juniper-
berries bruised, of each a drachm; cinnamon in powder, three drachms; salt 
of wormwood, a drachm and a half; infuse in an English pint and a half of 
old hock-wine, and when fit for use, filter the liquor. A wine-glass of it 
may be taken three or four times a-day.

IN the anasarca it is usual to scarify the feet and legs. By this means 
the water is often discharged; but the operator must be cautious not to 
make the incisions too deep; they ought barely to pierce through the skin, 
and especial care must be taken, by spirituous fomentations and proper 
digestives, to prevent a gangrene.

IN an ascites, when the disease does not evidently and speedily give way 
to purgative and diuretic medicines, the water ought to be let off by 
tapping. This is a very simple and safe operation, and would often 
succeed, if it were performed in due time; but if it be delayed till the 
humours are vitiated, or the bowels spoiled, by long soaking in water, it 
can hardly be expected that any permanent relief will be procured. The 
very name of an operation is dreadful to most people, and they wish to try 
every thing before they have recourse to it. This is is the reason why 
tapping so seldom succeeds to our wish. I have had a patient who regularly 
tapped once a month for several years, and who used to eat her dinner as 
well after the operation as as if nothing had happened. She died at last 
rather worn out by age than by the disease.

AFTER the evacuation of the water, the patient is to be put on a course of 
strengthening medicines; as the Peruvian bark; the elixir of vitriol; warm 
aromatics, with a due proportion of rhubarb, infused in wine, and such 
like. His diet ought to be dry and nourishing, such as is recommended in 
the beginning of the Chapter; and he should take as much exercise as he 
can bear without fatigue. He should wear flannel next his skin, and make 
daily use of the flesh-brush.



CHAPTER XXXVIII.
OF THE GOUT.

THERE is no disease which shews the imperfection of medicine, or sets the 
advantages of temperance and exercise in a stronger light, than the gout. 
Excess and idleness are the true sources from whence it originally sprung, 
and all who would avoid it must be active and temperate.

THOUGH idleness and intemperance are the principal causes of the gout, yet 
many other things may contribute to bring on the disorder in those who are 
not, and to induce a paroxysm in those who are subject to it; as intense 
study; too free an use of acid liquors; night-watching; grief or 
uneasiness of mind; an obstruction or defect of any of the customary 
discharges, as the menses, sweating of the feet, perspiration, &c.

SYMPTOMS. - A fit of the gout is generally preceded by indigestion, 
drowsiness, belching of wind, a slight head-ach, sickness, and sometimes 
vomiting. The patient complains of weariness and dejection of spirits, and 
has often a pain in the limbs, with a sensation as if wind or cold water 
were passing down the thigh. The appetite is often remarkably keen a day 
or two before the fit, and there is a slight pain in passing urine and 
sometimes an involuntary shedding of tears. Sometimes these symptoms are 
much more violent, especially upon the near approach of the fit; and some 
observe, that as is the fever which ushers in the gout, so will the fit 
be; if the fever be short and sharp, the fit will be so likewise; if it be 
feeble, long, and lingering, the fit will be such also. But this 
observation can only hold with respect to very regular fits of the gout.

THE regular gout generally makes its attack in the spring, or beginning of 
winter, in the following manner: About two or three in the morning, the 
patient is seized with a pain in his great toe, sometimes in the heel, and 
at other times in the ancle or calf of the Ieg. This pain is accompanied 
with a sensation as if cold water were poured upon the part, which is 
succeeded by a shivering, with some degree of fever. Afterwards the pain 
increases, and fixing among the small bones of the foot, the patient feels 
all the different kinds of torture, as if the part were stretched, burnt, 
squeezed., gnawed, or torn in pieces, &c. The part at length becomes so 
exquisitely sensible, that the patient cannot bear to have it touched, or 
even suffer any person to walk across the room.

THE patient is generally in exquisite torture for twenty-four hours, from 
the time of the coming on of the fit: He then becomes easier, the part 
begins to swell, appears red, and is covered with a little moisture. 
Towards morning he drops asleep, and generally falls into a gentle 
breathing sweat. This terminates the first paroxysm, a number of which 
constitutes a fit of the gout; which is longer or shorter according to the 
patients age, strength, the season of the year, and the disposition of the 
body to this disease.

THE patient is always worse towards night, and easier in the morning, The 
paroxysms however generally grow milder every day, till at length the 
disease is carried off by perspiration, urine, and the other evacuations. 
In some patients this happens in a few days; in others, it requires weeks, 
and, in some, months, to finish the fit.

THOSE whom age and frequent fits of the a gout have greatly debilitated, 
seldom get free of it before the approach of summer, and sometimes not 
till it be pretty far advanced.

REGIMEN. - As there are no medicines yet known that will cure the gout, we 
shall confine our observations chiefly to regimen, both in and out of the 
fit.

IN the fit, if the patient be young and strong, his diet ought to be thin 
and cooling, and his drink of a diluting nature; but where the 
constitution is weak, and the patient has been accustomed to live high, 
this is not a proper time to retrench. In this case he must keep nearly to 
his usual diet, and should take frequently a cup of strong negus, or a 
glass of generous wine. Wine-whey is a very proper drink in this case, as 
it promotes the pespiration without
greatly heating the patient. It will answer this purpose better if a tea-
spoonful of sal volatile oleosum, or spirits of hartshorn, be put into a 
cup of it twice a-day.

IT will likewise be proper to give at bed-time a tea-spoonful of the 
volatlle tincture of guaiacum in a large draught of warm wine-whey. This 
will greatly promote perspiration through the night.

AS the most safe and efficacious method of discharging the gouty matter is 
by perspiration, this ought to be kept up by all means, especially in the 
affected part. For this purpose the leg and foot should be wrapt in soft 
fiannel, fur, or wool. The last is most readily obtained, and seems to 
answer the purpose better than any thing else. The people of Lancashire 
look upon wool as a kind of specific in the gout. They wrapt a great 
quantity of it about the leg and foot affected, and cover it with a a skin 
of soft dressed leather. This they suffer to continue for eight or ten 
days, and sometimes for a fortnight or three weeks, or longer if the pain 
does not cease. I never knew any external application answer so well in 
the gout. I have often seen it applied when the swelling and inflammation 
were very great, with violent pain, and have found all these symptoms 
relieved by it in a few days. The wool which they use is generally 
greased, and carded or combed. They chuse the softest which can be had, 
and seldom or never remove it till the fit be entirely gone off.

THE patient ought likewise to be kept quiet and easy during the fit. Every 
thing that affects the mind disturbs the paroxysm, and tends to throw the 
gout upon the nobler parts. All external applications that repel the 
matter are to be avoided as death. They do not cure the disease, but 
remove it from a safer to a more dangerous part of the body, where it 
often proves fatal. A fit of the gout is to be considered as Nature's 
method of removing something that might prove destructive to the body, and 
all that we can do, with safety, is to promote her intentions, and to 
assist her in expelling the enemy in her own way. Evacuations by bleeding, 
stool, &c. are Iikewise to be used with caution; they do not remove the 
cause of the disease, and sometimes by weakening the patient prolong the 
fit: But, where the constitution is able to bear it, it will be of use to 
keep the body gently open by diet, or very mild laxative medicines.

MANY things will indeed shorten a fit of the gout, and some will drive it 
off altogether; but nothing has yet been found which will do this with 
safety to the patient. In pain we eagerly grasp at any thing that promises 
immediate ease and even hazard life itself for a temporary relief. This is 
the true reason why so many infallible remedies have been proposed for the 
gout, and why such numbers have lost their lives by the use of them. It 
would be as prudent to stop the small-pox from rising, and to drive them 
into the blood, as to repel the gouty matter after it has been thrown upon 
the extremities. The latter is as much an effort of Nature to free herself 
from an offending cause as the former, and ought equally to be promoted.

WHEN the pain however is very great, and the patient is restless, thirty 
or forty drops of laudanum, more or less, according to the violence of the 
symptoms, may be taken at bed-time. This will ease the pain, procure rest, 
promote perspiration, and forward the crisis of the disease.

AFTER the fit is over, the patient ought to take a gentle dose or two of 
the bitter tincture of rhubarb, or some other warm stomachic purge. He 
should also drink a weak infusion of stomachic bitters in small wine or 
ale, as the Peruvian bark, with cinnamon, Virginian snake-root, and orange-
peel. The diet at this time should be light, but nourishing, and gentle 
exercise ought to be taken on horseback, or in a carriage.

OUT of the fit, it is in the patient's power to do many things towards 
preventing a return of the disorder, or rendering the fit, if it should 
return, less severe. This however is not to be attempted by medicine. I 
have frequently known the gout kept off for several years by the Peruvian 
bark and other astringent medicines: but in all the cases where I had 
occasion to see this tried, the persons died suddenly, and, to all 
appearance, for want of a regular fit of the gout. One would be apt, from 
hence, to conclude, that a fit of the gout, to some constitutions, in the 
decline of life, is rather salutary than hurtful.

THOUGH it may be dangerous to stop a fit of the gout by medicine, yet if 
the constitution can be so changed by diet and exercise, as to lessen or 
totally prevent its return, there certainly can be no danger in following 
such a course. It is well known that the whole habit may be so altered by 
a proper regimen as quite to eradicate this disease; and those only who 
have sufficient resolution to persist in such a course have reason to 
expect a cure.

THE course which we would recommend for preventing the gout is as follows: 
In the first place, universal temperance. In the next place sufficient 
exercise. Some make secret of curing the gout by muscuIar exercise. This 
secret, however, is as old as Celsus, who strongly recommends that mode of 
cure; and whoever will submit to it, in the fullest extent, may expect to 
reap solid and permanent advantages.

BY this we do not mean sauntering about in an indolent manner, but labour, 
sweat, and toil. These only can render the humours wholesome, and keep 
them so. Going early to bed, and rising betimes, are also of great 
importance. It is likewise proper to avoid night studies, and all intense 
thought. The supper should be light, and taken early. All strong liquors, 
especially generous wines and sour punch, are to be avoided.

WE would likewise recommend some doses of magnesia alba and rhubarb to be 
taken every spring and autumn; and afterwards a course of stomachic 
bitters, as tansy or water-trefoil tea, an infusion of gentian and 
camomile flowers, or a decoction of burdock root, &c. Any of these, or an 
infusion of any wholesome bitter that is more agreeable to the patient, 
may be drank for two or three weeks in March and October twice a-day. An 
issue or perpetual blister has a great tendency to prevent the gout. If 
these were more generally used in the decline of life, they would not only 
often prevent the gout, but also other chronic maladies. Such as can 
afford to go to Bath, will find great benefit from bathing and drinking 
the water. It both promotes digestion and invigorates the habit.

THOUGH there is little room for medicine during a regular fit of the gout, 
yet when it leaves the extremities, and falls on some of the internal 
parts, proper applications to recall and fix it, become absolutely 
necessary. When the gout affects the head, the pain of the joints ceases, 
and the swelling disappears, while either severe head-ach, drowsiness, 
trembling, giddiness, convulsions, or delirium come on. When it seizes the 
lungs, great oppression, with cough and difficulty of breathing, ensue. If 
it attacks the stomach, extreme sickness, vomiting, anxiety, pain in the 
epigastric region,and, total loss of strength, will succeed.

WHEN the gout attacks the head or lungs, every method must be taken to fix 
it in the feet. They must be frequently bathed in warm water, and acrid 
cataplasms applied to the soles. Blistering-plasters ought likewise to be 
applied to the ancles or calves of the legs. Bleeding in the feet or 
ancles is also necessary, and warm stomachic purges. The patient ought to 
keep in bed for the most part, if there be any signs of inflammation, and 
should be very careful not to catch cold.

IF it attacks the stomach with a sense of cold, the most warm cordials are 
necessary; as strong wine boiled up with cinnamon or other spices; 
cinnamon-water; peppermint-water; and even brandy or rum. The patient 
should keep his bed, and endeavour to promote a sweat by drinking warm 
liquors; and if he should be troubled with a nausea, or inclination to 
vomit, he may drink camomile-tea, or any thing that will make him vomit 
freely.

WHEN the gout attacks the kidneys, and imitates gravel-pains, the patient 
ought to drink freely of a decoction of marsh-mallows, and to have the 
parts fomented with warm water. An emollient clyster ought likewise to be 
given, and afterwards an opiate. If the pain be very violent, twenty or 
thirty drops of laudanum may be taken in a cup of the decoction.

PERSONS who have had the gout should be very attentive to any complaints 
that may happen to them about the time when they have reason to expect a 
return of the fit. The gout imitates many other disorders, and by being 
mistaken for them, and treated improperly, is often diverted from its 
regular course, to the great danger of the patient's life.

THOSE who never had the gout, but who, from their constitution or manner 
of living, have reason to expect it, ought likewise to be very circumspect 
with regard to its first approach. If the disease, by wrong conduct or 
improper medicine, be diverted from its proper course, the miserable 
patient has a chance to be ever after tormented with head-achs, coughs, 
pains of the stomach and intestines; and to fall, at last, a victim to its 
attack upon some of the more noble parts.


OF THE RHEUMATISM.

THIS disease has often a resemblance to the gout. It generally attacks the 
joints with exquisite pain, and is sometimes attended with inflammation 
and swelling. It is most common in the spring, and towards the end of 
autumn. It is usually distinguished into acute and chronic; or the 
rheumatism with and without a fever.

CAUSES. - The causes of a rheumatism are frequently the same as those of 
an inflammatory fever; viz. an obstructed perspiration, the immoderate use 
of strong liquors, and the like. Sudden changes of the weather, and all 
quick transitions from heat to cold, are very apt to occasion the 
rheumatism. The most extraordinary case of a rheumatism that I ever saw, 
where almost every joint of the body was distorted, was a man who used to 
work one part of the day by the fire, and the other part of it in the 
water. Very obstinate rheumatisms have been likewise brought on by persons 
not accustomed to it, allowing their feet to continue long wet. The same 
effects are often produced by wet cloths, damp beds, sitting or lying on 
the damp ground; travelling in the night, &c.

THE rheumatism may likewise be occasioned by excessive evacuations, or the 
stoppage of customary discharges. It is often the effect of chronic 
diseases which vitiate the humours; as the scurvy, the lues venerea, 
obstinate autumnal agues, &c.

THE rheumatism prevails in cold, damp, marshy countries. It is most common 
amongst the poorer sort of peasants, who are ill clothed, live in low damp 
houses, and eat coarse unwholesome food, which contains but little 
nourishment, and is not easily digested.

SYMPTOMS. - The acute rheumatism commonly begins with weariness, 
shivering, a quick pulse, restlessness, thirst, and other symptoms of 
fever. Afterwards the patient complains of lying pains, which are 
increased by the least motion. These at length fix in the joints, which 
are often affected with swelling and inflammation. If blood be let in this 
disease, it has generally the same appearance as in the pleurisy.

IN this kind of rheumatism the treatment of the patient is nearly the same 
as in an acute or inflammatory fever. If he be young and strong, bleeding 
is necessary, which may be repeated according to the exigencies of the 
case. The body ought likewise to be kept open by emollient clysters, or 
cool opening liquors; as decoctions of tamarinds, cream tartar whey, senna 
tea, and the like. The diet should be light, and in small quantity, 
consisting chiefly of roasted apples, goat-gruel, or weak chicken broth. 
After the feverish symptoms have abated, if the pain still continues, the 
patient must keep his bed, and take such things as promote perspiration; 
as wine-whey, with spiritus Mindereri, &c. He may likewise take for a few 
nights, at bed-time, in a cup of wine-whey, a drachm of the cream of 
tartar, and half drachm of gum guaiacum in powder.

WARM bathing, after proper evacuations, has often an exceeding good 
effect. The patient may either be put into a bath of warm water, or have 
cloths wrung out of it applied to the parts affected. Great care must be 
taken that he do not catch cold after bathing.

THE chronic rheumatism is seldom attended with any considerable degree of 
fever, and is generally confined to some particular part of the body, as 
the shoulders, the back, or the loins. There is seldom any inflammation or 
swelling in this case. Persons in the decline of life are most subject to 
the chronic rheumatism. In such patients it often proves extremely 
obstinate, and sometimes incurable.

IN this kind of rheumatism the regimen should be nearly the same as in the 
acute. Cool and diluting diet, consisting chiefly of vegetable substances, 
as stewed prunes, coddled apples, currants or gooseberries boiled in milk, 
is most proper. Arbuthnot says, "If there be a specific in an aliment for 
the rheumatism, it is certainly whey" and adds, "That he knew a person 
subject to this disease, who could never be cured by any other method but 
a diet of whey and bread." He likewise says, "That cream of tartar in 
water gruel, taken for several days, will ease rheumatiic pains 
considerably." This I have often experienced, but found it always more 
efficacious when joined with gum guaiacum as already directed. In this 
case the patient may take the dose formerly mentioned twice a-day, and 
likewise a tea-spoonful of the volatile tincture of gum guaiacum, at bed-
time, in wine-whey.

THIS course may be continued for a week, or longer, if the case proves 
obstinate, and the patient's strength will permit. It ought then to be 
omitted for a few days, and repeated again. At the same time leeches or a 
blistering-plaster may be applied to the part affected. What I have 
generally found answer better than either of these, in obstinate fixed 
rheumatic pains, is the warm plaster. See Appendix, Warm Plaster. I have 
likewise known a plaster of Burgundy pitch worn for some time on the part 
affected give great relief in rheumatic pains. My ingenious friend, Dr. 
Alexander of Edinburgh, says, he has frequently cured very obstinate 
rheumatic pains by rubbing the part affected with tincture of cantharides. 
When the common tincture did not succeed; he used it of a double or treble 
strength. Cupping upon the part affected is likewise often very 
beneficial, and is greatly preferable to the application of leeches.

THOUGH this disease may not seem to yield to medicines for some time, yet 
they ought still to be persisted in.

PERSONS who are subject to frequent returns of the rheumatism, will often 
find their account in using medicines, whether they be immediately 
affected with the disease or not. The chronic rheumatism is similar to the 
gout in this respect, that the most proper time for using medicines to 
extirpate it, is when the patient is most free from the disorder.

TO those who can afford the expence, I would recommend the warm baths of 
Buxton or Matlock in Derbyshire. These have often, to my knowledge, cured 
very obstinate rheumatisms, and are always safe either in or out of the 
fit. When the rheumatism is complicated with scorbutic complaints, which 
is not seldom the case, the Harrowgate waters, and those of Moffat are 
proper. They should likewise be drank and used as a warm bath.

THERE are several of our own domestic plants which may be used with 
advantage in the rheumatism. One of the best is the white mustard. A table-
spoonful of the seed of this plant may be taken twice or thrice a-day, in 
a glass of water or small wine. The water-trefoil is likewise of great use 
in this complaint, it may be infused in wine or ale, or drank in form of 
tea. The ground-ivy, camomile, and several other bitters, are also 
benificial, and may be used in the same manner. No benefit however is to 
be expected from them, unless they be taken for a considerable time. 
Excellent medicines are often despised in this disease, because they do 
not perform an immediate cure; whereas nothing would be more certain than 
their effect, were they duly persisted in. Want of perseverance in the use 
of medicines is one reason why chronic diseases are so seldom cured.

COLD bathing, especially in salt water, often cures the rheumatism. We 
would also recommend riding on horseback, and wearing flannel next the 
skin.

ISSUES are very proper, especially in chronic cases. If the pain affects 
the shoulders, an issue may be made in the arm, but if it affects the 
loins, it should be put in the leg, or thigh.

PERSONS afflicted with the scurvy are very subject to rheumatic 
complaints. The best medicines in this case are bitters and mild 
purgatives. These may either be taken separately or together, as the 
patient inclines. An ounce of Peruvian bark, and half an ounce of rhubarb 
in powder, may be infused in a bottle of wine; and one, two, or three wine 
glasses of it taken daily, as shall be found necessary for keeping the 
body gently open. In cases where the bark itself proves sufficiently 
purgative, the rhubarb may be omitted.

SUCH as are subject to frequent attacks of the rheumatism ought to make 
choice of a dry, warm situation, to avoid night-air, wet cloths, and wet 
feet, as much as possible. Their clothing should be warm, and they should 
wear flannel next their skin, and make frequent use of the flesh-brush.



CHAPTER XXXIX.
OF THE SCURVY.

THIS disease prevails chiefly in cold northern countries especially in low 
damp situations, near large marshes, or great quantities of stagnating 
water. Sedentary people, of a dull melancholy disposition, are most 
subject to it. It proves often fatal to sailors on long voyages, 
particularly in ships that are not properly ventilated, have many people 
on board, or where cleanliness is neglected.

IT is not necessary to mention the different species into which this 
disease has been divided, as they differ from one another chiefly in 
degree. What is called the land scurvy, however, is seldom attended with 
those highly putrid symptoms which appear in patients who have been long 
at sea, and which, we presume, are rather owing to confined air, want of 
exercise, and the unwholesome food eat by sailors on long voyages, than to 
any specific difference in the disease.

CAUSES. - The scurvy is occasioned by cold moist air; by the long use of 
saIted or smoke-dried provisions, or any kind of food that is hard of 
digestion, and affords little nourishment. It may also proceed from the 
suppression of customary evacuations: as the menses, the haemorrhoidal 
flux, &c. It is sometimes owing to a hereditary taint, in which case a 
very small cause will excite the latent disorder. Grief, fear, and other 
depressing passions, have great tendency both to excite and aggravate this 
disease. The same observation holds with regard to neglect of cleanliness; 
bad clothing; the want of proper exercise; confined air; unwholesome food; 
or any disease which greatly weakens the body, or vitiates the humours.

SYMPTOMS. - This disease may be known by unusual weariness, heaviness, and 
difficulty of breathing, especially after motion; rottenness of the gums, 
which are apt to bleed on the slightest touch; a stinking breath; frequent 
bleeding at the nose; crackling of the joints; difficulty of walking; 
sometimes a swelling and sometimes a falling away of the legs, on which 
there are livid, yellow, or violet coloured spots; the face is generally 
of a pale or leaden colour. As the disease advances, other symptoms come 
on as rottenness of the teeth, haemorrhages, or discharges of blood from 
different parts of the body, foul obstinate ulcers, pains in various 
parts, especially about the breast, dry scaly eruptions all over the body, 
&c. At last a wasting or hectic fever comes on, and the miserable patient 
is often carried off by a dysentery, a diarrhoea, a dropsy, the palsy, 
fainting fits, or a mortification of some of the bowels.

CURE. - We know no way of curing this disease but by pursuing a plan, 
directly opposite to that which brings it on. It proceeds from a vitiated 
state of the humours, occasioned by errors in diet, air, or exercise; and 
this cannot be removed but by a proper attention to these important 
articles.

IF the patient has been obliged to breathe a cold, damp, or confined air, 
he should be removed, as soon as possible, to a dry, open, and moderately 
warm one. If there is reason to believe that the disease proceeds from a 
sedentary life, or depressing passions, as grief, fear, &c. the patient 
must take daily as much exercise in the open air as he can bear, and his 
mind should be diverted by cheerful company and other amusements. Nothing 
has a greater tendency either to prevent, or to remove this disease, than 
constant cheerfulness and good humour. But this, alas! is seldom the lot 
of persons afflicted with the scurvy; they are generally surly, peevish, 
and morose. When the scurvy has been brought on by a long use of salted 
provisions, the proper medicine is a diet consisting chiefly of fresh 
vegetables; as oranges, apples, lemons, limes, tamarinds, water-cresses, 
scurvy-grass, brook-lime, &c. The use of these, with milk, pot-herbs, new 
bread, and fresh beer or cyder, will seldom fail to remove a scurvy of 
this kind, if taken before it be too far advanced; but to have this 
effect, they must be persisted in for a considerable time. When fresh 
vegetables cannot be obtained, pickled or preserved ones may be used; and 
where these are wanting, recourse must be had to the chymical acids. All 
the patient's food and drink should in this case be sharpened with cream 
of tartar, elixir of vitriol, vinegar, or the spirit of sea-salt.

THESE things however will more certainly prevent than cure the scurvy; for 
which reason sea-faring people, especially on long voyages, ought to lay 
in plenty of them. Cabbages, onions, gooseberries, and many other 
vegetables, may be kept a long time by pickling, preserving, &c. and when 
these fail, the chymical acids, recommended above, which will keep for any 
length of time, may be used. We have reason to believe, if ships were well 
ventilated, had good store of fruits, greens, cyder, &c. laid in, and if 
proper regard were paid to cleanliness and warmth, the sailors would be 
the most healthy people in the world, and would seldom suffer either from 
the scurvy or putrid fevers, which are so fatal to that useful set of men; 
but it is too much the temper of such people to despise all precaution; 
they will not think of any calamity till it overtakes them, when it is too 
late to ward off the blow.

IT must indeed be owned, that many of them have it not in their power to 
make the provision we are speaking of; but in this case it is the duty of 
their employers to make it for them; and no man ought to engage in a long 
voyage without having these articles secured.

I HAVE often seen very extraordinary effects in the land-scurvy from a 
milk diet. This preparation of Nature is a mixture of animal and vegetable 
properties, which of all others is the most fit for restoring a decayed 
constitution, and removing that particular acrimony of the humours, which 
seems to constitute the very essence of the scurvy, and many other 
diseases. But people despise this wholesome and nourishing food, because 
it is cheap, and devour with greediness, flesh, and fermented liquors, 
while milk is only deemed fit for their hogs.

THE most proper drink in the scurvy is whey or butter-milk. When these 
cannot be had, sound cyder, perry, or spruce-beer, may be used. Wort has 
likewise been found to be a proper drink in the scurvy, and may be used at 
sea, as malt will keep during the longest voyage. A decoction of the tops 
of the spruce fir is likewise proper. It may be drank in the quantity of 
an English pint twice a-day. Tar-water may be used for the same purpose, 
or decoctions of any of the mild mucilaginous vegetables; as sarsaparilla, 
marsh-mallow roots, &c. Infusions of the bitter plants, as ground-ivy, the 
lesser centaury, marsh-trefoil, &c. are likewise beneficial. I have seen 
the peasants in some parts of Britain express the juice of the last-
mentioned plant, and drink it with good effect in those foul scorbutic 
eruptions with which they are often troubled in the spring season.

HARROWGATE water is certainly an excellent medicine in the land-scurvy. I 
have often seen patients who had been reduced to most deplorable condition 
by this disease, greatly relieved by drinking the sulphur-water, and 
bathing in it. The chalybeate-water may also be used with advantage, 
especiaIly with a view to brace the stomach after drinking the sulphur-
water, which, though it sharpens the appetite, never fails to weaken the 
powers of digestion.

A SLIGHT degree of scurvy may be carried off by frequently sucking a 
little of the juice of a bitter orange, or a lemon. When the disease 
affects the gums only, this practice, if continued for some time, will 
generally carry it off. We would however recommend the bitter-orange as 
greatly preferable to lemon; it seems to be as good a medicine, and is not 
near so hurtful to the stomach. Perhaps our own sorrel may be little 
inferior to either of them.

ALL kinds of sallad are good in the scurvy, and ought to be eat very 
plentifully, as spinage, lettuce, parsley, celery, endive, radish, 
dandelion, &c. It is amazing to see how soon fresh vegetables in the 
spring cure the brute animals of any scab or foulness which is upon their 
skins. It is reasonable to suppose that their effects would be as great 
upon the human species, were they used in proper quantity for a sufficient 
length of time.

I HAVE sometimes seen good effects in scorbutic complaints of very long 
standing, from the use of a decoction of the roots of water-dock. It is 
usually made by boiling a pound of the fresh root in six English pints of 
water, till about one-third of it be consumed. The dose is from half a 
pint to a whole pint of the decoction every day. But in all the cases 
where I have seen it prove beneficial, it was made much stronger, and 
drank in larger quantities. The safest way, however, is for the patient to 
begin with small doses, and increase them both in strength and quantity as 
he finds his stomach will bear it. It must be used for a considerable 
time. I have known some who had used it for several years, before they 
were sensible of any benefit, but who, nevertheless, were cured by it at 
length.

THE LEPROSY, which was so common in this country long ago, seems to have 
been near a-kin to the scurvy. Perhaps its appearing so seldom now, may be 
owing to the inhabitants of Britain eating more vegetable food than 
formerly, living more upon tea, and other diluting diet, using less salted 
meat, being more cleanly, better lodged and clothed, &c. - For the cure of 
this disease we would recommend the same course of diet and medicine as in 
the scurvy.


OF THE SCCROPHULA, OR KING'S EVIL.

THIS disease chiefly affects the glands, especially those of the neck. 
Children and young persons of a sedentary life are very subject to it. It 
is one of those diseases which may be removed by proper regimen, but 
seldom yields to medicine. The inhabitants of cold, damp, marshy countries 
are most liable to the scrophula.

CAUSES. - This disease may proceed from a hereditary taint, from a 
scrophulous nurse, &c. Children who have the misfortune to be born of 
sickly parents whose constitutions have been greatly injured by the pox, 
or other chronic diseases, are apt to be affected with the scrophula. It 
may likewise proceed from such diseases as weaken the habit or vitiate the 
humours, as the small-pox, measles, &c. External injuries, as blows, 
bruises, and the like, sometimes produce scrophulous ulcers; but we have 
reason to believe, when this happens, that there has been a predisposition 
in the habit to this disease. In short, whatever tends to vitiate the 
humours or relax the solids, paves the way to the scrophula; as the want 
of proper exercise, too much heat or cold, confined air, unwholesome food, 
bad water, the long use of poor, weak, watery aliments, the neglect of 
cleanliness, &c. Nothing tends more to induce this disease in children 
than allowing them to continue long wet. The scrophula, as well as the 
rickets, is found to prevail in large manufacturing towns, where people 
live gross, and lead sedentary lives.

SYMPTOMS. - At first small knots appear under the chin or behind the ears, 
which gradually increase In number and size, till they form one large hard 
tumour. This often continues for a long time without breaking, and when it 
does break, it only discharges a thin sanies or watery humour. Other parts 
of the body are likewise liable to its attack, as the arm-pits, groins, 
feet, hands, eyes, breasts, &c. Nor are the internal parts exempt from it. 
It often affects the lungs, liver, or spleen; and I have frequently seen 
the glands of the mysentery greatly enlarged by it.

THOSE obstinate ulcers which break out upon the feet and hands with 
swelling, and little or no redness, are of the scrophulous kind. They 
seIdom discharge good matter, and are exceedingly difficult to cure. The 
white swellings of the joints seem likewise to be of this kind. They are 
with difficulty brought to a suppuration, and when opened they only 
discharge a thin ichor. There is not a more general symptom of the 
scrophula than a swelling of the upper lip and nose.

REGIMEN. - As this disease proceeds, in a great measure, from relaxation, 
the diet ought to be generous and nourishing, but at the same time light 
and of easy digestion; as well fermented bread, made of sound grain, the 
flesh and broth of young animals, with now and then a glass of generous 
wine, or good ale. The air ought to be open, dry, and not too cold, and 
the patient should take as much exercise as he can bear. This is of the 
utmost importance. Children who have enough of exercise are seldom 
troubled with the scrophula.

MEDICINE - The vulgar are remarkably credulous with regard to the cure of 
the scrophula, many of them believing in the virtue of the royal touch, 
that of the seventh son, &c. The truth is, we know but little either of 
the nature or cure of this dlsease, and where reason or medicines fail, 
superstition always comes in their place. Hence it is, that in diseases 
which are the most difficult to understand, we generally hear of the 
greatest number of miraculous cures being performed. Here, however, the 
deception is easily accounted for. The scrophula, at a certain period of 
life, often cures of itself; and, if the patient happens to be touched 
about this time, the cure is imputed to the touch, and not to Nature, who 
is really the physician. In the same way the insignificant nostrums of 
quacks and old women often gain applause when they deserve none.

THERE is nothing more pernicious than the custom of plying children in the 
scrophula with strong purgative medicines. People imagine it proceeds from 
humours which must be purged off, without considering that these 
purgatives increase the debility, and aggravate the disease. It has indeed 
been found, that keeping the body gently open, for some time, especially 
with sea-water, has a good effect; but this should only be given in gross 
habits, and in such quantity as to procure one, or at most two stools 
every day.

BATHING in the salt water has likewise a very good effect, especially in 
the warm season. I have often known a course of bathing in salt water, and 
drinking it in such quantities as to keep the body gently open, cure a 
scrophula, after many other medicines had been tried in vain. When salt 
water cannot be obtained, the patient may be bathed in fresh water, and 
his body kept open by small quantities of salt and water, or some other 
mild purgative.

NEXT to cold bathing, and drinking the salt-water, we would recommend the 
Peruvian bark. The cold bath may be used in summer, and the bark in 
winter. To an adult half a drachm of the bark in powder may be given, in a 
glass of red wine, four or five times a-day. Children, and such as cannot 
take it in substance, may use the decoction made in the following manner:

BOIL an ounce of Peruvian bark and a drachm of Winter's bark, both grossly 
powdered, in an English quart of water to a pint: towards the end half an 
ounce of sliced liquorice-root, and a handful of raisins may be added, 
which will both render the decoction less disagreeable, and make it take 
up more of the bark. The liquor must be strained, and two, three, or four 
table-spoonfuls, according to the age of the patient. given three times a-
day.

THE Moffat and Harrowgate waters, especially the latter, are likewise very 
proper medicines in the scrophula. They ought not however to be drank in 
large quantities, but should be taken so as to keep the body gently open, 
and must be used for a considerable time.

THE hemlock may sometimes be used with advantage in the scrophula. Some 
lay it down as a general rule, that the sea-water is most proper before 
there are any suppuration or symptoms of tabes; the Peruvian bark, when 
there are running sores, and a degree of hectic fever; and the hemlock in 
old inveterate cases, approaching to the scirrhous or cancerous state. 
Either the extract or the fresh juice of this plant may be used. The dose 
must be small at first, and increased gradually as far as the stomach is 
able to bear it.

EXTERNAL applications are of little use. Before the tumour breaks, nothing 
ought to be applied to it, unless a piece of flannel, or something to keep 
it warm. After it breaks, the sore may be dressed with some digestive 
ointment. What I have always found to answer best, was the yellow 
basilicon mixed with about a sixth or eighth part of its weight of red 
precipitate of mercury. The sore may be dressed with this twice a-day; and 
if it be very fungous, and does not digest well, a larger proportion of 
the precipitate may be added.

MEDICINES which mitigate this disease, though they do not cure it, are not 
to be despised If the patient can be kept alive by any means till he 
arrives at the age of puberty, he has a great chance to get well; but if 
he does not recover at this time, in all probability he never will.

THERE is no malady which parents are so apt to communicate to their 
offspring as the scrophula, for which reason people ought to beware of 
marrying into families affected with this disease.

FOR the means of preventing the scrophula, we must refer the reader to the 
observations on nursing, at the beginning of the book.


OF THE ITCH.

THOUGH this disease is commonIy communicated by infection, yet it seldom 
prevails where due regard is paid to cleanliness, fresh air, and wholesome 
diet. It generally appears in form of small watery pustules, first about 
the wrists, or between the fingers; afterwards it affects the arms, legs, 
thighs, &c. These pustules are attended with an intolerable itching, 
especially when the patient is warm a-bed, or sits by the fire. Sometimes 
indeed the skin is covered with large blotches or scabs, and at other 
times with a white scurf, or scaly eruption. This last is called the dry 
itch, and is the most difficult to cure.

THE itch is seldom a dangerous disease, unless when it is rendered so by 
neglect, or improper treatment. If it be suffered to continue too long, it 
may vitiate the whole mass of humours; and, if it be suddenly drove in, 
without proper evacuations, it may occasion fevers, inflammations of the 
viscera, or other internal disorders.

THE best medicine yet known for the itch is sulphur, which ought to be 
used both externally and internally. The parts most affected may be rubbed 
with an ointment made of the flowers of sulphur, two ounces; crude sal 
ammoniac finely powdered two drachms; hog's lard, or butter, four ounces. 
If a scruple or half a drachm of the essence of lemon be added, It will 
entirely take away the disageeeable smell. About the bulk of a nutmeg of 
this may be rubbed upon the extremities, at bed-time, twice or thrice a-
week. It is seldom necessary to rub the whole body, but when it is, it 
ought to be done all at once, but by turns, as it is dangerous to stop too 
many pores at the same tlme.

BEFORE the patient begins to use the ointment, he ought, if he be of a 
full habit, to bleed or take a purge or two. It will likewise be proper, 
during the use of it, to take every night and morning as much of the 
flower of brimstone and cream of tartar, in a little treacle or new milk, 
as will keep the body gently open. He should beware of catching cold, 
should wear more clothes than usual, and take every thing warm. The same 
clothes, the linen excepted, ought to be worn all the time of using the 
ointment and such clothes as have been worn while the patient was under 
the disease, are not to be used again, unless they have been fumigated 
with brimstone, and thoroughly cleaned, otherwise they will communicate 
the infection anew. Sir John Pringle observes that, though this disease 
may seem trifling, there is no one in the army that is more troublesome to 
cure, as the infection often lurks in clothes, &c. and breaks out a 
second, or even a third time. The same inconveniency occurs in private 
families, unless particular regard is paid to the changing or cleaning of 
their clothes, which last is by no means an easy operation.

I NEVER knew brimstone, when used as directed above, fail to cure the 
itch; and I have reason to believe, that, if duly persisted in, it never 
will fail; but if it be only used once or twice, and cleanliness 
neglected, it is no wonder if the disorder returns. The quantity of 
ointment mentioned above will generally be sufficient for the cure of one 
person; but, if any symptoms of the disease should appear again, the 
medicine may be repeated. It is both more safe and efficacious when 
persisted in for a considerable time, than when a large quantity is 
applied at once. As most people dislike the smell of sulphur, they may 
use, in its place, the powder of white hellebore root made up into an 
ointment, in the same manner, which will seldom fail to cure the itch.

PEOPLE ought to be extremely cautious lest they take other eruptions for 
the itch; as the stoppage of these may be attended with fatal 
consequences. Many of the eruptive disorders to which children are liable, 
have a near resemblance to this disease; and I have often known infants 
killed by being rubbed with greasy ointments that made these eruptions 
strike suddenly in, which Nature had thrown out to preserve the patient's 
life, or prevent some other malady.

MUCH mischief is likewise done by the use of mercury in this disease. Some 
persons are so fool hardy as to wash the parts affected with a strong 
solution or the corrosive sublimate. Others use the mercurial ointment, 
without taking the least care either to avoid cold, keep the body open, or 
observe a proper regimen. The consequences of such conduct may be easily 
guessed. I have known even the mercurial girdles produce tragical effects, 
and would advise every person, as he values his health, to beware how he 
uses them. Mercury ought never to be used as a medicine without the 
greatest care. Ignorant people look upon these girdles as a kind of charm, 
without considering that the mercury enters the body.

IT is not to be told what mischief is done by using mercurial ointment for 
curing the itch and killing vermin; yet it is unnecessary for either: The 
former may be always more certainly cured by sulphur, and the latter will 
never be found where due regard is paid to cleanliness.

THOSE who would avoid this detestable disease ought to beware of infected 
persons, to use wholesome food, and to study universal cleanliness. The 
itch is now by cleanliness banished from every genteel family in Britain. 
It still however prevails among the poorer sort of peasants in Scotland, 
and among the manufacturers in England. These are not only sufficient to 
keep the seeds of the disease alive, but to spread the infection among 
others. It were to be wished that some effectual method could be devised 
for extirpating it altogether. Several country clergymen have told me, 
that by getting such as were infected cured, and strongly recommending an 
attention to cleanliness, they have banished the itch entirely out of 
their parishes. Why might not others do the same?



CHAPTER XL.
OF THE ASTHMA.

THE asthma is a disease of the lungs, which seldom admits of a cure. 
Persons in the decline of life are most liable to it. It is distinguished 
into the moist and dry, or humoural and nervous. The former is attended 
with expectoration or spitting; but in the latter the patient seldom 
spits, unless sometimes a little tough phlegm by the mere force of 
coughing.

CAUSES. - The asthma is sometimes hereditary. It may likewise proceed from 
a bad formation of the breast; the fumes of metals or minerals taken into 
the lungs; violent exercise, especially running; the obstruction of 
customary evacuations, as the menses, haemorrhoids, &c. the sudden 
retrocession of the gout, or striking in of eruptions, as the small-pox, 
measles, &c. violent passions of the mind, as sudden fear, or surprise. In 
a word, the disease may proceed from any cause that either impedes the 
circulation of the blood through the lungs, or prevents their being duly 
expanded by the air.

SYMPTOMS. - An asthma is known by a quick laborious breathing, which is 
generally performed with a kind of wheezing noise. Sometimes the 
difficulty of breathing is so great that the patient is obliged to keep in 
an erect posture, otherwise he is in danger of being suffocated. A fit or 
paroxysm of the asthma generally happens after a person has been exposed 
to cold easterly winds, or has been abroad in thick foggy weather, or has 
got wet, or continued long in a damp place under ground, &c.

THE paroxysm is commonly ushered in with listlessness, want of sleep, 
hoarseness, a cough, belching of wind, a sense of heaviness about the 
breast, and difficulty of breathing. To these succeed heat, fever, pain of 
the head, sickness and nausea, great oppression of the breast, palpitation 
of the heart, a weak and sometimes intermitting pulse, an involuntary flow 
of tears, bilious vomitings, &c. All the symptoms grow worse towards 
night; the patient is easier when up than in bed, and is very desirous of 
cool air.

REGIMEN. - The food ought to be light, and of easy digestion. Boiled meats 
are to be preferred to roasted, and the flesh of young animals to that of 
old. All windy food, and whatever is apt to swell in the stomach, is to be 
avoided. Light puddings, white broths, and ripe fruits baked, boiled, or 
roasted, are proper. Strong liquors of all kinds, especially malt-liquor, 
are hurtful. The patient should eat a very light supper, or rather none at 
all, and should never suffer himself to be long costive. His clothing 
should be warm, especially in the winter season. As all disorders of the 
breast are much relieved by keeping the feet warm, and promoting the 
perspiration, a flannel shirt or waistcoat, and thick shoes, will be of 
singular service.

BUT nothing is of so great importance in the asthma as pure and moderately 
warm air. Asthmatic people can seldom bear either the close heavy air of a 
large town, or the sharp, keen atmosphere of a bleak hilly country; a 
medium therefore between these is to be chosen. The air near a large town 
is often better than at a distance, provided the patient be removed so far 
as not to be affected by the smoke. Some asthmatic patients indeed breathe 
easier in town than in the country; but this is seldom the case, 
especially in towns where much coal is burnt. Asthmatic persons who are 
obliged to be in town all day, ought, at least, to sleep out of it. Even 
this will often prove of great service. Those who can afford it ought to 
travel into a warmer climate. Many asthmatic persons who cannot live in 
Britain, enjoy very good health in the south of France, Portugal, Spain, 
or Italy.

EXERCISE is likewise of very great importance in the asthma, as it 
promotes the digestion, preparation of the blood, &c. The blood of 
asthmatic persons is seldom duly prepared, owing to the proper action of 
the lungs being impeded. For this reason such people ought daily to take 
as much exercise, either on foot, horseback, or in a carriage, as they can 
bear.

MEDIC1NE. - Almost all that can be done by medicine in this disease, is to 
relieve the patient when seized with a violent flt. This indeed requires 
the greatest expedition, as the disease often proves suddenly fatal. In 
the paroxysm or fit, the body is generally bound; a purging clyster, with 
a solution of asafoetida, ought therefore to be administered, and if there 
be occasion, it may be repeated two or three times. The patient's feet and 
legs ought to be immersed in warm water, and afterwards rubbed with a warm 
hand, or dry cloth. Bleeding, unless extreme weakness or old age should 
forbid it, is highly proper. If there be a violent spasm about the breast 
or stomach, warm fomentations, or bladders filled with warm milk and 
water, may be applied to the part affected, and warm cataplasms to the 
soles of the feet. The patient must drink freely of diluting liquors, and 
may take a tea-spoonful of the tincture of castor and of saffron mixed 
together, in a cup of valerian-tea, twice or thrice a-day. Sometimes a 
vomit has a very good effect, and snatches the patient, as it were, from 
the jaws of death. This however will be more safe after other evacuations 
have been premised. A very strong infusion of roasted coffee is said to 
give ease in an asthmatic paroxysm.

IN the moist asthma, such things as promote expectoration or spitting 
ought to be used; as the syrup of squills, gum ammoniac, and such like. A 
common spoonful of the syrup of oxymel of squills, mixed with an equal 
quantity of cinnamon-water, may be taken three or four times through the 
day, and four or five pills, made of equal parts of asafoetida and gum-
ammonlac, at bed-time. After copious evacuations, large doses of aether 
have been found very efficacious in removing a fit of the asthma. I have 
likewise known the following mixture produce very happy effects: To four 
or five ounces of the solution of gum-ammoniac add two ounces of simple 
cinnamon-water, the same quantity of balsamic syrup, and half an ounce of 
the paregoric elixir. Of this two table-spoonfuls may be taken every three 
hours.

FOR the convulsive or nervous asthma, antispasmodics and bracers are the 
most proper medicines. The patient may take a tea-spoonful of the 
paregoric elixir twice a-day. The Peruvian bark is sometimes found to be 
of use in this case. It may be taken in substance, or infused in wine. In 
short, every thing that braces the nerves, or takes off spasm, may be
of use in a nervous asthma. It is often relieved by the use of asses milk; 
I have likewise known cows milk drank warm in the morning have a very good 
effect in this case.

IN every species of asthma, setons and issues have a good effect; they may 
either be put in the back or side, and should never be allowed to dry up. 
We shall here, once and for all, observe, that not only in asthma, but in 
most chronic diseases, issues are extremely proper. They are both a safe 
and efficacious remedy and though they do not always cure the disease, yet 
they will often prolong the patient's life.