Domestic Medicine - Chapters 41-43



CHAPTER XLI.
OF THE APOPLEXY.

THE apoplexy is a sudden loss of sense and motion, wherein the patient is 
to all appearance dead; the heart and lungs however still continue to 
move. Though this disease proves often fatal, yet it may sometimes be 
removed by proper care. It chiefly attacks sedentary persons of a gross 
habit, who use a rich and plentiful diet, and indulge in strong liquors. 
People in the decline of life are most subject to the apoplexy. It 
prevails most in winter, especially in rainy seasons, and very low states 
of the barometer.

CAUSES. -The immediate cause of an apoplexy is a compression of the brain, 
occasioned by an excess of blood, or a collection of watery humours. The 
former is called a sanguine, and the latter a serous apoplexy. It may be 
occasioned by any thing that increases the circulation towards the brain, 
or prevents the return of the blood from the head; as intense study; 
violent passions; viewing objects for a long time obliquely; wearing any 
thing too tight about the neck, a rich and luxurious diet; suppression of 
urine; suffering the body to cool suddenly after having been greatly 
heated; continuing long in a warm bath; the excessive use of spiceries, or 
high-seasoned food; excess of venery; the sudden striking in of any 
eruption; suffering issues, setons, &c. suddenly to dry up, or the 
stoppage of any customary evacuation; a mercurial salivation pushed too 
far, or suddenly checked by cold; wounds or bruises on the head; long 
exposure to excessive cold; poisonous exhalations, &c. I knew a woman who 
in a violent fit of anger was seized with a sanguine apoplexy. She at 
first complained of extreme pain, as if daggers had been thrust through 
her head, as she expressed it. Afterwards she became comatose, her pulse 
sunk very low, and was exceeding slow. By bleeding, blistering, and other 
evacuations, she was kept alive for about a fortnight. When her head was 
opened, a large quantity of extravasated blood was found in the left 
ventricle of the brain.

SYMPTOMS, and method of cure. - The usual forerunners of an apoplexy are 
giddiness, pain and swimming of the head; loss of memory; drowsiness; 
noise in the ears; the night-mare; a spontaneous flux of tears, and 
laborious respiration. When persons of an apoplectic make observe these 
symptoms, they have reason to fear the approach of a fit, and should 
endeavour to prevent it by bleeding, a slender diet, and opening medicines.

IN the sanguine apoplexy, if the patient does not die suddenly, the 
countenance appears florid, the face is swelled or puffed up, and the 
blood-vessels, especially about the neck and temples, are turgid; the 
pulse beats strong; the eyes are prominent and fixed, and the breathing is 
difficult, and performed with a snorting noise. The excrements and urine 
are often voided spontaneously, and the patient is sometimes seized with 
vomiting.

IN this species of apoplexy every method must be taken to lessen the force 
of the circulation towards the head. The patient should be kept perfectly 
easy and cool. His head should be raised pretty high, and his feet 
suffered to hang down. His clothes ought to be loosened, especially about 
the neck, and fresh air admitted into his chamber. His garters should be 
tied pretty tight, by which means the motion of the blood from the lower 
extremities will be retarded. As soon as the patient is placed in a proper 
posture, he should be bled freely in the neck or arm, and, if there be 
occasion, the operation may be repeated in two or three hours. A laxative 
clyster, with plenty of sweet oil, or fresh butter, and a spoonful or two 
of common salt in it, may be administered every two hours; and blistering-
plasters applied betwixt the shoulders, and to the calves of the legs.

AS soon as the symptoms are a little abated, and the patient is able to 
swallow, he ought to drink freely of some diluting opening liquor, as a 
decoction of tamarinds and liquorice, cream-tartar-whey, or common whey 
with cream of tartar dissolved in it. Or he may take any cooling purge, as 
Glauber's salts, manna dissolved in an infusion of senna, or the like. All 
spirits and other strong liquors are to be avoided. Even volatile salts 
held to the nose do mischief. Vomits, for the same reason, ought not to be 
given, nor any thing that may increase the motion of the blood towards the 
head.

IN the serous apoplexy, the symptoms are nearly the same, only the pulse 
is not so strong, the countenance is less florid, and the breathing less 
difficult. Bleeding is not so necessary here, as in the former case. It 
may, however, generally be performed once with safety and advantage, but 
should not be repeated. The patient should be placed in the same posture 
as directed above, and should have blistering-plasters applied, and 
receive opening clysters in the same manner. Purges here are likewise 
necessary, and the patient may drink strong balm-tea. If he be inclined to 
sweat, it ought to be promoted by drinking small wine-whey, or an infusion 
of carduus benedictus. A plentiful sweat kept up for a considerable time, 
has often carried off a serous apoplexy.

WHEN apoplectic symptoms proceed from opium, or other narcotic substances 
taken into the stomach, vomits are necessary. The patient is generally 
relieved as soon as he has discharged the poison in this way.

PERSONS of an apoplectic make, or those who have been attacked by it, 
ought to use a very spare and slender diet, avoiding all strong liquors, 
spiceries, and high-seasoned food. They ought likewise to guard against 
all violent passions, and to avoid the extremes of heat and cold. The head 
should be shaved, and daily washed with cold water. The feet ought to be 
kept warm, and never suffered to continue long wet. The body must be kept 
open either by food or medicine, and a little blood may be let every 
spring and fall. Exercise should by no means be neglected; but it ought to 
be taken in moderation. Nothing has a more happy effect in preventing an 
apoplexy than perpetual issues or setons; great care however must be taken 
not to suffer them to dry up, without opening others in their stead. 
Apoplectic persons ought never to go to rest with a full stomach, or to 
lie with their heads low, or wear any thing too tight about their necks.



CHAPTER XLII.
OF COSTIVENESS, AND OTHER AFFECTIONS OF THE STOMACH AND BOWELS.

WE do not here mean to treat of those astrictions of the bowels which are 
the symptoms of diseases, as of the cholic, the iliac passion, &c. but 
only to take notice of that infrequency of stools which sometimes happens, 
and in which in some particular constitutions may occasion diseases.

COSTIVENESS may proceed from drinking rough red wines, or other astringent 
liquors; too much exercise, especially on horseback: It may likewise 
proceed from a long use of cold insipid food, which does not sufficiently 
stimulate the intestines. Sometimes it is owing to the bile not descending 
to the intestines, as in the jaundice; and at other times it proceeds from 
diseases of the intestines themselves, as a palsy, spasms, torpor, 
tumours, a cold dry state of the intestines, &c.

EXCESSIVE costiveness is apt to occasion pains of the head, vomiting, 
colics, and other complaints of the bowels. It is peculiarly hurtful to 
hypochondriac and hysteric persons, as it generates wind and other 
grievous symptoms. Some people however can bear costiveness to a great 
degree. I know persons who enjoy pretty good health, yet do not go to 
stool above once a-week, and others not above once a fortnight.

PERSONS who are generally costive should live upon a moistening and 
laxative diet, as roasted or boiled apples, pears, stewed prunes, raisins, 
gruels with currants, butter, honey, sugar, and such like. Broths with 
spinage, leeks, and other soft pot-herbs, are likewise proper. Rye-bread, 
or that which is made of a mixture of wheat and rye together, ought to be 
eat. No person troubled with costiveness should eat white bread alone, 
especially that which is made of fine flour. The best bread for keeping 
the body soluble is what in some parts of England they call meslin. It is 
made of a mixture of wheat and rye, and is very agreeable to those who are 
accustomed to it.

COSTIVENESS is increased by keeping the body too warm, and by every thing 
that promotes the perspiration; as wearing flannel, lying too long a-bed, 
&c. Intense thought, and a sedentary life, are likewise hurtful. All the 
secretions and excretions are promoted by moderate exercise without doors, 
and by a gay, cheerful, sprightly temper of mind.

THE drink should be of an opening quality. All ardent spirits, austre and 
astringent wines, as port, claret, &c. ought to be avoided. Malt-liquor 
that is fine, and of a moderate strength, is very proper. Butter-milk, 
whey, and other watery liquors, are likewise proper, and may be drank in 
turns, as the patient's inclination directs.

THOSE who are troubled with costiveness, ought, if possible, to remedy it 
by diet, as the constant use of medicines for that purpose is attended 
with many inconveniencies, and often with bad consequences. I never knew 
any one get into a habit of taking medicine for keeping the body open, who 
could leave it off. In time the custom becomes necessary, and generally 
ends in a total relaxation of the bowels, indigestion, loss of appetite, 
wasting of the strength, and death. The learned Dr. Arbuthnot advises 
those who are troubled with costiveness to use animal oils, as fresh 
butter, cream, marrow, fat broths, especially those made of the internal 
parts of animals, as the liver, heart, midriff, &c. He likewise recommends 
the expressed oils of mild vegetables, as olives, almonds, pastaches, and 
the fruits themselves; all oily and mild fruits, as figs; decoctions of 
mealy vegetables; these lubricate the intestines; some saponaceous 
substances which stimulate gently, as honey, hydromel, or boiled honey and 
water, unrefined sugar, &c.

THE Doctor observes that such lenitive substances are proper for persons 
of dry atrabilarian constitutions, who are subject to astriction of the 
belly, and the piles, and will operate when stronger medicinal substances 
are sometimes ineffectual; but that such lenitive diet hurts those whose 
bowels are weak and lax. He likewise observes, that all watery substances 
are lenitive, and that even common water, whey, sour milk, and butter milk 
have that effect; - That new milk, especially asses milk, stimulates still 
more when it sours on the stomach; and that whey turned sour will purge 
strongly; - That most garden fruits are likewise laxative; and that some 
of them, as grapes, will throw such as take them immoderately, into a 
cholera morbus, or incurable diarrhoea.

WHEN the body cannot be kept open without medicine, we would recommend 
gentle doses of rhubarb to be taken twice or thrice a-week. This is not 
near so injurious to the stomach as aloes, jalap, or the other drastic 
purgatives so much in use. Infusions of senna and manna may likewise be 
taken, or half an ounce of soluble tartar dissolved in water-gruel. About 
the size of a nutmeg of lenitive electuary taken twice or thrice a-day, 
generally answers the purpose very well.


WANT OF APPETITE.

THIS may proceed from a foul stomach; indigestion; the want of free air 
and exercise; grief; fear; anxiety, or any of the depressing passions; 
excessive heat; the use of strong broths, fat meats, or any thing that 
palls the appetite, or is hard of digestion; the immoderate use of strong 
liquors, tea, tobacco, opium, &c.

THE patient ought, if possible, to make choice of an open dry air; to take 
exercise daily on horseback or in a carriage; to rise betimes; and to 
avoid all intense thought. He should use a diet of easy digestion; and 
should avoid excessive heat and great fatigue.

IF want of appetite proceeds from errors in diet, or any other part of the 
patient's regimen, it ought to be changed. If nausea and reachings shew 
that the stomach is loaded with crudities, a vomit will be of service. 
After this a gentle purge or two of rhubarb, or of any of the bitter 
purging salts, may be taken. The patient ought next to use some of the 
stomachic bitters infused in wine. Though gentle evacuations be necessary, 
yet strong purges and vormits are to be avoided, as they weaken the 
stomach, and hurt digestion.

ELIXIR of vitriol is an excellent medicine in most cases of indigestion, 
weakness of the stomach, or want of appetite. Twenty or thirty drops of it 
may be taken twice or thrice a-day in a glass of wine or water. It may 
likewise be mixed with the tincture of the bark, one drachm of the former 
to an ounce of the latter, and two tea-spoonfuls of it taken in wine or 
water, as above.

THE chalybeate waters, if drank in moderation, are generally of 
considerable service in this case. The salt water has likewise good 
effects; but it must not be used too freely. The waters of Harrowgate, 
Scarborough, Moffat, and most other Spas in Britain, may be used with 
advantage. We would advise all who are afflicted with indigestion and want 
of appetite, to repair to these places and public rendezvous. The very 
change of air, and the cheerful company, will be of service; not to 
mention the exercise, dissipation, amusements, &c.


OF THE HEART-BURN.

WHAT is commonly called the heart-burn, is not a disease of that organ, 
but an uneasy sensation of heat or acrimony about the pit of the stomach, 
which is sometimes attended with anxiety, nausea, and vomiting.

IT may proceed from debility of the stomach, indigestion, bile, the 
abounding of an acid in the stomach, &c. Persons who are liable to this 
complaint ought to avoid stale liquors, acids, windy or greasy aliments, 
and should never use violent exercise soon after a plentiful meal. I know 
many persons who never fail to have the heart-burn, if they ride soon 
after dinner, provided they have drank ale, wine, or any fermented liquor; 
but are never troubled with it when they have drank rum or brandy and 
water without any sugar or acid.

WHEN the heart-burn proceeds from debility of the stomach or indigestion, 
the patient ought to take a dose or two of rhubarb; afterwards he must use 
infusions of the Peruvian bark, or any other of the stomachic bitters, in 
wine or brandy. Exercise in the open air will likewise be of use, and 
every thing that promotes digestion.

WHEN bilious humours occasion the heart-burn, a tea-spoonful of the sweet 
spirit of nitre in a glass of water, or a cup of tea, will generally give 
ease. If it proceeds from the use of greasy aliments, a dram of brandy or 
rum may be taken.

IF acidity or sourness of the stomach occasions the heart-burn, absorbents 
are the proper medicines. In this case an ounce of powdered chalk, half an 
ounce of fine sugar, and a quarter of an ounce of gum arabic, may be mixed 
in an English quart of water, and a tea-cupful of it taken as often as is 
necessary. Such as do not chuse chalk may take a tea-spoonful of prepared 
oyster-shells, or of the powder called crabs-eyes, in a glass of cinnamon 
or peppermint-water. But the safest and best absorbent is magnesia alba. 
This not only acts as an absorbent, but likewise as a purgative; whereas 
chalk, and other absorbents of that kind, are apt to lie in the 
intestines, and occasion obstructions. This powder is not disagreeable, 
and may be taken in a cup of tea, or a glass of mint-water. A large tea-
spoonful is the usual dose, but it may be taken in a much greater quantity 
when there is occasion. These things are now generally made up into 
lozenges for the conveniency of being carried in the pocket, and taken at 
pleasure.

lF wind be the cause of this complaint, the most proper medicines are 
those called carminatives; as aniseeds, juniper-berries, ginger, canella 
alba, cardamom seeds, &c. These may either be chewed, or infused in wine, 
brandy, or other spirits. One of the safest medicines of this kind is the 
tincture, made by infusing an ounce of rhubarb; and a quarter of an ounce 
of the lesser cardamom seeds, in an English pint of brandy. After this has 
digested for two or three days, it ought to be strained, and four ounces 
of white sugar-candy added to it. It must stand to digest a second time 
till the sugar be dissolved. A table-spoonful of it may be taken 
occasionally for a dose.

I HAVE frequently known the heart-burn cured, particularly in pregnant 
women, by chewing green tea.



CHAPTER XLIII.
OF NERVOUS DISEASES.

OF all diseases incident to mankind, those of the nervous kind are the 
most complicated and difficult to cure. A volume would not be sufficient 
to point out their various appearances. They imitate almost every disease; 
and are seldom alike in two different persons, or even in the same person 
at different times. Proteus-like, they are continually changing shape; and 
upon every fresh attack, the patient thinks he feels symptoms which he 
never experienced before. Nor do they only affect the body; the mind 
likewise suffers, and is often thereby rendered extremely weak and 
peevish. The low spirits, timorousness, melancholy, and fickleness of 
temper, which generally attend nervous disorders, induce many to believe, 
that they are entirely diseases of the mind; but this change of temper is 
rather a consequence, than the cause of nervous diseases.

CAUSES. - Every thing that tends to relax or weaken the body, disposes it 
to nervous diseases, as indolence, excessive venery, drinking too much 
tea, or other weak watery liquors, frequent bleeding, purging, vomiting, 
&c. Whatever hurts the digestion, or prevents the proper assimilation of 
the food, has likewise this effect; as long fasting, excess in eating or 
drinking; the use of windy, crude, or unwholesome aliments, an 
unfavourable posture of the body, &c.

NERVOUS disorders often proceed from intense application to study. Indeed 
few studious persons are entirely free from them. Nor is this at all to be 
wondered at; intense thinking not only preys upon the spirits, but 
prevents the person from taking proper exercise, by which means the 
digestion is impaired, the nourishment prevented, the solids relaxed, and 
the whole mass of humours vitiated. Grief and disappointment likewise 
produce the same effects. I have known more nervous patients, who dated 
the commencement of their disorders from the loss of a husband, a 
favourite child, or from some disappointment in life, than from any other 
cause. In a word, whatever weakens the body, or depresses the spirits, may 
occasion nervous disorders, as unwholesome air, want of great fatigue, 
disagreeable apprehensions, anxiety vexation, &c.

SYMPTOMS -We shall only mention some of the most general symptoms of these 
disorders, as it would be both an useless and an endless task to enumerate 
the whole. They generally begin with windy inflations or distentions of 
the stornach and intestines, the appetite and digestion are usually bad; 
yet sometirnes there is an uncommon craving for food, and a quick 
digestion. The food often turns sour on the stomach; and the patient is 
troubled with vomiting of clear water, tough phleghm, or a blackish 
coloured liquor resembling the grounds of coffee. Excruciating pains are 
often felt about the navel, attended with a rumbling or murmuring noise in 
the bowels. The body is sometimes loose, but more commonly bound, which 
occasions a retention of wind and great uneasiness.

THE urine is sometimes in small quantity, at other times very copious and 
quite clear. There is a great straitness of the breast, with difficulty of 
breathing; violent palpitations of the heart; suddden flushings of heat in 
various parts of the body; at other times a sense of cold, as if water 
were poured on them; flying pains in the arms and limbs; pains in the back 
and belly, resembling those occasioned by gravel; the pulse very variable, 
sometimes uncommonly slow, and at other times very quick; yawning, the 
hiccup, frequent sighing, and a sense of suffocation, as if from a ball or 
lump in the throat; alternate fits of crying and convulsive laughing; the 
sleep is unsound and seldom seldom refreshing; and the patient is often 
troubled with the night-mare.

AS the disease increases, the patient is molested with head-achs, cramps, 
and fixed pains in various parts of the body; the eyes are clouded, and 
often affected with pain and dryness; there is a noise in the ears, and 
often a dulness of hearing; in short, the whole animal functions are 
impaired. The mind is disturbed on the most trivial occasions, and is 
hurried into the most perverse commotions, inquietudes, terror, sadness, 
anger, diffidence, &c. The patient is apt to entertain wild imaginations 
and fancies; the memory becomes weak, and the judgment fails.

NOTHING is more characteristic of this disease than constant dread of 
death. This renders those unhappy persons who labour under it peevish, 
fickle, impatient, and apt to run from one physician to another; which is 
one reason why they seldom reap any benefit from medicine, as they have 
not sufficient resolution to persist in any one course till it has time to 
produce its proper effects. They are likewise apt to imagine that they 
labour under diseases from which they are quite free; and are very angry 
if any one attempts to set them right, or laugh them out of their 
ridiculous notions.

REGIMEN. - Persons afflicted with nervous diseases ought never to fast 
long. Their food should be solid and nourishing, but of easy digestion. 
Fat meats, and heavy sauces, are hurtful. All excess should be carefully 
avoided. They ought never to eat more at a time than they can easily 
digest; but if they feel themseIves weak and faint between meals, they 
ought to eat a bit of bread, and drink a glass of wine. Heavy suppers are 
to be avoided. Though wine in excess enfeebles the body, and impairs the 
faculties of the mind, yet taken in moderation, it strengthens the 
stomach, and promotes digestion. Wine and water is a very proper drink at 
meals: but if wine sours on the stornach, or the patient is much troubled 
with wind, brandy and water will answer better. Every thing that is windy 
or hard of digestion must be avoided. All weak and warm liquors are 
hurtful, as tea, coffee, punch, &c. People may find a ternporary relief in 
the use of these, but they always increase the malady, as they weaken the 
stomach and hurt digestion. Above all things, drams are to be avoided. 
Whatever immediate ease the patient may feel from the use of ardent 
spirits, they are sure to aggravate the malady, and prove certain poisons 
at last. These cautions are the more necessary, as most nervous people are 
peculiarly fond of tea, and ardent spirits; to the use of which many of 
them fall victims.

EXERCISE in nervous disorders is superior to all medicines. Riding on 
horseback is generally esteemed the best, as it gives motion to the whole 
body, without fatiguing it. I have known some patients however, with whom 
walking agreed better, and others who were most benefited by riding in a 
carriage. Every one ought to use that which he finds most beneficial. Long 
sea voyages have an excellent effect; and to those who can afford to take 
them, and have sufficient resolution, we would by all means recommend this 
course. Even change of place, and the sight of new objects, by diverting 
the mind, have a great tendency to remove these complaints. For this 
reason a long journey, or a voyage, is of much more advantage than riding 
short journeys near home.

A COOL dry air is proper, as it braces and invigorates the whole body. Few 
things tend more to relax and enervate than hot air, especially that which 
is rendered so by great fires, or stoves in small apartments. But when the 
stomach or bowels are weak, the body ought to be well guarded against 
cold, especially in winter, by wearing a thin flannel waist-coat next the 
skin. This will keep up an equal perspiration, and defend the alimentary 
canal from many impressions to which it would otherwise be subject, upon 
every sudden change from warm to cold weather. Rubbing the body frequently 
with a flesh brush, or a coarse linen cloth, is likewise beneficial, as it 
promotes the circulation, perspiration, &c. Persons who have weak nerves 
ought to rise early, and take exercise before breakfast, as lying too long 
a-bed cannot fail to relax the solids. They ought likewise to be diverted, 
and to be kept as easy and cheerful as possible. There is not any thing 
which hurts the nervous system, or weakens the digestive powers, more than 
fear, grief, or anxiety.

MEDICINES. - Though nervous diseases are seldom radically cured, yet their 
symptoms may sometimes be alleviated, and the patient's life rendered, at 
least, more comfortable, by proper medicines.

WHEN the patient is costive, he ought to take a little rhubarb, or some 
other mild purgative, and should never suffer his body to be long bound. 
All strong and violent purgatives are however to be avoided, as aloes, 
jalap, &c. I have generally seen an infusion of senna and rhubarb in 
brandy answer very well. This may be made of any strength, and taken in 
such quantity as the patient finds necessary. When digestion is bad, or 
the stomach relaxed and weak, the following infusion of Peruvian bark and 
other bitters may be used with advantage.

TAKE of Peruvian bark an ounce, gentian root, orange-peel, and coriander-
seed, of each half an ounce; let these ingredients be all bruised in a 
rnortar, and infused in a bottle of brandy or whisky, for the space of 
five or six days. A table-spoonful of the strained liquor may be taken in 
half a glass of water, an hour before breakfast, dinner, and supper.

FEW things tend more to strengthen the nervous system than cold bathing. 
This practice, if duly persisted in, will produce very extraordinary 
effects; but when the liver or other viscera are obstructed, or otherwise 
unsound, the cold bath is improper. It is therefore to be used with very 
great caution. The most proper seasons for it are summer and autumn. It 
will be sufficient, especially for persons of a spare habit, to go into 
the cold bath three or four times a-week. If the patient be weakened by 
it, or feels chilly for a long time after coming out, it is improper.

IN a patient affected with wind, I have always observed the greatest 
benefit from the acid elixir of vitriol. It may be taken in the quantity 
of fifteen, twenty, or thirty drops, twice or thrice a-day in a glass of 
water. This both expels wind, strengthens the stomach, and promotes 
digestion.

OPIATES are generally extolled in these maladies; but as they only 
palliate the symptoms, and generally afterwards increase the disease, we 
would advise people to be extremely sparing in the use of them, lest habit 
render them at last absolutely necessary.

IT would be an easy matter to enumerate many medicines which have been 
extolled for relieving nervous disorders; but whoever wishes for a 
thorough cure must expect it from regimen alone; we shall therefore omit 
mentioning more medicines, and again recommend the strictest attention to 
DIET, AIR, EXERCISE and AMUSEMENTS.


OF MELANCHOLY.

MELANCHOLY is that state of alienation or weakness of mind which renders 
people incapable of enjoying the pleasures, or performing the duties of 
life. It is a degree of insanity, and often terminates in absolute madness.

CAUSES. - It may proceed from a hereditary disposition; intense thinking, 
especially where the mind is long occupied about one object; violent 
passions or affections of the mind, as love, fear, joy, grief, overweaning 
pride, and such like. It may also be occasioned by excessive venery, 
narcotic or stupefactive poisons; a sedentary life; solitude; the 
suppression of custornary evacuations; acute fevers, or other diseases. 
Violent anger will change melancholy into madness; and excessive cold, 
especially of the lower extremities, Will force the blood into the brain, 
and produce all the symptoms of madness. It may likewise proceed from the 
use of aliment that is hard of digestion, or which cannot be easily 
assimilated; from a callous state of the integuments of the brain, or 
dryness of the brain itself. To all which we may add gloomy or mistaken 
notions of religion.

SYMPTOMS. - When persons begin to be melancholy, they are timorous; 
watchful; fond of solitude, fretful; fickle; captious and inquisitive; 
solicitous about trifles; sometimes niggardly, and at other times 
prodigal. The body is generally bound; the urine thin, and in small 
quantity; the stomach and bowels inflated with wind; the complexion pale; 
the pulse slow and weak. The functions of the mind are also greatly 
perverted, in so much that the patient often imagines himself dead, or 
changed into some other animal. Some have imagined their bodies were made 
of glass, or other brittle substances, and were afraid to move, lest they 
should be broken to pieces. The unhappy patient, in this case, unless 
carefully watched, is apt to put an end to his own miserable life.

WHEN the disease is owing to an obstruction of customary evacuations, or 
any bodily disorder, it is easier cured than when it proceeds from 
affections of the mind, or an hereditary taint. A discharge of blood from 
the nose, looseness, scabby eruptions, the bleeding piles, or the menses, 
carry off this disease.

REGIMEN - The diet should consist chiefly of vegetables of a cooling and 
opening quality. Animal food, especially salted or smoke-dried fish or 
flesh ought to be avoided. All kinds of shell-fish are bad. Aliments 
prepared with onions, garlic, or any thing that generates thick blood are 
likewise improper. All kind of fruits that are wholesome may be eat with 
advantage . Boerhaave gives an instance of a patient who, by a long use of 
whey, water, and garden-fruit, recovered, after having evacuated a great 
quantity of black-couloured matter.

STRONG liuors of every kind ought to be avoided as poison. The most proper 
drink is water, whey, or very small beer. Tea and coffee are improper. If 
honey agrees with the patient, it may be eat freely, or his drink may be 
sweetened with it. Infusions of balm-leaves, penny-royal, the roots of 
wild valerian, or the flowers of the lime-tree may be drank freely, either 
by themselves, or sweetened with honey, as the patient shall chuse.

THE patient ought to take as much exercise in the open air as he can bear. 
This helps to dissolve the viscid humours, it removes obstructions, 
promotes the perspiration, and all the other secretions. Every kind of 
madness is attended with a diminished perspiration; all means ought 
therefore to be used to promote that necessary and salutary discharge. 
Nothing can have a more direct tendency to increase the disease than 
confining the patient to a close apartment. Were he forced to ride, or 
walk a certain number of rniles every day, it would tend greatly to 
alleviate his disorder; but it would have still a better effect if he were 
obliged to labour a piece of ground. By digging, hoeing, planting, sowing, 
&c. both the body and mind would be exercised. A long journey, or a 
voyage, especially towards a warmer climate, with agreeable companions, 
has often very happy effects. A plan of this kind, with a strict attention 
to diet, is a much more rational method of cure, than confining the 
patient within doors and plying him with medicines.

MEDICINE. - In the cure of this disease particular attention must be paid 
to the mind. When the patient is in a low state, his mind ought to be 
soothed and diverted with a variety of amusements, as entertaining 
stories, pastimes, music, &c. This seems to have been the method of curing 
rnelancholy among the Jews, as we learn from the story of King Saul; and 
indeed it is a very rational one. Nothing can remove dieases of the mind 
so effectually as applications to the mind itself, the most efficacious of 
which is music. The patient's company ought likewise to consult of such 
persons as are agreeabIe to him. People in this state are apt to conceive 
unaccountable aversions against particular persons; and the very sight of 
such persons is sufficient to distract their minds, and throw them into 
the utmost perturbation.

WHEN the patient is high, evacuations are necessary. In this case he must 
be bled, and have his body kept open by purging medicines, as manna, 
rhubarb, cream of tartar, or the soluble tartar. I have seen the last have 
very happy effects. It may be taken in the dose of half an ounce, 
dissolved in water-gruel, every day, for sundry weeks, or even for months, 
if necessary. More or less may be given according as it operates. Vomits 
have likewise a good effect; but they must be pretty strong, otherwise 
they will not operate.

WHATEVER increases the evacuation of urine or promotes perspiration, has a 
tendency to rermove this disease. Both these secretions may be promoted by 
the use of nitre and vinegar. Half a drachm of purified nitre may be given 
three or four times a-day in any manner that is most agreeable to the 
patient; and an ounce and a half of distilled vinegar may be daily mixed 
with his drink. Dr. Locker seems to think vinegar the best medicine that 
can be given in this disease.

CAMPHIRE and musk have likewise been used in this case with advantage. Ten 
or twelve grains of camphire may be rubbed in a mortar with half a drachm 
of nitre, and taken twice a-day, or oftener, if the stomach will bear it. 
If it will not sit upon the stomach in this form, it may be made into 
pills with gum asafoetida and Russian castor, and taken in the quantity 
above directed. If musk is to be administered, a scruple or twenty-five 
grains of it may be made into a bolus with a little honey or common syrup, 
and taken twice or thrice a-day. We do not mean that all these medicines 
should be administered at once; but whichever of them is given, must be 
duly persisted in, and where one fails another may be tried.

AS it is very difficult to induce patients in this disease to take 
medicines, we shall mention a few outward applications which sometimes do 
good; the principal of these are issues, setons, and warm bathing. Issues 
may be made in any part of the body, but they generally have the best 
effect near the spine. The discharge from these may be greatly promoted by 
dressing them with the mild blistering ointment, and keeping what are 
commonly called the orrice pease in them. The most proper place for a 
seton is between the shoulder blades; and it ought to be upwards and 
downwards, or in the direction of the spine.


OF THE PALSY.

THE palsy is a loss or diminution of sense or motion, or of both, in one 
or more parts of the body. Of all the affections called nervous, this is 
the most suddenly fatal. It is more or less dangerous, according to the 
importance of the part affected. A palsy of the heart, lungs, or any part 
necessary to life, is mortal. When it affects the stomach, the intestines, 
or the bladder, it is highly dangerous. If the face be affected, the case 
is bad, as it shews that the disease proceeds from the brain. When the 
part affected feels cold, is insensible, or wastes away, or when the 
judgment and memory begin to fail, there is small hope of a cure.

CAUSES. - The immediate cause of palsy is any thing that prevents the 
regular exertion of the nervous power upon any particular rnuscle or part 
of the body. The occasional and predisposing causes are various, as 
drunkness; wounds of the brain, or spinal marrow; pressure upon the brain 
or nerves; very cold or damp air; the supression of customary evacuations; 
sudden fear; want of exercise; or whatever greatly relaxes the system, as 
drinking much tea, or coffee, &c. Many people imagine, that tea has no 
tendency to hurt the nerves, and that drinking the same quantity of warm 
water would be equally pernicious. This however seems to be a mistake. 
Many persons drink three or four cups of warm milk and water daily, 
without feeling any bad consequences; yet the same quantity of tea will 
make their hands shake for twenty-four hours. That tea affects the nerves 
is likewise evident from its preventing sleep, occasioning giddiness, 
dimness of the sight, sickness, &c. The palsy may likewise proceed from 
wounds of the nerves themselves, from the poisonous fumes of metals or 
minerals, as mercury, lead, arsenic,

IN young persons of a full habit, the palsy must be treated in the same 
manner as the sanguine apoplexy. The patient must be bled, blistered, and 
have his body opened by sharp clysters or purgative medicines. But, in old 
age, or when the disease proceeds from relaxation or debility, which is 
generally the case, a quite contrary course must be pursued. The diet must 
be warm and invigorating, seasoned with spicy and aromatic vegetables, as 
mustard, horse-radish, &c. The drink may be generous wine, mustard, whey, 
or brandy and water. Friction with the flesh brush, or a warm hand, is 
extremely proper, especially on the parts affected. Blistering-plasters 
may likewise be applied to the affected parts with advantage. When this 
cannot be done, they may be rubbed with the volatile linement, or the 
nerve ointment of the Edinbuirgh dispensatory. One of the best external 
applications is electricity. The shocks should be received on the part 
affected; and they ought daily to be repeated for several weeks.

VOMITS are very beneficial in this kind of palsy, and ought frequently to 
be administered. Cephalic snuff, or any thing that makes the patient 
sneeze, is likewise of use. Some pretend to have found great benefit from 
rubbing the parts affected with nettles; but this does not seem to be any 
way preferable to blistering. If the tongue is affected, the patient may 
gargle his mouth frequently with brandy and mustard, or he may hold a bit 
of sugar in his mouth wet with the palsy-drops or compound spirits of 
lavender. The wild valerian-root is a very proper medicine in this case. 
It may either be taken in an infusion with sage leaves, or half a drachm 
of it in powder may be given in a glass of wine three times a-day. If the 
patient cannot use the valerian, he may take of sal volatile oleosum, 
compound spirits of lavender, and tincture of castor, each half an ounce. 
Mix these together, and take forty or fifty drops in a glass of wine, 
three or four times a-day. A table-spoonful of mustard-seed taken 
frequently is a very good medicine. The patient ought likewise to chew 
cinnamon-bark, ginger, or other warm spiceries.

EXERCISE is of the utmost importance in the palsy; but the patient must 
beware of a cold, damp, and moist air. He ought to wear flannel next his 
skin; and, if possible, should remove into a warmer climate.


OF THE EPILEPSY, OR FALLING SICKNESS.

THE epilepsy is a sudden deprivation of all the senses, wherein the 
patient falls suddenly down, and is effected with violent convulsive 
motions. Children, especially those who are delicately brought up, are 
most subject to it. It more frequently attacks men than women, and is very 
difficult to cure. When the epilepsy attacks children, there is reason to 
hope it may go off about the time of puberty. When it attacks any person 
after twenty years of age, the cure is difficult; but when after forty, a 
cure is hardly to be expected. If the fit continues only for a short 
space, and returns seldom, there is reason to hope; but if it continues 
long and returns frequently, the prospect is bad. It is a very 
unfavourable symptom when the patient is seized with the fits in his sleep.

CAUSES. - The epilepsy is sometimes hereditary. It may likewise proceed 
from frights of the mother when with child; from blows, bruises or wounds 
on the head; a collection of water, blood, or serous humours in the brain; 
a polypus; tumours or concretions within the skull; excessive drinking; 
intense study; excess of venery; worms; teething; suppression of customary 
evacuations; too great emptiness or repletion; violent passions or 
affections of the mind, as fear, joy, &c. hysteric affections; contagion 
received into the body, as the infection of the small-pox, measles, &c.

SYMPTOMS - An epileptic fit is generally preceded by unusual weariness; 
pain of the head,; dullness; giddiness; noise in the ears; dimness of 
sight; palpitation of the heart; disturbed sleep; difficult breathing; the 
bowels are inflated with wind; the urine is in great quantity, but thin; 
the complexion is pale; the extremities are cold, and the patient often 
feels, as it were, a stream of cold air ascending towards his head.

IN the fit, the patient generally makes an unusual noise; his thumbs are 
drawn in towards the palms of the hands; his eyes are distorted; he 
starts, and foams at the mouth; his extremities are bent or twisted 
various ways; he often discharges his seed, urine, and faeces 
involuntarfly; and is quite destitute of all sense and reason. After the 
fit is over, his senses gradually return, and he complains of a kind of 
stupor, weariness, and pain of his head; but has no remembrance of what 
happened to him during the fit.

THE fits are sometimes excited by violent affections of the mind, a 
debauch of liquor, excessive heat, cold, or the like.

THIS disease, from the difficulty of investigating its causes, and its 
strange symptoms, was formerly attributed to the wrath of the gods, or the 
agency of evil spirits. In modern times it has often, by the vulgar, been 
imputed to witchcraft or fascination. It depends however as much upon 
natural causes as any other malady; and its cure may often be effected by 
persisting in the use of proper means.

REGIMEN. - Epileptic patients ought, if possible, to breathe a pure and 
free air. Their diet should be light but nourishing. They ought to drink 
nothing strong, to avoid swines flesh, water-fowl, and likewise all windy 
and oily vegetables, as cabbage, nuts, &c. They ought to keep themselves 
cheerful, carefully guarding all violent passions, as anger fear, 
excessive joy, and the like.

EXERCISE is likewise of great use; but the patient must be careful to 
avoid all extremes either of heat or cold, all dangerous situations, as 
standing upon precipices, riding deep waters, and such like.

MEDICINE. - The intentions of cure must vary according to the cause of the 
disease. If the patient be of a sanguine temperament, and there be reason 
to fear an obstruction in the brain, bleeding and other evacuations will 
be necessary. When the disease is occassoned by the stoppage of customary 
evacuations, these, if possible, must be restored; if this cannot be done, 
others may be substituted in their place. Issues or setons, in this case, 
have often a very good effect. When there is reason to believe that the 
disease proceeds from worms, proper medicines must be used to kill, or 
carry off these vermin. When the disease proceeds from teething, the body 
should he kept open by emollient clysters, the feet frequently bathed in 
warm water, and, if the fits prove obstinate, a blistering-plaster may be 
put betwixt the shoulders. The same method is to be followed when 
epileptic fits precede the eruption of the small-pox, or measles, &c.

WHEN the disease is hereditary, or proceeds from a wrong formation of the 
brain, a cure is not to be expected. When it is owing to a debility, or 
too great an irritability of the nervous system, such medicines as tend to 
brace and strengthen the nerves may be used, as the Peruvian bark, and 
steel; or the anti-epileptic electuaries, recommended by Fuller and Mead. 
See Appendix, Electuary for the Epilepsy

THE flowers of zinc have of late been highly extolled for the cure of the 
epilepsy. Though this medicine will not be found to answer the 
expectations which have been raised concerning it, yet in obstinate 
epileptic cases it deserves a trial. The dose is from one to three or four 
grains, which may be taken either in pills, or a bolus, as the patient 
inclines. The best method is to begin with a single grain four or five 
times a-day, and gradually to increase the dose as far as the patient can 
bear it. I have known this medicine, when duly persisted in, prove 
beneficial.

MUSK has sometimes been found to succeed in the epilepsy. Ten or twelve 
grains of it with the same quantity of factious cinnabar, may be made up 
into a bolus, and taken every night and morning.

SOMETIMES the epilepsy has been cured by electricity.

CONVULSION FITS proceed from the same causes, and must be treated in the 
same manner as the epilepsy.

THERE is one particular species of convulsion fits which commonly goes by 
the name of St. Vitus's dance, wherein the patient is agitated with 
strange motions and gesticulations, which by the common people are 
generally believed to be the effects of witchcraft. This disease may be 
cured by repeated bleedings and purges; and afterwards using the medicines 
prescribed above for the epilepsy, viz. the Peruvian bark, and snake-root, 
&c. Chalybeate-waters are found to be beneficial in this case. The cold 
bath is likewise of singular service, and ought never to be neglected when 
the patient can bear it.


OF THE HICCUP.

THE hiccup is a spasmodic or convulsive affection of the stomach and 
midriff, arising from any cause that irritates their nervous fibres.

IT may proceed from excess in eating or drinking; from a hurt of the 
stomach; poisons; inflammations or scirrhous tumours of the stomach, 
intestines, bladder, midriff, or the rest of the viscera. In gangrenes, 
acute and malignant fevers, a hiccup is often the forerunner of death.

WHEN the hiccup proceeds from the use of aliment that is flatulent, or 
hard of digestion, a draught of generous wine, or a dram of any spirituous 
liquor, will generally remove it. If poison be the cause, plenty of milk 
and oil must be drank, as has been formerly recommended. When it proceeds 
from an inflammation of the stomach, &c. it is very dangerous. In this 
case the cooling regimen ought to be strictly observed, The patient must 
be bled, and take frequently a few drops of the sweet spirits of nitre in 
a cup of wine-whey. His stomach should likewise be fomented with cloths 
dipped in warm water; or have bladders filled with warm milk and water 
applied to it.

WHEN the hiccup proceeds from a gangrene or mortification, the Peruvian 
bark, with other antiseptics, are the only medicines which have a chance 
to succeed. When it is a primary disease, and proceeds from a foul 
stomach, loaded either with a pituitous or a bilious humour, a gentle 
vomit and purge, if the patient be able to bear them, will be of service. 
If it arises from flatulencies, the carminative medicines, directed for 
the heart-burn, must be used.

WHEN the hiccup proves very obstinate, recourse must be had to the most 
powerful aromatic and antispasmodic medicines. The principal of these is 
musk; fifteen or twenty grains of which may be made into a bolus, and 
repeated occasionally. Opiates are likewise of service, but they must be 
used with caution. A bit of sugar dipped in compound spirits of lavender, 
or the volatile aromatic tincture, may be taken frequently. External 
applications are sometimes also beneficial; as the stomach plaster, or a 
cataplasm of the Venice treacle of the Edinburgh or London dispensatory, 
applied to the region of the stomach.

I LATELY attended a patient who had almost a constant hiccup for above 
nine weeks. It was frequently stopped by the use of musk, opium, wine, and 
other cordial and antispasmodic medicines, but always returned. Nothing 
however gave the patient so much ease as brisk small beer. By drinking 
freely of this, the hiccup was often kept off for several days, which was 
more than could be done by the most powerful medicines. The patient was at 
length seized with a vomiting of blood, which soon put an end to his life. 
Upon opening the body, a large scirrhous tumour was found near the pylorus 
or right orifice of the stomach.


CRAMP OF THE STOMACH.

THIS disease often seizes people suddenly, is very dangerous, and requires 
immediate assistance. It is most incident to persons in the decline of 
life, especially the nervous, gouty, hysteric, and hypochondriac.

IF the patient has any inclination to vomit, he ought to take some 
draughts of warm water, or weak camomile-tea, to cleanse his stomach. 
After this, if he has been costive, a laxative clyster may be given. He 
ought then to take laudanum. The best way of administering it is in a 
clyster. Sixty or seventy drops of liquid laudanum may be given in a 
clyster of warm water. This is much more certain than laudanum given by 
the mouth, which is often vomited, and in some cases increases the pain 
and spasms in the stomach.

IF the pain and cramps return with great violence, after the effects of 
the anodyne clyster are over, another, with an equal or a larger quantity 
of opium, may be given; and every four or five hours a bolus, with ten or 
twelve grains of musk, and half a drachm of the Venice treacle.

IN the mean time, the stomach ought to be fomented with cloths dipped in 
warm water, or bladders filled with warm milk and water, should be 
constantly applied to it. I have often seen these produce the most happy 
effects. The anodyne balsam may also be rubbed on the part affected; and 
an anti-hysteric plaster worn upon it, for some time after the cramps are 
removed, to prevent their return.

IN very violent and lasting pains of the stomach, some blood ought to be 
let, unless the weakness of the patient forbids it. When the pain or 
cramps proceed from a suppression of the menses, bleeding is of use. If 
they be owing to the gout, recourse must be had to spirits, or some of the 
warm cordial waters. Blistering-plasters ought likewise, in this case, to 
be applied to the ancles. I have often seen violent cramps and pains of 
the stomach removed by covering it with a large plaster of Venice treacle.


OF THE NIGHT-MARE.

IN this disease the patient, in time of sleep, imagines he feels an 
uncommon oppression of weight about his breast or stomach, which he can by 
no means shake off. He groans, and sometimes cries out, though he oftener 
attempts to speak in vain. Sometimes he imagines himself encgaged with an 
enemy, and in danger of being killed, attempts to run away, but finds he 
cannot. Sometimes he fancies himself in a house that is on fire, or that 
he is in danger of being drowned in a river. He often thinks he is falling 
over a precipice, and the dread of being dashed to pieces suddenly awakes 
him.

THIS disorder has been supposed to proceed from too much blood; from a 
stagnation of blood in the brain and lungs; &c. But it is rather a nervous 
affection, and arises chiefly from indigestion. Hence we find that persons 
of weak nerves, who lead a sedentary life, and live full, are most 
commonly afflicted with the night-mare. Nothing tends more to produce it 
than heavy suppers, especially when ate late, or the patient goes to bed 
soon after. Wind is likewise a very frequent cause of this disease; for 
which reason those who are afflicted with it ought to avoid all flatulent 
food. Deep thought, anxiety, or any thing that oppresses the mind, ought 
also to be avoided.

AS persons afflicted with the night-mare generally moan, or make some 
noise in the fit, they should be waked, or spoken to by such as hear them, 
as the uneasiness generally goes off as soon as the patient is awake. Dr. 
Whytt says, he generally found a dram of brandy taken at bed-time, prevent 
this disease. That, however, is a bad custom, and, in time, loses its 
effect. We would rather have the patient depend upon the use of food of 
easy digestion, cheerfulness, exercise through the day, and a light supper 
taken early, than to accustom himself to drams. A glass of peppermint-
water will often promote digestion as much as a glass of brandy, and is 
much safer. After a person of weak digestion, however, has ate flatulent 
food, a dram may be necessary; in this case we would recommend it as the 
most proper medicine.

PERSONS who are young, and full of blood, if troubled with the night-mare, 
ought to take a purge frequently, and use a spare diet.


OF SWOONINGS.

PEOPLE of weak nerves or delicate constitutions are liable to swoonings or 
fainting fits. These indeed are seldom dangerous when duly attended to; 
but when wholly neglected, or improperly treated, they often prove 
hurtful, and sometimes fatal.

THE general causes of swoonings are sudden transitions from cold to heat; 
breathing air that is deprived of its proper spring or elasticity; great 
fatigue; excessive weakness; loss of blood; long fasting; fear, grief, and 
other violent passions, or affections of the mind.

IT is well known, that persons who have been long exposed to cold, often 
faint or fall into a swoon, upon coming into the house, especially if they 
drink hot liquor, or sit near a large fire. This might easily be prevented 
by people taking care not to go into a warm room immediately after they 
have been exposed to the cold air, to approach the fire gradually, and not 
to eat or drink any thing hot, till the body has been gradually brought 
into a warm temperature.

WHEN any one, in consequence of neglecting these precautions, falls into a 
swoon, he ought immediately to be removed to a cooler apartment, to have 
ligatures applied above his knees and elbows, and to have his hands and 
face sprinkled with vinegar or cold water. He should likewise be made to 
smell to vinegar, and should have a spoonful or two of water, if he can 
swallow, with about a third part of vinegar mixed with it, poured into his 
mouth. If these should not remove the complaint, it will be necessary to 
bleed the patient, and afterwards to give him a clyster.

AS air that is breathed frequently, loses its elasticity or spring, it is 
no wonder if persons who respire in it often fall into a swoon or fainting 
fit. They are, in this case, deprived of the very principle of life. Hence 
it is that fainting fits are so frequent in all crowded assemblies, 
especially in hot seasons. Such fits however must be considered as a kind 
of temporary death; and to the weak and delicate, they sometimes prove 
fatal. They ought therefore with the utmost care to be guarded against. 
The method of doing this is obvious. Let assembly rooms, and all other 
places of public resort, be large and well ventilated; and let the weak 
and delicate avoid such places, particularly in warm seasons.

A PERSON who faints, in such a situation, ought immediately to be carried 
into the open air; his temples should be rubbed with strong vinegar or 
brandy, and volatile spirits or salts held to his nose. He should be laid 
upon his back with his head low, and have a little wine, or some other 
cordial, as soon as he is able to swallow it, poured into his mouth. If 
the person has been subject to hysteric fits, castor or asafoetida should 
be applied to the nose, or burnt feathers, horn, or leather, &c.

WHEN fainting fits proceed from mere weakness or exhaustion, which is 
often the case after great fatigue, long fasting, loss of blood, or the 
like, the patient must be supported with generous cordials. as jellies, 
wines, spirituous liquors, &c. These however must be given at first in 
very small quantities, and increased gradually as the patient is able to 
bear them. He ought to be allowed to lie quite still and easy upon his 
back, with his head low, and should have fresh air admitted into his 
chamber. His food should consist of nourishing broths, sago-gruel with 
wine, new milk, and other things of a light and cordial nature. These 
things are to be given out of the fit. All that can be done in the fit is 
to let him smell to a bottle of Hungary-water, eau de luce, or spirits of 
hartshorn, and to rub his temples with warm brandy, or to lay a compress 
dipped in it to the pit of the stomach.

IN fainting fits that proceed from fear, grief, or other violent passions 
or affections of the mind, the patient must be very cautiously managed. He 
should be suffered to remain at rest, and only made to smell to some 
vinegar. After he is come to himself he may drink freely of warm lemonade, 
or balm tea, with some orange or lemon-peel in it. It will likewise be 
proper, if the fainting fits have been long and severe, to clean the 
bowels by throwing in an emollient clyster.

IT is common in fainting fits, from whatever cause they proceed, to bleed 
the patient. This practice may be very proper in strong persons of a full 
habit; but in those who are weak and delicate, or subject to nervous 
disorders, it is dangerous. The proper method with such people is to 
expose them to the free air, and to use cordial and stimulating medicines, 
as volatile salts, Hungary-water, spirits of lavender, tincture of castor, 
and the like.


OF FLATULENCIES, OR WIND.

ALL nervous patients, without exception, are afflicted with wind or 
flatulencies in the stomach and bowels, which arise chiefly from the want 
of tone or vigour in these organs. Crude flatulent aliment, as green peas, 
beans, coleworts, cabbages, and such like, may increase this complaint; 
but strong and healthy people are seldom troubled with wind, unless they 
either overload their stomachs, or drink liquors that are in a fermenting 
state, and consequently full of elastic air. While therefore the matter of 
flatulence proceeds from our aliments, the cause which makes air separate 
from them in such quantity as to occasion complaints, is almost always a 
fault of the bowels themselves, which are too weak either to prevent the 
product of elastic air, or to expel it after it is produced.

TO relieve this complaint, medicines ought to be used as have a tendency 
to expel wind, and by strengthening the alimentary canal to prevent its 
being produced there. Many nervous people find great benefit from eating a 
dry biscuit, especially when the stomach is empty. I look upon this as one 
of the best carminative medicines; and would recommend it in all 
complaints of the stomach, arising from flatulence, indigestion, &c.

THE list of medicines for expelling wind is very numerous; they often 
however disappoint the expectations of both the physician and his patient. 
The most celebrated among the class of carminatives are juniper berries; 
the roots of ginger and zedoary; the seeds of anise, caraway, and 
coriander; gum asafoetida and opium; the warm waters, tinctures, and 
spirits, as the aromatic water, the tincture of woodfoot, the volatile 
aromatic spirit, aether, &c.

DR. WHYTT says, he found no medicines more efficacious in expelling wind 
than aether and laudanum. He generally gave the laudanum in a mixture with 
peppermint-water and tincture of castor, or sweet spirits of nitre. 
Sometimes, in place of this, he gave opium in pills with asafoetida. He 
observes that the good effects of opiates are equally conspicuous, whether 
the flatulence be contained in the stomach or intestines; whereas these 
warm medicines, commonly called carminatives, do not often give immediate 
relief, except when the wind is in the stomach.

WITH regard to aether, the Doctor says, he has often seen very good 
effiects from it in flatulent complaints, where other medicines failed. 
The dose is a tea-spoonful mixed with two table-spoonfuls of water. Though 
the patient may begin with this quantity, it will be necessary to increase 
the dose gradually as the stomach can bear it. Aether is now given in 
considerable greater doses than it was in Dr. Whytt's time. In gouty cases 
he observes that aether, a glass of French brandy, or of the aromatic 
water; or ginger, either taken in substance or infused in boiling water, 
are among the best medicines for expelling wind.

WHEN the care of flatulent patients is such as makes it improper to give 
them warm medicines inwardly, the Doctor recommends external applications, 
which are sometimes of advantage. Equal parts of the anti-hysteric and 
stomach plaster may be spread upon a piece of soft leather, of such size 
as to cover the greatest part of the belly. This should be kept on for a 
considerable time, provided the patient be able to bear it; if it should 
give great uneasiness, it may be taken off, and the following liniment 
used in its stead.

TAKE of Bates's anodyne balsam an ounce; of the expressed oil of mace half 
an ounce; oil of mint two drachms. Let these ingredients be mixed 
together, and about a table-spoonful well rubbed on the parts at bed-time.

FOR strengthening the stomach and bowels, and consequently for lessening 
the production of flatulence, the Doctor recommends the Peruvian bark, 
bitters, chalybeates, and exercise. In flatulent cases, he thinks some 
nutmeg or ginger should be added to the tincture of the bark and bitters, 
and that the aromatic powder should be joined with the filings of iron.

WHEN windy complaints are attended with costiveness, which is often the 
case, few things will be found to answer better than four or five of the 
following pills taken every night at bed-time.

TAKE of asafoetida two drachms; succotrine aloes, salt of iron, and 
powdered ginger, of each one drachm; as much of the elixir proprietatis as 
will be sufficient to form them into pills.

ON the other hand, when the body is too open, twelve or fifteen grains of 
rhubarb, with half a drachm or two scruples of the Japonic confection, 
given every other evening, will have very good effects.

IN those flatulent complaints which come on about the time the menses 
cease, repeated small bleedings often give more relief than any other 
remedy.

WITH regard to diet, the Doctor observes, that tea, and likewise all 
flatulent aliments, are to be avoided; and that for drink, water with a 
little brandy or rum is not only preferable to malt liquor, but, in most 
cases, also to wine.

AS Dr. Whytt has paid great attention to this subject, and as his 
sentiments upon it in a great measure agree with mine, I have taken the 
liberty to adopt them; and should only add to his observations, that 
exercise is in my opinion, superior to all medicine, both for preventing 
the production and likewise for expelling of flatulencies. These effects, 
however, are not to be expected from sauntering about or lolling in a 
carriage, but from labour, or such active amusements as give exercise to 
every part of the body.


OF LOW SPIRITS.

ALL who have weak nerves are subject to low spirits in a greater or less 
degree. Generous diet, the cold bath, exercise and amusements, are the 
most likely means to remove this complaint. It is greatly increased by 
solitude and indulging gloomy ideas; but may often be relieved by cheerful 
company and sprightly amusements.

WHEN low spirits are owing to a weak relaxed state of the stomach and 
bowels, an infusion of the Peruvian bark with cinnamon or nutmeg will be 
proper. Steel joined with aromatics may likewise in this case be used with 
advantage; but riding, and a proper diet, are most to be depended on.

WHEN they arise from a foulness of the stomach and intestines, or 
obstruction in the hypochondriac viscera, aloetic purges will be proper. I 
have sometimes known the Harrowgate sulphur-water of service in this case.

WHEN low spirits proceed from a suppression of the menstrual or of the 
hemorrhoidal flux, these evacuations may either be restored, or some 
others substituted in their place, as issues, setons, or the like. Dr. 
Whytt observes, that nothing has such sudden good effects in this case as 
bleeding.

WHEN low spirits have been brought on by long continued grief, anxiety, or 
other distress of mind, agreeable company, variety of amusements, and 
change of place, especially travelling into foreign countries, will afford 
the most certain relief.

PERSONS afflicted with low spirits should avoid all kind of excess, 
especially of venery and strong liquors. The moderate use of wine and 
other strong liquors is by no means hurtful; but when taken to excess they 
weaken the stomach, vitiate the humours, and depress the spirits. This 
caution is the more necessary, as the unfortunate and melancholy often fly 
to strong liquors for relief, by which means they never fail to 
precipitate their own destruction.


OF HYSTERIC AFFECTIONS.

THESE likewise belong to the numerous tribe of nervous diseases, which may 
be justly reckoned the reproach of medicine. Women of a delicate habit, 
whose stomach and intestines are relaxed, and whose nervous system is 
extremely sensible, are most subject to hysteric complaints. In such 
persons a hysteric fit, as it is called, may be brought on by an 
irritation of the nerves of the stomach or intestines, by wind, acrid 
humour, or the like. A sudden suppression of the menses often gives rise 
to hysteric fits. They may likewise be excited by violent passions or 
affections of the mind, as fear, grief, anger, or great disappointments.

SOMETIMES the hysteric fit resembles a swoon or fainting fit, during which 
the patient lies as in a sleep, only the breathing is so low as scarce to 
be perceived. At other times the patient is affected with catchings and 
strong convulsions. The symptoms which precede hysterical fits are 
likewise various in different persons. Sometimes the fits come on with 
coldness of the extremities, yawning and stretching, lowness of spirits, 
oppression and anxiety. At other times the approach of the fit is foretold 
by a feeling, as if there were a ball at the lower part of the belly, 
which gradually rises towards the stomach, where it occasions inflation, 
sickness, and sometimes vomiting; afterwards it rises into the gullet, and 
occasions a degree of suffocation, to which quick breathing, palpitation 
of the heart, giddiness of the head, dimness of the sight, loss of 
hearing, with convulsive motions of the extremities and other parts of the 
body, succeed. The hysteric paroxysm is often introduced by an immoderate 
fit of laughter, and sometimes it goes off by crying. Indeed there is not 
much difference between the laughing and crying of an highly hysteric lady.

OUR aim in the treatment of this disease must be to shorten the fit or 
paroxysm when present, and to prevent its return. The longer the fits 
continue, and the more frequently they return, the disease becomes the 
more obstinate. Their strength is increased by habit, and they induce so 
great a relaxation of the system, that it is with difficulty removed.

IT is customary, during the hysteric fit or paroxysm, to bleed the 
patient. In strong persons of a plethoric habit, and where the pulse is 
full, this may be proper, but in weak and delicate constitutions, or where 
the disease has been of long standing, or arises from inanimation, it is 
not safe. The best course in such cases is to rouse the patient by strong 
smells, as burnt feathers, asafoetida, or spirits of hartshorn, held to 
the nose. Hot bricks may also be applied to the soles of the feet, and the 
legs, arms, and belly may be strongly rubbed with a warm cloth. But the 
best application is to put the feet and legs into warm water. This is 
peculiarly proper when the fits precede the flow of the menses. In case of 
costiveness, a laxative clyster with asafoetida will be proper and, as 
soon as the patient can swallow, two table-spoonfuls of a solution of 
asafoetida, or of some cordial julep, may be given.

THE radical cure of this disorder will be best attempted at a time when 
the patient is most free from the fits. It will be greatly promoted by a 
proper attention to diet. A milk and vegetable diet, when duly persisted 
in, will often perform a cure. If, however, the patient has been 
accustomed to a more generous diet, it will not be safe to leave it off 
all at once, but by degrees. The most proper drink is water with a small 
quantity of spirits. A cool dry air is the best. Cold bathing and every 
thing that braces the nerves, and invigorates the system, is beneficial; 
but lying too long in bed, or whatever relaxes the body is hurtful. It is 
of the greatest importance to have the mind kept constantly easy and 
cheerful, and, if possible, to have it always engaged in some agreeable 
and interesting pursuit.

WHEN hysteric fits are occasioned by sympathy, they may be cured by 
exciting an opposite passion. This is said to have been the case of a 
whole school of young ladies in Holland, who were all cured by being told, 
that the first who was seized should be burnt to death. But this method of 
cure, to my knowledge, will not always succeed. I would therefore advise, 
that young ladies who are subject to hysteric fits should not be sent to 
boarding schools, as the disease may be caught by imitation,

THE proper medicines are those which strengthen the alimentary canal and 
the whole nervous system, as the preparations of iron, the Peruvian bark, 
and other bitters. Twenty drops of the elixir of vitriol, in a cup of the 
infusion of the bark, may be taken twice or thrice a-day. The bark and 
iron may likewise be taken in substance, provided the stomach can bear 
them; but they are generally given in too small doses to have any effect. 
The chalybeate waters generally prove beneficial in this disorder.

IF the stomach is loaded with phlegm, vomits will be of use; but they 
should not be too strong, nor frequently repeated, as they tend to relax 
and weaken the stomach. If there be a tendency to costiveness, it must be 
removed either by diet, or by taking an opening pill as often as it shall 
be found necessary.

TO lessen the irritability of the system, antispasmodic medicines will be 
of use. The best antispasmodic medicines are musk, opium, and castor. When 
opium disagrees with the stomach, it may either be applied externally, or 
given in clysters. It is often successful in removing those periodical 
head-achs to which hysteric and hypochondriac patients are subject. Castor 
has in some cases been found to procure sleep where opium failed; for 
which reason Dr. Whytt advises, that they should be joined together. He 
likewise recommends the anti-hysteric plaster to be applied to the 
abdomen. Though antispasmodics and anodynes are universally recommended in 
this disease, yet all the extraordinary cures that I ever knew in hysteric 
cases were performed by means of tonic and corroborating medicines.

HYSTERIC women are often afflicted with cramps in various parts of the 
body, which are most apt to seize them in bed, or when asleep. The most 
efficacious medicines in this case are opium, blistering-plasters, and 
warm bathing or fomentations. When the cramp or spasm is very violent, 
opium is the remedy most to be depended on. In milder cases, immersing the 
feet and legs in warm water, or applying a blistering-plaster to the part 
affected, will often be sufficient to remove the complaint. In patients 
whose nerves are uncommonly delicate and sensible, it will be better to 
omit the blistering-plaster, and to attempt the cure by opiates, musk, 
camphire, and the warm bath.

CRAMPS are often prevented or cured by compression. Thus cramps in the 
legs are prevented, and sometimes removed, by tight bandages, and, when 
convulsions arise from a flatulent distention, of the intestines, or from 
spasms beginning in them, they may be often lessened or cured by making a 
pretty strong compression upon the abdomen by means of a broad belt. A 
roll of brimstone held in the hand is frequently used as a remedy for 
cramps: Though this seems to owe its effect chiefly to imagination; yet, 
as it sometimes succeeds, it merits a trial. When spasms or convulsive 
motions arise from sharp humours in the stomach and intestines, no lasting 
relief can be procured till these are either corrected or expelled. The 
Peruvian bark has sometimes cured periodic convulsions after other 
medicines had failed. Some persons afflicted with cramps pretend to reap 
great benefit from small bundles of rosemary tied all night about their 
feet, ancles, and knees.


OF HYPOCHONDRIAC AFFECTIONS.

THIS disease generally attacks the indolent, the luxurious, the 
unfortunate, and the studious. It becomes daily more common in this 
country, owing no doubt to the increase of luxury and sedentary 
employments. It has so near a resemblance to the immediately preceding, 
that many authors consider them as the same disease, and treat them 
accordingly. They require however a very different regimen; and the 
symptoms of the latter, though less violent, are more permanent than those 
of the former.

MEN of a melancholy temperament, whose minds are capable of great 
attention, and whose passions are not easily moved, are, in the advanced 
periods of life, most liable to this disease. It is usually brought on by 
long and serious attention to abstruse subjects, grief, the suppression of 
customary evacuations, excess of venery, the repulsion of cutaneous 
eruptions, long continued evacuations, obstructions in some of the 
viscera, as the liver, spleen, &c.

HYPOCHONDRIAC persons ought never to fast long, and their food should be 
solid and nourishing. All acescent, and windy vegetables are to be 
avoided. Flesh meats agree best with them, and their drink should be old 
claret, or good madeira. Should these disagree with the stomach, water 
with a little brandy or rum in it may be drank.

CHEERFULNESS and serenity of mind are by all means to be cultivated. 
Exercise of every kind is useful. The cold bath is likewise beneficial; 
and where it does not agree with the patient, frictions with the flesh-
brufh or a coarse cloth may be tried. If the patient has it in his power, 
he ought to travel either by sea or land. A voyage or a long journey, 
especially towards a warmer climate will be of more service than any 
medicine.

THE general intentions of cure, in this disease, are to strengthen the 
alimentary canal, and to promote the secretions. These intentions will be 
best answered by the different preparations of iron and the Peruvian bark, 
which, after proper evacuations, may be taken in the same manner as 
directed in the preceding disease.

IF the patient be costive, it will be necessary to make use of some gentle 
opening medicine, as pills composed of equal parts of aloes, rhubarb, and 
asafoetida, with as much of the elixir proprietatis, as is necessary to 
form the ingredients into pills, Two, three, or four of these may be taken 
as often as it shall be found needful to keep the body gently open. Such 
as cannot bear the asafoetida may substitute Spanish soap in its place.

THOUGH a cheerful glass may have good effects in this disease, yet all 
manner of excess is hurtful. Intense study, and every thing that depresses 
the spirits, are likewise pernicious.

THOUGH the general symptoms and treatment of nervous disorders were 
pointed out in the beginning of this chapter; yet, for the behoof of the 
unhappy persons afflicted with those obstinate and complicated maladies, I 
have treated several of their capital symptoms under distinct or separate 
heads. These however are not to be considered as different diseases, but 
as various modifications of the same disease.They all arise from the same 
general causes, and require nearly the same method of treatment. There are 
many other symptoms that merit particular attention, which the nature of 
my plan will not permit me to treat of at full length. I shall therefore 
omit them altogether, and conclude this chapter with a few general remarks 
on the most obvious means of preventing or avoiding nervous disorders.

IN all persons afflicted with nervous disorders, there is a great delicacy 
and sensibility of the whole nervous system, and an uncommon degree of 
weakness of the organs of digestion. These may be either natural or 
acquired. When owing to a defect in the constitution, they are hardly to 
be removed; but may be mitigated by proper care. When induced by diseases, 
as long or repeated fevers, profuse haemorrhages, or the like, they prove 
also very obstinate, and will yield only to a course of regimen calculated 
to restore and invigorate the habit.

BUT nervous affections arise more frequently from causes which it is in a 
great measure in our own power to avoid, than from diseases, or an 
original fault in the constitution. Excessive grief, intense study, 
improper diet, and neglect of exercise, are the great sources of this 
extensive class of diseases.

IT has been already been observed, that grief indulged destroys the 
appetite and digestion, depresses the spirits, and induces an universal 
relaxation and debility of the whole system. Instances of this are daily 
to be seen. The loss of a near relation, or any other misfortune in life, 
is often sufficient to occasion the most complicated series of nervous 
symptoms. Such misfortunes indeed are not to be avoided, but surely their 
effects, by a vigorous and proper exertion of the mind, might be rendered 
less hurtful. For directions in this matter we must refer the reader to 
the article GRIEF, in the Chapter on the passions.

THE effects of intense study are pretty similar to those occasioned by 
grief. It preys upon the animal spirits, and destroys the appetite and 
digestion. To prevent these effects, studious persons ought, according to 
the Poet, to toy with their books. They should never study too long at a 
time; nor attend long to one particular subject, especially if it be of a 
serious nature. They ought likewise to be attentive to their posture, and 
should take care frequently to unbend their minds by music, diversions, or 
going into agreeable company.

WITH regard to diet, I shall only observe, that nervous diseases may be 
induced either by excess or inanition. Both of these extremes hurt 
digestion, and vitiate the humours. When Nature is oppressed with fresh 
loads of food, before she has had time to digest and assimilate the former 
meal, her powers are weakened, and the vessels are filled with crude 
humours. On the other hand, when the food is not sufficiently nourishing, 
or is taken too seldom, the bowels are inflated with wind, and the 
humours, for want of regular fresh supplies of wholesome chyle, are 
vitiated. These extremes are therefore with equal care to be avoided. They 
both tend to induce a relaxation and debility of the nervous system, with 
all its dreadful train of consequences.

BUT the most general cause of nervous disorders is indolence. The active 
and laborious are seldom troubled with them. They are reserved for the 
children of ease and affluence, who generally feel their keenest force. 
All we shall say to such persons is, that the means of prevention and cure 
are both in their own power. If the constitution of human nature be such, 
that man must either labour or suffer diseases, surely no individual has 
any right to expect an exemption from the general rule.

THOSE, however, who are willing to take exercise, but whose occupations 
confine them to the house, and perhaps to an unfavourable posture, really 
deserve our pity, We have in a former part of the book endeavoured to lay 
down rules for their conduct; and shall only add, that where these cannot 
be complied with, their place may, in some measure, be supplied by the use 
of bracing and strengthening medicines, as the Peruvian bark, with other 
bitters; the preparations of steel; the elixir of vitriol, &c.