Domestic medicine _ or_ a treatise on the prevention and cure of diseases by regimen and simple medicines. With an appendix_ containing a dispensatory for the use of private practi

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Title: Domestic medicine
or, a treatise on the prevention and cure of diseases by
regimen and simple medicines. With an appendix, containing
a dispensatory for the use of private practitioners

Author: William Buchan

Release date: September 3, 2024 [eBook #74359]

Language: English

Original publication: London: printed for A. Strahan, T. Cadell, 1791

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MEDICINE ***

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Domestic Medicine:

OR, A

TREATISE
ON THE

PREVENTION AND CURE

OF

DISEASES

BY

REGIMEN AND SIMPLE MEDICINES.

WITH

An APPENDIX, containing a DISPENSATORY

for the Use of Private Practitioners.

By WILLIAM BUCHAN, M. D.
Fellow of the Royal College of Physicians, Edinburgh.

THE TWELFTH EDITION.

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

M DCC XCI.

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

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

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

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

SIR,

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

London,
Nov. 10, 1783.

W. BUCHAN.

ADVERTISEMENT.

Twenty years have now elapsed since the first Edition of this Book made its
appearance. During this period, the Author, having been in constant
practice, has taken occasion to improve several articles, which were with
less accuracy inserted in the more early impressions. For this he has been
censured by some, but the more candid and discerning must approve his
conduct. It would be unpardonable in an Author to suffer an error in a book,
on which health and life may depend, to stand uncorrected; nor would it be
much less so to perceive an omission, and leave it unsupplied. His
improvements, however, are not the result of mercenary views. The same
principle which prompted the Author to write the Book, will ever induce
him to improve it to the utmost of his power.
The Author has indeed to regret, that the limits of one volume preclude
many interesting observations, and likewise deprive him of the pleasure of
inserting a number of very useful remarks made by his learned and
ingenious friend Doctor Duplanil, of Paris, who has done him the honour
of publishing an elegant translation of this Work, in five volumes octavo,
accompanied with an excellent commentary.
The improvements of the later editions are chiefly inserted in the form of
notes. These are intended either to illustrate the text, or to put people on
their guard in dangerous situations, and prevent fatal mistakes in the
practice of medicine, which it is to be regretted are but too common.
Some attention has likewise been paid to the language. Where that was
either inaccurate or obscure, as far as was practicable, it has been corrected.
Indeed, the Author has all along endeavoured to observe such simplicity
and perspicuity in his style as might enable the reader clearly to understand
it: a circumstance of the utmost importance in a performance of this nature.

Although the Domestic Medicine was never intended to supercede the use
of a physician, but to supply his place in situations where medical
assistance could not easily be obtained; yet the Author is sorry to observe,
that the jealousies and fears of the Faculty have prompted many of them to
treat this Work in a manner altogether unbecoming the professors of a
liberal science: notwithstanding their injurious treatment, he is determined
to persist in his plan, being fully convinced of its utility; nor shall interest or
prejudice ever deter him from exerting his best endeavours to render the
Medical Art more extensively beneficial to Mankind.
But this illiberal treatment of the Faculty is not the only thing of which
the Author has cause to complain. By some of them his Book has been
served up mangled and mutilated, and its title, type, size, &c. so closely
imitated, that purchasers are misled, and frequently buy these spurious
productions instead of the real one. That a needy Author, incapable himself
of producing an original work, should prey upon another, and that a
mercenary Bookseller should vend such productions, knowing them to be
stolen, are things not at all to be wondered at: but that all this can be done
with impunity, shews that the laws of this country respecting literary
property, are still in a very imperfect state, and stand much in need of
amendment.
London,
Dec. 10, 1789.

PREFACE.

When I first signified my intention of publishing the following sheets, I was
told by my friends it would draw on me the resentment of the whole
Faculty. As I never could entertain such an unfavourable idea, I was
resolved to make the experiment, which indeed came out pretty much as
might have been expected. Many whose learning and liberality of
sentiments do honour to medicine received the book in a manner which at
once shewed their indulgence, and the falsity of the opinion that every
physician wishes to conceal his art; while the more selfish and narrow-
minded, generally the most numerous in every profession, have not failed to
persecute both the book and its author.
The reception, however, which this work has met with from the Public
merits my most grateful acknowledgments. As the best way of expressing
these, I have endeavoured to render it more generally useful, by enlarging
the prophylaxis, or that part which treats of preventing diseases; and by
adding many articles which had been entirely omitted in the former
impressions. It is needless to enumerate these additions; I shall only say,
that I hope they will be found real improvements.
The observations relative to Nursing and the Management of Children,
were chiefly suggested by an extensive practice among infants, in a large
branch of the Foundling Hospital, where I had an opportunity not only of
treating the diseases incident to childhood, but likewise of trying different
plans of nursing, and observing their effects. Whenever I had it in my
power to place the children under the care of proper nurses, to instruct these
nurses in their duty, and to be satisfied that they performed it, very few of
them died; but when, from distance of place, and other unavoidable
circumstances, the children were left to the sole care of mercenary nurses,

without any person to instruct or superintend them, scarce any of them
lived.
This was so apparent, as with me to amount to a proof of the following
melancholy fact: That almost one half of the human species perish in
infancy, by improper management or neglect. This reflection has made me
often wish to be the happy instrument of alleviating the miseries of those
suffering innocents, or of rescuing them from an untimely grave. No one,
who has not had an opportunity of observing them, can imagine what
absurd and ridiculous practices still prevail in the nursing and management
of infants, and what numbers of lives are by that means lost to society. As
these practices are chiefly owing to ignorance, it is to be hoped, that when
nurses are better informed, their conduct will be more proper.
The application of medicine to the various occupations of life has been in
general the result of observation. An extensive practice for several years, in
one of the largest manufacturing towns in England, afforded me sufficient
opportunities of observing the injuries which those useful people sustain
from their particular employments, and likewise of trying various methods
of obviating such injuries. The success which attended these trials was
sufficient to encourage this attempt, which I hope will be of use to those
who are under the necessity of earning their bread by such employments as
are unfavourable to health.
I do not mean to intimidate men, far less to insinuate that even those arts,
the practice of which is attended with some degree of danger, should not be
carried on; but to guard the less cautious and unwary against those dangers
which they have it in their power to avoid, and which they often, through
mere ignorance, incur. As every occupation in life disposes those who
follow it to some particular diseases more than to others, it is certainly of
importance to know these, in order that people may be upon their guard
against them. It is always better to be warned of the approach of an enemy,
than to be surprised by him, especially where there is a possibility of
avoiding the danger.
The observations concerning Diet, Air, Exercise, &c. are of a more
general nature, and have not escaped the attention of physicians in any age.
They are subjects of too great importance, however, to be passed over in an
attempt of this kind, and can never be sufficiently recommended. The man
who pays a proper attention to these, will seldom need the physician; and he

who does not, will seldom enjoy health, let him employ as many physicians
as he pleases.
Though we have endeavoured to point out the causes of diseases, and to
put people upon their guard against them, yet it must be acknowledged that
they are often of such a nature as to admit of being removed only by the
diligence and activity of the public magistrate. We are sorry, indeed, to
observe, that the power of the magistrate is seldom exerted in this country
for the preservation of health. The importance of a proper medical police is
either not understood, or little regarded. Many things highly injurious to the
public health are daily practiced with impunity, while others, absolutely
necessary for its preservation, are entirely neglected.
Some of the public means of preserving health are mentioned in the
general prophylaxis, as the inspection of provisions, widening the streets of
great towns, keeping them clean, supplying the inhabitants with wholesome
water, &c.; but they are passed over in a very cursory manner. A proper
attention to these would have swelled this volume to too large a size; I have
therefore reserved them for the subject of a future publication.
In the treatment of diseases, I have been peculiarly attentive to regimen.
The generality of people lay too much stress upon Medicine, and trust too
little to their own endeavours. It is always in the power of the patient, or of
those about him, to do as much towards his recovery as can be effected by
the physician. By not attending to this, the designs of Medicine are often
frustrated; and the patient, by pursuing a wrong plan of regimen, not only
defeats the Doctor’s endeavours, but renders them dangerous. I have often
known patients killed by an error in regimen, when they were using very
proper medicines. It will be said, the physician always orders the regimen
when he prescribes a medicine. I wish it were so, both for the honour of the
Faculty and the safety of their patients: but physicians, as well as other
people, are too little attentive to this matter.
Though many reckon it doubtful whether physic is more beneficial or
hurtful to mankind, yet all allow the necessity and importance of a proper
regimen in diseases. Indeed the very appetites of the sick prove its
propriety. No man in his senses ever imagined that a person in a fever, for
example, could eat, drink, or conduct himself in the same manner as one in
perfect health. This part of medicine, therefore, is evidently founded in
Nature, and is every way consistent with reason and common sense. Had

men been more attentive to it, and less solicitous in hunting after secret
remedies, Medicine had never become an object of ridicule.
This seems to have been the first idea of Medicine. The ancient
physicians acted chiefly in the capacity of nurses. They went very little
beyond aliment in their prescriptions; and even this they generally
administered themselves, attending the sick for that purpose through the
whole course of the disease; which gave them an opportunity not only of
marking the changes of diseases with great accuracy, but likewise of
observing the effects of their different applications, and adapting them to
the symptoms.
The learned Dr. Arbuthnot asserts, that by a proper attention to those
things which are almost within the reach of every body, more good and less
mischief will be done in acute diseases, than by medicines improperly and
unseasonably administered; and that great cures may be effected in
chronical distempers, by a proper regimen of the diet only. So entirely do
the Doctor’s sentiments and mine agree, that I would advise every person,
ignorant of physic, to confine his practice solely to diet, and the other parts
of regimen; by which means he may often do much good, and can seldom
do any hurt.
This seems also to have been the opinion of the ingenious Dr. Huxham,
who observes, that we often seek from Art what all-bountiful Nature most
readily, and as effectually, offers us, had we diligence and sagacity enough
to observe and make use of them; that the dietetic part of Medicine is not so
much studied as it ought to be; and that, though less pompous, yet it is the
most natural method of curing diseases.
To render the book more generally useful, however, as well as more
acceptable to the intelligent part of mankind, I have in most diseases,
besides regimen, recommended some of the most simple and approved
forms of medicine, and added such cautions and directions as seemed
necessary for their safe administration, it would no doubt have been more
acceptable to many, had it abounded with pompous prescriptions, and
promised great cures in consequence of their use; but this was not my plan:
I think the administration of medicines always doubtful, and often
dangerous, and would much rather teach men how to avoid the necessity of
using them, than how they should be used.

Several medicines, and those of considerable efficacy, may be
administered with great freedom and safety. Physicians generally trifle a
long time with medicines before they learn their proper use. Many peasants
at present know better how to use some of the most important articles in the
materia medica, than physicians did a century ago; and doubtless the same
observation will hold with regard to others some time hence. Wherever I
was convinced that medicine might be used with safety, or where the cure
depended chiefly upon it, I have taken care to recommend it; but where it
was either highly dangerous, or not very necessary, it is omitted.
I have not troubled the reader with an useless parade of quotations from
different authors, but have in general adopted their observations where my
own were either defective, or totally wanting. Those to whom I am most
obliged are, Ramazini, Arbuthnot, and Tissot; the last of which, in his Avis
au Peuple, comes the nearest to my views of any author which I have seen.
Had the Doctor’s plan been as complete as the execution is masterly, we
should have had no occasion for any new treatise of this kind soon; but by
confining himself to the acute diseases, he has in my opinion omitted the
most useful part of his subject. People in acute diseases may sometimes be
their own physicians; but in the chronic, the cure must ever depend chiefly
upon the patient’s own endeavours. The Doctor has also passed over the
Prophylaxis, or preventive part of Medicine, very slightly, though it is
certainly of the greatest importance in such a work. He had no doubt his
reasons for so doing, and I am so far from finding fault with him, that I
think his performance does great honour both to his head and to his heart.
Several other foreign physicians of eminence have written on nearly the
same plan with Tissot, as the Baron Van Swieten, physician to their Imperial
Majesties, M. Rosen, first physician of the kingdom of Sweden, &c.; but
these gentlemen’s productions have never come to my hand. I cannot help
wishing, however, that some of our distinguished countrymen would follow
their example. There still remains much to be done on this subject, and it
does not appear to me how any man could better employ his time or talents,
than in eradicating hurtful prejudices, and diffusing useful knowledge
among the people.
I know some of the Faculty disapprove of every attempt of this nature,
imagining that it must totally destroy their influence. But this notion
appears to me to be as absurd as it is illiberal. People in distress will always

apply for relief to men of superior abilities, when they have it in their
power; and they will do this with far greater confidence and readiness when
they believe that Medicine is a rational science, than when they take it to be
only a matter of mere conjecture.
Though I have endeavoured to render this Treatise plain and useful, yet I
found it impossible to avoid some terms of art; but those are in general
either explained, or are such as most people understand. In short, I have
endeavoured to conform my style to the capacities of mankind in general;
and, if my Readers do not flatter either themselves or me, with some degree
of success. On a medical subject, this is not so easy a matter as some may
imagine. To make a shew of learning is easier than to write plain sense,
especially in a science which has been kept at such a distance from common
observation. It would however be no difficult matter to prove, that every
thing valuable in the practical part of Medicine is within the reach of
common abilities.
It would be ungenerous not to express my warmest acknowledgments to
those Gentlemen who have endeavoured to extend the usefulness of this
Performance, by translating it into the language of their respective
countries. Most of them have not only given elegant translations of the
Book, but have also enriched it with many useful observations; by which it
is rendered more complete, and better adapted to the climate and the
constitutions of their countrymen. To the learned Dr. Duplanil of Paris,
physician to the Count d’Artois, I lie under particular obligations; as this
Gentleman has not only considerably enlarged my Treatise, but, by his very
ingenious and useful notes, has rendered it so popular on the Continent, as
to occasion its being translated into all the languages of modern Europe.
I have only to add, that the book has not more exceeded my expectations
in its success, than in the effects it has produced. Some of the most
pernicious practices, with regard to the treatment of the sick, have already
given place to a more rational conduct; and many of the most hurtful
prejudices, which seemed to be quite insurmountable, have in a great
measure yielded to better information. Of this a stronger instance cannot be
given than the inoculation of the small-pox. Few mothers, some years ago,
would submit to have their children inoculated even by the hand of a
Physician; yet nothing is more certain, than that of late many of them have
performed this operation with their own hands; and as their success has

been equal to that of the most dignified inoculators, there is little reason to
doubt that the practice will become general. Whenever this shall be the
case, more lives will be saved by inoculation alone, than are at present by
all the endeavours of the Faculty.

INTRODUCTION.

The improvements in Medicine, since the revival of learning, have by no
means kept pace with those of the other arts. The reason is obvious.
Medicine has been studied by few, except those who intended to live by it
as a trade. Such, either from a mistaken zeal for the honour of Medicine, or
to raise their own importance, have endeavoured to disguise and conceal the
art. Medical authors have generally written in a foreign language; and those
who were unequal to this talk, have even valued themselves upon couching,
at least, their prescriptions, in terms and characters unintelligible to the rest
of mankind.
The contentions of the clergy, which happened soon after the restoration
of learning, engaged the attention of mankind, and paved the way for that
freedom of thought and inquiry, which has since prevailed in most parts of
Europe with regard to religious matters. Every man took a side in those
bloody disputes; and every gentleman, that he might distinguish himself on
one side or other, was instructed in Divinity. This taught people to think and
reason for themselves in matters of religion, and at last totally destroyed
that complete and absolute dominion which the clergy had obtained over
the minds of men.
The study of Law has likewise, in most civilized nations, been justly
deemed a necessary part of the education of a gentleman. Every gentleman
ought certainly to know at least the laws of his own country: and, if he were
also acquainted with those of others, it might be more than barely an
ornament to him.
The different branches of Philosophy have also of late been very
universally studied by all who pretended to a liberal education. The
advantages of this are manifest. It frees the mind from prejudice and
superstition; fits it for the investigation of truth; induces habits of reasoning

and judging properly; opens an inexhaustible source of entertainment; paves
the way to the improvement of arts and agriculture; and qualifies men for
acting with propriety in the most important stations of life.
Natural History is likewise become an object of general attention; and it
well deserves to be so. It leads to discoveries of the greatest importance.
Indeed agriculture, the most useful of all arts, is only a branch of Natural
History, and can never arrive at a high degree of improvement where the
study of that science is neglected.
Medicine however has not, as far as I know, in any country, been
reckoned a necessary part of the education of a gentleman. But surely no
sufficient reason can be assigned for this omission. No science lays open a
more extensive field of useful knowledge, or affords more ample
entertainment to an inquisitive mind. Anatomy, Botany, Chymistry, and the
Materia Medica, are all branches of Natural History, and are fraught with
such amusement and utility, that the man who entirely neglects them has but
a sorry claim either to taste or learning. If a gentleman has a turn for
observation, says an excellent and sensible writer[1], surely the natural
history of his own species is a more interesting subject, and presents a more
ample field for the exertion of genius, than the natural history of spiders and
cockle-shells.
We do not mean that every man should become a physician. This would
be an attempt as ridiculous as it is impossible. All we plead for is, that men
of sense and learning should be so far acquainted with the general
principles of Medicine, as to be in a condition to derive from it some of
those advantages with which it is fraught; and at the same time to guard
themselves against the destructive influences of Ignorance, Superstition,
and Quackery.
As matters stand at present, it is easier to cheat a man out of his life than
of a shilling, and almost impossible either to detect or punish the offender.
Notwithstanding this, people still shut their eyes, and take every thing upon
trust that is administered by any Pretender to Medicine, without daring to
ask him a reason for any part of his conduct. Implicit faith, every where else
the object of ridicule, is still sacred here. Many of the faculty are no doubt
worthy of all the confidence that can be reposed in them; but as this can
never be the character of every individual in any profession, it would
certainly be for the safety, as well as the honour, of mankind, to have some

check upon the conduct of those to whom they entrust so valuable a treasure
as health.
The veil of mystery, which still hangs over medicine, renders it not only a
conjectural, but even a suspicious art. This has been long ago removed from
the other sciences, which induces many to believe that Medicine is a mere
trick, and that it will not bear a fair and candid examination. Medicine,
however, needs only to be better known, in order to secure the general
esteem of mankind. Its precepts are such as every wise man would chuse to
observe, and it forbids nothing but what is incompatible with true
happiness.
Disguising Medicine not only retards its improvement as a science, but
exposes the profession to ridicule, and is injurious to the true interests of
society. An art founded on observation never can arrive at any high degree
of improvement, while it is confined to a few who make a trade of it. The
united observations of all the ingenious and sensible part of mankind,
would do more in a few years towards the improvement of Medicine, than
those of the Faculty alone in a great many. Any man can tell when a
medicine gives him ease as well as a physician; and if he only knows the
name and dose of the medicine, and the name of the disease, it is sufficient
to perpetuate the fact. Yet the man who adds one single fact to the stock of
medical observations, does more real service to the art, than he who writes a
volume in support of some favourable hypothesis.
Very few of the valuable discoveries in Medicine have been made by
physicians. They have in general either been the effect of chance or of
necessity, and have been usually opposed by the Faculty, till every one else
was convinced of their importance. An implicit faith in the opinions of
teachers, an attachment to systems and established forms, and the dread of
reflections, will always operate upon those who follow Medicine as a trade.
Few improvements are to be expected from a man who might ruin his
character and family by even the smallest deviation from an established
rule.
If men of letters, says the author of the performance quoted above, were
to claim their right of inquiry into a matter that so nearly concerns them, the
good effects on Medicine would soon appear. Such men would have no
separate interest from that of the art. They would detect and expose
assuming Ignorance under the mask of Gravity and Importance, and would

be the judges and patrons of modest merit. Not having their understandings
perverted in their youth by false theories, unawed by authority, and
unbiassed by interest, they would canvass with freedom the most
universally received principles in Medicine, and expose the uncertainty of
many of those doctrines, of which a physician dares not so much as seem to
doubt.
No argument, continues he, can be brought against laying open Medicine,
which does not apply with equal, if not greater force, to religion; yet
experience has shewn, that since the laity have asserted their right of
inquiry into these subjects, Theology, considered as a science, has been
improved, the interests of real religion have been promoted, and the clergy
have become a more learned, a more useful, and a more respectable body of
men, than they ever were in the days of their greatest power and splendour.
Had other medical writers been as honest as this gentleman, the art had
been upon a very different footing at this day. Most of them extol the merit
of those men who brought Philosophy out of the schools, and subjected it to
the rules of common sense. But they never consider that Medicine, at
present, is in nearly the same situation as Philosophy was at that time, and
that it might be as much improved by being treated in the same manner.
Indeed, no science can either be rendered rational or useful, without being
submitted to the common sense and reason of mankind. These alone stamp
a value upon science; and what will not bear the test of these ought to be
rejected.
I know it will be said, that diffusing medical knowledge among the
people might induce them to tamper with Medicine, and to trust to their
own skill instead of calling a physician. The reverse of this however is true.
Persons who have most knowledge in these matters, are commonly most
ready both to ask and to follow advice, when it is necessary. The ignorant
are always most apt to tamper with Medicine, and have the least confidence
in physicians. Instances of this are daily to be met with among the ignorant
peasants, who, while they absolutely refuse to take a medicine which has
been prescribed by a physician, will swallow with greediness any thing that
is recommended to them by their credulous neighbours. Where men will act
even without knowledge, it is certainly more rational to afford them all the
light we can, than to leave them entirely in the dark.

It may also be alleged, that laying Medicine more open to mankind
would lessen their faith in it. This would indeed be the case with regard to
some; but it would have a quite contrary effect upon others. I know many
people who have the utmost dread and horror of every thing prescribed by a
physician, but who will nevertheless very readily take a medicine which
they know, and whose qualities they are in some measure acquainted with.
Hence it is evident, that the dread arises from the doctor, not from the drug.
Nothing ever can or will inspire mankind with an absolute confidence in
physicians, but an open, frank, and undisguised behaviour. While the least
shadow of mystery remains in the conduct of the Faculty, doubts,
jealousies, and suspicions, will arise in the minds of men.
No doubt cases will sometimes occur, where a prudent physician may
find it expedient to disguise a medicine. The whims and humours of men
must be regarded by those who mean to do them service; but this can never
affect the general argument in favour of candour and openness. A man
might as well allege, because there are knaves and fools in the world, that
he ought to take every one he meets for such, and to treat him accordingly.
A sensible physician will always know where disguise is necessary; but it
ought never to appear on the face of his general conduct.
The appearance of mystery in the conduct of physicians not only renders
their art suspicious, but lays the foundations of Quackery, which is the
disgrace of Medicine. No two characters can be more different than that of
the honest physician and the quack; yet they have generally been very much
confounded. The line between them is not sufficiently apparent; at least it is
too fine for the general eye. Few persons are able to distinguish sufficiently
between the conduct of that man who administers a secret medicine, and
him who writes a prescription in mystical characters and an unknown
tongue. Thus the conduct of the honest physician, which needs no disguise,
gives a sanction to that of the villain, whose sole consequence depends
upon secrecy.
No laws will ever be able to prevent quackery, while people believe that
the quack is as honest a man, and as well qualified, as the physician. A very
small degree of medical knowledge, however, would be sufficient to break
this spell; and nothing else can effectually undeceive them. It is the
ignorance and credulity of the multitude, with regard to medicine, which
renders them such an easy prey to every one who has the hardiness to attack

them on this quarter. Nor can the evil be remedied by any other means but
by making them wiser.
The most effectual way to destroy quackery in any art or science, is to
diffuse the knowledge of it among mankind. Did physicians write their
prescriptions in the common language of the country, and explain their
intentions to the patient, as far as he could understand them, it would enable
him to know when the medicine had the desired effect; would inspire him
with absolute confidence in the physician; and would make him dread and
detest every man who pretended to cram a secret medicine down his throat.
Men in the different states of society, have very different views of the
same object. Some time ago it was the practice of this country for every
person to say his prayers in Latin, whether he knew any thing of that
language or not. This conduct, though sacred in the eyes of our ancestors,
appears ridiculous enough to us; and doubtless some parts of ours will seem
as strange to posterity. Among these we may reckon the present mode of
medical prescription, which, we venture to affirm, will sometime hence
appear to have been completely ridiculous, and a very high burlesque upon
the common sense of mankind.
But this practice is not only ridiculous, it is likewise dangerous. However
capable physicians may be of writing Latin, I am certain apothecaries are
not always in a condition to read it, and that dangerous mistakes, in
consequence of this, often happen. But suppose the apothecary ever so able
to read the physician’s prescription, he is generally otherwise employed,
and the business of making up prescriptions is left entirely to the apprentice.
By this means the greatest man in the kingdom, even when he employs a
first-rate physician, in reality trusts his life in the hands of an idle boy, who
has not only the chance of being very ignorant, but likewise giddy and
careless. Mistakes will sometimes happen in spite of the greatest care; but,
where human lives are concerned, all possible methods ought certainly to
be taken to prevent them. For this reason, the prescriptions of physicians,
instead of being couched in mystical characters and a foreign language,
ought, in my humble opinion, to be conceived in the most plain and obvious
terms imaginable.
Diffusing medical knowledge among the people would not only tend to
improve the art, and to banish quackery, but likewise to render Medicine
more universally useful, by extending its benefits to society. However long

Medicine may have been known as a science, we will venture to say, that
many of its most important purposes to society have either been
overlooked, or very little attended to. The cure of diseases is doubtless a
matter of great importance; but the preservation of health is of still greater.
This is the concern of every man, and surely what relates to it ought to be
rendered as plain and obvious to all as possible. It is not to be supposed,
that men can be sufficiently upon their guard against diseases, who are
totally ignorant of their causes. Neither can the legislature, in whose power
it is to do much more for preserving the public health than can ever be done
by the Faculty, exert that power with propriety, and to the greatest
advantage, without some degree of medical knowledge.
Men of every occupation and condition in life might avail themselves of
a degree of medical knowledge; as it would teach them to avoid the dangers
peculiar to their respective stations; which is always easier than to remove
their effects. Medical knowledge, instead of being a check upon the
enjoyments of life, only teaches men how to make the most of them. It has
indeed been said, that to live medically is to live miserably: but it might
with equal propriety be said, that to live rationally is to live miserably. If
physicians obtrude their own ridiculous whims upon mankind, or lay down
rules inconsistent with reason or common sense, no doubt they will be
despised. But this is not the fault of Medicine. It proposes no rules that I
know, but such as are perfectly consistent with the true enjoyment of life,
and every way conducive to the real happiness of mankind.
We are sorry indeed to observe, that Medicine has hitherto hardly been
considered as a popular science, but as a branch of knowledge solely
confined to a particular set of men, while all the rest have been taught not
only to neglect, but even to dread and despise it. It will however appear,
upon a more strict examination, that no science better deserves their
attention, or is more capable of being rendered generally useful.
People are told, that if they dip the least into medical knowledge, it will
render them fanciful, and make them believe they have every disease of
which they read. This I am satisfied will seldom be the case with sensible
people; and, suppose it were, they must soon be undeceived. A short time
will shew them their error, and a little more reading will infallibly correct it.
A single instance will shew the absurdity of this notion. A sensible lady,
rather than read a medical performance, which would instruct her in the

management of her children, must leave them entirely to the care and
conduct of the most ignorant, credulous, and superstitious part of the human
species.
No part of Medicine is of more general importance than that which
relates to the nursing and management of children. Yet few parents pay a
proper attention to it. They leave the sole care of their tender offspring, at
the very time when care and attention are most necessary, to hirelings, who
are either too careless to do their duty, or too ignorant to know it. We will
venture to affirm, that more human lives are lost by the carelessness and
inattention of parents and nurses, than are saved by the Faculty; and that the
joint and well-conducted endeavours, both of private persons and the
public, for the preservation of infant lives, would be of more advantage to
society, than the whole art of Medicine, upon its present footing.
The benefits of Medicine, as a trade, will ever be confined to those who
are able to pay for them; and of course, the far greater part of mankind will
be every where deprived of them. Physicians, like other people, must live
by their employment, and the poor must either want advice altogether, or
take up with that which is worse than none. There are not however any
where wanting well-disposed people, of better sense, who are willing to
supply the defect of medical advice to the poor, did not their fear of doing
ill often suppress their inclination to do good. Such people are often
deterred from the most noble and praise-worthy actions, by the foolish
alarms sounded in their ears by a set of men who, to raise their own
importance, magnify the difficulties of doing good, find fault with what is
truly commendable, and fleer at every attempt to relieve the sick which is
not conducted by the precise rules of Medicine. These gentlemen must
however excuse me for saying, that I have often known such well-disposed
persons do much good; and that their practice, which is generally the result
of good sense and observation, assisted by a little medical reading, is
frequently more rational than that of the ignorant retainer to physic, who
despises both reason and observation, that he may go wrong by rule; and
who, while he is dosing his patient with medicines, often neglects other
things of far greater importance.
Many things are necessary for the sick besides medicine. Nor is the
person who takes care to procure those for them, of less importance than a
physician. The poor oftener perish in diseases for want of proper nursing

than of medicine. They are frequently in want of even the necessaries of
life, and still more so of what is proper for a sickbed. No one can imagine,
who has not been a witness of these situations, how much good a well-
disposed person may do, by only taking care to have such wants supplied.
There certainly cannot be a more necessary, a more noble, or a more
godlike action, than to administer to the wants of our fellow-creatures in
distress. While virtue or religion are known among mankind, this conduct
will be approved; and while Heaven is just, it must be rewarded!
Persons who do not chuse to administer medicine to the sick, may
nevertheless direct their regimen. An eminent medical author has said, That
by diet alone all the intentions of Medicine may be answered[2]. No doubt a
great many of them may; but there are other things beside diet, which ought
by no means to be neglected. Many hurtful and destructive prejudices, with
regard to the treatment of the sick, still prevail among the people, which
persons of better sense and learning alone can eradicate. To guard the poor
against the influence of these prejudices, and to instil into their minds some
just ideas of the importance of proper food, fresh air, cleanliness, and other
pieces of regimen necessary in diseases, would be a work of great merit,
and productive of many happy consequences. A proper regimen, in most
diseases, is at least equal to medicine, and in many of them it is greatly
superior.
To assist the well-meant endeavours of the humane and benevolent in
relieving distress; to eradicate dangerous and hurtful prejudices; to guard
the ignorant and credulous against the frauds and impositions of quacks and
impostors; and to shew men what is in their own power, both with regard to
the prevention and cure of diseases, are certainly objects worthy of the
physician’s attention. These were the leading views in composing and
publishing the following sheets. They were suggested by an attention to the
conduct of mankind, with regard to Medicine, in the course of a pretty long
practice in different parts of this island, during which the author has often
had occasion to wish that his patients, or those about them, had been
possessed of some such plain directory for regulating their conduct. How
far he has succeeded in his endeavours to supply this deficiency, must be
left for others to determine; but if they be found to contribute in any
measure towards alleviating the calamities of mankind, he will think his
labour very well bestowed.

CONTENTS.

PART I.
Of the general Causes of Diseases.

CHAP. I.
Of Children Page 1
— Diseased Parents 7
— Clothing of Children 9
— Food of ditto 15
— Exercise of ditto 21
— Bad Effects of unwholesome Air upon ditto 30
— Nurses 33

CHAP. II.
Of the Laborious, &c. 37
— the Sedentary 47
— the Studious 54

CHAP. III.
Of Aliment 62

CHAP. IV.
Of Air 75

CHAP. V.
Of Exercise 81

CHAP. VI.
Of Sleep 87
— Clothing 89

CHAP. VII.
Of Intemperance 94

CHAP. VIII.
Of Cleanliness 100

CHAP. IX.
Of Infection 106

CHAP. X.

Of the Passions 111
— Anger 112
— Fear ib.
— Grief 116
— Love 119
— Religious Melancholy 120

CHAP. XI.
Of the Common Evacuations 121
— Stool ib.
— Urine 123
— Perspiration 125
— being affected by Changes in the Atmosphere 126
— Wet Clothes 127
— Wet Feet ib.
— Night Air 128
— Damp Beds ib.
— Damp Houses 130
— Sudden Transitions from Heat to Cold 131

PART II.
Of Diseases.

CHAP. XII.
Of the Knowledge and Cure of Diseases 135

CHAP. XIII.
Fevers in general 140

CHAP. XIV.
Of intermitting Fevers or Agues 147

CHAP. XV.
Of an Acute Continual Fever 157

CHAP. XVI.
Of the Pleurisy 163
—— Bastard ditto 169
—— Paraphrenitis 170

CHAP. XVII.

Inflammation of the Lungs 171

CHAP. XVIII.
Of Consumptions 174

CHAP. XIX.
Of the Slow or Nervous Fever 188

CHAP. XX.
Malignant, Putrid, or Spotted Fever 195

CHAP. XXI.
Miliary Fever 205

CHAP. XXII.
Remitting Fever 210

CHAP. XXIII.
The Small-pox 214
Inoculation 227

CHAP. XXIV.
The Measles 240
— Scarlet Fever 245
— Bilious Fever 247

CHAP. XXV.
St. Anthony’s Fire 248

CHAP. XXVI.
Inflammation of the Brain 254

CHAP. XXVII.
Inflammation of the Eyes 258

CHAP. XXVIII.
The Quinsey 264
— Malignant ditto 271

CHAP. XXIX.
Colds and Coughs 276

A Common Cough 280
Hooping-Cough 284

CHAP. XXX.
Inflammation of the Stomach 289
—— of the Intestines 291
Of the Colic 295
Inflammation of the Kidnies 301
—— of the Bladder 304
—— of the Liver 305

CHAP. XXXI.
Of the Cholera Morbus, and other excessive Discharges from the Stomach and Bowels 309
— a Diarrhœa, or Looseness 312
— Vomiting 315

CHAP. XXXII.
Disorders of the Kidnies and Bladder 319
Of the Diabetes, or excessive Discharge of Urine ib.
— Suppression of ditto 322
— the Gravel and Stone 324

CHAP. XXXIII.
Involuntary Discharges of Blood 328
Bleeding at the Nose 331
Bleeding and Blind Piles 334
Spitting of Blood 337
Vomiting of ditto 341
Bloody Urine 342
—— Flux 345
Cœliac Passion 351

CHAP. XXXIV.
Of the Head-ach 352
—— Tooth-ach 357
—— Ear-ach 360
Pain of the Stomach, &c. 362

CHAP. XXXV.
Of Worms 365

CHAP. XXXVI.
Of the Jaundice 370

CHAP. XXXVII.
Of the Dropsy 374

CHAP. XXXVIII.
Of the Gout 380
—— Rheumatism 388

CHAP. XXXIX.
Of the Scurvy 393
—— Scrophula 398
—— Itch 403

CHAP. XL.
Of the Asthma 406

CHAP. XLI.
Of the Apoplexy 410

CHAP. XLII.
Of Costiveness 414
— Want of Appetite 416
— Heart-burn 418

CHAP. XLIII.
Of Nervous Diseases 420
— Melancholy 426
— the Palsy 430
— the Epilepsy, or Falling Sickness 432
— the Hiccup 436
— Cramp of the Stomach 438
— the Night-mare 439
— Swoonings 440
— Flatulencies, or Wind 443
— Low Spirits 446
— Hysteric Affections 447
— Hypochondriac Affections 451

CHAP. XLIV.

Disorders of the Senses 456
—— of the Eye ib.
A Gutta Serena 458
A Cataract 458
Short Sightedness 459
Seeing only at too great a Distance ib.
Squinting ib.
Spots or Specks ib.
Bloodshot Eye ib.
Watery or Weeping Eye 460
Of the Ear ib.
—— Taste and Smell 463
—— Touch 465

CHAP. XLV.
Of a Scirrhus and Cancer 466

CHAP. XLVI.
Of Poisons 472
— Mineral Poisons 474
— Vegetable ditto 475
Bites of poisonous Animals 477
—— of the Mad Dog ib.
—— of the Viper 485
—— of poisonous Infects 486
—— of the Rattle-Snake 488

CHAP. XLVII.
Of the Venereal Disease 489
—— Virulent Gonorrhœa 490
— Gleets 500
— Swelled Testicle 503
— Buboes 504
— Chancres 506
— A Confirmed Lues or Pox 510
General Observations 515

CHAP. XLVIII.
Diseases of Women 521
Of the Menstrual Discharge 522
— Pregnancy 530

— Childbirth 533
— Barrenness 542

CHAP. XLIX.
Diseases of Children 544
Of the Meconium 546
— the Apthæ or Thrush 547
— Acidities 548
— Galling and Excoriation 550
— Stoppage of the Nose ib.
— Vomiting 551
— a Looseness 552
— Eruptions 554
— the Croup 557
— Teething 559
— the Rickets 562
— Convulsions 565
— Water in the Head 567

CHAP. L.
Of Surgery 569
— Bleeding 570
— Inflammations and Abscesses 573
— Wounds 575
— Burns 580
— Bruises 582
Ulcers 583

CHAP. LI.
Of Dislocations 586
Dislocation of the Jaw 588
—— of the Neck 589
—— of the Ribs 590
—— of the Shoulder ib.
—— of the Elbow 591
—— of the Wrist and Fingers 592
—— of the Thigh ib.
—— of the Knees ib.
—— of the Ancles ib.
—— of the Toes ib.

CHAP. LII.
Of broken Bones, &c. 593
— Strains 597
— Ruptures 598

CHAP. LIII.
Of Casualties 600
— Substances stopt between the Mouth and Stomach 602
— Drowned Persons 608
— Noxious Vapours 613
Effects of Extreme Cold 616
—— Heat 618

CHAP. LIV.
Of Fainting Fits, and other Cases which require immediate Assistance 618
— Intoxication 623
— Suffocation and Strangling 626
— Persons who expire in Convulsion Fits 629

CHAP. LV.
Cautions concerning Cold Bathing, and drinking the Mineral Waters 633

CONTENTS of the APPENDIX.

Introduction Page 649
List of Simples 654

Medical Preparations.
Balsams 657
Boluses 658
Cataplasms and Sinapisms 659
Clysters 660
Collyria, or Eye-waters 662
Confections 663
Conserves and Preserves 664
Decoctions 665
Draughts 668
Electuaries 669
Emulsions 672
Extracts 673
Fomentations ib.
Gargles 674
Infusions 676
Juleps 678
Mixtures 680
Ointments, Liniments, and Cerates 681
Pills 684
Plasters 688
Powders 690
Syrups 694
Tinctures, Elixirs, &c. ib.
Vinegars 699
Waters by Infusion, &c. 701
Simple distilled Waters 703
Spirituous distilled Waters 704
Wheys ib.
Wines 705

A GLOSSARY 708
INDEX 713

PART I.
OF THE
GENERAL CAUSES OF DISEASES.

CHAP. I.
OF CHILDREN.

The better to trace diseases from their original causes, we shall take a view
of the common treatment of mankind in the state of infancy. In this period
of our lives, the foundations of a good or bad constitution are generally laid;
it is therefore of importance, that parents be well acquainted with the
various causes which may injure the health of their offspring.
It appears from the annual registers of the dead, that almost one half of
the children born in Great Britain die under twelve years of age. To many,
indeed, this may appear a natural evil; but, on due examination, it will be
found to be one of our own creating. Were the death of infants a natural
evil, other animals would be as liable to die young as man; but this we find
is by no means the case.
It may seem strange that man, notwithstanding his superior reason,
should fall so far short of other animals in the management of his young:
But our surprise will soon cease, if we consider that brutes, guided by
instinct, never err in this respect; while man, trusting solely to art, is seldom
right. Were a catalogue of those infants who perish annually by art alone
exhibited to public view, it would astonish most people.

If parents are above taking care of their children, others must be
employed for that purpose: these will always endeavour to recommend
themselves by the appearance of extraordinary skill and address. By this
means such a number of unnecessary and destructive articles have been
introduced into the diet, clothing, &c. of infants, that it is no wonder so
many of them perish.
Nothing can be more preposterous than a mother who thinks it below her
to take care of her own child, or who is so ignorant as not to know what is
proper to be done for it. If we search Nature throughout, we cannot find a
parallel to this. Every other animal is the nurse of its own offspring, and
they thrive accordingly. Were the brutes to bring up their young by proxy,
they would share the same fate with those of the human species.
We mean not, however, to impose it as a task upon every mother to
suckle her own child. This, whatever speculative writers may allege, is in
some cases impracticable, and would inevitably prove destructive both to
the mother and child. Women of delicate constitutions, subject to hysteric
fits, or other nervous affections, make very bad nurses: and these
complaints are now so common, that it is rare to find a woman of fashion
free from them; such women, therefore, supposing them willing, are often
unable to suckle their own children.
Almost every mother would be in a condition to give suck, did mankind
live agreeably to Nature: but whoever considers how far many mothers
deviate from her dictates, will not be surprised to find some of them unable
to perform that necessary office. Mothers who do not eat a sufficient
quantity of solid food, nor enjoy the benefit of free air and exercise, can
neither have wholesome juices themselves, nor afford proper nourishment
to an infant. Hence children who are suckled by delicate women, either die
young, or continue weak and sickly all their lives.
When we say that mothers are not always in a condition to suckle their
own children, we would not be understood as discouraging that practice.
Every mother who can, ought certainly to perform so tender and agreeable
an office[3]. But, suppose it to be out of her power, she may, nevertheless, be
of great service to her child. The business of nursing is by no means
confined to giving suck. To a woman who abounds with milk, this is the
easiest part of it. Numberless other offices are necessary for a child, which
the mother ought at least to see done.

A mother who abandons the fruit of her womb, as soon as it is born, to
the sole care of an hireling, hardly deserves that name. A child, by being
brought up under the mother’s eye, not only secures her affection, but may
reap all the advantages of a parent’s care, though it be suckled by another.
How can a mother be better employed than in superintending the nursery?
This is at once the most delightful and important office; yet the most trivial
business or insipid amusements are often preferred to it! A strong proof
both of the bad taste and wrong education of modern females.
It is indeed to be regretted, that more care is not bestowed in teaching the
proper management of children to those whom Nature has designed for
mothers. This, instead of being made the principal, is seldom considered as
any part of female education. Is it any wonder, when females so educated
come to be mothers, that they should be quite ignorant of the duties
belonging to that character? However strange it may appear, it is certainly
true, that many mothers, and those of fashion too, are as ignorant, when
they have brought a child into the world, of what is to be done for it, as the
infant itself. Indeed, the most ignorant of the sex are generally reckoned
most knowing in the business of nursing. Hence, sensible people become
the dupes of ignorance and superstition; and the nursing of children, instead
of being conducted by reason, is the result of whim and caprice[4].
Were the time that is generally spent by females in the acquisition of
trifling accomplishments, employed in learning how to bring up their
children; how to dress them so as not to hurt, cramp, or confine their
motions; how to feed them with wholesome and nourishing food; how to
exercise their tender bodies, so as best to promote their growth and strength:
were these made the objects of female instruction, mankind would derive
the greatest advantages from it. But while the education of females implies
little more than what relates to dress and public shew, we have nothing to
expect from them but ignorance even in the most important concerns.
Did mothers reflect on their own importance, and lay it to heart, they
would embrace every opportunity of informing themselves of the duties
which they owe to their infant offspring. It is their province, not only to
form the body, but also to give the mind its most early bias. They have it
very much in their power to make men healthy or valetudinary, useful in
life, or the pests of society.

But the mother is not the only person concerned in the management of
children. The father has an equal interest in their welfare, and ought to
assist in every thing that respects either the improvement of the body or
mind.
It is pity that the men should be so inattentive to this matter. Their
negligence is one reason why females know so little of it. Women will ever
be desirous to excel in such accomplishments as recommend them to the
other sex. But men generally keep at such a distance from even the smallest
acquaintance with the affairs of the nursery, that many would reckon it an
affront, were they supposed to know any thing of them. Not so, however,
with the kennel or the stables: a gentleman of the first rank is not ashamed
to give directions concerning the management of his dogs or horses, yet
would blush were he surprised in performing the same office for that being
who derived its exigence from himself, who is the heir of his fortunes, and
the future hope of his country.
Nor have physicians themselves been sufficiently attentive to the
management of children: this has been generally considered as the sole
province of old women, while men of the first character in physic have
refused to visit infants even when sick. Such conduct in the faculty has not
only caused this branch of medicine to be neglected, but has also
encouraged the other sex to assume an absolute title to prescribe for
children in the most dangerous diseases. The consequence is, that a
physician is seldom called till the good women have exhausted all their
skill; when his attendance can only serve to divide the blame, and appease
the disconsolate parents.
Nurses should do all in their power to prevent diseases; but when a child
is taken ill, some person of skill ought immediately to be consulted. The
diseases of children are generally acute, and the least delay is dangerous.
Were physicians more attentive to the diseases of infants, they would not
only be better qualified to treat them properly when sick, but likewise to
give useful directions for their management when well. The diseases of
children are by no means so difficult to be understood as many imagine. It
is true, children cannot tell their complaints; but the causes of them may be
pretty certainly discovered by observing the symptoms, and putting proper
questions to the nurses. Besides, the diseases of infants being less
complicated, are easier cured than those of adults[5].

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

Of Diseased Parents.

One great source of the diseases of children is, the unhealthiness of
Parents. It would be as reasonable to expect a rich crop from a barren soil,
as that strong and healthy children should be born of parents whose
constitutions have been worn out with intemperance or disease.
An ingenious writer[6] observes, that on the constitution of mothers
depends originally that of their offspring. No one who believes this, will be
surprised, on a view of the female world, to find diseases and death so
frequent among children. A delicate female, brought up within doors, an
utter stranger to exercise and open air, who lives on tea and other slops,
may bring a child into the world, but it will hardly be fit to live. The first
blast of disease will nip the tender plant in the bud: or, should it struggle
through a few years existence, its feeble frame, shaken with convulsions
from every trivial cause, will be unable to perform the common functions of
life, and prove a burden to society.
If to the delicacy of mothers, we add the irregular lives of fathers, we
shall see further cause to believe that children are often hurt by the
constitution of their parents. A sickly frame may be originally induced by
hardships or intemperance, but chiefly by the latter. It is impossible that a
course of vice should not spoil the best constitution: and, did the evil
terminate here, it would be a just punishment for the folly of the sufferer;
but when once a disease is contracted and riveted in the habit, it is entailed
on posterity. What a dreadful inheritance is the gout, the scurvy, or the
King’s evil, to transmit to our offspring! how happy had it been for the heir
of many a great estate, had he been born a beggar, rather than to inherit his
father’s fortunes at the expence of inheriting his diseases!

A person labouring under any incurable malady ought not to marry. He
thereby not only shortens his own life, but transmits misery to others: but
when both parties are deeply tainted with the scrophula, the scurvy, or the
like, the effects must be still worse. If such have any issue, they must be
miserable indeed. Want of attention to these things, in forming connexions
for life, has rooted out more families than plague, famine, or the sword; and
as long as these connexions are formed from mercenary views, the evil will
be continued[7].
In our matrimonial contracts, it is amazing so little regard is had to the
health and form of the object. Our sportsmen know, that the generous
courser cannot be bred out of the foundered jade, nor the sagacious spaniel
out of the snarling cur. This is settled upon immutable laws. The man who
marries a woman of a sickly constitution, and descended of unhealthy
parents, whatever his views may be, cannot be said to act a prudent part. A
diseased woman may prove fertile; should this be the case, the family must
become an infirmary: what prospect of happiness the father of such a family
has, we shall leave any one to judge[8].
Such children as have the misfortune to be born of diseased parents, will
require to be nursed with greater care than others. This is the only way to
make amends for the defects of constitution; and it will often go a great
length. A healthy nurse, wholesome air, and sufficient exercise, will do
wonders. But when these are neglected, little is to be expected from any
other quarter. The defects of constitution cannot be supplied by medicine.
Those who inherit any family disease ought to be very circumspect in
their manner of living. They should consider well the nature of such
disease, and guard against it by a proper regimen. It is certain, that family
diseases have often, by proper care, been kept off for one generation; and
there is reason to believe, that, by persisting in the same course, such
diseases might at length be wholly eradicated. This is a subject very little
regarded, though of the greatest importance. Family constitutions are as
capable of improvement as family estates; and the libertine, who impairs
the one, does greater injury to his posterity, than the prodigal who
squanders away the other.

Of the Clothing of Children.

The clothing of an infant is so simple a matter, that it is surprising how
any person should err in it; yet many children lose their lives, and others are
deformed, by inattention to this article.
Nature knows no use of clothes to an infant, but to keep it warm. All that
is necessary for this purpose, is to wrap it in a soft loose covering. Were a
mother left to the dictates of Nature alone, she would certainly pursue this
course. But the business of dressing an infant has long been out of the hands
of mothers, and has at last become a secret which none but adepts pretend
to understand.
From the most early ages it has been thought necessary, that a woman in
labour should have some person to attend her. This in time became a
business; and, as in all others, those who were employed in it strove to
outdo one another in the different branches of their profession. The dressing
of a child came of course to be considered as the midwife’s province, who
no doubt imagined, that the more dexterity she could shew in this article,
the more her skill would be admired. Her attempts were seconded by the
vanity of parents, who, too often desirous of making a shew of the infant as
soon as it was born, were ambitious to have as much finery heaped upon it
as possible. Thus it came to be thought as necessary for a midwife to excel
in bracing and dressing an infant, as for a surgeon to be expert in applying
bandages to a broken limb; and the poor child, as soon as it came into the
world, had as many rollers and wrappers applied to its body, as if every
bone had been fractured in the birth; while these were often so tight, as not
only to gall and wound its tender frame, but even to obstruct the motion of
the heart, lungs, and other organs necessary for life.
In most parts of Britain, the practice of rolling children with so many
bandages is now, in some measure, laid aside; but it would still be a difficult
task to persuade the generality of mankind, that the shape of an infant does
not entirely depend on the care of the midwife. So far, however, are all her
endeavours to mend the shape from being successful, that they constantly
operate the contrary way, and mankind become deformed in proportion to
the means used to prevent it. How little deformity of body is to be found
among uncivilized nations? So little indeed, that it is vulgarly believed they
put all their deformed children to death. The truth is, they hardly know such
a thing as a deformed child. Neither should we, if we followed their
example. Savage nations never think of manacling their children. They

allow them the full use of every organ, carry them abroad in the open air,
wash their bodies daily in cold water, &c. By this management, their
children become so strong and hardy, that, by the time our puny infants get
out of the nurse’s arms, theirs are able to shift for themselves[9].
Among brute animals, no art is necessary to procure a fine shape. Though
many of them are extremely delicate when they come into the world, yet we
never find them grow crooked for want of swaddling bands. Is nature less
generous to the human kind? No: but we take the business out of Nature’s
hands.
Not only the analogy of other animals, but the very feelings of infants tell
us, they ought to be kept easy and free from all pressure. They cannot
indeed tell their complaints; but they can shew signs of pain; and this they
never fail to do, by crying when hurt by their clothes. No sooner are they
freed from their bracings, than they seem pleased and happy; yet, strange
infatuation! the moment they hold their peace, they are again committed to
their chains.
If we consider the body of an infant as a bundle of soft pipes, replenished
with fluids in continual motion, the danger of pressure will appear in the
strongest light. Nature, in order to make way for the growth of children, has
formed their bodies soft and flexible; and lest they should receive any
injury from pressure in the womb, has surrounded the fœtus every where
with fluids. This shews the care which Nature takes to prevent all unequal
pressure on the bodies of infants, and to defend them against every thing
that might in the least cramp or confine their motions.
Even the bones of an infant are so soft and cartilaginous, that they readily
yield to the slightest pressure, and easily assume a bad shape, which can
never after be remedied. Hence it is, that so many people appear with high
shoulders, crooked spines, and flat breasts, who were as well proportioned
at their birth as others, but had the misfortune to be squeezed out of shape
by the application of stays and bandages.
Pressure, by obstructing the circulation, likewise prevents the equal
distribution of nourishment to the different parts of the body, by which
means the growth becomes unequal. One part grows too large, while
another remains too small; and thus in time the whole frame becomes
disproportioned and misshapen. To this we must add, that when a child is

cramped in its clothes, it naturally shrinks from the part that is hurt; and, by
putting its body into unnatural postures it becomes deformed by habit.
Deformity of body may indeed proceed from weakness or disease; but, in
general, it is the effect of improper clothing. Nine-tenths, at least, of the
deformity among mankind, must be imputed to this cause. A deformed body
is not only disagreeable to the eye, but by a bad figure both the animal and
vital functions must be impeded, and of course health impaired. Hence few
people remarkably mishapen are strong or healthy.
The new motions which commence at the birth, as the circulation of the
whole mass of blood through the lungs, respiration, the peristaltic motion,
&c. afford another strong argument for keeping the body of an infant free
from all pressure. These organs, not having been accustomed to move, are
easily stopped; but when this happens, death must ensue. Hardly any
method could be devised more effectually to stop these motions, than
bracing the body too tight with rollers[10] and bandages. Were these to be
applied in the same manner to the body of an adult for an equal length of
time, they would hardly fail to hurt the digestion and make him sick. How
much more hurtful they must prove to the tender bodies of infants, we shall
leave any one to judge.
Whoever considers these things will not be surprised, that so many
children die of convulsions soon after the birth. These fits are generally
attributed to some inward cause; but in fact, they oftener proceed from our
own imprudent conduct. I have known a child seized with convulsion-fits
soon after the midwife had done swaddling it, who, upon taking off the
rollers and bandages, was immediately relieved, and never had the disease
afterwards. Numerous examples of this might be given, were they
necessary.
It would be safer to fasten the cloths of an infant with strings than pins,
as these often gall and irritate their tender skins, and occasion disorders.
Pins have been found sticking above half an inch into the body of a child,
after it had died of convulsion fits, which, in all probability, proceeded from
that cause.
Children are not only hurt by the tightness of their clothes, but also by the
quantity. Every child has some degree of fever after the birth; and if it be
loaded with too many clothes, the fever must be increased. But this is not
all; the child is generally laid in bed with the mother, who is often likewise

feverish; to which we may add the heat of the bed-chamber, the wines, and
other heating things, too frequently given to children immediately after the
birth. When all these are combined, which does not seldom happen, they
must increase the fever to such a degree as will endanger the life of the
infant.
The danger of keeping infants too hot will further appear, if we consider
that, after they have been for some time in the situation mentioned above,
they are often sent into the country to be nursed in a cold house. Is it any
wonder, if a child, from such a transition, catches a mortal cold, or contracts
some other fatal disease? When an infant is kept too hot, its lungs, not being
sufficiently expanded, are apt to remain weak and flaccid for life; hence
proceed coughs, consumptions, and other diseases of the breast.
It would answer little purpose to specify the particular species of dress
proper for an infant. These will always vary in different countries,
according to custom and the humour of parents. The great rule to be
observed is, That a child have no more clothes than are necessary to keep it
warm, and that they be quite easy for its body.
Stays are the very bane of infants. A volume would not suffice to point
out all the bad effects of this ridiculous piece of dress both on children and
adults. The madness in favour of stays seems, however, to be somewhat
abated; and it is to be hoped the world will, in time, become wise enough to
know, that the human shape does not solely depend upon whale-bone and
bend-leather[11].
I shall only add with respect to the clothes of children, that they ought to
be kept thoroughly clean. Children perspire more than adults; and if their
clothes be not frequently changed, they become very hurtful. Dirty clothes
not only gall and fret the tender skins of infants, but likewise occasion ill
smells; and, what is worse, tend to produce vermin and cutaneous diseases.
Cleanliness is not only agreeable to the eye, but tends greatly to preserve
the health of children. It promotes the perspiration, and, by that means,
frees the body from superfluous humours, which, if retained, could not fail
to occasion diseases. No mother or nurse can have any excuse for allowing
a child to be dirty. Poverty may oblige her to give it coarse clothes; but if
she does not keep them clean, it must be her own fault.

Of the Food of Children.

Nature not only points out the food proper for an infant, but actually
prepares it. This, however, is not sufficient to prevent some who think
themselves wiser than Nature, from attempting to bring up their children
without her provision. Nothing can shew the disposition which mankind
have to depart from Nature, more than their endeavouring to bring up
children without the breast. The mother’s milk, or that of a healthy nurse, is
unquestionably the best food for an infant. Neither art nor nature can afford
a proper substitute for it. Children may seem to thrive for a few months
without the breast; but, when teething, the small-pox, and other diseases
incident to childhood, come on, they generally perish.
A child, soon after the birth, shews an inclination to suck; and there is no
reason why it should not be gratified. It is true, the mother’s milk does not
always come immediately after the birth; but this is the way to bring it:
besides, the first milk that the child can squeeze out of the breast answers
the purpose of cleansing, better than all the drugs in the apothecary’s shop,
and at the same time prevents inflammations of the breast, fevers, and other
diseases incident to mothers.
It is strange how people came to think that the first thing given to a child
should be drugs. This is beginning with medicine by times, and no wonder
if they generally ended with it. It sometimes happens, indeed, that a child
does not discharge the meconium so soon as could be wished; this has
induced physicians, in such cases, to give something of an opening nature
to cleanse the first passages. Midwives have improved upon this hint, and
never fail to give syrups, oils, &c. whether they be necessary or not.
Cramming an infant with such indigestible stuff as soon as it is born, can
hardly fail to make it sick, and is more likely to occasion diseases, than to
prevent them. Children are seldom long after the birth without having
passage both by stool and urine; though these evacuations may be wanting
for some time without any danger. But if children must have something
before they be allowed the breast, let it be a little thin water-pap, to which
may be added an equal quantity of new milk; or rather water alone, with the
addition of a little raw sugar. If this be given without any wines or spiceries,
it will neither heat the blood, load the stomach, nor occasion gripes.

Upon the first sight of an infant, almost every person is struck with the
idea of its being weak, feeble, and wanting support. This naturally suggests
the need of cordials. Accordingly wines are universally mixed with the first
food of children. Nothing can be more fallacious than this way of
reasoning, or more hurtful to infants than the conduct founded upon it.
Children require very little food for some time after the birth; and what they
receive should be thin, weak, light, and of a cooling quality. A very small
quantity of wine is sufficient to heat and inflame the blood of an infant; but
every person conversant in these matters must know, that most of the
diseases of infants proceed from the heat of their humours.
If the mother or nurse has enough of milk, the child will need little or no
other food before the third or four month. It will then be proper to give it,
once or twice a day, a little of some food that is easy of digestion, as water-
pap, milk-pottage, weak broth with bread in it, and such like. This will ease
the mother, will accustom the child by degrees to take food, and will render
the weaning both less difficult and less dangerous. All great and sudden
transitions are to be avoided in nursing. For this purpose, the food of
children ought not only to be simple, but to resemble, as nearly as possible,
the properties of milk. Indeed milk itself should make a principal part of
their food, not only before they are weaned, but for some time after.
Next to milk, we would recommend good light bread. Bread may be
given to a child as soon as it shews an inclination to chew; and it may at all
times be allowed as much plain bread as it will eat. The very chewing of
bread will promote the cutting of the teeth, and the discharge of saliva,
while, by mixing with the nurse’s milk in the stomach, it will afford an
excellent nourishment. Children discover an early inclination to chew
whatever is put into their hands. Parents observe the inclination, but
generally mistake the object. Instead of giving the child something which
may at once exercise its gums and afford it nourishment, they commonly
put into its hands a piece of hard metal, or impenetrable coral. A crust of
bread is the best gum-stick. It not only answers the purpose better than any
thing else, but has the additional properties of nourishing the child and
carrying the saliva down to the stomach, which is too valuable a liquor to be
lost.
Bread, besides being used dry, may be many ways prepared into food for
children. One of the best methods is to boil it in water, afterwards pouring

the water off, and mixing with the bread a proper quantity of new milk
unboiled. Milk is both more wholesome and nourishing this way than
boiled, and is less apt to occasion costiveness. For a child farther advanced,
bread may be mixed in veal or chicken broth, made into puddings, or the
like. Bread is a proper food for children at all times, provided it be plain,
made of wholesome grain, and well fermented; but when enriched with
fruits, sugars, or such things, it becomes very unwholesome.
It is soon enough to allow children animal food when they have got teeth
to eat it. They should never taste it till after they are weaned, and even then
they ought to use it sparingly. Indeed, when children live wholly on
vegetable food, it is apt to sour on their stomachs; but, on the other hand,
too much flesh heats the body, and occasions fevers and other inflammatory
diseases. This plainly points out a due mixture of animal and vegetable food
as most proper for children.
Few things prove more hurtful to infants, than the common method of
sweetening their food. It entices them to take more than they ought to do,
which makes them grow fat and bloated. It is pretty certain, if the food of
children were quite plain, that they would never take more than enough.
Their excesses are entirely owing to nurses. If a child be gorged with food
at all hours, and enticed to take it, by making it sweet and agreeable to the
palate, is it any wonder that such a child should in time be induced to crave
more food than it ought to have?
Children may be hurt by too little as well as too much food. After a child
is weaned, it ought to be fed four or five times a day; but should never be
accustomed to eat in the night; neither should it have too much at a time.
Children thrive best with small quantities of food frequently given. This
neither overloads the stomach nor hurts the digestion, and is certainly most
agreeable to Nature.
Writers on nursing have inveighed with such vehemence against giving
children too much food, that many parents, by endeavouring to shun that
error, have run into the opposite extreme, and ruined the constitutions of
their children. But the error of pinching children in their food is more
hurtful than the other extreme. Nature has many ways of relieving herself
when overcharged; but a child, who is pinched with hunger, will never
become a strong or healthy man. That errors are frequently committed on
both sides, we are ready to acknowledge; but where one child is hurt by the

quantity of its food, ten suffer from the quality. This is the principal evil,
and claims our strictest attention.
Many people imagine, that the food which they themselves love cannot
be bad for their children: but this notion is very absurd. In the more
advanced periods of life we often acquire an inclination for food, which
when children we could not endure. Besides, there are many things that by
habit may agree very well with the stomach of a grown person, which
would be hurtful to a child; as high-seasoned, salted, and smoke-dried
provisions, &c. It would also be improper to feed children with fat meat,
strong broths, rich soups, or the like.
All strong liquors are hurtful to children. Some parents teach their
children to guzzle ale, and other fermented liquors, at every meal. Such a
practice cannot fail to do mischief. These children seldom escape the
violence of the small-pox, measles, hooping cough, or some inflammatory
disorder. Milk, water, butter-milk, or whey, are the most proper for children
to drink. If they have any thing stronger, it may be fine small beer, or a little
wine mixed with water. The stomachs of children can digest well enough
without the assistance of warm stimulants: besides, being naturally hot, they
are easily hurt by every thing of a heating quality.
Few things are more hurtful to children than unripe fruits. They weaken
the powers of digestion, and sour and relax the stomach, by which means it
becomes a proper nest for insects. Children indeed shew a great inclination
for fruit, and I am apt to believe, that if good ripe fruit were allowed them
in proper quantity, it would have no bad effects. We never find a natural
inclination wrong, if properly regulated. Fruits are generally of a cooling
nature, and correct the heat and acrimony of the humours. This is what most
children require; only care should be taken lest they exceed. Indeed the best
way to prevent children from going to excess in the use of fruit, or eating
that which is bad, is to allow them a proper quantity of what is good[12].
Roots which contain a crude viscid juice should be sparingly given to
children. They fill the body with gross humours, and tend to produce
eruptive diseases. This caution is peculiarly necessary for the poor; glad to
obtain at a small price what will fill the bellies of their children, they stuff
them two or three times a day with greasy potatoes, or other crude
vegetables. Children had better eat a smaller quantity of food which yields a

wholesome nourishment, than be crammed with what their digestive powers
are unable properly to assimilate.
Butter ought likewise to be sparingly given to children. It both relaxes the
stomach, and produces gross humours. Indeed, most things that are fat or
oily, have this effect. Butter, when salted, becomes still more hurtful.
Instead of butter, so liberally given to children in most parts of Britain, we
would recommend honey. Honey is not only wholesome, but cooling,
cleansing, and tends to sweeten the humours. Children who eat honey are
seldom troubled with worms: they are also less subject to cutaneous
diseases, as itch, scabbed head, &c.
Many people err in thinking that the diet of children ought to be
altogether moist. When children live entirely upon slops, it relaxes their
solids, renders them weak, and disposes them to the rickets, the scrophula,
and other glandular disorders. Relaxation is one of the most general causes
of the diseases of children. Every thing therefore which tends to unbrace
their solids, ought to be carefully avoided.
We would not be understood by these observations as confining children
to any particular kind of food. Their diet may be frequently varied, provided
always that sufficient regard be had to simplicity.

Of the Exercise of Children.

Of all the causes which conspire to render the life of man short and
miserable, none has greater influence than the want of proper EXERCISE:
healthy parents, wholesome food, and proper clothing, will avail little,
where exercise is neglected. Sufficient exercise will make up for several
defects in nursing; but nothing can supply the want of it. It is absolutely
necessary to the health, the growth, and the strength of children.
The desire of exercise is coëval with life itself. Were this principle
attended to, many diseases might be prevented. But, while indolence and
sedentary employments prevent two-thirds of mankind from either taking
sufficient exercise themselves, or giving it to their children, what have we
to expect but diseases and deformity among their offspring? The rickets, so
destructive to children, never appeared in Britain till manufactures began to
flourish, and people, attracted by the love of gain, left the country to follow

sedentary employments in great towns. It is amongst these people that this
disease chiefly prevails, and not only deforms, but kills many of their
offspring.
The conduct of other young animals shews the propriety of giving
exercise to children. Every other animal makes use of its organs of motion
as soon as it can, and many of them, even when under no necessity of
moving in quest of food, cannot be restrained without force. This is
evidently the case with the calf, the lamb, and most other young animals. If
these creatures were not permitted to frisk about and take exercise, they
would soon die or become diseased. The same inclination appears very
early in the human species; but as they are not able to take exercise
themselves, it is the business of their parents and nurses to assist them.
Children may be exercised various ways. The best method, while they are
light, is to carry them about in the nurse’s arms[13]. This gives the nurse an
opportunity of talking to the child, and of pointing out every thing that may
please and delight its fancy. Besides, it is much safer than swinging an
infant in a machine, or leaving it to the care of such as are not fit to take
care of themselves. Nothing can be more absurd than to set one child to
keep another: this conduct has proved fatal to many infants, and has
rendered others miserable for life.
When children begin to walk, the safest and best method of leading them
about, is by the hands. The common way, of swinging them in leading-
strings fixed to their backs, has several bad consequences. It makes them
throw their bodies forward, and press with their whole weight upon the
stomach and breast; by this means the breathing is obstructed, the breast
flattened, and the bowels compressed; which must hurt the digestion, and
occasion consumptions of the lungs, and other diseases.
It is a common notion, that if children are set upon their feet too soon,
their legs will become crooked. There is reason to believe, that the very
reverse of this is true. Every member acquires strength in proportion as it is
exercised. The limbs of children are weak indeed, but their bodies are
proportionally light; and had they skill to direct themselves, they would
soon be able to support their own weight. Who ever heard of any other
animal that became crooked by using its legs too soon? Indeed, if a child is
not permitted to make any use of its legs till a considerable time after the
birth, and be then set upon them with its whole weight at once, there may be

some danger; but this proceeds entirely from the child’s not having been
accustomed to use its legs from the beginning.
Mothers of the poorer sort think they are great gainers by making their
children lie or sit while they themselves work. In this they are greatly
mistaken. By neglecting to give their children exercise, they are obliged to
keep them a long time before they can do any thing for themselves, and to
spend more on medicine than would have paid for proper care.
To take care of their children, is the most useful business in which even
the poor can be employed: but, alas! it is not always in their power. Poverty
often obliges them to neglect their offspring, in order to procure the
necessaries of life. When this is the case, it becomes the interest as well as
the duty of the public to assist them. Ten thousand times more benefit
would accrue to the State, by enabling the poor to bring up their own
children, than from all the hospitals[14] that ever can be erected for that
purpose.
Whoever considers the structure of the human body will soon be
convinced of the necessity of exercise for the health of children. The body
is composed of an infinite number of tubes, whose fluids cannot be pushed
on without the action and pressure of the muscles. But, if the fluids remain
inactive, obstructions must happen, and the humours will of course be
vitiated, which cannot fail to occasion diseases. Nature has furnished both
the vessels which carry the blood and lymph with numerous valves, in order
that the action of every muscle might push forward their contents; but
without action, this admirable contrivance can have no effect. This part of
the animal œconomy proves to a demonstration the necessity of exercise for
the preservation of health.
Arguments to shew the importance of exercise might be drawn from
every part of the animal œconomy; without exercise, the circulation of the
blood cannot be properly carried on, nor the different secretions duly
performed; without exercise, the fluids cannot be properly prepared, nor the
solids rendered strong or firm. The action of the heart, the motion of the
lungs, and all the vital functions, are greatly assisted by exercise. But to
point out the manner in which these effects are produced, would lead us
farther into the œconomy of the human body, than most of those for whom
this treatise is intended would be able to follow. We shall therefore only
add, that, where exercise is neglected, none of the animal functions can be

duly performed; and when that is the case, the whole constitution must go
to wreck.
A good constitution ought certainly to be our first object in the
management of children. It lays a foundation for their being useful and
happy in life; and whoever neglects it, not only fails in his duty to his
offspring, but to society.
One very common error of parents, by which they hurt the constitutions
of their children, is the sending them too young to school. This is often done
solely to prevent trouble. When the child is at school, he needs no keeper.
Thus the schoolmaster is made the nurse; and the poor child is fixed to a
seat seven or eight hours a day, which time ought to be spent in exercise
and diversions. Sitting so long cannot fail to produce the worst effects upon
the body; nor is the mind less injured. Early application weakens the
faculties, and often fixes in the mind an aversion to books, which continues
for life[15].
But, suppose this were the way to make children scholars, it certainly
ought not to be done at the expence of their constitutions. Our ancestors,
who seldom went to school very young, were not less learned than we. But
we imagine the boy’s education will be quite marred, unless he be carried to
school in his nurse’s arms. No wonder if such hotbed plants seldom become
either scholars or men!
Not only the confinement of children in public schools, but their number,
often proves hurtful. Children are much injured by being kept in crowds
within doors; their breathing not only renders the place unwholesome, but if
any one of them happens to be diseased, the rest catch the infection. A
single child has been often known to communicate the bloody flux, the
hooping-cough, the itch, or other diseases, to almost every individual in a
numerous school.
But, if fashion must prevail, and infants are to be sent to school, we
would recommend it to teachers, as they value the interests of society, not to
confine them too long at a time, but allow them to run about and play at
such active diversions as may promote their growth, and strengthen their
constitutions. Were boys, instead of being whipped for stealing an hour to
run, ride, swim, or the like, encouraged to employ a proper part of their
time in these manly and useful exercises, it would have many excellent
effects.

It would be of great service to boys, if, at a proper age, they were taught
the military exercise. This would increase their strength, inspire them with
courage, and when their country called for their assistance, would enable
them to act in her defence, without being obliged to undergo a tedious and
troublesome course of instructions, at a time when they are less fit to learn
new motions, gestures, &c.[16]
An effeminate education will infallibly spoil the best natural constitution;
and if boys are brought up in a more delicate manner than even girls ought
to be, they never will be men.
Nor is the common education of girls less hurtful to the constitution than
that of boys. Miss is set down to her frame before she can put on her
clothes; and is taught to believe, that to excel at the needle is the only thing
that can entitle her to general esteem. It is unnecessary here to insist upon
the dangerous consequences of obliging girls to sit too much. They are
pretty well known, and are too often felt at a certain time of life. But
supposing this critical period to be got over, greater dangers still await them
when they come to be mothers. Women who have been early accustomed to
a sedentary life, generally run great hazard in child-bed; while those who
have been used to romp about, and take sufficient exercise, are seldom in
any danger.
One hardly meets with a girl who can at the same time boast of early
performances by the needle, and a good constitution. Close and early
confinement generally occasions indigestions, head-achs, pale complexions,
pain of the stomach, loss of appetite, coughs, consumptions of the lungs,
and deformity of body. The last of these indeed is not to be wondered at,
considering the awkward postures in which girls sit at many kinds of
needle-work, and the delicate flexible state of their bodies in the early
periods of life.
Would mothers, instead of having their daughters instructed in many
trifling accomplishments, employ them in plain work and housewifery, and
allow them sufficient exercise in the open air, they would both make them
more healthy mothers, and more useful members of society. I am no enemy
to genteel accomplishments, but would have them only considered as
secondary, and always disregarded when they impair health.
Many people imagine it a great advantage for children to be early taught
to earn their bread. This opinion is certainly right, provided they were so

employed as not to hurt their health or growth; but, when these suffer,
society, instead of being benefited, is a real loser by their labour. There are
few employments, except sedentary ones, by which children can earn a
livelihood; and if they be set to these too soon, it ruins their constitutions.
Thus, by gaining a few years from childhood, we generally lose twice as
many in the latter period of life, and even render the person less useful
while he does live.
In order to be satisfied of the truth of this observation, we need only look
into the great manufacturing towns, where we shall find a puny degenerate
race of people, weak and sickly all their lives, seldom exceeding the middle
period of life; or if they do, being unfit for business, they become a burden
to society. Thus arts and manufactures, though they may increase the riches
of a country, are by no means favourable to the health of its inhabitants.
Good policy would therefore require, that such people as labour during life,
should not be set too early to work. Every person conversant in the breed of
horses, or other working animals, knows, that if they be set to hard labour
too soon, they never will turn out to advantage. This is equally true with
respect to the human species.
There are nevertheless various ways of employing young people without
hurting their health. The easier parts of gardening, husbandry, or any
business carried on without doors, are most proper. These are employments
which most young people are fond of, and some parts of them may always
be adapted to their age, taste, and strength[17].
Such parents, however, as are under the necessity of employing their
children within doors, ought to allow them sufficient time for active
diversions without. This would both encourage them to do more work, and
prevent their constitutions from being hurt.
Some imagine, that exercise within doors is sufficient; but they are
greatly mistaken. One hour spent in running, or any other exercise without
doors, is worth ten within. When children cannot go abroad, they may
indeed be exercised at home. The best method of doing this, is to make
them run about in a long room, or dance. This last kind of exercise, if not
carried to excess, is of excellent service to young people. It cheers the
spirits, promotes perspiration, strengthens the limbs, &c. I know an eminent
physician who used to say, that he made his children dance, instead of
giving them physic. It were well if more people followed his example.

The COLD BATH may be considered as an aid to exercise. By it the body is
braced and strengthened, the circulation and secretions promoted, and, were
it conducted with prudence, many diseases, as the rickets, scrophula, &c.
might thereby be prevented. The ancients, who took every method to render
children hardy and robust, were no strangers to the use of the cold bath;
and, if we may credit report, the practice of immersing children daily in
cold water must have been very common among our ancestors.
The greatest objection to the use of the cold bath arises from the
superstitious prejudices of nurses. These are often so strong, that it is
impossible to bring them to make a proper use of it. I have known some of
them who would not dry a child’s skin after bathing it, lest it should destroy
the effect of the water. Others will even put cloths dipt in the water upon the
child, and either put it to bed, or suffer it to go about in that condition.
Some believe, that the whole virtue of the water depends upon its being
dedicated to a particular saint: while others place their confidence in a
certain number of dips, as three, seven, nine, or the like; and the world
could not persuade them, if these do not succeed, to try it a little longer.
Thus, by the whims of nurses, children lose the benefit of the cold bath, and
the hopes of the physician from that medicine are often frustrated.
We ought not, however, entirely to set aside the cold bath, because some
nurses make a wrong use of it. Every child, when in health, should at least
have its extremities daily washed in cold water. This is a partial use of the
cold bath, and is better than none. In winter this may suffice; but, in the
warm season, if a child be relaxed, or seem to have a tendency to the rickets
or scrophula, its whole body ought to be frequently immersed in cold water.
Care however must be taken not to do this when the body is hot, or the
stomach full. The child should be dipt only once at a time, should be taken
out immediately, and have its skin well rubbed with a dry cloth.

The bad Effects of unwholesome Air upon Children.

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

Want of wholesome air is likewise destructive to many of the children
born in great towns. There the poorer sort of inhabitants live in low, dirty,
confined houses, to which the fresh air has hardly any access. Though
grown people, who are hardy and robust, may live in such situations, yet
they generally prove fatal to their offspring, few of whom arrive at maturity,
and those who do are weak and deformed. As such people are not in a
condition to carry their children abroad into the open air, we must lay our
account with losing the greater part of them. But the rich have not this
excuse. It is their business to see that their children be daily carried abroad,
and that they be kept in the open air for a sufficient time. This will always
succeed better if the mother goes along with them. Servants are often
negligent in these matters, and allow a child to sit or lie on the damp
ground, instead of leading or carrying it about. The mother surely needs air
as well as her children; and how can she be better employed than in
attending them?
A very bad custom prevails, of making children sleep in small
apartments, or crowding two or three beds into one chamber. Instead of this,
the nursery ought always to be the largest and best aired room in the house.
When children are confined in small apartments, the air not only becomes
unwholesome, but the heat relaxes their solids, renders them delicate, and
disposes them to colds and many other disorders. Nor is the custom of
wrapping them up too close in cradles less pernicious. One would think that
nurses were afraid lest children should suffer by breathing free air, as many
of them actually cover the child’s face while asleep, and others wrap a
covering over the whole cradle, by which means the child is forced to
breathe the same air over and over all the time it sleeps. Cradles indeed are
on many accounts hurtful to children, and it would be better if the use of
them were totally laid aside[18].
A child is generally laid to sleep with all its clothes on; and if a number
of others are heaped above them, it must be overheated; by which means it
cannot fail to catch cold on being taken out of the cradle, and exposed to the
open air with only its usual clothing, which is too frequently the case.
Children who are kept within doors all day, and sleep all night in warm
close apartments, may, with great propriety, be compared to plants, nursed
in a hot-house, instead of the open air. Though such plants may by this
means be kept alive for some time, they will never arrive at that degree of

strength, vigour, and magnitude, which they would have acquired in the
open air, nor would they be able to bear it afterwards, should they be
exposed to it.
Children brought up in the country, who have been accustomed to open
air, should not be too early sent to great towns, where it is confined and
unwholesome. This is frequently done with a view to forward their
education, but proves very hurtful to their health. All schools and
seminaries of learning ought, if possible, to be so situated as to have fresh,
dry, wholesome air, and should never be too much crowded.
Without entering into a detail of the particular advantages of wholesome
air to children, or of the bad consequences which proceed from the want of
it, I shall only observe, that, of several thousands of children which have
been under my care, I do not remember one instance of a single child who
continued healthy in a close confined situation; but have often known the
most obstinate diseases cured by removing them from such a situation to an
open free air.

Of Nurses.

It is not here intended to lay down rules for the choice of nurses. This
would be wasting time. Common sense will direct every one to chuse a
woman who is healthy, and has plenty of milk[19]. If she be at the same time
cleanly, careful, and goodnatured, she can hardly fail to make a proper
nurse. After all, however, the only certain proof of a good nurse, is a healthy
child upon her breast. But, as the misconduct of nurses often proves fatal to
children, it will be of importance to point out a few of their most baneful
errors, in order to rouse the attention of parents, and to make them look
more strictly into the conduct of those to whom they commit the care of
their infant offspring.
Though it admits of some exceptions, yet we may lay it down as a
general rule, that every woman who nurses for hire should be carefully
looked after, otherwise she will not do her duty. For this reason parents
ought always to have their children nursed under their own eye, if possible;
and where this cannot be done, they should be extremely circumspect in the
choice of those persons to whom they entrust them. It is folly to imagine
that any woman, who abandons her own child to suckle another for the sake

of gain, should feel all the affections of a parent towards her nursing; yet so
necessary are these affections in a nurse, that, but for them, the human race
would soon be extinct.
One of the most common faults of those who nurse for hire, is to dose
children with stupefactives, or such things as lull them asleep. An indolent
nurse, who does not give a child sufficient exercise in the open air to make
it sleep, and does not chuse to be disturbed by it in the night, will seldom
fail to procure for it a dose of laudanum, diacodium, saffron, or what
answers the same purpose, a dose of spirits, or other strong liquors. These,
though they be certain poison to infants, are every day administered by
many who bear the character of very good nurses[20].
A nurse who has not milk enough is apt to imagine that this defect may
be supplied by giving the child wines, cordial waters, or other strong
liquors. This is an egregious mistake. The only thing that has any chance to
supply the place of the nurse’s milk, must be somewhat nearly of the same
quality, as cow’s milk, ass’s milk, or beef tea, with good bread. It never can
be done by the help of strong liquors. These, instead of nourishing an infant,
never fail to produce the contrary effect.
Children are often hurt by nurses suffering them to cry long and
vehemently. This strains their tender bodies, and frequently occasions
ruptures, inflammations of the throat, lungs, &c. A child never continues to
cry long without some cause, which might always be discovered by proper
attention; and the nurse who can hear an infant cry till it has almost spent
itself, without endeavouring to please it, must be cruel indeed, and is
unworthy to be intrusted with the care of an human creature.
Nurses who deal much in medicine are always to be suspected. They trust
to it, and neglect their duty. I never knew a good nurse who had her
Godfrey’s cordials, Daffy’s elixirs, &c. at hand. Such generally imagine,
that a dose of medicine will make up for all defects in food, air, exercise,
and cleanliness. By errors of this kind, I will venture to say, that one half
the children who die annually in London lose their lives.
Allowing children to continue long wet, is another very pernicious
custom of indolent nurses. This is not only disagreeable, but it galls and
frets the infant, and by relaxing the solids, occasions scrophulas, rickets,
and other diseases. A dirty nurse is always to be suspected.

Nature often attempts to free the bodies of children from bad humours,
by throwing them upon the skin: by this means fevers and other diseases are
prevented. Nurses are apt to mistake such critical eruptions for an itch, or
some other infectious disorder. Accordingly they take every method to drive
them in. In this way many children lose their lives; and no wonder, as
Nature is opposed in the very method she takes to relieve them. It ought to
be a rule, which every nurse should observe, never to stop any eruption
without proper advice, or being well assured that it is not of a critical
nature. At any rate, it is never to be done without previous evacuations.
Loose stools is another method by which Nature often prevents or carries
off the diseases of infants. If these proceed too far, no doubt they ought to
be checked; but this is never to be done without the greatest caution.
Nurses, upon the first appearance of loose stools, frequently fly to the use of
astringents, or such things as bind the body. Hence inflammatory fevers,
and other fatal diseases, are occasioned. A dose of rhubarb, a gentle vomit,
or some other evacuation, should always precede the use of astringent
medicines.
One of the greatest faults of nurses is, concealing the diseases of children
from their parents. This they are extremely ready to do, especially when the
disease is the effect of their own negligence. Many instances might be given
of persons who have been rendered lame for life by a fall from their nurse’s
arms, which she, through fear, concealed till the misfortune was past cure.
Every parent who intrusts a nurse with the care of a child, ought to give her
the strictest charge not to conceal the most trifling disorder or misfortune
that may befal it.
We can see no reason why a nurse, who conceals any misfortune which
happens to a child under her care, till it loses its life or limbs, should not be
punished. A few examples of this would save the lives of many infants; but
as there is little reason to expect that it ever will be the case, we would
earnestly recommend it to all parents to look carefully after their children,
and not to trust so valuable a treasure entirely in the hands of an hireling.
No person ought to imagine these things unworthy of his attention. On
the proper management of children depend not only their health and
usefulness in life, but likewise the safety and prosperity of the state to
which they belong. Effeminacy ever will prove the ruin of any state where it
prevails; and, when its foundations are laid in infancy, it can never

afterwards be wholly eradicated. Parents who love their offspring, and wish
well to their country, ought therefore, in the management of their children,
to avoid every thing that may have a tendency to make them weak or
effeminate, and to take every method in their power to render their
constitutions strong and hardy.
——By arts like these
Laconia nurs’d of old her hardy sons;
And Rome’s unconquer’d legions urg’d their way,
Unhurt, thro’ every toil in every clime[21].

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

That men are exposed to particular diseases from the occupations which
they follow, is a fact well known; but to remedy this evil is a matter of some
difficulty. Most people are under the necessity of following those
employments to which they have been bred, whether they be favourable to
health or not. For this reason, instead of inveighing, in a general way, as
some authors have done, against those occupations which are hurtful to
health, we shall endeavour to point out the circumstances in each of them
from which the danger chiefly arises, and to propose the most rational
methods of preventing it.
Chymists, founders, forgers, glass-makers, and several other artists, are
hurt by the unwholesome air which they are obliged to breathe. This air is
not only loaded with the noxious exhalations arising from metals and
minerals, but is so charged with phlogiston as to be rendered unfit for
expanding the lungs sufficiently, and answering the other important
purposes of respiration. Hence proceed asthmas, coughs, and consumptions
of the lungs, so incident to persons who follow these employments.
To prevent such consequences, as far as possible, the places where these
occupations are carried on, ought to be constructed in such a manner as to
discharge the smoke and other exhalations, and admit a free current of fresh
air. Such artists ought never to continue too long at work; and when they
give over, they should suffer themselves to cool gradually, and put on their
clothes before they go into the open air. They ought never to drink large
quantities of cold, weak, or watery liquors, while their bodies are hot, nor to
indulge in raw fruits, sallads, or any thing that is cold on the stomach[22].
Miners, and all who work under ground, are likewise hurt by
unwholesome air. The air, by its stagnation in deep mines, not only loses its
proper spring and other qualities necessary for respiration, but is often
loaded with such noxious exhalations as to become a most deadly poison.

The two kinds of air which prove most destructive to miners, are what
they call the fire damp, and the choke damp. In both cases the air becomes a
poison, by its being loaded with phlogiston. The danger from the former
may be obviated by making it explode before it accumulates in too great
quantities; and the latter may be generally carried off by promoting a free
circulation of air in the mine.
Miners are not only hurt by unwholesome air, but likewise by the
particles of metal which adhere to their skin, clothes, &c. These are
absorbed, or taken up into the body, and occasion palsies, vertigoes, and
other nervous affections, which often prove fatal. Fallopius observes, that
those who work in mines of mercury seldom live above three or four years.
Lead, and several other metals, are likewise very pernicious to the health.
Miners ought never to go to work fasting, nor to continue too long at
work. Their food ought to be nourishing, and their liquor generous: nothing
more certainly hurts them than living too low. They should by all means
avoid costiveness. This may either be done by chewing a little rhubarb, or
taking a sufficient quantity of sallad oil. Oil not only opens the body, but
sheaths and defends the intestines from the ill effects of the metals. All who
work in mines or metals ought to wash carefully, and to change their clothes
as soon as they give over working. Nothing would tend more to preserve
the health of such people than a strict, and almost religious regard to
cleanliness.
Plumbers, painters, gilders, smelters, makers of white lead, and many
others who work in metals, are liable to the same diseases as miners, and
ought to observe the same directions for avoiding them.
Tallow-chandlers, boilers of oil, and all who work in putrid animal
substances, are likewise liable to suffer from the unwholesome smells or
effluvia of these bodies. They ought to pay the same regard to cleanliness as
miners; and when they are affected with nausea, sickness, or indigestion, we
would advise them to take a vomit or a gentle purge. Such substances ought
always to be manufactured as soon as possible. When long kept, they not
only become unwholesome to those who manufacture them, but likewise to
people who live in the neighbourhood.
It would greatly exceed the limits of this part of our subject, to specify
the diseases peculiar to persons of every occupation; we shall therefore

consider mankind under the general classes of Laborious, Sedentary, and
Studious.

THE LABORIOUS.

Though those who follow laborious employments are in general the most
healthy of mankind, yet the nature of their occupations, and the places
where they are carried on, expose them more particularly to some diseases.
Husbandmen, for example, are exposed to all the vicissitudes of the
weather, which, in this country, are often very great and sudden, and
occasion colds, coughs, quinsies, rheumatisms, fevers, and other acute
disorders. They are likewise forced to work hard, and often to carry burdens
above their strength, which, by overstraining the vessels, occasion asthmas,
ruptures, pleurisies, &c.
Those who labour without doors are often afflicted with intermitting
fevers or agues, occasioned by the frequent vicissitudes of heat and cold,
poor living, bad water, sitting or lying on the damp ground, evening dews,
night air, &c. to which they are frequently exposed.
Such as bear heavy burdens, as porters, labourers, &c. are obliged to
draw in the air with much greater force, and also to keep their lungs
distended with more violence than is necessary for common respiration: by
this means the tender vessels of the lungs are overstretched, and often burst,
insomuch that a spitting of blood or fever ensues. Hippocrates mentions an
instance to this purpose, of a man, who, upon a wager, carried an ass; but
was soon after seized with a fever, a vomiting of blood, and a rupture.
Carrying heavy burdens is generally the effect of mere laziness, which
prompts people to do at once what should be done at twice. Sometimes it
proceeds from vanity or emulation. Hence it is, that the strongest men are
most commonly hurt by heavy burdens, hard labour, or feats of activity. It is
rare to find one who boasts of his strength without a rupture, a spitting of
blood, or some other disease, which he reaps as the fruit of his folly. One
would imagine, the daily instances we have, of the fatal effects of carrying
great weights, running, wrestling, and the like, would be sufficient to
prevent such practices.

There are indeed some employments which necessarily require a great
exertion of strength, as porters, blacksmiths, carpenters, &c. None ought to
follow these but men of strong body; and they should never exert their
strength to the utmost, nor work too long. When the muscles are violently
strained, frequent rest is necessary, in order that they may recover their
tone; without this, the strength and constitution will soon be worn out, and a
premature old age be induced.
The erysipelas, or St. Anthony’s fire, is a disease very incident to the
laborious. It is occasioned by whatever gives a sudden check to the
perspiration, as drinking cold water when the body is warm, wet feet,
keeping on wet clothes, sitting or lying on the damp ground, &c. It is
impossible for those who labour without doors always to guard against
these inconveniences; but it is known from experience, that their ill
consequences might often be prevented by proper care.
The iliac passion, the cholic, and other complaints of the bowels, are
often occasioned by the same causes as the erysipelas; but they may
likewise proceed from flatulent and indigestible food. Labourers generally
eat unfermented bread, made of peas, beans, rye, and other windy
ingredients. They also devour great quantities of unripe fruits, baked,
stewed, or raw, with various kinds of roots and herbs, upon which they
often drink sour milk, stale small beer, or the like. Such a mixture cannot
fail to fill the bowels with wind, and occasion diseases of those parts.
Inflammations, whitloes, and other diseases of the extremities, are
likewise common among those who labour without doors. These diseases
are often attributed to venom, or some kind of poison; but they generally
proceed either from sudden heat after cold, or the contrary. When labourers,
milk-maids, &c. come from the field, cold or wet, they run to the fire, and
often plunge their hands in warm water, by which means the blood and
other humours in those parts are suddenly expanded, and, the vessels not
yielding so quickly, a strangulation happens, and an inflammation or a
mortification ensues.
When such persons come home cold, they ought to keep at a distance
from the fire for some time, to wash their hands in cold water, and to rub
them well with a dry cloth. It sometimes happens, that people are so
benumbed with cold, as to be quite deprived of the use of their limbs. In this
case, the only remedy is to rub the parts affected with snow, or, where it

cannot be had, with cold water. If they be held near the fire, or plunged into
warm water, a mortification will generally ensue.
Labourers in the hot season are apt to lie down, and sleep in the sun. This
practice is so dangerous, that they often wake in a burning fever. These
ardent fevers, which prove so fatal about the end of summer and beginning
of autumn, are frequently occasioned by this means. When labourers leave
off work, which they ought always to do during the heat of the day, they
should go home, or, at least, get under some cover, where they may repose
themselves in safety.
Many people follow their employments in the fields from morning till
night, without eating any thing. This cannot fail to hurt their health.
However homely their fare be, they ought to have it at regular times; and
the harder they work, the more frequently they should eat. If the humours
be not frequently replenished with fresh nourishment, they soon become
putrid, and produce fevers of the very worst kind.
Many peasants are extremely careless with respect to what they eat or
drink, and often, through mere indolence, use unwholesome food, when
they might for the same expence have that which is wholesome. In some
parts of Britain, the peasants are too careless even to take the trouble of
dressing their own victuals. Such people would live upon one meal a day in
indolence, rather than labour, though it were to procure them the greatest
affluence.
Fevers of a very bad kind are often occasioned among labourers by poor
living. When the body is not sufficiently nourished, the humours become
vitiated, and the solids weak; from whence the most fatal consequences
ensue. Poor living is likewise productive of many of those cutaneous
diseases so frequent among the lower class of people. It is remarkable that
cattle, when pinched in their food, are generally affected with diseases of
the skin, which seldom fail to disappear, when they are put upon a good
pasture. This shews how much a good state of the humours depends upon a
sufficient quantity of proper nourishment.
Poverty not only occasions, but aggravates, many of the diseases of the
laborious. Few of them have much foresight; and, if they had, it is seldom
in their power to save any thing. They are glad to make a shift to live from
day to day; and, when any disease overtakes them, they are miserable
indeed. Here the godlike virtue of charity ought always to exert itself. To

relieve the industrious poor in distress, is surely the most exalted act of
religion and humanity. They alone, who are witnesses of those scenes of
calamity, can form a notion of what numbers perish in diseases, for want of
proper assistance, and even for want of the necessaries of life.
Labourers are often hurt by a foolish emulation, which prompts them to
vie with one another, till they overheat themselves to such a degree as to
occasion a fever, or even to drop down dead. Such as wantonly throw away
their lives in this manner, deserve to be looked upon in no better light than
self-murderers.
The office of a soldier, in time of war, may be ranked among the
laborious employments. Soldiers suffer many hardships from the
inclemency of seasons, long marches, bad provisions, hunger, watching,
unwholesome climates, bad water, &c. These occasion fevers, fluxes,
rheumatisms, and other fatal diseases, which generally do greater execution
than the sword, especially when campaigns are continued too late in the
season. A few weeks of cold rainy weather will often prove more fatal than
an engagement.
Those who have the command of armies should take care that their
soldiers be well clothed and well fed. They ought also to finish their
campaigns in due season, and to provide their men with dry and well-aired
winter quarters. These rules, taking care, at the same time, to keep the sick
at a proper distance from those in health, would tend greatly to preserve the
lives of the soldiery[23].
Sailors may also be numbered among the laborious. They undergo great
hardships from change of climate, the violence of weather, hard labour, bad
provisions, &c. Sailors are of so great importance both to the trade and
safety of this kingdom, that too much pains can never be bestowed in
pointing out the means of preserving their lives.
One great source of the diseases of sea-faring people is excess. When
they get on shore, after having been long at sea, without regard to the
climate, or their own constitutions, they plunge headlong into all manner of
riot, and often persist till a fever puts an end to their lives. Thus
intemperance, and not the climate, is often the cause why so many of our
brave sailors die on foreign coasts. Such people ought not to live too low;
but they will find moderation the best defence against fevers, and many
other maladies.

Sailors, when on duty, cannot avoid sometimes getting wet. When this
happens, they should change their clothes as soon as they are relieved, and
take every method to restore the perspiration. They should not, in this case,
make too free with spirits or other strong liquors, but should rather drink
them diluted with warm water, and go immediately to bed, where a sound
sleep and a gentle sweat would set all to rights.
But the health of sailors suffers most from unwholesome food. The
constant use of salted provisions vitiates their humours, and occasions the
scurvy, and other obstinate maladies. It is no easy matter to prevent this
disease in long voyages; yet we cannot help thinking, that much might be
done towards effecting so desirable an end, were due pains bestowed for
that purpose. For example, various roots, greens, and fruits, might be kept a
long time at sea, as onions, potatoes, cabbages, lemons, oranges, tamarinds,
apples, &c. When fruits cannot be kept, the juices of them, either fresh or
fermented, may. With these all the drink, and even the food of the ship’s
company, ought to be acidulated in long voyages.
Stale bread and beer likewise contribute to vitiate the humours. Flour will
keep for a long time on board, of which fresh bread might frequently be
made. Malt too might be kept, and infused with boiling water at any time.
This liquor, when drank even in form of wort, is very wholesome, and is
found to be an antidote against the scurvy. Small wines and cyder might
likewise be plentifully laid in; and should they turn sour, they would still be
useful as vinegar. Vinegar is a great antidote against diseases, and should be
used by all travellers, especially at sea. It may either be mixed with the
water they drink, or taken in their food.
Such animals as can be kept alive, ought likewise to be carried on board,
as hens, ducks, pigs, &c. Fresh broths made of portable soup, and puddings
made of peas, or other vegetables, ought to be used plentifully. Many other
things will readily occur to people conversant in these matters, which would
tend to preserve the health of that brave and useful set of men[24].
We have reason to believe, if due attention were paid to the diet, air,
clothing, and above all things to the cleanliness of sea-faring people, they
would be the most healthy set of men in the world; but when these are
neglected, the very reverse will happen.
The best medical antidote that we can recommend to sailors or soldiers,
on foreign coasts, especially where dampness prevails, is the Peruvian bark.

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

THE SEDENTARY.

Though nothing can be more contrary to the nature of man than a
sedentary life, yet this class comprehends by far the greater part of the
species. Almost the whole female world, and in manufacturing countries,
the major part of the males, may be reckoned sedentary[25].
Agriculture, the first and most healthful of all employments, is now
followed by few who are able to carry on any other business. But those who
imagine that the culture of the earth is not sufficient to employ all its
inhabitants are greatly mistaken. An ancient Roman, we are told, could
maintain his family from the produce of one acre of ground. So might a
modern Briton, if he would be contented to live like a Roman. This shews
what an immense increase of inhabitants Britain might admit of, and all of
them live by the culture of the ground.
Agriculture is the great source of domestic riches. Where it is neglected,
whatever wealth may be imported from abroad, poverty and misery will
abound at home. Such is, and ever will be, the fluctuating state of trade and
manufactures, that thousands of people may be in full employment to-day,
and in beggary to-morrow. This can never happen to those who cultivate the
ground. They can eat the fruit of their labour, and can always by industry
obtain, at least, the necessaries of life.
Though sedentary employments are necessary, yet there seems to be no
reason why any person should be confined for life to these alone. Were such
employments intermixed with the more active and laborious, they would
never do hurt. It is constant confinement that ruins the health. A man may

not be hurt by sitting five or six hours a-day; but if he is obliged to sit ten or
twelve, he will soon become diseased.
But it is not want of exercise alone which hurts sedentary people; they
likewise suffer from the confined air which they breathe. It is very common
to see ten or a dozen taylors[26], or staymakers, for example, crowded into
one small apartment, where there is hardly room for one person to breathe
freely. In this situation they generally continue for many hours at a time,
often with the addition of several candles, which tend likewise to waste the
air, and render it less fit for respiration. Air that is breathed repeatedly
becomes unfit for expanding the lungs. This is one cause of the phthisical
coughs, and other complaints of the breath, so incident to sedentary
artificers.
Even the perspiration from a great number of persons pent up together,
renders the air unwholesome. The danger from this quarter will be greatly
increased, if any one of them happens to have bad lungs, or to be otherwise
diseased. Those who sit near him, being forced to breathe the same air, can
hardly fail to be infected. It would be a rare thing, however, to find a dozen
of sedentary people all in good health. The danger of crowding them
together must therefore be evident to every one.
Many of those who follow sedentary employments are constantly in a
bending posture, as shoemakers, taylors, cutlers, &c. Such a situation is
extremely hurtful. A bending posture obstructs all the vital motions, and of
course must destroy the health. Accordingly we find such artificers
generally complaining of indigestions, flatulencies, head-achs, pains of the
breast, &c.
The aliment in sedentary people, instead of being pushed forwards by an
erect posture, and the action of the muscles, is in a manner confined in the
bowels. Hence indigestions, costiveness, wind, and other hypochondriacal
affections, the constant companions of the sedentary. Indeed none of the
excretions can be duly performed where exercise is wanting; and when the
matter which ought to be discharged in this way is retained too long in the
body, it must have bad effects, as it is again taken up into the mass of
humours.
A bending posture is likewise hurtful to the lungs. When this organ is
compressed, the air cannot have free access into all its parts, so as to expand
them properly. Hence tubercles, adhesions, &c. are formed, which often end

in consumptions. Besides, the proper action of the lungs being absolutely
necessary for making good blood, when that organ fails, the humours soon
become universally depraved, and the whole constitution goes to wreck.
Sedentary artificers are not only hurt by pressure on the bowels, but also
on the inferior extremities, which obstructs the circulation in these parts,
and renders them weak and feeble. Thus taylors, shoemakers, &c.
frequently lose the use of their legs altogether: besides, the blood and
humours are, by stagnation, vitiated, and the perspiration is obstructed:
from whence proceed the scab, ulcerous sores, foul blotches, and other
cutaneous diseases, so common among sedentary artificers.
A bad figure of body is a very common consequence of close application
to sedentary employments. The spine, for example, by being continually
bent, puts on a crooked shape, and generally remains so ever after. But a
bad figure of body has already been observed to be hurtful to health, as the
vital functions are thereby impeded.
A sedentary life seldom fails to occasion an universal relaxation of the
solids. This is the great source from whence most of the diseases of
sedentary people flow. The scrophula, consumption, hysterics, and nervous
diseases, now so common, were very little known in this country before
sedentary artificers became so numerous: and they are very little known still
among such of our people as follow active employments without doors,
though in great towns at least two-thirds of the inhabitants are afflicted with
them.
It is very difficult to remedy those evils, because many who have been
accustomed to a sedentary life, like rickety children, lose all inclination for
exercise; we shall, however, throw out a few hints with respect to the most
likely means for preserving the health of this useful set of people, which
some of them, we hope, will be wise enough to take.
It has been already observed, that sedentary artificers are often hurt by
their bending posture. They ought therefore to stand or sit as erect as the
nature of their employments will permit. They should likewise change their
posture frequently, and should never sit too long at a time, but leave off
work, and walk, ride, run, or do any thing that will promote the vital
functions.
Sedentary artificers are generally allowed too little time for exercise; yet,
short as it is, they seldom employ it properly. A journeyman taylor or

weaver, for example, instead of walking abroad for exercise and fresh air, at
his hours of leisure, chuses often to spend them in a public-house, or in
playing at some sedentary game, by which he generally loses both his time
and his money.
The awkward postures in which many sedentary artificers work, seem
rather to be the effect of custom than necessity. For example, a table might
surely be contrived for ten or a dozen taylors to sit round, with liberty for
their legs either to hang down, or rest upon a foot-board, as they should
chuse. A place might likewise be cut out for each person, in such a manner
that he might sit as conveniently for working as in the present mode of
sitting cross-legged.
All sedentary artificers ought to pay the most religious regard to
cleanliness. Both their situation and occupations render this highly
necessary. Nothing would contribute more to preserve their health, than a
strict attention to it; and such of them as neglect it, not only run the hazard
of losing health, but of becoming a nuisance to their neighbours.
Sedentary people ought to avoid food that is windy, or hard of digestion,
and should pay the strictest regard to sobriety. A person who works hard
without doors will soon throw off a debauch; but one who sits has by no
means an equal chance. Hence it often happens, that sedentary people are
seized with fevers after hard drinking. When such persons feel their spirits
low, instead of running to the tavern for relief, they should ride, or walk in
the fields. This would remove the complaint more effectually than strong
liquor, and would never hurt the constitution.
Instead of multiplying rules for preserving the health of the sedentary, we
shall recommend to them the following general plan, viz. That every person
who follows a sedentary employment should cultivate a piece of ground
with his own hands. This he might dig, plant, sow, and weed at leisure
hours, so as to make it both an exercise and amusement, while it produced
many of the necessaries of life. After working an hour in a garden, a man
will return with more keenness to his employment within doors, than if he
had been all the while idle.
Labouring the ground is every way conducive to health. It not only gives
exercise to every part of the body, but the very smell of the earth and fresh
herbs revives and cheers the spirits, whilst the perpetual prospect of
something coming to maturity, delights and entertains the mind. We are so

formed as to be always pleased with somewhat in prospect, however distant
or however trivial. Hence the happiness that most men feel in planting,
sowing, building, &c. These seem to have been the chief employments of
the more early ages: and, when kings and conquerors cultivated the ground,
there is reason to believe that they knew as well wherein true happiness
consisted as we do.
It may seem romantic to recommend gardening to manufacturers in great
towns; but observation proves that the plan is very practicable. In the town
of Sheffield, in Yorkshire, where the great iron manufacture is carried on,
there is hardly a journeyman cutler who does not possess a piece of ground,
which he cultivates as a garden. This practice has many salutary effects. It
not only induces these people to take exercise without doors, but also to eat
many greens, roots, &c. of their own growth, which they would never think
of purchasing. There can be no reason why manufacturers in any other town
in Great Britain should not follow the same plan. It is indeed to be
regretted, that in such a place as London a plan of this kind is not
practicable; yet even there sedentary artificers may find opportunities of
taking air and exercise, if they chuse to embrace them.
Mechanics are too much inclined to crowd into great towns. The situation
may have some advantages; but it has likewise many disadvantages. All
mechanics who live in the country have it in their power to cultivate a piece
of ground; which indeed most of them do. This not only gives them
exercise, but enables them to live more comfortably. So far at least as my
observation extends, mechanics who live in the country are far more happy
than those in great towns. They enjoy better health, live in greater affluence,
and seldom fail to rear a healthy and numerous offspring.
In a word, exercise without doors, in one shape or another, is absolutely
necessary to health. Those who neglect it, though they may for a while drag
out life, can hardly be said to enjoy it. Weak and effeminate, they languish
for a few years, and soon drop into an untimely grave.

THE STUDIOUS.

Intense thinking is so destructive to health, that few instances can be
produced of studious persons who are strong and healthy. Hard study
always implies a sedentary life; and when intense thinking is joined to the

want of exercise, the consequences must be bad. We have frequently known
even a few months of close application to study ruin an excellent
constitution, by inducing a train of nervous complaints which could never
be removed. Man is evidently not formed for continual thought more than
for perpetual action, and would be as soon worn out by the one as by the
other.
So great is the power of the mind over the body, that, by its influence, the
whole vital motions may be accelerated or retarded, to almost any degree.
Thus cheerfulness and mirth quicken the circulation, and promote all the
secretions; whereas sadness and profound thought never fail to retard them.
Hence it would appear, that even a degree of thoughtlessness is necessary to
health. Indeed, the perpetual thinker seldom enjoys either health or spirits;
while the person, who can hardly be said to think at all, generally enjoys
both.
Perpetual thinkers, as they are called, seldom think long. In a few years
they generally become quite stupid, and exhibit a melancholy proof how
readily the greatest blessings may be abused. Thinking, like every thing
else, when carried to extreme, becomes a vice: nor can any thing afford a
greater proof of wisdom, than for a man frequently and reasonably to
unbend his mind. This may generally be done by mixing in cheerful
company, active diversions, or the like.
Instead of attempting to investigate the nature of that connection which
subsists between the mind and body, or to inquire into the manner in which
they mutually affect each other, we shall only mention those diseases to
which the learned are more peculiarly liable, and endeavour to point out the
means of avoiding them.
Studious persons are very subject to the gout. This painful disease in a
great measure proceeds from indigestion, and an obstructed perspiration. It
is impossible that the man who sits from morning till night should either
digest his food, or have any of the secretions in due quantity. But when that
matter, which should be thrown off by the skin, is retained in the body, and
the humours are not duly prepared, diseases must ensue.
The studious are likewise very liable to the stone and gravel. Exercise
greatly promotes both the secretion and discharge of urine; consequently a
sedentary life must have the contrary effect. Any one may be satisfied of

this by observing, that he passes much more urine by day than in the night,
and also when he walks or rides, than when he sits.
The circulation in the liver being flow, obstructions in that organ can
hardly fail to be the consequence of inactivity. Hence sedentary people are
frequently afflicted with schirrous livers. But the proper secretion and
discharge of the bile is so necessary a part of the animal œconomy, that
where these are not duly performed, the health must soon be impaired.
Jaundice, indigestion, loss of appetite, and a wasting of the whole body,
seldom fail to be the consequences of a vitiated state of the liver, or
obstructions of the bile.
Few diseases prove more fatal to the studious than consumptions of the
lungs. It has already been observed, that this organ cannot be duly expanded
in those who do not take proper exercise; and where that is the case,
obstructions and adhesions will ensue. Not only want of exercise, but the
posture in which studious persons generally sit, is very hurtful to the lungs.
Those who read or write much are ready to contract a habit of bending
forwards, and often press with their breast upon a table or bench. This
posture cannot fail to hurt the lungs.
The functions of the heart may likewise by this means be injured. I
remember to have seen a man opened, whose pericardium adhered to the
breast-bone in such a manner as to obstruct the motion of the heart, and
occasion his death. The only probable cause that could be assigned for this
singular symptom was, that the man, whose business was writing, used
constantly to sit in a bending posture, with his breast pressing upon the edge
of a plain table.
No person can enjoy health who does not properly digest his food. But
intense thinking and inactivity never fail to weaken the powers of digestion.
Hence the humours become crude and vitiated, the solids weak and relaxed,
and the whole constitution goes to ruin.
Long and intense thinking often occasions grievous head-achs, which
bring on vertigoes, apoplexies, palsies, and other fatal disorders. The best
way to prevent these is, never to study too long at one time, and to keep the
body regular, either by proper food, or taking frequently a little of some
opening medicine.
Those who read or write much are often afflicted with sore eyes.
Studying by candle-light is peculiarly hurtful to the sight. This ought to be

practised as seldom as possible. When it is unavoidable, the eyes should be
shaded, and the head should not be held too low. When the eyes are weak or
painful, they should be bathed every night and morning in cold water, to
which a little brandy may be added.
It has already been observed, that the excretions are very defective in the
studious. The dropsy is often occasioned by the retention of those humours
which ought to be carried off in this way. Any person may observe, that
sitting makes his legs swell, and that this goes off by exercise; which clearly
points out the method of prevention.
Fevers, especially of the nervous kind, are often the effect of study.
Nothing affects the nerves so much as intense thought. It in a manner
unhinges the whole human frame, and not only hurts the vital motions, but
disorders the mind itself. Hence a delirium, melancholy, and even madness,
are often the effect of close application to study. In fine, there is no disease
which can proceed either from a bad state of the humours, a defect of the
usual secretions, or a debility of the nervous system, which may not be
induced by intense thinking.
But the most afflicting of all the diseases which attack the studious is the
hypochondriac. This disease seldom fails to be the companion of deep
thought. It may rather be called a complication of maladies than a single
one. To what a wretched condition are the best of men often reduced by it!
Their strength and appetite fail; a perpetual gloom hangs over their minds;
they live in the constant dread of death, and are continually in search of
relief from medicine, where, alas! it is not to be found. Those who labour
under this disorder, though they are often made the subject of ridicule,
justly claim our highest sympathy and compassion.
Hardly any thing can be more preposterous than for a person to make
study his sole business. A mere student is seldom an useful member of
society. He often neglects the most important duties of life, in order to
pursue studies of a very trifling nature. Indeed it rarely happens, that any
useful invention is the effect of mere study. The farther men dive into
profound researches, they generally deviate the more from common sense,
and too often lose sight of it altogether. Profound speculations, instead of
making men wiser or better, generally render them absolute sceptics, and
overwhelm them with doubt and uncertainty. All that is necessary for man

to know, in order to be happy, is easily obtained; and the rest, like the
forbidden fruit, serves only to increase his misery.
Studious persons, in order to relieve their minds, must not only
discontinue to read and write, but engage in some employment or diversion,
that will so far occupy the thought as to make them forget the business of
the closet. A solitary ride or walk are so far from relaxing the mind, that
they rather encourage thought. Nothing can divert the mind, when it gets
into a train of serious thinking, but attention to subjects of a more trivial
nature. These prove a kind of play to the mind, and consequently relieve it.
Learned men often contract a contempt for what they call trifling
company. They are ashamed to be seen with any but philosophers. This
however is no proof of their being philosophers themselves. No man
deserves that name who is ashamed to unbend his mind, by associating with
the cheerful and gay. Even the society of children will relieve the mind, and
expel the gloom which application to study is too apt to occasion.
As studious people are necessarily much within doors, they should make
choice of a large and well-aired place for study. This would not only
prevent the bad effects which attend confined air, but would cheer the
spirits, and have a most happy influence both on the body and mind. It is
said of Euripides the tragedian, that he used to retire to a dark cave to
compose his tragedies, and of Demosthenes the Grecian orator, that he
chose a place for study where nothing could be either heard or seen. With
all deference to such venerable names, we cannot help condemning their
taste. A man may surely think to as good purpose in an elegant apartment as
in a cave; and may have as happy conceptions where the all-cheering rays
of the sun render the air wholesome, as in places where they never enter.
Those who read or write much should be very attentive to their posture.
They ought to sit and stand by turns, always keeping as nearly in an erect
posture as possible. Those who dictate, may do it walking. It has an
excellent effect frequently to read or speak aloud. This not only exercises
the lungs, but almost the whole body. Hence studious people are greatly
benefited by delivering discourses in public. Public speakers, indeed,
sometimes hurt themselves by overacting their part; but this is their own
fault. The martyr to mere vociferation merits not our sympathy.
The morning has, by all medical writers, been reckoned the best time for
study. It is so. But it is also the most proper season for exercise, while the

stomach is empty, and the spirits refreshed with sleep. Studious people
should therefore sometimes spend the morning in walking, riding, or some
manly diversions without doors. This would make them return to study with
greater alacrity, and would be of more service than twice the time after their
spirits are worn out with fatigue. It is not sufficient to take diversion only
when we can think no longer. Every studious person should make it a part
of his business, and should let nothing interrupt his hours of recreation more
than those of study.
Music has a very happy effect in relieving the mind when fatigued with
study. It would be well if every studious person were so far acquainted with
that science as to amuse himself after severe thought, by playing such airs
as have a tendency to raise the spirits, and inspire cheerfulness and good
humour.
It is a reproach to Learning, that any of her votaries, to relieve the mind
after study, should betake themselves to the use of strong liquors. This
indeed is a remedy; but it is a desperate one, and always proves destructive.
Would such persons, when their spirits are low, get on horseback, and ride
ten or a dozen miles, they would find it a more effectual remedy than any
cordial medicine in the apothecary’s shop, or all the strong liquors in the
world.
The following is my plan, and I cannot recommend a better to others.
When my mind is fatigued with study, or other serious business, I mount
my horse, and ride ten or twelve miles into the country, where I spend a day,
and sometimes two, with a cheerful friend; after which I never fail to return
to town with new vigour, and to pursue my studies or business with fresh
alacrity.
It is much to be regretted, that learned men, while in health, pay so little
regard to these things! There is not any thing more common than to see a
miserable object over-run with nervous diseases, bathing, walking, riding,
and, in a word, doing every thing for health after it is gone; yet, if any one
had recommended these things to him by way of prevention, the advice
would, in all probability, have been treated with contempt, or, at least, with
neglect. Such is the weakness and folly of mankind, and such the want of
foresight, even in those who ought to be wiser than others!
With regard to the diet of the studious, we see no reason why they should
abstain from any kind of food that is wholesome, provided they use it in

moderation. They ought, however, to be sparing in the use of every thing
that is windy, rancid, or hard of digestion. Their suppers should always be
light, or taken soon in the evening. Their drink may be water, fine malt
liquor, not too strong, good cyder, wine and water, or, if troubled with
acidities, water mixed with a little brandy, rum, or any other genuine spirit.
We shall only observe, with regard to those kinds of exercise which are
most proper for the studious, that they should not be too violent, nor ever
carried to the degree of excessive fatigue. They ought likewise to be
frequently varied so as to give action to all the different parts of the body;
and should, as often as possible, be taken in the open air. In general, riding
on horseback, walking, working in a garden, or playing at some active
diversions, are the best.
We would likewise recommend the use of the cold bath to the studious. It
will, in some measure, supply the place of exercise, and should not be
neglected by persons of a relaxed habit, especially in the warm season.
No person ought either to take violent exercise, or to study immediately
after a full meal.

CHAP. III.
OF ALIMENT.

Unwholesome food, and irregularities in diet, occasion many diseases.
There is no doubt but the whole constitution of body may be changed by
diet alone. The fluids may be thereby attenuated or condensed, rendered
mild or acrimonious, coagulated or diluted, to almost any degree. Nor are
its effects upon the solids less considerable. They may be braced or relaxed,
have their sensibility, motions, &c. greatly increased or diminished, by
different kinds of aliment. A very small attention to these things will be
sufficient to shew, how much the preservation of health depends upon a
proper regimen of the diet.
Nor is an attention to diet necessary for the preservation of health only: it
is likewise of importance in the cure of diseases. Every intention in the cure
of many diseases, may be answered by diet alone. Its effects, indeed, are not
always so quick as those of medicine, but they are generally more lasting:
besides, it is neither so disagreeable to the patient, nor so dangerous as
medicine, and is always more easily obtained.
Our intention here is not to inquire minutely into the nature and
properties of the various kinds of aliment in use among mankind; nor to
shew their effects upon the different constitutions of the human body; but to
mark some of the most pernicious errors which people are apt to fall into,
with respect both to the quantity and qualities of their food, and to point out
their influence upon health.
It is not indeed an easy matter to ascertain the exact quantity of food
proper for every age, sex, and constitution: but a scrupulous nicety here is
by no means necessary. The best rule is to avoid all extremes. Mankind
were never intended to weigh and measure their food. Nature teaches every
creature when it has enough; and the calls of thirst and hunger are sufficient
to inform them when more is necessary.

Though moderation is the chief rule with regard to the quantity, yet the
quality of food merits a farther consideration. There are many ways by
which provisions may be rendered unwholesome. Bad seasons may either
prevent the ripening of grain, or damage it afterwards. These, indeed, are
acts of Providence, and we must submit to them; but surely no punishment
can be too severe for those who suffer provisions to spoil by hoarding them,
on purpose to raise the price, or who promote their own interest by
adulterating the necessaries of life[27].
Animal, as well as vegetable food, may be rendered unwholesome, by
being kept too long. All animal substances have a constant tendency to
putrefaction; and, when that has proceeded too far, they not only become
offensive to the senses, but hurtful to health. Diseased animals, and such as
die of themselves, ought never to be eaten. It is a common practice,
however, in some grazing countries, for servants and poor people to eat
such animals as die of any disease, or are killed by accident. Poverty,
indeed, may oblige people to do this; but they had better eat a smaller
quantity of what is sound and wholesome: it would both afford a better
nourishment, and be attended with less danger.
The injunctions given to the Jews, not to eat any creature which died of
itself, seem to have a strict regard to health; and ought to be observed by
Christians as well as Jews. Animals never die themselves without some
previous disease; but how a diseased animal should be wholesome food, is
inconceivable: even those which die by accident must be hurtful, as their
blood is mixed with the flesh, and soon turns putrid.
Animals which feed grossly, as tame ducks, hogs, &c. are neither so
easily digested, nor afford such wholesome nourishment as others. No
animal can be wholesome which does not take sufficient exercise. Most of
our stalled cattle are crammed with gross food, but not allowed exercise nor
free air; by which means they indeed grow fat, but their juices not being
properly prepared or assimilated, remain crude, and occasion indigestions,
gross humours, and oppression of the spirits, in those who feed upon them.
Animals are often rendered unwholesome by being overheated.
Excessive heat causes a fever, exalts the animal salts, and mixes the blood
so intimately with the flesh, that it cannot be separated. For this reason,
butchers should be severely punished who over-drive their cattle. No person
would chuse to eat the flesh of an animal which had died in a high fever;

yet that is the case with all over-drove cattle; and the fever is often raised
even to the degree of madness.
But this is not the only way by which butchers render meat
unwholesome. The abominable custom of filling the cellular membrane of
animals with air, in order to make them appear fat, is every day practised.
This not only spoils the meat, and renders it unfit for keeping, but is such a
dirty trick, that the very idea of it is sufficient to disgust a person of any
delicacy at every thing which comes from the shambles. Who can bear the
thought of eating meat which has been blown up with air from the lungs of
a dirty fellow, perhaps labouring under the very worst of diseases?
Butchers have likewise a method of filling the cellular membranes of
animals with blood. This makes the meat seem fatter, and likewise weigh
more, but is notwithstanding a very pernicious custom, as it both renders
the meat unwholesome and unfit for keeping. I seldom see a piece of meat
from the shambles, where the blood is not diffused through the cellular
texture. I shall not say that this is always the effect of design; but I am
certain it is not the case with animals that are killed for domestic use, and
properly blooded. Veal seems to be most frequently spoilt in this way.
Perhaps that may in some measure be owing to the practice of carrying
calves from a great distance to market, by which means their tender flesh is
bruised, and many of their vessels burst.
No people in the world eat such quantities of animal food as the English,
which is one reason why they are so generally tainted with the scurvy and
its numerous train of consequences, indigestion, low spirits,
hypochondriacism, &c. Animal food was surely designed for man, and,
with a proper mixture of vegetables, it will be found the most wholesome;
but to gorge beef, mutton, pork, fish, and fowl, twice or thrice a day, is
certainly too much. All who value health ought to be contented with making
one meal of flesh in the twenty-four hours, and this ought to consist of one
kind only.
The most obstinate scurvy has often been cured by a vegetable diet; nay,
milk alone will frequently do more in that disease than any medicine. Hence
it is evident, that if vegetables and milk were more used in diet, we should
have less scurvy, and likewise fewer putrid and inflammatory fevers. Fresh
vegetables, indeed, come to be daily more used in diet; this laudable
practice we hope will continue to gain ground.

Our aliment ought neither to be too moist nor too dry. Moist aliment
relaxes the solids, and renders the body feeble. Thus we see females, who
live much on tea and other watery diet, generally become weak, and unable
to digest solid food: hence proceed hysterics, and all their dreadful
consequences. On the other hand, food that is too dry, renders the solids in a
manner rigid, and the humours viscid, which disposes the body to
inflammatory fevers, scurvies, and the like.
Much has been said on the ill effects of tea in diet. They are, no doubt,
numerous; but they proceed rather from the imprudent use of it, than from
any bad qualities in the tea itself. Tea is now the universal breakfast in this
part of the world; but the morning is surely the most improper time of the
day for drinking it. Most delicate persons, who, by the bye, are the greatest
tea-drinkers, cannot eat any thing in the morning. If such persons, after
fasting ten or twelve hours, drink four or five cups of tea without eating
almost any bread, it must hurt them. Good tea, taken in moderate quantity,
not too strong, nor too hot, nor drank upon an empty stomach, will seldom
do harm; but if it be bad, which is often the case, or substituted in the room
of solid food, it must have many ill effects.
The arts of cookery render many things unwholesome, which are not so
in their own nature. By jumbling together a number of different ingredients,
in order to make a poignant sauce or rich soup, the composition proves
almost a poison. All high seasoning, pickles, &c. are only incentives to
luxury, and never fail to hurt the stomach. It were well for mankind, if
cookery, as an art, were entirely prohibited. Plain roasting or boiling is all
that the stomach requires. These alone are sufficient for people in health,
and the sick have still less need of a cook.
The liquid part of our aliment likewise claims our attention. Water is not
only the basis of most liquors, but also composes a great part of our solid
food. Good water must therefore be of the greatest importance in diet. The
best water is that which is most pure, and free from any mixture of foreign
bodies. Water takes up parts of most bodies with which it comes into
contact; by this means it is often impregnated with metals or minerals of a
hurtful or poisonous nature. Hence the inhabitants of some hilly countries
have peculiar diseases, which in all probability proceed from the water.
Thus the people who live near the Alps in Switzerland, and the inhabitants
of the Peak of Derby in England, have large tumours or wens on their

necks. This disease is generally imputed to the snow water; but there is
more reason to believe it is owing to the minerals in the mountains through
which the waters pass.
When water is impregnated with foreign bodies, it generally appears by
its weight, colour, taste, smell, heat, or some other sensible quality. Our
business therefore is to chuse such water, for common use, as is lightest,
and without any particular colour, taste, or smell. In most places of Britain
the inhabitants have it in their power to make choice of their water; and few
things would contribute more to health than a due attention to this article.
But mere indolence often induces people to make use of the water that is
nearest to them, without considering its qualities.
Before water is brought into great towns, the strictest attention ought to
be paid to its qualities, as many diseases may be occasioned or aggravated
by bad water; and when once it has been procured at a great expence,
people are unwilling to give it up.
The common methods of rendering water clear by filtration, or soft, by
exposing it to the sun and air, &c. are so generally known, that it is
unnecessary to spend time in explaining them. We shall only, in general,
advise all to avoid waters which stagnate long in small lakes, ponds, or the
like, as such waters often become putrid, by the corruption of animal and
vegetable bodies with which they abound. Even cattle frequently suffer by
drinking, in dry seasons, water which has stood long in small reservoirs,
without being supplied by springs, or freshened with showers. All wells
ought to be kept clean, and to have a free communication with the air.
As fermented liquors, notwithstanding they have been exclaimed against
by many writers, still continue to be the common drink of almost every
person who can afford them; we shall rather endeavour to assist people in
the choice of these liquors, than pretend to condemn what custom has so
firmly established. It is not the moderate use of sound fermented liquors
which hurts mankind: it is excess, and using such as are ill prepared or
vitiated.
Fermented liquors, which are too strong, hurt digestion; and the body is
so far from being strengthened by them, that it is weakened and relaxed.
Many imagine that hard labour could not be supported without drinking
strong liquors: this is a very erroneous notion. Men who never taste strong
liquors are not only able to endure more fatigue, but also live much longer,

than those who use them daily. But, suppose strong liquors did enable a
man to do more work, they must nevertheless waste the powers of life, and
occasion premature old age. They keep up a constant fever, which exhausts
the spirits, inflames the blood, and disposes the body to numberless
diseases.
But fermented liquors may be too weak as well as too strong: when that
is the case, they must either be drank new, or they become sour and dead:
when such liquors are drank new, the fermentation not being over, they
generate air in the bowels, and occasion flatulencies; and, when kept till
stale, they turn sour on the stomach, and hurt digestion. For this reason all
malt liquors, cider, &c. ought to be of such strength as to keep till they be
ripe, and then they should be used. When such liquors are kept too long,
though they should not become sour, yet they generally contract a hardness,
which renders them unwholesome.
All families, who can, ought to prepare their own liquors. Since
preparing and vending of liquors became one of the most general branches
of business, every method has been tried to adulterate them. The great
object both to the makers and venders of liquor is, to render it intoxicating,
and give it the appearance of age. But it is well known that this may be
done by other ingredients than those which ought to be used for making it
strong. It would be imprudent even to name those things which are daily
made use of to render liquors heady. Suffice it to say, that the practice is
very common, and that all the ingredients used for this purpose are of a
narcotic or stupefactive quality. But as all opiates are poisonous, it is easy to
see what must be the consequence of their general use. Though they do not
kill suddenly, yet they hurt the nerves, relax and weaken the stomach, and
spoil the digestion.
Were fermented liquors faithfully prepared, kept to a proper age, and
used in moderation, they would prove real blessings to mankind. But, while
they are ill prepared, various ways adulterated, and taken to excess, they
must have many pernicious effects.
We would recommend it to families, not only to prepare their own
liquors, but likewise their bread. Bread is so necessary a part of diet, that
too much care cannot be bestowed in order to have it sound and
wholesome. For this purpose, it is not only necessary that it be made of
good grain, but likewise properly prepared, and kept free from all

unwholesome ingredients. This, however, we have reason to believe is not
always the case with bread prepared by those who make a trade of vending
it. Their object is rather to please the eye, than to consult the health. The
best bread is that which is neither too coarse nor too fine; well fermented
and made of wheat flour, or rather of wheat and rye mixed together.
To specify the different kinds of aliment, to explain their nature and
properties, and to point out their effects in different constitutions, would far
exceed the limits of our design. Instead of a detail of this kind, which would
not be generally understood, and of course little attended to, we shall only
mention the following easy rules with respect to the choice of aliment.
Persons, whose solids are weak and relaxed, ought to avoid all viscid
food, or such things as are hard of digestion. Their diet, however, ought to
be nourishing; and they should take sufficient exercise in the open air.
Such as abound with blood should be sparing in the use of every thing
that is highly nourishing, as fat meat, rich wines, strong ale, and such like.
Their food should consist chiefly of bread and other vegetable substances;
and their drink ought to be water, whey, or small beer.
Fat people should not eat freely of oily nourishing diet. They ought
frequently to use raddish, garlic, spices, or such things as are heating and
promote perspiration and urine. Their drink should be water, coffee, tea, or
the like; and they ought to take much exercise and little sleep.
Those who are too lean must follow an opposite course.
Such as are troubled with acidities, or whose food is apt to sour on the
stomach, should live much on animal food; and those who are afflicted with
hot alkaline eructations, ought to use a diet consisting chiefly of acid
vegetables.
People who are affected with the gout, low spirits, hypochondriac or
hysteric disorders, ought to avoid all flatulent food, every thing that is
viscid, or hard of digestion, all salted or smoke-dried provisions, and
whatever is austere, acid, or apt to turn sour on the stomach. Their food
should be light, spare, cool, and of an opening nature.
The diet ought not only to be suited to the age and constitution, but also
to the manner of life: a sedentary or studious person should live more
sparingly than one who labours hard without doors. Many kinds of food
will nourish a peasant very well which would be almost indigestible to a

citizen; and the latter will live upon a diet on which the former would
starve.
Diet ought not to be too uniform. The constant use of one kind of food
might have some bad effects. Nature teaches us this, by the great variety of
aliment which she has provided for man, and likewise by giving him an
appetite for different kinds of food.
Those who labour under any particular disease, ought to avoid such
aliments as have a tendency to increase it: for example, a gouty person
should not indulge in rich wines, strong soups, or gravies, and should avoid
all acids. One who is troubled with the gravel ought to shun all austere and
astringent aliments; and those who are scorbutic should be sparing in the
use of salted provisions, &c.
In the first period of life, our food ought to be light, but nourishing, and
frequently taken. Food that is solid, with a sufficient degree of tenacity, is
most proper for the state of manhood. The diet suited to the last period of
life, when nature is upon the decline, approaches nearly to that of the first.
It should be lighter and more succulent than that of vigorous age, and
likewise more frequently taken.
It is not only necessary for health that our diet be wholesome, but also
that it be taken at regular periods. Some imagine long fasting will atone for
excess; but this, instead of mending the matter, generally makes it worse.
When the stomach and intestines are over-distended with food, they lose
their proper tone, and, by long fasting, they become weak, and inflated with
wind. Thus, either gluttony or fasting destroys the powers of digestion.
The frequent repetition of aliment is not only necessary for repairing the
continual waste of our bodies, but likewise to keep the fluids sound and
sweet. Our humours, even in the most healthy state, have a constant
tendency to putrefaction, which can only be prevented by frequent supplies
of fresh nourishment: when that is wanting too long, the putrefaction often
proceeds so far as to occasion very dangerous fevers. From hence we may
learn the necessity of regular meals. No person can enjoy a good state of
health, whose vessels are either frequently overcharged, or the humours
long deprived of fresh supplies of chyle.
Long fasting is extremely hurtful to young people; it not only vitiates
their humours, but prevents their growth. Nor is it less injurious to the aged.
Most persons, in the decline of life, are afflicted with wind: this complaint

is not only increased, but even rendered dangerous, and often fatal, by long
fasting. Old people, when their stomachs are empty, are frequently seized
with giddiness, head-achs, and faintness. These complaints may generally
be removed by a piece of bread and a glass of wine, or taking any other
solid food; which plainly points out the method of preventing them.
It is more than probable, that many of the sudden deaths, which happen
in the advanced periods of life, are occasioned by fasting too long, as it
exhausts the spirits, and fills the bowels with wind; we would therefore
advise people, in the decline of life, never to allow their stomachs to be too
long empty. Many people take nothing but a few cups of tea and a little
bread, from nine o’clock at night till two or three next afternoon. Such may
be said to fast almost three-fourths of their time. This can hardly fail to ruin
the appetite, vitiate the humours, and fill the bowels with wind; all which
might be prevented by a solid breakfast.
It is a very common practice to eat a light breakfast and a heavy supper.
This custom ought to be reversed. When people sup late, their supper
should be very light; but the breakfast ought always to be solid. If any one
eats a light supper, goes soon to bed, and rises betimes in the morning, he
will be sure to find an appetite for his breakfast, and he may freely indulge
it.
The strong and healthy do not indeed suffer so much from fasting as the
weak and delicate; but they run great hazard from its opposite, viz.
repletion. Many diseases, especially fevers, are the effect of a plethora, or
too great fulness of the vessels. Strong people, in high health, have
generally a great quantity of blood and other humours. When these are
suddenly increased, by an overcharge of rich and nourishing diet, the
vessels become too much distended, and obstructions and inflammations
ensue. Hence so many people are seized with inflammatory and eruptive
fevers after a feast or debauch.
All great and sudden changes in diet are dangerous. What the stomach
has been long accustomed to digest, though less wholesome, will agree
better with it than food of a more salutary nature which it has not been used
to. When therefore a change becomes necessary, it ought always to be made
gradually; a sudden transition from a poor and low, to a rich and luxurious
diet, or the contrary, might so disturb the functions of the body as to
endanger health, or even to occasion death itself.

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

CHAP. IV.
OF AIR.

Unwholesome air is a very common cause of diseases. Few are aware of the
danger arising from it. People generally pay some attention to what they eat
and drink, but seldom regard what goes into the lungs, though the latter
proves often more suddenly fatal than the former.
Air, as well as water, takes up parts of most bodies with which it comes
in contact, and is often so replenished with those of a noxious quality, as to
occasion immediate death. But such violent effects seldom happen, as
people are generally on their guard against them. The less perceptible
influences of bad air prove more generally hurtful to mankind; we shall
therefore endeavour to point out some of these, and to shew from whence
the danger chiefly arises.
Air may become noxious many ways. Whatever greatly alters its degree
of heat, cold, moisture, &c. renders it unwholesome: for example, that
which is too hot dissipates the watry parts of the blood, exalts the bile, and
renders the whole humour adust and thick. Hence proceed bilious and
inflammatory fevers, cholera morbus, &c. Very cold air obstructs the
perspiration, constringes the solids, and condenses the fluids. It occasions
rheumatisms, coughs, and catarrhs, with other diseases of the throat and
breast. Air that is too moist destroys the elasticity or spring of the solids,
induces phlegmatic or lax constitutions, and disposes the body to agues, or
intermitting fevers, dropsies, &c.
Wherever great numbers of people are crowded into one place, if the air
has not a free circulation, it soon becomes unwholesome. Hence it is that
delicate persons are so apt to turn sick or faint in crowded churches,
assemblies, or any place where the air is injured by breathing, fires, candles,
or the like.
In great cities so many things tend to contaminate the air, that it is no
wonder it proves so fatal to the inhabitants. The air in cities is not only

breathed repeatedly over, but is likewise loaded with sulphur, smoke, and
other exhalations, besides the vapours continually arising from innumerable
putrid substances, as dunghills, slaughterhouses, &c. All possible care
should be taken to keep the streets of large towns open and wide, that the air
may have a free current through them. They ought likewise to be kept very
clean. Nothing tends more to pollute and contaminate the air of a city than
dirty streets.
It is very common in this country to have church-yards in the middle of
populous cities. Whether this be the effect of ancient superstition, or owing
to the increase of such towns, is a matter of no consequence. Whatever gave
rise to the custom, it is a bad one. It is habit alone which reconciles us to
these things; by means of which the most ridiculous, nay pernicious
customs, often become sacred. Certain it is, that thousands of putrid
carcasses, so near the surface of the earth, in a place where the air is
confined, cannot fail to taint it; and that such air, when breathed into the
lungs, must occasion diseases[28].
Burying within churches is a practice still more detestable. The air in
churches is seldom good, and the effluvia from putrid carcasses must render
it still worse. Churches are commonly old buildings with arched roofs. They
are seldom open above once a week, are never ventilated by fires nor open
windows, and rarely kept clean. This occasions that damp, musty,
unwholesome smell which one feels upon entering a church, and renders it
a very unsafe place for the weak and valetudinary. These inconveniences
might, in a great measure, be obviated, by prohibiting all persons from
burying within churches, by keeping them clean, and permitting a stream of
fresh air to pass frequently through them, by opening opposite doors and
windows[29].
Wherever air stagnates long, it becomes unwholesome. Hence the
unhappy persons confined in jails not only contract malignant fevers
themselves, but often communicate them to others. Nor are many of the
holes, for we cannot call them houses, possessed by the poor in great towns,
much better than jails. These low dirty habitations are the very lurking-
places of bad air and contagious diseases. Such as live in them seldom
enjoy good health; and their children commonly die young. In the choice of
a house, those who have it in their power ought always to pay the greatest
attention to open free air.

The various methods which luxury has invented to make houses close
and warm, contribute not a little to render them unwholesome. No house
can be wholesome unless the air has a free passage through it. For which
reason houses ought daily to be ventilated, by opening opposite windows,
and admitting a current of fresh air into every room. Beds, instead of being
made up as soon as people rise out of them, ought to be turned down, and
exposed to the fresh air from the open windows through the day. This would
expel any noxious vapour, and could not fail to promote the health of the
inhabitants.
In hospitals, jails, ships, &c. where that cannot be conveniently done,
ventilators should be used. The method of expelling foul, and introducing
fresh air, by means of ventilators, is a most salutary invention, and is indeed
the most useful of all our modern medical improvements. It is capable of
universal application, and is fraught with numerous advantages, both to
those in health and sickness. In all places, where numbers of people are
crowded together, ventilation becomes absolutely necessary.
Air which stagnates in mines, wells, cellars, &c. is extremely noxious.
That kind of air is to be avoided as the most deadly poison. It often kills
almost as quickly as lightning. For this reason, people should be very
cautious in opening cellars that have been long shut, or going down into
deep wells or pits, especially if they have been kept close covered[30].
Many people who have splendid houses, chuse to sleep in small
apartments. This conduct is very imprudent. A bed-chamber ought always to
be well-aired; as it is generally occupied in the night only, when all doors
and windows are shut. If a fire be kept in it, the danger from a small room
becomes still greater. Numbers have been stifled when asleep by a fire in a
small apartment, which is always hurtful.
Those who are obliged, on account of business, to spend the day in close
towns, ought, if possible, to sleep in the country. Breathing free air in the
night will, in some measure, make up for the want of it through the day.
This practice would have a greater effect in preserving the health of citizens
than is commonly imagined.
Delicate persons ought, as much as possible, to avoid the air of great
towns. It is peculiarly hurtful to the asthmatic and consumptive. Such
persons should avoid cities as they would the plague. The hypochondriac
are likewise much hurt by it. I have often seen persons so much afflicted

with this malady while in town, that it seemed impossible for them to live,
who, upon being removed to the country, were immediately relieved. The
same observation holds with regard to nervous and hysteric women. Many
people, indeed, have it not in their power to change their situation in quest
of better air. All we can say to such persons is, that they should go as often
abroad into the open air as they can, that they should admit fresh air
frequently into their houses, and take care to keep them very clean.
It was necessary in former times, for safety, to surround cities, colleges,
and even single houses, with high walls. These, by obstructing the free
current of air, never fail to render such places damp and unwholesome. As
such walls are now, in most parts of this country, become useless, they
ought to be pulled down, and every method taken to admit a free passage to
the air. Proper attention to Air and Cleanliness would tend more to
preserve the health of mankind, than all the endeavours of the faculty.
Surrounding houses too closely with planting, or thick woods, likewise
tends to render the air unwholesome. Wood not only obstructs the free
current of the air, but sends forth great quantities of moist exhalations,
which render it constantly damp. Wood is very agreeable at a proper
distance from a house, but should never be planted too near it, especially in
a flat country. Many of the gentlemen’s seats in England are rendered very
unwholesome from the great quantity of wood which surrounds them.
Houses situated in low marshy countries, or near large lakes of stagnating
water, are likewise unwholesome. Waters which stagnate not only render
the air damp, but load it with putrid exhalations, which produce the most
dangerous and fatal diseases. Those who are obliged to inhabit marshy
countries, ought to make choice of the dryest situations they can find, to
live generously, and to pay the strictest regard to cleanliness.
If fresh air be necessary for those in health, it is still more so for the sick,
who often lose their lives for want of it. The notion that sick people must be
kept very hot, is so common, that one can hardly enter the chamber where a
patient lies, without being ready to faint, by reason of the hot suffocating
smell. How this must affect the sick any one may judge. No medicine is so
beneficial to the sick as fresh air. It is the most reviving of all cordials, if it
be administered with prudence. We are not, however, to throw open doors
and windows at random upon the sick. Fresh air is to be let into the

chamber gradually, and, if possible, by opening the windows of some other
apartment.
The air of a sick person’s chamber may be greatly freshened, and the
patient much revived, by sprinkling the floor, bed, &c. frequently with
vinegar, juice of lemon, or any other strong vegetable acid.
In places where numbers of sick are crowded into the same house, or,
which is often the case, into the same apartment, the frequent admission of
fresh air becomes absolutely necessary. Infirmaries, hospitals, &c. are often
rendered so noxious, for want of proper ventilation, that the sick run more
hazard from them than from the disease. This is particularly the case when
putrid fevers, dysenteries, and other infectious diseases prevail.
Physicians, surgeons, and others who attend hospitals, ought, for their
own safety, to take care that they be properly ventilated. Such persons as are
obliged to spend most of their time amongst the sick, run great hazard of
being themselves infected when the air is bad. All hospitals, and places of
reception for the sick, ought to have an open situation, at some distance
from any great town, and such patients as labour under any infectious
disease ought never to be suffered to come near the rest[31].

CHAP. V.
OF EXERCISE.

Many people look upon the necessity man is under of earning his bread by
labour, as a curse. Be this as it may, it is evident from the structure of the
body, that exercise is not less necessary than food for the preservation of
health: those whom poverty obliges to labour for daily bread, are not only
the most healthy, but generally the most happy part of mankind. Industry
seldom fails to place them above want, and activity serves them instead of
physic. This is peculiarly the case with those who live by the culture of the
ground. The great increase of inhabitants in infant colonies, and the
longevity of such as follow agriculture every where, evidently prove it to be
the most healthful as well as the most useful employment.
The love of activity shews itself very early in man. So strong is this
principle, that a healthy youth cannot be restrained from exercise, even by
the fear of punishment. Our love of motion is surely a strong proof of its
utility. Nature implants no disposition in vain. It seems to be a catholic law
throughout the whole animal creation, that no creature, without exercise,
should enjoy health, or be able to find subsistence. Every creature, except
man, takes as much of it as is necessary. He alone, and such animals as are
under his direction, deviate from this original law, and they suffer
accordingly.
Inactivity never fails to induce an universal relaxation of the solids,
which disposes the body to innumerable diseases. When the solids are
relaxed, neither the digestion, nor any of the secretions, can be duly
performed. In this case, the worst consequences must ensue. How can
persons who loll all day in easy chairs, and sleep all night on beds of down,
fail to be relaxed? Nor do such greatly mend the matter, who never stir
abroad but in a coach, sedan, or such like. These elegant pieces of luxury
are become so common, that the inhabitants of great towns seem to be in
some danger of losing the use of their limbs altogether. It is now below any
one to walk, who can afford to be carried. How ridiculous would it seem, to

a person unacquainted with modern luxury, to behold the young and healthy
swinging along on the shoulders of their fellow-creatures! or to see a fat
carcase, over-run with diseases occasioned by inactivity, dragged through
the streets by half a dozen horses[32]!
Glandular obstructions, now so common, generally proceed from
inactivity. These are the most obstinate of maladies. So long as the liver,
kidnies, and other glands, duly perform their functions, health is seldom
impaired; but, when they fail, nothing can restore it. Exercise is almost the
only cure we know for glandular obstructions; indeed, it does not always
succeed as a remedy; but there is reason to believe that it would seldom fail
to prevent these complaints, were it used in due time. One thing is certain,
that, amongst those who take sufficient exercise, glandular diseases are very
little known; whereas the indolent and inactive are seldom free from them.
Weak nerves are the constant companions of inactivity. Nothing but
exercise and open air can brace and strengthen the nerves, or prevent the
endless train of diseases which proceed from a relaxed state of these organs.
We seldom hear the active or laborious complain of nervous diseases; these
are reserved for the sons of ease and affluence. Many have been completely
cured of these disorders by being reduced, from a stare of opulence, to
labour for their daily bread. This plainly points out the sources from whence
nervous diseases flow, and the means by which they may be prevented.
It is absolutely impossible to enjoy health, where the perspiration is not
duly carried on; but that can never be the case where exercise is neglected.
When the matter which ought to be thrown off by perspiration is retained in
the body, it vitiates the humours, and occasions the gout, fevers,
rheumatism, &c. Exercise alone would prevent many of those diseases
which cannot be cured, and would remove others where medicine proves
ineffectual.
A late author[33], in his excellent treatise on health, says, that the weak and
valetudinary ought to make exercise a part of their religion. We would
recommend this, not only to the weak and valetudinary, but to all whose
business does not oblige them to take sufficient exercise, as sedentary
artificers[34], shop-keepers, studious persons, &c. Such ought to use exercise
as regularly as they take food. This might generally be done without any
interruption to business or real loss of time.

No piece of indolence hurts the health more than the modern custom of
lying a-bed too long in a morning. This is the general practice in great
towns. The inhabitants of cities seldom rise before eight or nine o’clock; but
the morning is undoubtedly the best time for exercise, while the stomach is
empty, and the body refreshed with sleep. Besides, the morning air braces
and strengthens the nerves, and, in some measure, answers the purpose of a
cold bath. Let any one who has been accustomed to lie a-bed till eight or
nine o’clock, rise by six or seven, spend a couple of hours in walking,
riding, or any active diversion without doors, and he will find his spirits
cheerful and serene through the day, his appetite keen, and his body braced
and strengthened. Custom soon renders early rising agreeable, and nothing
contributes more to the preservation of health.
The inactive are continually complaining of pains of the stomach,
flatulencies, indigestions, &c. These complaints, which pave the way to
many others, are not to be removed by medicines. They can only be cured
by a vigorous course of exercise, to which indeed they seldom fail to yield.
Exercise, if possible, ought always to be taken in the open air. When that
cannot be done, various methods may be contrived for exercising the body
within doors, as the dumb bell, dancing, fencing, &c. It is not necessary to
adhere strictly to any particular kind of exercise. The best way is to take
them by turns, and to use that longest which is most suitable to the strength
and constitution. Those kinds of exercise which give action to most of the
bodily organs, are always to be preferred, as walking, running, riding,
digging, swimming, and such like.
It is much to be regretted, that active and manly diversions are now so
little practised. Diversions make people take more exercise than they
otherwise would do, and are of the greatest service to such as are not under
the necessity of labouring for their bread. As active diversions lose ground,
those of a sedentary kind seem to prevail. Sedentary diversions are of no
other use but to consume time. Instead of relieving the mind, they often
require more thought than either study or business. Every thing that induces
people to sit still, unless it be some necessary employment, ought to be
avoided.
The diversions which afford the best exercise are, hunting, shooting,
playing at cricket, handball, golf[35], &c. These exercise the limbs, promote

perspiration, and the other secretions. They likewise strengthen the lungs,
and give firmness and agility to the whole body.
Such as can, ought to spend two or three hours a-day on horseback; those
who cannot ride, should employ the same time in walking. Exercise should
never be continued too long. Over-fatigue prevents the benefit of exercise,
and instead of strengthening the body tends to weaken it.
Every man should lay himself under some sort of necessity to take
exercise. Indolence, like other vices when indulged, gains ground, and at
length becomes agreeable. Hence many who were fond of exercise in the
early part of life, become quite averse from it afterwards. This is the case of
most hypochondriac and gouty people, which renders their diseases in a
great measure incurable.
In some countries laws have been made, obliging every man, of whatever
rank, to learn some mechanical employment. Whether such laws were
designed for the preservation of health, or the encouragement of
manufacture, is a question of no importance, Certain it is, that if gentlemen
were frequently to amuse and exercise themselves in this way, it might have
many good effects. They would at least derive as much honour from a few
masterly specimens of their own workmanship, as from the character of
having ruined most of their companions by gaming or drinking. Besides,
men of leisure, by applying themselves to the mechanical arts, might
improve them, to the great benefit of society.
Indolence not only occasions diseases, and renders men useless to
society, but promotes all manner of vice. To say a man is idle, is little better
than to call him vicious. The mind, if not engaged in some useful pursuit, is
constantly in quest of ideal pleasures, or impressed with the apprehension
of some imaginary evil. From these sources proceed most of the miseries of
mankind. Certainly man was never intended to be idle. Inactivity frustrates
the very design of his creation; whereas an active life is the best guardian of
virtue, and the greatest preservative of health.

CHAP. VI.
OF SLEEP AND CLOTHING.

Sleep, as well as diet, ought to be duly regulated. Too little sleep weakens
the nerves, exhausts the spirits, and occasions diseases; and too much
renders the mind dull, the body gross, and disposes to apoplexies,
lethargies, and other complaints of a similar nature. A medium ought
therefore to be observed; but this is not easy to fix. Children require more
sleep than grown persons, the laborious than the idle, and such as eat and
drink freely, than those who live abstemiously. Besides, the real quantity of
sleep cannot be measured by time; as one person will be more refreshed by
five or six hours sleep, than another by eight or ten.
Children may always be allowed to take as much sleep as they please;
but, for adults, six or seven hours is certainly sufficient, and no one ought to
exceed eight. Those who lie a-bed more than eight hours may slumber, but
they can hardly be said to sleep; such generally toss and dream away the
fore-part of the night, sink to rest towards morning, and dose till noon. The
best way to make sleep sound and refreshing is to rise betimes. The custom
of lying a-bed for nine or ten hours, not only makes the sleep less
refreshing, but relaxes the solids, and greatly weakens the constitution.
Nature points out night as the proper season for sleep. Nothing more
certainly destroys the constitution than night-watching. It is great pity that a
practice so destructive to health should be so much in fashion. How quickly
the want of rest in due season will blast the most blooming complexion, or
ruin the best constitution, is evident from the ghastly countenances of those
who, as the phrase is, turn day into night, and night into day.
To make sleep refreshing, the following things are requisite: First, to take
sufficient exercise in the open air; to avoid strong tea or coffee; next, to eat
a light supper; and lastly, to lie down with a mind as cheerful and serene as
possible.

It is certain that too much exercise will prevent sleep, as well as too little.
We seldom however hear the active and laborious complain of restless
nights. It is the indolent and slothful who generally have these complaints.
Is it any wonder that a bed of down should not be refreshing to a person
who sits all day in an easy chair? A great part of the pleasure of life consists
in alternate rest and motion; but they who neglect the latter can never relish
the former. The labourer enjoys more true luxury in plain food and sound
sleep, than is to be found in sumptuous tables and downy pillows, where
exercise is wanting.
That light suppers cause sound sleep, is true even to a proverb. Many
persons, if they exceed the least at that meal, are sure to have uneasy nights;
and, if they fall asleep, the load and oppression on their stomach and spirits
occasion frightful dreams, broken and disturbed repose, the night-mare, &c.
Were the same persons to go to bed with a light supper, or sit up till that
meal was pretty well digested, they would enjoy sound sleep, and rise
refreshed and cheerful. There are indeed some people who cannot sleep
unless they have eat some solid food at night, but this does not imply the
necessity of a heavy supper; besides, these are generally persons who have
accustomed themselves to this method, and who do not take a sufficient
quantity of solid food and exercise.
Nothing more certainly disturbs our repose than anxiety. When the mind
is not at ease, one seldom enjoys sound sleep. The greatest of human
blessings flies the wretched, and visits the happy, the cheerful, and the gay.
This is a sufficient reason why every man should endeavour to be as easy in
his mind as possible when he goes to rest. Many, by indulging grief and
anxious thought, have banished sound sleep so long, that they could never
afterwards enjoy it.
Sleep, when taken in the fore-part of the night, is generally reckoned
most refreshing. Whether this be the effect of habit or not, is hard to say;
but as most people are accustomed to go early to bed when young, it may
be presumed that sleep, at this season, will prove most refreshing to them
ever after. Whether the fore-part of the night be best for sleep or not, surely
the fore-part of the day is fitted both for business and amusement. I hardly
ever knew an early riser who did not enjoy a good state of health[36].

Of Clothing.

The clothing ought to be suited to the climate. Custom has no doubt a
very great influence in this article; but no custom can ever change the
nature of things so far, as to render the same clothing fit for an inhabitant of
Nova Zembla and the island of Jamaica. It is not indeed necessary to
observe an exact proportion between the quantity of clothes we wear, and
the degree of latitude which we inhabit; but, at the same time, proper
attention ought to be paid to it, as well as to the openness of the country, the
frequency and violence of storms, &c.
In youth, while the blood is hot and the perspiration free, it is less
necessary to cover the body with a great quantity of clothes; but, in the
decline of life, when the skin becomes rigid and the humours more cool, the
clothing should be increased. Many diseases in the latter period of life
proceed from a defect of perspiration: these may, in some measure, be
prevented by a suitable addition to the clothing, or by wearing such as are
better calculated for promoting the discharge from the skin, as clothes made
of cotton, flannel, &c.
The clothing ought likewise to be suited to the season of the year.
Clothing may be warm enough for summer, which is by no means sufficient
for winter. The greatest caution, however, is necessary in making these
changes. We ought neither to put off our winter clothes too soon, nor to
wear our summer ones too long. In this country, the winter often sets in
very early with great rigour, and we have frequently cold weather even after
the commencement of the summer months. It would likewise be prudent not
to make the change all at once, but to do it gradually; and indeed the
changes of apparel in this climate ought to be very inconsiderable,
especially among those who have passed the meridian of life[37].
Clothes often become hurtful by their being made subservient to the
purposes of pride or vanity. Mankind in all ages seem to have considered
clothes in this view; accordingly their fashion and figure have been
continually varying, with very little regard either to health, the climate, or
conveniency: a farthingale, for example, may be very necessary in hot
southern climates, but surely nothing can be more ridiculous in the cold
regions of the north.
Even the human shape is often attempted to be mended by dress, and
those who know no better believe that mankind would be monsters without
its assistance. All attempts of this nature are highly pernicious. The most

destructive of them in this country is that of squeezing the stomach and
bowels into as narrow a compass as possible, to procure, what is falsely
called, a fine shape[38]. By this practice the action of the stomach and
bowels, the motion of the heart and lungs, and almost all the vital functions,
are obstructed. Hence proceed indigestions, syncopes, or fainting fits,
coughs, consumptions of the lungs, and other complaints so common
among females.
The feet likewise often suffer by pressure. How a small foot came to be
reckoned genteel, I will not pretend to say; but certain it is, that this notion
has made many persons lame. Almost nine-tenths of mankind are troubled
with corns: a disease that is seldom or never occasioned but by strait shoes.
Corns are not only very troublesome, but by rendering people unable to
walk, they may likewise be considered as the remote cause of other
diseases[39].
The size and figure of the shoe ought certainly to be adapted to the foot.
In children the feet are as well shaped as the hands, and the motion of the
toes as free and easy as that of the fingers; yet few persons in the advanced
periods of life are able to make any use of their toes. They are generally, by
narrow shoes, squeezed all of a heap, and often laid over one another in
such a manner as to be rendered altogether incapable of motion. Nor is the
high heel less hurtful than the narrow toe. A lady may seem taller for
walking on her tiptoes, but she will never walk well in this manner. It
strains her joints, distorts her limbs, makes her stoop, and utterly destroys
all her ease and gracefulness of motion: it is entirely owing to shoes with
high heels and narrow toes, that not one female in ten can be said to walk
well.
In fixing on the clothes, due care should be taken to avoid all tight
bandages. Garters, buckles, &c. when drawn too tight, not only prevent the
free motion and use of the parts about which they are bound, but likewise
obstruct the circulation of the blood, which prevents the equal nourishment
and growth of these parts, and occasions various diseases. Tight bandages
about the neck, as stocks, cravats, necklaces, &c. are extremely dangerous.
They obstruct the blood in its course from the brain, by which means head-
achs, vertigoes, apoplexies, and other fatal diseases are often occasioned.
The perfection of dress is to be easy and clean. Nothing can be more
ridiculous, than for any one to make himself a slave to fine clothes. Such a

one, and many such there are, would rather remain as fixt as a statue from
morning till night, than discompose a single hair or alter the position of a
pin. Were we to recommend any particular pattern for dress, it would be that
which is worn by the people called Quakers. They are always neat, clean,
and often elegant, without any thing superfluous. What others lay out upon
tawdry laces, ruffles, and ribands, they bestow upon superior cleanliness.
Finery is only the affectation of dress, and very often covers a great deal of
dirt.
We shall only add, with regard to clothing, that it ought not only to be
suited to the climate, the season of the year, and the period of life; but
likewise to the temperature and constitution. Robust persons are able to
endure either cold or heat better than the delicate; consequently may be less
attentive to their clothing. But the precise quantity of clothes necessary for
any person cannot be determined by reasoning. It is entirely a matter of
experience, and every man is the best judge for himself what quantity of
clothes is necessary to keep him warm[40].

CHAP. VII.
OF INTEMPERANCE.

A modern author[41] observes, that temperance and exercise are the two best
physicians in the world. He might have added, that if these were duly
regarded, there would be little occasion for any other. Temperance may
justly be called the parent of health; yet numbers of mankind act as if they
thought diseases and death too slow in their progress, and by intemperance
and debauch seem as it were to solicit their approach.
The danger of intemperance appears from the very construction of the
human body. Health depends on that state of the solids and fluids which fits
them for the due performance of the vital functions; and, while these go
regularly on, we are sound and well; but whatever disturbs them necessarily
impairs health. Intemperance never fails to disorder the whole animal
œconomy; it hurts the digestion, relaxes the nerves, renders the different
secretions irregular, vitiates the humours, and occasions numberless
diseases.
The analogy between the nourishment of plants and animals affords a
striking proof of the danger of intemperance. Moisture and manure greatly
promote vegetation; yet an over-quantity of either will entirely destroy it.
The best things become hurtful, nay destructive, when carried to excess.
Hence we learn, that the highest degree of human wisdom consists in
regulating our appetites and passions so as to avoid all extremes. It is that
chiefly which entitles us to the character of rational beings. The slave of
appetite will ever be the disgrace of human nature.
The Author of Nature hath endued us with various passions, for the
propagation of the species, the preservation of the individual, &c.
Intemperance is the abuse of these passions; and moderation consists in the
proper regulation of them. Men, not contented with satisfying the simple
calls of Nature, create artificial wants, and are perpetually in search of
something that may gratify them; but imaginary wants can never be

gratified. Nature is content with little; but luxury knows no bounds. Hence
the epicure, the drunkard, and the debauchee, seldom stop in their career,
till their money or their constitution fails: then indeed they generally see
their error when too late.
It is impossible to lay down fixt rules with regard to diet, on account of
the different constitutions of mankind. The most ignorant person, however,
certainly knows what is meant by excess; and it is in the power of every
man, if he chuses, to avoid it.
The great rule of diet is to study simplicity. Nature delights in the most
plain and simple food, and every animal, except man, follows her dictates.
Man alone riots at large, and ransacks the whole creation in quest of
luxuries, to his own destruction. An elegant writer[42] of the last age speaks
thus of intemperance in diet: “For my part, when I behold a fashionable
table set out in all its magnificence, I fancy that I see gouts and dropsies,
fevers and lethargies, with other innumerable distempers, lying in
ambuscade among the dishes.”
Nor is intemperance in other things less destructive than in diet. How
quickly does the immoderate pursuit of carnal pleasures, or the abuse of
intoxicating liquors, ruin the best constitution! Indeed these vices generally
go hand in hand. Hence it is that we so often behold the votaries of Bacchus
and Venus, even before they have arrived at the prime of life, worn out with
diseases, and hasting with swift pace to an untimely grave. Did men reflect
on the painful diseases, and premature deaths, which are daily occasioned
by intemperance, it would be sufficient to make them shrink back with
horror from the indulgence even of their darling pleasures.
Intemperance does not hurt its votaries alone; the innocent too often feel
the direful effects of it. How many wretched orphans are to be seen
embracing dunghills, whose parents, regardless of the future, spent in riot
and debauch what might have served to bring up their offspring in a decent
manner? How often do we behold the miserable mother, with her helpless
infants, pining in want, while the cruel father is indulging his insatiate
appetites?
Families are not only reduced to misery, but even extirpated, by
intemperance. Nothing tends so much to prevent propagation, and to
shorten the lives of children, as the intemperance of parents. The poor man
who labours all day, and at night lies down contented with his humble fare,

can boast a numerous offspring, while his pampered lord, sunk in ease and
luxury, often languishes without an heir to his ample fortunes. Even states
and empires feel the influence of intemperance, and rise or fall as it
prevails.
Instead of mentioning the different kinds of intemperance, and pointing
out their influence upon health, we shall only, by way of example, make a
few observations on one particular species of that vice, viz. the abuse of
intoxicating liquors.
Every act of intoxication puts Nature to the expence of a fever, in order to
discharge the poisonous draught. When this is repeated almost every day, it
is easy to foresee the consequences. That constitution must be strong
indeed, which is able long to hold out under a daily fever! but fevers
occasioned by drinking do not always go off in a day; they frequently end in
an inflammation of the breast, liver, or brain, and produce fatal effects.
Though the drunkard should not fall by an acute disease, he seldom
escapes those of a chronic kind. Intoxicating liquors, when used to excess,
weaken the bowels and spoil the digestion; they destroy the power of the
nerves, and occasion paralytic and convulsive disorders; they likewise heat
and inflame the blood, destroy its balsamic quality, render it unfit for
circulation, and the nourishment of the body. Hence obstructions, atrophies,
dropsies, and consumptions of the lungs. These are the common ways in
which drunkards make their exit. Diseases of this kind, when brought on by
hard drinking, seldom admit of a cure.
Many people injure their health by drinking, who seldom get drunk. The
continual habit of soaking, as it is called, though its effects be not so
violent, is not less pernicious. When the vessels are kept constantly full and
upon the stretch, the different digestions can neither be duly performed, nor
the humours properly prepared. Hence most people of this character are
afflicted with the gout, the gravel, ulcerous sores in the legs, &c. If these
disorders do not appear, they are seized with low spirits, hypochondriacal
affections, and other symptoms of indigestion.
Consumptions are now so common, that it is thought one-tenth of the
inhabitants of great towns die of that disease. Hard drinking is no doubt one
of the causes to which we must impute the increase of consumptions. The
great quantities of viscid malt liquor drank by the common people of
England, cannot fail to render the blood sizy and unfit for circulation; from

whence proceed obstructions, and inflammations of the lungs. There are
few great ale-drinkers who are not phthisical: nor is that to be wondered at,
considering the glutinous and almost indigestible nature of strong ale.
Those who drink ardent spirits or strong wines run still greater hazard;
these liquors heat and inflame the blood, and tear the tender vessels of the
lungs to pieces; yet so great is the consumption of them in this country, that
one would almost be induced to think that the inhabitants lived upon
them[43].
The habit of drinking proceeds frequently from misfortunes in life. The
miserable fly to it for relief. It affords them indeed a temporary ease. But,
alas! this solace is short-lived; and when it is over, the spirits sink as much
below their usual tone as they had before been raised above it. Hence a
repetition of the dose becomes necessary, and every fresh dose makes way
for another, till the unhappy wretch becomes a slave to the bottle, and at
length falls a sacrifice to what at first perhaps was taken only as a medicine.
No man is so dejected as the drunkard when his debauch is gone off. Hence
it is, that those who have the greatest flow of spirits while the glass
circulates freely, are of all others the most melancholy when sober, and
often put an end to their own miserable existence in a fit of spleen or ill
humour.
Drunkenness not only proves destructive to health, but likewise to the
faculties of the mind. It is strange that creatures who value themselves on
account of a superior degree of reason to that of brutes, should take pleasure
in sinking so far below them. Were such as voluntarily deprive themselves
of the use of reason, to continue ever after in that condition, it would seem
but a just punishment. Though this be not the consequence of one act of
intoxication, it seldom fails to succeed a course of it. By a habit of drinking,
the greatest genius is often reduced to a mere idiot[44].
Intoxication is peculiarly hurtful to young persons. It heats their blood,
impairs their strength, and obstructs their growth; besides, the frequent use
of strong liquors in the early part of life destroys any benefit that might
arise from them afterwards. Those who make a practice of drinking
generous liquors when young, cannot expert to reap any benefit from them
as a cordial in the decline of life.
Drunkenness is not only in itself a most abominable vice, but is an
inducement to many others. There is hardly any crime so horrid that the

drunkard will not perpetrate for the love of liquor. We have known mothers
sell their children’s clothes, the food that they should have eat, and
afterwards even the infants themselves, in order to purchase the accursed
draught.

CHAP. VIII.
OF CLEANLINESS.

The want of cleanliness is a fault which admits of no excuse. Where water
can be had for nothing, it is surely in the power of every person to be clean.
The continual discharge from our bodies by perspiration, renders frequent
change of apparel necessary. Changing apparel greatly promotes the
secretion from the skin, so necessary for health. When that matter which
ought to be carried off by perspiration, is either retained in the body, or
resorbed from dirty clothes, it must occasion diseases.
Diseases of the skin are chiefly owing to want of cleanliness[45]. They
may indeed be caught by infection, or brought on by poor living,
unwholesome food, &c. but they will seldom continue long where
cleanliness prevails. To the same cause must we impute the various kinds of
vermin which infest the human body, houses, &c. These may always be
banished by cleanliness alone, and wherever they abound, we have reason
to believe it is neglected.
One common cause of putrid and malignant fevers, is the want of
cleanliness. These fevers commonly begin among the inhabitants of close
dirty houses, who breathe unwholesome air, take little exercise, and wear
dirty clothes. There the infection is generally hatched, which often spreads
far and wide, to the destruction of many. Hence cleanliness may be
considered as an object of public attention. It is not sufficient that I be clean
myself, while the want of it in my neighbour affects my health as well as his
own. If dirty people cannot be removed as a common nuisance, they ought
at least to be avoided as infectious. All who regard their health should keep
at a distance even from their habitations.
In places where great numbers of people are collected, cleanliness
becomes of the utmost importance. It is well known that infectious diseases
are communicated by tainted air. Every thing, therefore, which tends to
pollute the air, or spread the infection, ought with the utmost care to be

guarded against. For this reason, in great towns, no filth, of any kind,
should be permitted to lie upon the streets. Nothing is more apt to convey
infection than the excrements of the diseased.
In many great towns the streets are little better than dunghills, being
frequently covered with ashes, dung, and nastiness of every kind. Even
slaughterhouses, or killing shambles, are often to be seen in the very centre
of great towns. The putrid blood, excrements, &c. with which these places
are generally covered, cannot fail to taint the air, and render it
unwholesome. How easily might this be prevented by active magistrates,
who have it always in their power to make proper laws relative to things of
this nature, and to enforce the observance of them!
We are sorry to say, that the importance of general cleanliness does not
seem to be sufficiently understood by the magistrates of most great towns in
Britain; though health, pleasure, and delicacy, all conspire to recommend an
attention to it. Nothing can be more agreeable to the senses, more to the
honour of the inhabitants, or more conducive to their health, than a clean
town; nor can any thing impress a stranger with a more disrespectful idea of
any people than its opposite. Whatever pretensions people may make to
learning, politeness, or civilization, we will venture to affirm, that while
they neglect cleanliness, they are in a state of barbarity[46].
The peasants in most countries seem to hold cleanliness in a sort of
contempt. Were it not for the open situation of their houses, they would
often feel the bad effects of this disposition. One seldom sees a farm-house
without a dunghill before the door, and frequently the cattle and their
masters lodge under the same roof. Peasants are likewise extremely careless
with respect to change of apparel, keeping their houses, &c. clean. This is
merely the effect of indolence and a dirty disposition. Habit may indeed
render it less disagreeable to them, but no habit can ever make it salutary to
wear dirty clothes or breathe unwholesome air.
As many articles of diet come through the hands of peasants, every
method should be taken to encourage and promote habits of cleanliness
among them. This, for example, might be done by giving a small premium
to the person who brings the cleanest and best article of any kind to market,
as butter, cheese, &c. and by punishing severely those who bring it dirty.
The same method should be taken with butchers, bakers, brewers, and all
who are employed in preparing the necessaries of life.

In camps the strictest regard should be paid to cleanliness. By negligence
in this matter, infectious diseases are often spread amongst a whole army;
and frequently more die of these than by the sword. The Jews during their
encampments in the wilderness, received particular instructions with respect
to cleanliness[47]. The rules enjoined them ought to be observed by all in the
like situation. Indeed the whole system of laws delivered to that people has
a manifest tendency to promote cleanliness. Whoever considers the nature
of their climate, the diseases to which they were liable, and their dirty
disposition, will see the propriety of such laws.
It is remarkable that, in most eastern countries, cleanliness makes a great
part of their religion. The Mahometan, as well as the Jewish religion,
enjoins various bathings, washings, and purifications. No doubt these might
be designed to represent inward purity; but they were at the same time
calculated for the preservation of health. However whimsical these
washings may appear to some, few things would tend more to prevent
diseases than a proper attention to many of them. Were every person, for
example, after visiting the sick, handling a dead body, or touching any thing
that might convey infection, to wash before he went into company, or sat
down to meat, he would run less hazard either of catching the infection
himself, or of communicating it to others.
Frequent washing not only removes the filth and sordes which adhere to
the skin, but likewise promotes the perspiration, braces the body, and
enlivens the spirits. How refreshed, how cheerful, and agreeable does one
feel on being shaved, washed, and shifted; especially when these offices
have been neglected longer than usual!
The eastern custom of washing the feet, though less necessary in this
country, is nevertheless a very agreeable piece of cleanliness, and
contributes greatly to the preservation of health. The sweat and dirt with
which these parts are frequently covered, cannot fail to obstruct the
perspiration. This piece of cleanliness would often prevent colds and fevers.
Were people careful to bathe their feet and legs in lukewarm water at night,
after being exposed to cold or wet through the day, they would seldom
experience the ill effects which often proceed from these causes.
A proper attention to cleanliness is no where more necessary than on
shipboard. If epidemical distempers break out there, no one can be safe. The
best way to prevent them, is to take care that the whole company be cleanly

in their clothes, bedding, &c. When infectious diseases do break out,
cleanliness is the most likely means to prevent their spreading; it is likewise
necessary to prevent their returning afterwards, or being conveyed to other
places. For this purpose, the clothes, bedding, &c. of the sick ought to be
carefully washed, and fumigated with brimstone. Infection will lodge a long
time in dirty clothes, and afterwards break out in the most terrible manner.
In places where great numbers of sick people are collected together,
cleanliness ought to be most religiously observed. The very smell in such
places is often sufficient to make one sick. It is easy to imagine what effect
that is likely to have upon the diseased. In an hospital or infirmary, where
cleanliness is neglected, a person in perfect health has a greater chance to
become sick, than a sick person has to get well.
Few things are more unaccountable than that neglect, or rather dread of
cleanliness, which appears among those who have the care of the sick; they
think it almost criminal to suffer any thing that is clean to come near a
person in a fever, for example, and would rather allow him to wallow in all
manner of filth, than change the least bit of his linen. If cleanliness be
necessary for persons in health, it is certainly more so for the sick. Many
diseases may be cured by cleanliness alone; most of them might be
mitigated by it; and, where it is neglected, the slightest disorders are often
changed into the most malignant. The same mistaken care which prompted
people to prevent the least admission of fresh air to the sick, seems to have
induced them to keep them dirty. Both these destructive prejudices will, we
hope, be soon entirely eradicated.
Cleanliness is certainly agreeable to our nature. We cannot help
approving it in others, even though we should not practice it ourselves. It
sooner attracts our regard than even finery itself, and often gains esteem
where that fails. It is an ornament to the highest as well as the lowest
station, and cannot be dispensed with in either. Few virtues are of more
importance to society than general cleanliness. It ought to be carefully
cultivated every where; but in populous cities it should be almost revered[48].

CHAP. IX.
OF INFECTION.

Many diseases are infectious. Every person ought therefore, as far as he
can, to avoid all communication with the diseased. The common practice of
visiting the sick, though often well meant, has many ill consequences. Far
be it from us to discourage any act of charity or benevolence, especially
towards those in distress; but we cannot help blaming such as endanger
their own or their neighbours lives by a mistaken friendship or an
impertinent curiosity.
The houses of the sick, especially in the country, are generally crowded
from morning till night with idle visitors. It is customary, in such places, for
servants and young people to wait upon the sick by turns, and even to sit up
with them all night. It would be a miracle indeed should such always
escape. Experience teaches us the danger of this conduct. People often catch
fevers in this way, and communicate them to others, till at length they
become epidemic.
It would be thought highly improper, for one who had not had the small-
pox, to wait upon a patient in that disease; yet many other fevers are almost
as infectious as the small-pox, and not less fatal. Some imagine that fevers
prove more fatal in villages than in great towns, for want of proper medical
assistance. This may sometimes be the case; but we are inclined to think it
oftener proceeds from the cause above mentioned.
Were a plan to be laid down for communicating infection, it could not be
done more effectually than by the common method of visiting the sick.
Such visitors not only endanger themselves and their connections, but
likewise hurt the sick. By crowding the house, they render the air
unwholesome, and by their private whispers and dismal countenances
disturb the imagination of the patient, and depress his spirits. Persons who
are ill, especially in fevers, ought to be kept as quiet as possible. The sight
of strange faces, and every thing that disturbs the mind, hurts them.

The common practice in country-places of inviting great numbers of
people to funerals, and crowding them into the same apartment where the
corpse lies, is another way of spreading infection. The infection does not
always die with the patient. Every thing that comes into contact with his
body while alive, receives the contagion, and some of them, as clothes,
blankets, &c. will retain it for a long time. Persons who die of infectious
disorders ought not to lie long unburied; and people should keep as much as
possible at a distance from them.
It would tend greatly to prevent the spreading of infectious diseases, if
those in health were kept at a proper distance from the sick. The Jewish
Legislator, among many other wise institutions for preserving health, has
been peculiarly attentive to the means of preventing infection, or defilement
as it is called, either from a diseased person or a dead body. In many cases
the diseased were to be separated from those in health; and it was deemed a
crime even to approach their habitations. If a person only touched a
diseased or dead body, he was appointed to wash himself in water, and to
keep for some time at a distance from society.
Infectious diseases are often communicated by clothes. It is extremely
dangerous to wear apparel which has been worn by the deceased, unless it
has been well washed and fumigated, as infection may lodge a long time in
it, and afterwards produce very tragical effects. This shews the danger of
buying at random the clothes which have been worn by other people.
Infectious disorders are frequently imported. Commerce, together with
the riches of foreign climes, brings us also their diseases. These do often
more than counterbalance all the advantages of that trade by means of
which they are introduced. It is to be regretted, that so little care is
commonly bestowed, either to prevent the introduction or spreading of
infectious maladies. Some attention indeed is generally paid to the plague;
but other diseases pass unregarded[49].
Infection is often spread through cities, by jails, hospitals, &c. These are
frequently situated in the very middle of populous towns; and when
infectious diseases break out in them, it is impossible for the inhabitants to
escape. Did magistrates pay any regard to the health of the people, this evil
might be easily remedied.
Many are the causes which tend to diffuse infection through populous
cities. The whole atmosphere of a large town is one contaminated mass,

abounding with various kinds of infection, and must be pernicious to health.
The best advice that we can give to such as are obliged to live in large cities
is, to chuse an open situation; to avoid narrow, dirty, crowded streets; to
keep their own house and offices clean; and to be as much abroad in the
open air as their time will permit.
It would tend greatly to prevent the spreading of infectious diseases, were
proper nurses every where employed to take care of the sick. This might
often save a family, or even a whole town, from being infected by one
person. We do not mean that people should abandon their friends or
relations in distress, but only to put them on their guard against being too
much in company with those who are afflicted with diseases of an
infectious nature.
Such as wait upon the sick in infectious diseases run very great hazard.
They should stuff their noses with tobacco, or some other strong smelling
herb, as rue, tansy, or the like. They ought likewise to keep the patient very
clean, to sprinkle the room where he lies with vinegar, or other strong acids,
frequently to admit a stream of fresh air into it, and to avoid the smell of his
breath as much as they can. They ought never to go into company without
having changed their clothes and washed their hands; otherwise, if the
disease be infectious, they will in all probability carry the contagion along
with them[50].
However trifling it may appear to inconsiderate persons, we will venture
to affirm, that a due attention to those things which tend to diffuse infection
would be of great importance in preventing diseases. As most diseases are
in some degree infectious, no one should continue long with the sick,
except the necessary attendants. I mean not, however, by this caution, to
deter those whose duty or office leads them to wait upon the sick, from such
a laudable and necessary employment.
Many things are in the power of the magistrate which would tend to
prevent the spreading of infection; as the promoting of public cleanliness;
removing jails, hospitals, burying grounds, and other places where infection
may be generated, at a proper distance from great towns[51]; widening the
streets; pulling down useless walls, and taking all methods to promote a free
circulation of air through every part of the town, &c. Public hospitals, or
proper places of reception for the sick, provided they were kept clean, well
ventilated, and placed in an open situation, would likewise tend to prevent

the spreading of infection. Such places of reception would prevent the poor,
when sick, from being visited by their idle or officious neighbours. They
would likewise render it unnecessary for sick servants to be kept in their
master’s houses. Masters had better pay for having their servants taken care
of in an hospital, than run the hazard of having an infectious disease
diffused among a numerous family. Sick servants and poor people, when
placed in hospitals, are not only less apt to diffuse infection among their
neighbours, but have likewise the advantage of being well attended.
We are not, however, to learn that hospitals, instead of preventing
infection, may become the means of diffusing it. When they are placed in
the middle of great towns; when numbers of patients are crowded together
in small apartments; when there is a constant communication kept up
between the citizens and the patients; and when cleanliness and ventilation
are neglected, they become nests for hatching diseases, and every one who
goes into them not only runs a risk of receiving infection himself, but
likewise of communicating it to others. This however is not the fault of the
hospitals, but of those who have the management of them. It were to be
wished, that they were both more numerous, and upon a more respectable
footing, as that would induce people to go into them with less reluctance.
This is the more to be desired, because most of the putrid fevers and other
infectious disorders break out among the poor, and are by them
communicated to the better sort. Were proper attention paid to the first
appearances of such disorders, and the patients early conveyed to an
hospital, we should seldom see a putrid fever, which is almost as infectious
as the plague, become epidemic.

CHAP. X.
OF THE PASSIONS.

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

Of Anger.

The passion of anger ruffles the mind, distorts the countenance, hurries
on the circulation of the blood, and disorders the whole vital and animal
functions. It often occasions fevers, and other acute diseases; and
sometimes even sudden death. This passion is peculiarly hurtful to the
delicate, and those of weak nerves. I have known such persons frequently
lose their lives by a violent fit of anger, and would advise them to guard
against the excess of this passion with the utmost care.
It is not indeed always in our power to prevent being angry; but we may
surely avoid harbouring resentment in our breast. Resentment preys upon
the mind, and occasions the most obstinate chronical disorders, which
gradually waste the constitution. Nothing shews true greatness of mind
more than to forgive injuries; it promotes the peace of society, and greatly
conduces to our own ease, health, and felicity.
Such as value health should avoid violent gusts of anger, as they would
the most deadly poison. Neither ought they to indulge resentment, but to
endeavour at all times to keep their minds calm and serene. Nothing tends
so much to the health of the body as a constant tranquillity of mind.

Of Fear.

The influence of fear, both in occasioning and aggravating diseases, is
very great. No man ought to be blamed for a decent concern about life; but
too great a desire to preserve it is often the cause of losing it. Fear and
anxiety, by depressing the spirits, not only dispose us to diseases, but often
render those diseases fatal which an undaunted mind would overcome.
Sudden fear has generally violent effects. Epileptic fits, and other
convulsive disorders, are often occasioned by it. Hence the danger of that
practice, so common among young people, of frightening one another.
Many have lost their lives, and others have been rendered miserable, by
frolics of this kind. It is dangerous to tamper with the human passions. The
mind may easily be thrown into such disorder as never again to act with
regularity.
But the gradual effects of fear prove most hurtful. The constant dread of
some future evil, by dwelling upon the mind, often occasions the very evil
itself. Hence it comes to pass, that so many die of those very diseases of
which they long had a dread, or which had been impressed on their minds
by some accident, or foolish prediction. This, for example, is often the case
with women in child-bed. Many of those who die in that situation are
impressed with the notion of their death a long time before it happens; and
there is reason to believe that this impression is often the cause of it.
The methods taken to impress the minds of women with the
apprehensions of the great pain and peril of child-birth, are very hurtful.
Few women die in labour, though many lose their lives after it; which may
be thus accounted for. A woman after delivery, finding herself weak and
exhausted, immediately apprehends she is in danger; but this fear seldom
fails to obstruct the necessary evacuations, upon which her recovery
depends. Thus the sex often fall a sacrifice to their own imaginations, when
there would be no danger, did they apprehend none.
It seldom happens that two or three women in a great town die in child-
bed, but their death is followed by many others. Every woman of their
acquaintance who is with child dreads the same fate, and the disease
becomes epidemical by the mere force of imagination. This should induce
pregnant women to despise fear, and by all means to avoid those tattling
gossips who are continually buzzing in their ears the misfortunes of others.
Every thing that may in the least alarm a pregnant or child-bed woman,
ought with the greatest care to be guarded against.

Many women have lost their lives in child-bed by the old superstitious
custom, still kept up in most parts of Britain, of tolling the parish bell for
every person who dies. People who think themselves in danger are very
inquisitive; and if they come to know that the bell tolls for one who died in
the same situation with themselves, what must be the consequence? At any
rate they are apt to suppose that this is the case, and it will often be found a
very difficult matter to persuade them of the contrary.
But this custom is not pernicious to child-bed women only. It is hurtful in
many other cases. When low fevers, in which it is difficult to support the
patient’s spirits, prevail, what must be the effect of a funeral peal sounding
five or six times a day in his ears? No doubt his imagination will suggest
that others died of the same disease under which he labours. This
apprehension will have a greater tendency to depress his spirits, than all the
cordials of which medicine can boast will have to raise them.
If this useless piece of ceremony cannot be abolished, we ought to keep
the sick as much from hearing it as possible, and from every other thing that
may tend to alarm them. So far however is this from being generally
attended to, that many make it their business to visit the sick, on purpose to
whisper dismal stories in their ears. Such may pass for sympathizing
friends, but they ought rather to be considered as enemies. All who wish
well to the sick ought to keep such persons at the greatest distance from
them.
A custom has long prevailed among physicians, of prognosticating, as
they call it, the patient’s fate, or foretelling the issue of the disease. Vanity
no doubt introduced this practice, and still supports it, in spite of common
sense and the safety of mankind. I have known a physician barbarous
enough to boast, that he pronounced more sentences than all his Majesty’s
judges. Would to God that such sentences were not often equally fatal! It
may indeed be alleged, that the doctor does not declare his opinion before
the patient. So much the worse. A sensible patient had better hear what the
doctor says, than learn it from the disconsolate looks, the watery eyes, and
the broken whispers of those about him. It seldom happens, when the doctor
gives an unfavourable opinion, that it can be concealed from the patient.
The very embarrassment which the friends and attendants shew in
disguising what he has said, is generally sufficient to discover the truth.

Kind Heaven has, for the wisest ends, concealed from mortals their fate;
and we do not see what right any man has to announce the death of another,
especially if such a declaration has a chance to kill him. Mankind are
indeed very fond of prying into future events, and seldom fail to solicit the
physician for his opinion. A doubtful answer, however, or one that may tend
rather to encourage the hopes of the sick, is surely the most safe. This
conduct could neither hurt the patient nor the physician. Nothing tends
more to destroy the credit of physic than those bold prognosticators, who,
by the bye, are generally the most ignorant of the faculty. The mistakes
which daily happen in this way are so many standing proofs of human
vanity, and the weakness of science.
We readily admit, that there are cases where the physician ought to give
intimation of the patient’s danger to some of his near connexions; though
even this ought always to be done with the greatest caution: but it never can
be necessary in any case that the whole town and country should know,
immediately after the doctor has made his first visit, that he has no hopes of
his patient’s recovery. Persons whose impertinent curiosity leads them to
question the physician, with regard to the fate of his patient, certainly
deserve no other than an evasive answer.
The vanity of foretelling the fate of the sick is not peculiar to the faculty.
Others follow their example, and those who think themselves wiser than
their neighbours often do much hurt in this way. Humanity surely calls upon
every one to comfort the sick, and not to add to their affliction by alarming
their fears. A friend, or even a physician, may often do more good by a mild
and sympathizing behaviour than by medicine, and should never neglect to
administer that greatest of all cordials, Hope.

Of Grief.

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

No person can prevent misfortunes in life; but it shews true greatness of
mind to bear them with serenity. Many persons make a merit of indulging
grief, and when misfortunes happen, they obstinately refuse all consolation,
till the mind, overwhelmed with melancholy, sinks under the load. Such
conduct is not only destructive to health, but inconsistent with reason,
religion, and common sense.
Change of ideas is as necessary for health as change of posture. When the
mind dwells long upon one subject, especially of a disagreeable nature, it
hurts the whole functions of the body. Hence grief indulged spoils the
digestion and destroys the appetite; by which means the spirits are
depressed, the nerves relaxed, the bowels inflated with wind, and the
humours, for want of fresh supplies of chyle, vitiated. Thus many an
excellent constitution has been ruined by a family misfortune, or any thing
that occasions excessive grief.
It is utterly impossible, that any person of a dejected mind should enjoy
health. Life may indeed be dragged out for a few years; but whoever would
live to a good old age, must be good-humoured and cheerful. This indeed is
not altogether in our own power; yet our temper of mind, as well as our
actions, depend greatly upon ourselves. We can either associate with
cheerful or melancholy companions, mingle in the amusements and offices
of life, or sit still and brood over our calamities as we choose. These, and
many such things, are certainly in our power, and from these the mind
generally takes its cast.
The variety of scenes which present themselves to the senses, were
certainly designed to prevent our attention from being too long fixed upon
any one object. Nature abounds with variety, and the mind, unless fixed
down by habit, delights in contemplating new objects. This at once points
out the method of relieving the mind in distress. Turn the attention
frequently to new objects. Examine them for some time. When the mind
begins to recoil, shift the scene. By this means a constant succession of new
ideas may be kept up, till the disagreeable ones entirely disappear. Thus
travelling, the study of any art or science, reading or writing on such
subjects as deeply engage the attention, will sooner expel grief than the
most sprightly amusements.
It has already been observed, that the body cannot be healthy unless it be
exercised; neither can the mind. Indolence nourishes grief. When the mind

has nothing else to think of but calamities, no wonder that it dwells there.
Few people who pursue business with attention are hurt by grief. Instead
therefore of abstracting ourselves from the world or business, when
misfortunes happen, we ought to engage in it with more than usual
attention, to discharge with double diligence the functions of our station,
and to mix with friends of a cheerful and social temper.
Innocent amusements are by no means to be neglected. These, by leading
the mind insensibly to the contemplation of agreeable objects, help to dispel
the gloom which misfortunes cast over it. They make time seem less
tedious, and have many other happy effects.
Some persons, when overwhelmed with grief, betake themselves to
drinking. This is making the cure worse than the disease. It seldom fails to
end in the ruin of fortune, character, and constitution.

Of Love.

Love is perhaps the strongest of all the passions; at least, when it
becomes violent, it is less subject to the control either of the understanding
or will, than any of the rest. Fear, anger, and several other passions, are
necessary for the preservation of the individual, but love is necessary for the
continuation of the species itself; it was therefore proper that this passion
should be deeply rooted in the human breast.
Though love be a strong passion, it is seldom so rapid in its progress as
several of the others. Few persons fall desperately in love all at once. We
would therefore advise every one, before he tampers with this passion, to
consider well the probability of his being able to obtain the object of his
love. When that is not likely, he should avoid every occasion of increasing
it. He ought immediately to fly the company of the beloved object; to apply
his mind attentively to business or study; to take every kind of amusement;
and above all, to endeavour, if possible, to find another object which may
engage his affections, and which it may be in his power to obtain.
There is no passion with which people are so ready to tamper as love,
although none is more dangerous. Some men make love for amusement,
others from mere vanity, or on purpose to shew their consequence with the
fair. This is perhaps the greatest piece of cruelty which any one can be

guilty of. What we eagerly wish for we easily credit. Hence the too
credulous fair are often betrayed into a situation which is truly deplorable,
before they are able to discover that the pretended lover was only in jest.
But there is no jesting with this passion. When love is got to a certain
height, it admits of no other cure but the possession of its object, which in
this case ought always if possible to be obtained[52].

Of Religious Melancholy.

Many persons of a religious turn of mind behave as if they thought it a
crime to be cheerful. They imagine the whole of religion consists in certain
mortifications, or denying themselves the smallest indulgence, even of the
most innocent amusements. A perpetual gloom hangs over their
countenances, while the deepest melancholy preys upon their minds. At
length the fairest prospects vanish, every thing puts on a dismal appearance,
and those very objects which ought to give delight afford nothing but
disgust. Life itself becomes a burden, and the unhappy wretch, persuaded
that no evil can equal what he feels, often puts an end to his own miserable
existence.
It is great pity that ever religion should be so far perverted, as to become
the cause of those very evils which it was designed to cure. Nothing can be
better calculated than True Religion, to raise and support the mind of its
votaries under every affliction that can befal them. It teaches them that even
the sufferings of this life are preparatory to the happiness of the next; and
that all who persist in a course of virtue shall at length arrive at complete
felicity.
Persons whose business it is to recommend religion to others, should
beware of dwelling too much on gloomy subjects. That peace and
tranquillity of mind, which true religion is calculated to inspire, is a more
powerful argument in its favour than all the terrors that can be uttered.
Terror may indeed deter men from outward acts of wickedness, but can
never inspire them with that love of God, and real goodness of heart, in
which alone true religion consists.
To conclude; the best way to counteract the violence of any passion, is to
keep the mind closely engaged in some useful pursuit.

CHAP. XI.
OF THE COMMON EVACUATIONS.

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

Of the Evacuation by Stool.

Few things conduce more to health than keeping the body regular. When
the fæces lie too long in the bowels, they vitiate the humours; and when
they are too soon discharged, the body is not sufficiently nourished. A
medium is therefore to be desired, which can only be obtained by regularity
in diet, sleep, and exercise. Whenever the body is not regular, there is
reason to suspect a fault in one or other of these.
Persons who eat and drink at irregular hours, and who eat various kinds
of food, and drink of several different liquors at every meal, have no reason
to expect either that their digestion will be good, or their discharges regular.
Irregularity in eating and drinking disturbs every part of the animal
œconomy, and never fails to occasion diseases. Either too much or too little
food will have this effect. The former indeed generally occasions looseness,
and the latter costiveness; but both have a tendency to hurt the health.
It would be difficult to ascertain the exact number of stools which may be
consistent with health, as these differ in the different periods of life, in
different constitutions, and even in the same constitution under a different
regimen of diet, exercise, &c. It is however generally allowed, that one
stool a-day is sufficient for an adult, and that less is hurtful. But this, like
most general rules, admits of many exceptions. I have known persons in

perfect health who did not go to stool above once a-week. Such a degree of
costiveness however is not safe; though the person who labours under it
may for some time enjoy tolerable health, yet at length it may occasion
diseases.
One method of procuring a stool every day is to rise betimes, and go
abroad in the open air. Not only the posture in bed is unfavourable to
regular stools, but also the warmth. This, by promoting the perspiration,
lessens all the other discharges.
The method recommended for this purpose by Mr. Locke is likewise very
proper, viz. to solicit nature, by going regularly to stool every morning
whether one has a call or not. Habits of this kind may be acquired, which
will in time become natural.
Persons who have frequent recourse to medicines for preventing
costiveness seldom fail to ruin their constitution. Purging medicines
frequently repeated weaken the bowels, hurt the digestion, and every dose
makes way for another, till at length they become as necessary as daily
bread. Those who are troubled with costiveness ought rather, if possible, to
remove it by diet than drugs. They should likewise go thinly clothed, and
avoid every thing of an astringent or of an heating nature. The diet and
other regimen necessary in this case will be found under the article
Costiveness, where this state of the bowels is treated as a disease.
Such persons as are troubled with a habitual looseness ought likewise to
suit their diet to the nature of their complaint. They should use food which
braces and strengthens the bowels, and which is rather of an astringent
quality, as wheat-bread made of the finest flour, cheese, eggs, rice boiled in
milk, &c. Their drink should be red port, claret, brandy and water in which
toasted bread has been boiled, and such like.
As a habitual looseness is often owing to an obstructed perspiration,
persons affected with it ought to keep their feet warm, to wear flannel next
their skin, and take every other method to promote the perspiration. Further
directions with regard to the treatment of this complaint will be found under
the article Looseness.

Of Urine.

So many things tend to change both the quantity and appearances of the
urine, that it is very difficult to lay down any determined rules for judging
of either[53]. Dr. Cheyne says, the urine ought to be equal to three-fourths of
the liquid part of our aliment. But suppose any one were to take the trouble
of measuring both, he would find that every thing which altered the degree
of perspiration, would alter this proportion, and likewise that different kinds
of aliment would afford very different quantities of urine. Though for these,
and other reasons, no rule can be given for judging of the precise quantity
of urine which ought to be discharged, yet a person of common sense will
seldom be at a loss to know when it is in either extreme.
As a free discharge of urine not only prevents but actually cures many
diseases, it ought by all means to be promoted; and every thing that may
obstruct it should be carefully avoided. Both the secretion and discharge of
urine are lessened by a sedentary life, sleeping on beds that are too soft and
warm, food of a dry and heating quality, liquors which are astringent and
heating, as red port, claret, and such like. Those who have reason to suspect
that their urine is in too small quantity, or who have any symptoms of the
gravel, ought not only to avoid these things, but whatever else they find has
a tendency to lessen the quantity of their urine.
When the urine is too long retained, it is not only resorbed, or taken up
again into the mass of fluids, but by stagnating in the bladder it becomes
thicker, the more watery parts flying off first, and the more gross and earthy
remaining behind. By the constant tendency which these have to concrete,
the formation of stones and gravel in the bladder is promoted. Hence it
comes to pass, that indolent and sedentary people are much more liable to
these diseases, than persons of a more active life.
Many persons have lost their lives, and others have brought on very
tedious, and even incurable disorders, by retaining their urine too long,
from a false delicacy. When the bladder has been over-distended, it often
loses its power of action altogether, or becomes paralytic, by which means
it is rendered unable either to retain the urine, or expel it properly. The calls
of Nature ought never to be postponed. Delicacy is doubtless a virtue, but
that can never be reckoned true delicacy, which induces any one to risk his
health or hazard his life.
But the urine may be in too great as well as too small a quantity. This
may be occasioned by drinking large quantities of weak watery liquors, by

the excessive use of alkaline salts, or any thing that stimulates the kidnies,
dilutes the blood, &c. This disorder very soon weakens the body, and
induces a consumption. It is difficult to cure, but may be mitigated by
strengthening diet and astringent medicines, such as are recommended
under the article Diabetes, or excessive discharge of urine.

Of the Perspiration.

Insensible perspiration is generally reckoned the greatest of all the
discharges from the human body. It is of so great importance to health, that
few diseases attack us while it goes properly on; but when it is obstructed,
the whole frame is soon disordered. This discharge however, being less
perceptible than any of the rest, is consequently less attended to. Hence it is,
that acute fevers, rheumatisms, agues, &c. often proceed from obstructed
perspiration before we are aware of its having taken place.
On examining patients, we find most of them impute their diseases either
to violent colds which they had caught, or to slight ones which had been
neglected. For this reason, instead of a critical inquiry into the nature of the
perspiration, its difference in different seasons, climates, constitutions, &c.
we shall endeavour to point out the causes which most commonly obstruct
it, and to shew how far they may be either avoided, or have their influence
counteracted by timely care. The want of a due attention to these, costs
Britain annually some thousands of useful lives.

Changes in the Atmosphere.

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

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

Wet Clothes.

Wet clothes not only by their coldness obstruct the perspiration, but their
moisture, by being absorbed, or taken up into the body, greatly increases the
danger. The most robust constitution is not proof against the danger arising
from wet clothes; they daily occasion fevers, rheumatisms, and other fatal
disorders, even in the young and healthy.
It is impossible for people who go frequently abroad to avoid sometimes
being wet. But the danger might generally be lessened, if not wholly
prevented, by changing their clothes soon; when this cannot be done, they
should keep in motion till they be dry. So far are many from taking this
precaution, that they often sit or lie down in the fields with their clothes
wet, and frequently sleep even whole nights in this condition. The frequent
instances which we have of the fatal effects of this conduct, ought certainly
to deter others from being guilty of it.

Wet Feet.

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

Night Air.

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

Damp Beds.

Beds become damp, either from their not being used, standing in damp
houses, or in rooms without fire. Nothing is more to be dreaded by
travellers than damp beds, which are very common in all places where fuel
is scarce. When a traveller, cold and wet, arrives at an inn, he may by means
of a good fire, warm diluting liquor, and a dry bed, have the perspiration
restored; but if he be put into a cold room, and laid on a damp bed, it will be
more obstructed, and the worst consequences will ensue. Travellers should
avoid inns which are noted for damp beds, as they would a house infected
with the plague, as no man, however robust, is proof against the danger
arising from them.
But inns are not the only places where damp beds are to be met with.
Beds kept in private families for the reception of strangers are often equally
dangerous. All kinds of linen and bedding, when not frequently used,
become damp. How then is it possible that beds, which are not slept in
above two or three times a year, should be safe? Nothing is more common
than to hear people complain of having caught cold by changing their bed.
The reason is obvious: were they careful never to sleep in a bed but what
was frequently used, they would seldom find any ill consequences from a
change.

Nothing is more to be dreaded by a delicate person when on a visit, than
being laid in a bed which is kept on purpose for strangers. That ill-judged
piece of complaisance becomes a real injury. All the bad consequences from
this quarter might easily be prevented in private families, by causing their
servants to sleep in the spare beds, and resign them to strangers when they
come. In inns where the beds are used almost every night, nothing else is
necessary than to keep the rooms well seasoned by frequent fires, and the
linen dry.
That baneful custom said to be practised in many inns, of damping
sheets, and pressing them in order to save washing, and afterwards laying
them on the beds, ought, when discovered; to be punished with the utmost
severity. It is really a species of murder, and will often prove as fatal as
poison or gunshot. Indeed no linen, especially if it has been washed in
winter, ought to be used till it has been exposed for some time to the fire;
nor is this operation less necessary for linen washed in summer, provided it
has lain by for any length of time. This caution is the more needful, as
gentlemen are often exceedingly attentive to what they eat or drink at an
inn, yet pay no regard to a circumstance of much more importance[55].

Damp Houses.

Damp houses frequently produce the like ill consequences; for this
reason those who build should be careful to chuse a dry situation. A house
which stands on a damp marshy soil or deep clay, will never be thoroughly
dry. All houses, unless where the ground is exceeding dry, should have the
first door a little raised. Servants and others, who are obliged to live in
cellars and sunk stories, seldom continue long in health: masters ought
surely to pay some regard to the health of their servants, as well as to their
own.
Nothing is more common than for people, merely to avoid some trifling
inconveniency, to hazard their lives, by inhabiting a house almost as soon as
the masons, plasterers, &c. have done with it: such houses are not only
dangerous from their dampness, but likewise from the smell of lime, paint,
&c. The asthmas, consumptions, and other diseases of the lungs, so incident
to people who work in these articles, are sufficient proofs of their being
unwholesome.

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

Sudden Transitions from Heat to Cold.

The perspiration is commonly obstructed by SUDDEN TRANSITIONS from
heat to cold. Colds are seldom caught, unless when people have been too
much heated. Heat rarifies the blood, quickens the circulation, and increases
the perspiration; but when these are suddenly checked, the consequences
must be bad. It is indeed impossible for labourers not to be too hot upon
some occasions; but it is generally in their power to let themselves cool
gradually, to put on their clothes when they leave off work, to make choice
of a dry place to rest themselves in, and to avoid sleeping in the open fields.
These easy rules, if observed, would often prevent fevers and other fatal
disorders.
It is very common for people, when hot, to drink freely of cold water, or
small liquors. This conduct is extremely dangerous. Thirst indeed is hard to
bear, and the inclination to gratify that appetite frequently gets the better of
reason, and makes us do what our judgment disapproves. Every peasant,
however, knows, if his horse be permitted to drink his bellyful of cold water
after violent exercise, and be immediately put into the stable, or suffered to
remain at rest, that it will kill him. This they take the utmost care to prevent.
It were well if they were equally attentive to their own safety.
Thirst may be quenched many ways without swallowing large quantities
of cold liquor. The fields afford variety of acid fruits and plants, the very
chewing of which would abate thirst. Water kept in the mouth for some
time, and spit out again, if frequently repeated, will have the same effect. If
a bit of bread be eaten along with a few mouthfuls of water, it will both
quench thirst more effectually, and make the danger less. When a person is
extremely hot, a mouthful of brandy, or other spirits, if it can be obtained,
ought to be preferred to any thing else. But if any one has been so foolish,

when hot, as to drink freely of cold liquor, he ought to continue his exercise
at least till what he drank be thoroughly warmed upon his stomach.
It would be tedious to enumerate all the bad effects which flow from
drinking cold liquors when the body is hot. Sometimes this has occasioned
immediate death. Hoarseness, quinseys, and fevers of various kinds, are its
common consequences. Neither is it safe when warm to eat freely of raw
fruits, sallads, or the like. These indeed have not so sudden an effect on the
body as cold liquors, but they are notwithstanding dangerous, and ought to
be avoided.
Sitting in a warm room, and drinking hot liquors till the pores are quite
open, and immediately going into the cold air, is extremely dangerous.
Colds, coughs, and inflammations of the breast, are the usual effects of this
conduct: yet nothing is more common than for people, after they have drank
warm liquors for several hours, to walk or ride a number of miles in the
coldest night, or to ramble about in the streets[57].
People are very apt, when a room is hot, to throw open a window, and to
sit near it. This is a most dangerous practice. Any person had better sit
without doors than in such a situation, as the current of air is directed
against one particular part of the body. Inflammatory fevers and
consumptions have often been occasioned by sitting or standing thinly
clothed near an open window. Nor is sleeping with open windows less to be
dreaded. That ought never to be done, even in the hottest season, unless the
window is at a distance. I have known mechanics frequently contract fatal
diseases, by working stript at an open window, and would advise all of them
to beware of such a practice.
Few things expose people more to catch cold than keeping their own
houses too warm; such persons may be said to live in a sort of hot-houses;
they can hardly stir abroad to visit a neighbour, but at the hazard of their
lives. Were there no other reason for keeping houses moderately cool, that
alone is sufficient: but no house that is too hot can be wholesome; heat
destroys the spring and elasticity of the air, and renders it less fit for
expanding the lungs, and the other purposes of respiration. Hence it is, that
consumptions and other diseases of the lungs prove so fatal to people who
work in forges, glasshouses, and the like.
Some are even so fool-hardy, as to plunge themselves when hot in cold
water. Not only fevers, but madness itself, has frequently been the effect of

this conduct. Indeed it looks too like the action of a madman to deserve a
serious consideration.
The result of all these observations is, that every one ought to avoid, with
the utmost attention, all sudden transitions from heat to cold, and to keep
the body in as uniform a temperature as possible; or, where that cannot be
done, to take care to let it cool gradually.
People may imagine that too strict an attention to these things would tend
to render them delicate. So far however is this from being my design, that
the very first rule proposed for preventing colds, is to harden the body, by
enuring it daily to the open air.
I shall put an end to what relates to this part of my subject, by giving an
abstract of the justly celebrated advice of Celsus, with respect to the
preservation of health. “A man,” says he, “who is blessed with good health,
should confine himself to no particular rules, either with respect to regimen
or medicine. He ought frequently to diversify his manner of living; to be
sometimes in town, sometimes in the country; to hunt, sail, indulge himself
in rest, but more frequently to use exercise. He ought to refuse no kind of
food that is commonly used, but sometimes to eat more and sometimes less;
sometimes to make one at an entertainment, and sometimes to forbear it; to
make rather two meals a-day than one, and always to eat heartily, provided
he can digest it. He ought neither too eagerly to pursue, nor too
scrupulously to avoid, intercourse with the fair sex: pleasures of this kind,
rarely indulged, render the body alert and active; but, when too frequently
repeated, weak and languid. He should be careful in time of health not to
destroy, by excesses of any kind, that vigour of constitution which should
support him under sickness.”

PART II.
OF DISEASES.

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

The knowledge of diseases does not depend so much upon scientific
principles as many imagine. It is chiefly the result of experience and
observation. By attending the sick, and carefully observing the various
occurrences in diseases, a great degree of accuracy may be acquired, both in
distinguishing their symptoms, and in the application of medicines. Hence
sensible nurses, and other persons who wait upon the sick, often discover a
disease sooner than those who have been bred to physic. We do not
however mean to insinuate that a medical education is of no use: it is
doubtless of the greatest importance; but it never can supply the place of
observation and experience.
Every disease may be considered as an assemblage of symptoms, and
must be distinguished by those which are most obvious and permanent.
Instead therefore of giving a classical arrangement of diseases, according to
the systematic method, it will be more suitable, in a performance of this
nature, to give a full and accurate description of each particular disease as it
occurs; and, where any of the symptoms of one disease have a near
resemblance to those of another, to take notice of that circumstance, and at
the same time to point out the peculiar or characteristic symptoms by which
it may be distinguished. By a due attention to these, the investigation of
diseases will be found to be a less difficult matter than most people would
at first be ready to imagine.
A proper attention to the patient’s age, sex, temper of mind, constitution,
and manner of life, will likewise greatly assist, both in the investigation and
treatment of diseases.
In childhood the fibres are lax and soft, the nerves extremely irritable,
and the fluids thin; whereas in old age the fibres are rigid, the nerves
become almost insensible, and many of the vessels imperviable. These and

other peculiarities render the diseases of the young and aged very different,
and of course they must require a different method of treatment.
Females are liable to many diseases which do not afflict the other sex:
besides, the nervous system being more irritable in them than in men, their
diseases require to be treated with greater caution. They are less able to bear
large evacuations; and all stimulating medicines ought to be administered to
them with a sparing hand.
Particular constitutions not only dispose persons to peculiar diseases, but
likewise render it necessary to treat these diseases in a peculiar manner. A
delicate person, for example, with weak nerves, who lives mostly within
doors, must not be treated, under any disease, precisely in the same manner
as one who is hardy and robust, and who is much exposed to the open air.
The temper of mind ought to be carefully attended to in diseases. Fear,
anxiety, and a fretful temper, both occasion and aggravate diseases. In vain
do we apply medicines to the body to remove maladies which proceed from
the mind. When it is affected, the best medicine is to sooth the passions, to
divert the mind from anxious thought, and to keep the patient as easy and
cheerful as possible.
Attention ought likewise to be paid to the climate, or place where the
patient lives, the air he breathes, his diet, &c. Such as live in low marshy
situations are subject to many diseases which are unknown to the
inhabitants of high countries. Those who breathe the impure air of cities,
have many maladies to which the more happy rustics are entire strangers.
Persons who feed grossly, and indulge in strong liquors, are liable to
diseases which do not affect the temperate and abstemious, &c.
It has already been observed, that the different occupations and situations
in life dispose men to peculiar diseases. It is therefore necessary to inquire
into the patient’s occupation, manner of life, &c. This will not only assist us
in finding out the disease, but will likewise direct us in the treatment of it. It
would be very imprudent to treat the laborious and the sedentary precisely
in the same manner, even supposing them to labour under the same disease.
It will likewise be proper to inquire, whether the disease be constitutional
or accidental; whether it has been of long or short duration; whether it
proceeds from any great and sudden alteration in the diet, manner of life,
&c. The state of the patient’s body, and of the other evacuations, ought also

to be inquired into; and likewise whether he can with ease perform all the
vital and animal functions, as breathing, digestion, &c.
Lastly, it will be proper to inquire what diseases the patient has formerly
been liable to, and what medicines were most beneficial to him; if he has a
strong aversion to any particular drug, &c.
As many of the indications of cure may be answered by diet alone, it is
always the first thing to be attended to in the treatment of diseases. Those
who know no better, imagine that every thing which goes by the name of a
medicine possesses some wonderful power or secret charm, and think, if the
patient swallows enough of drugs, that he must do well. This mistake has
many ill consequences; it makes people trust to drugs, and neglect their own
endeavours; besides, it discourages all attempts to relieve the sick where
medicines cannot be obtained.
Medicines are no doubt useful in their place; and, when administered
with prudence, they may do much good; but when they are put in place of
every thing else, or administered at random, which is not seldom the case,
they must do mischief. We would therefore wish to call the attention of
mankind from the pursuit of secret medicines, to such things as they are
acquainted with. The proper regulation of these may often do much good,
and there is little danger of their ever doing hurt.
Every disease weakens the digestive powers. The diet ought therefore, in
all diseases, to be light and of easy digestion. It would be as prudent for a
person with a broken leg to attempt to walk, as for one in a fever to eat the
same kind of food, and in the same quantity, as when he was in perfect
health. Even abstinence alone will often cure a fever, especially when it has
been occasioned by excess in eating or drinking.
In all fevers attended with inflammation, as pleurisies, peripneumonies,
&c. thin gruels, wheys, watery infusions of mucilaginous plants, roots, &c.
are not only proper for the patients food, but they are likewise the best
medicines which can be administered.
In fevers of a slow, nervous, or putrid kind, where there are no symptoms
of inflammation, and where the patient must be supported with cordials,
that intention can always be more effectually answered by nourishing diet
and generous wines, than by any medicines yet known.
Nor is a proper attention to diet of less importance in chronic than in
acute diseases. Persons afflicted with low spirits, wind, weak nerves, and

other hypochondriacal affections, generally find more benefit from the use
of solid food and generous liquors, than from all the cordial and carminitive
medicines which can be administered to them.
The scurvy, that most obstinate malady, will sooner yield to a proper
vegetable diet, than to all the boasted antiscorbutic remedies of the shops.
In consumptions, when the humours are vitiated, and the stomach so
much weakened as to be unable to digest the solid fibres of animals, or even
to assimilate the juices of vegetables, a diet consisting chiefly of milk will
not only support the patient, but will often cure the disease after every other
medicine has failed.
Nor is an attention to other things of less importance than to diet. The
strange infatuation which has long induced people to shut up the sick from
all communication with the external air, has done great mischief. Not only
in fevers, but in many other diseases, the patient will receive more benefit
from having the fresh air prudently admitted into his chamber, than from all
the medicines which can be given him.
Exercise may likewise in many cases be considered as a medicine.
Sailing, or riding on horseback, for example, will be of more service in the
cure of consumptions, glandular obstructions, &c. than any medicine yet
known. In diseases which proceed from a relaxed state of the solids, the
cold bath, and other parts of the gymnastic regimen, will be found equally
beneficial.
Few things are of greater importance in the cure of diseases than
cleanliness. When a patient is suffered to lie in dirty clothes, whatever
perspires from his body is again resorbed, or taken up into it, which serves
to nourish the disease and increase the danger. Many diseases may be cured
by cleanliness alone; most of them may be mitigated by it, and in all of
them it is highly necessary both for the patient and those who attend him.
Many other observations, were it necessary, might be adduced to prove
the importance of a proper regimen in diseases. Regimen will often cure
diseases without medicine, but medicine will seldom succeed where a
proper regimen is neglected. For this reason, in the treatment of diseases,
we have always given the first place to regimen. Those who are ignorant of
medicine may confine themselves to it only. For others who have more
knowledge, we have recommended some of the most simple but approved
forms of medicine in every disease. These however are never to be

administered but by people of better understanding; nor even by them
without the greatest precaution.

CHAP. XIII.
OF FEVERS IN GENERAL.

As more than one half of mankind is said to perish by fevers, it is of
importance to be acquainted with their causes. The most general causes of
fevers are, infection, errors in diet, unwholesome air, violent emotions of the
mind, excess or suppression of usual evacuations, external or internal
injuries, and extreme degrees of heat or cold. As most of these have already
been treated of at considerable length, and their effects shewn, we shall not
now resume the consideration of them, but shall only recommend it to all,
as they would wish to avoid fevers and other fatal diseases, to pay the most
punctual attention to these articles.
Fevers are not only the most frequent of all diseases, but they are
likewise the most complex. In the most simple species of fever there is
always a combination of several different symptoms. The distinguishing
symptoms of fever are, increased heat, frequency of pulse, loss of appetite,
general debility, pain in the head, and a difficulty in performing some of the
vital or animal functions. The other symptoms usually attendant on fevers
are, nausea, thirst, anxiety, delirium, weariness, wasting of the flesh, want
of sleep, or the sleep disturbed and not refreshing.
When the fever comes on gradually, the patient generally complains first
of languor or listlessness, soreness of the flesh, or the bones, as the country
people express it, heaviness of the head, loss of appetite, sickness, with
clamminess of the mouth; after some time come on excessive heat, violent
thirst, restlessness, &c.
When the fever attacks suddenly, it always begins with an uneasy
sensation of excessive cold, accompanied with debility and loss of appetite;
frequently the cold is attended with shivering, oppression about the heart,
and sickness at stomach, or vomiting.
Fevers are divided into continual, remitting, intermitting, and such as are
attended with cutaneous eruption or topical inflammation, as the small-pox,

erysipelas, &c. By a continual fever is meant that which never leaves the
patient during the whole course of the disease, or which shews no
remarkable increase or abatement in the symptoms. This kind of fever is
likewise divided into acute, slow, and malignant. The fever is called acute
when its progress is quick, and the symptoms violent; but when these are
more gentle, it is generally denominated slow. When livid or petechial spots
shew a putrid state of the humours, the fever is called malignant, putrid, or
petechial.
A remitting fever differs from a continual only in a degree. It has frequent
increases and decreases, or exacerbations and remissions, but never wholly
leaves the patient during the course of the disease. Intermitting fevers or
agues are those which, during the time that the patient may be said to be ill,
have evident intervals or remissions of the symptoms.
As a fever is only an effort of Nature to free herself from an offending
cause, it is the business of those who have the care of the sick to observe
with diligence which way Nature points, and to endeavour to assist her
operations. Our bodies are so framed, as to have a constant tendency to
expel or throw off whatever is injurious to health. This is generally done by
urine, sweat, stool, expectoration, vomit, or some other evacuation.
There is reason to believe, if the efforts of Nature, at the beginning of a
fever, were duly attended to and promoted, it would seldom continue long;
but when her attempts are either neglected or counteracted, it is no wonder
if the disease proves fatal. There are daily instances of persons who, after
catching cold, have all the symptoms of a beginning fever; but by keeping
warm, drinking diluting liquors, bathing their feet in warm water, &c. the
symptoms in a few hours disappear, and the danger is prevented.
When fevers of a putrid kind threaten, the best method of obviating their
effects is by repeated vomits.
Our design is not to enter into a critical inquiry into the nature and
immediate causes of fevers, but to mark their most obvious symptoms, and
to point out the proper treatment of the patient with respect to his diet,
drink, air, &c. in the different stages of the disease. In these articles the
inclinations of the patient will in a great measure direct our conduct.
Almost every person in a fever complains of great thirst, and calls out for
drink, especially of a cooling nature. This at once points out the use of
water, and other cooling liquors. What is so likely to abate the heat,

attenuate the humours, remove spasms and obstructions, promote
perspiration, increase the quantity of urine, and in short produce every
salutary effect in an ardent or inflammatory fever, as drinking plentifully of
water, thin gruel, or any other weak liquor, of which water is the basis? The
necessity of diluting liquors is pointed out by the dry tongue, the parched
skin, and the burning heat, as well as by the unquenchable thirst of the
patient.
Many cooling liquors, which are extremely grateful to patients in a fever,
may be prepared from fruits, as decoctions of tamarinds, apple-tea, orange-
whey, and the like. Mucilaginous liquors might also be prepared from
marsh-mallow roots, linseed, lime-tree buds, and other mild vegetables.
These liquors, especially when acidulated, are highly agreeable to the
patient, and should never be denied him.
At the beginning of a fever the patient generally complains of great
lassitude or weariness, and has no inclination to move. This evidently shews
the propriety of keeping him easy, and if possible in bed. Lying in bed
relaxes the spasms, abates the violence of the circulation, and gives Nature
an opportunity of exerting all her force to overcome the disease. The bed
alone would often remove a fever at the beginning; but when the patient
struggles with the disease, instead of driving it off, he only fixes it the
deeper, and renders it more dangerous. This observation is too often verified
in travellers, who happen when on a journey to be seized with a fever. Their
anxiety to get home induces them to travel with the fever upon them, which
conduct seldom fails to render it fatal.
In fevers the mind as well as the body should be kept easy. Company is
seldom agreeable to the sick. Indeed every thing that disturbs the
imagination increases the disease; for which reason every person in a fever
ought to be kept perfectly quiet, and neither allowed to see nor hear any
thing that may in the least affect or discompose his mind.
Though the patient in a fever has the greatest inclination for drink, yet he
seldom has any appetite for solid food; hence the impropriety of urging him
to take victuals is evident. Much solid food in a fever is every way hurtful.
It oppresses nature, and, instead of nourishing the patient, serves only to
feed the disease. What food the patient takes should be in small quantity,
light, and of easy digestion. It ought to be chiefly of the vegetable kind, as
panada, roasted apples, gruels, and such like.

Poor people, when any of their family are taken ill, run directly to their
rich neighbours for cordials, and pour wine, spirits, &c. into the patient,
who perhaps never had been accustomed to taste such liquors when in
health. If there be any degree of fever, this conduct must increase it, and if
there be none, this is the ready way to raise one. Stuffing the patient with
sweetmeats and other delicacies is likewise very pernicious. These are
always harder to digest than common food, and cannot fail to hurt the
stomach.
Nothing is more desired by a patient in a fever than fresh air. It not only
removes his anxiety, but cools the blood, revives the spirits, and proves
every way beneficial. Many patients are in a manner stifled to death in
fevers for want of fresh air; yet such is the unaccountable infatuation of
most people, that the moment they think a person in a fever, they imagine
he should be kept in a close chamber, into which not one particle of fresh
air must be admitted. Instead of this, there ought to be a constant stream of
fresh air into a sick person’s chamber, so as to keep it moderately cool.
Indeed its degree of warmth ought never to be greater than is agreeable to
one in perfect health.
Nothing spoils the air of a sick person’s chamber, or hurts the patient
more, than a number of people breathing in it. When the blood is inflamed,
or the humours in a putrid state, air that has been breathed repeatedly will
greatly increase the disease. Such air not only loses its spring, and becomes
unfit for the purpose of respiration, but acquires a noxious quality, which
renders it in a manner poisonous to the sick.
In fevers, when the patient’s spirits are low and depressed, he is not only
to be supported with cordials, but every method should be taken to cheer
and comfort his mind. Many, from a mistaken zeal, when they think a
person in danger, instead of solacing his mind with the hopes and
consolations of religion, fright him with the views of hell and damnation. It
would be unsuitable here to dwell upon the impropriety and dangerous
consequences of this conduct; it often hurts the body, and there is reason to
believe seldom benefits the soul.
Among common people, the very name of a fever generally suggests the
necessity of bleeding. This notion seems to have taken its rise from most
fevers in this country having been formerly of an inflammatory nature; but
true inflammatory fevers are now seldom to be met with. Sedentary

occupations, and a different manner of living, have so changed the state of
diseases in Britain, that there is now hardly one fever in ten where the
lancet is necessary. In most low, nervous, and putrid fevers, which are now
so common, bleeding is really hurtful, as it weakens the patient, sinks his
spirits, &c. We would recommend this general rule, never to bleed at the
beginning of a fever, unless there be evident signs of inflammation.
Bleeding is an excellent medicine when necessary, but should never be
wantonly performed.
It is likewise a common notion, that sweating is always necessary in the
beginning of a fever. When the fever proceeds from an obstructed
perspiration, this notion is not ill-founded. If the patient only lies in bed,
bathes his feet and legs in warm water, and drinks freely of water-gruel, or
any other weak diluting liquor, he will seldom fail to perspire freely. The
warmth of the bed, and the diluting drink, will relax the universal spasm,
which generally affects the skin at the beginning of a fever; it will open the
pores, and promote the perspiration, by means of which the fever may often
be carried off. But instead of this, the common practice is to heap clothes
upon the patient, and to give him things of a hot nature, as spirits, spiceries,
&c. which fire his blood, increase the spasms, and render the disease more
dangerous.
In all fevers a proper attention should be paid to the patient’s longings.
These are the calls of Nature, and often point out what may be of real use.
Patients are not indeed to be indulged in every thing that the sickly appetite
may crave; but it is generally right to let them have a little of what they
eagerly desire, though it may not seem altogether proper. What the patient
longs for, his stomach will generally digest; and such things have
sometimes a very happy effect.
When a patient is recovering from a fever, great care is necessary to
prevent a relapse. Many persons, by too soon imagining themselves well,
have lost their lives, or contracted other diseases of an obstinate nature. As
the body after a fever is weak and delicate, it is necessary to guard against
catching cold. Moderate exercise in the open air will be of use, but great
fatigue is by all means to be avoided; agreeable company will also have a
good effect. The diet must be light, but nourishing. It should be taken
frequently, but in small quantities. It is dangerous at such a time to eat as
much as the stomach may crave.

CHAP. XIV.
OF INTERMITTING FEVERS, OR AGUES.

Intermitting fevers afford the best opportunity both of observing the nature
of a fever, and also the effects of medicine. No person can be at a loss to
distinguish an intermitting fever from any other, and the proper medicine
for it is now almost universally known.
The several kinds of intermitting fevers take their names from the period
in which the fit returns, as quotidian, tertian, quartan, &c.
CAUSES.——Agues are occasioned by effluvia from putrid stagnating
water. This is evident from their abounding in rainy seasons, and being most
frequent in countries where the soil is marshy, as in Holland, the Fens of
Cambridgeshire, the Hundreds of Essex, &c. This disease may also be
occasioned by eating too much stone fruit, by a poor watery diet, damp
houses, evening dews, lying upon the damp ground, watching, fatigue,
depressing passions, and the like. When the inhabitants of a high country
remove to a low one, they are generally seized with intermitting fevers, and
to such the disease is most apt to prove fatal. In a word, whatever relaxes
the solids, diminishes the perspiration, or obstructs the circulation in the
capillary or small vessels, disposes the body to agues.
SYMPTOMS.——An intermitting fever generally begins with a pain of
the head and loins, weariness of the limbs, coldness of the extremities,
stretching, yawning, with sometimes great sickness and vomiting; to which
succeed shivering and violent shaking. Afterwards the skin becomes moist,
and a profuse sweat breaks out, which generally terminates the fit or
paroxysm. Sometimes indeed the disease comes on suddenly, when the
person thinks himself in perfect health; but it is more commonly preceded
by listlessness, loss of appetite, and the symptoms mentioned above.
REGIMEN.——While the fit continues, the patient ought to drink freely
of water-gruel, orange-whey, weak camomile-tea; or, if his spirits be low,
small wine-whey, sharpened with the juice of lemon. All his drink should be

warm, as that will assist in bringing on the sweat, and consequently shorten
the paroxysm[58].
Between the paroxysms the patient must be supported with food that is
nourishing, but light and easy of digestion, as veal or chicken-broths, sago,
gruel with a little wine, light puddings, and such like. His drink may be
small negus, acidulated with the juice of lemons or oranges, and sometimes
a little weak punch. He may likewise drink infusions of bitter herbs, as
camomile, wormwood, or water-trefoil, and may now and then take a glass
of small wine, in which gentian root, centaury, or some other bitter, has
been infused.
As the chief intentions of cure in an ague are to brace the solids, and
promote perspiration, the patient ought to take as much exercise between
the fits as he can bear. If he be able to go abroad, riding on horseback, or in
a carriage, will be of great service. But if he cannot bear that kind of
exercise, he ought to take such as his strength will permit. Nothing tends
more to prolong an intermitting fever, than indulging a lazy indolent
disposition.
Intermitting fevers, under a proper regimen, will often go off without
medicine; and when the disease is mild, in an open dry country, there is
seldom any danger from allowing it to take its course; but when the
patient’s strength seems to decline, or the paroxysms are so violent that his
life is in danger, medicine ought immediately to be administered. This
however should never be done till the disease be properly formed, that is to
say, till the patient has had several fits of shaking and sweating.
MEDICINE.——The first thing to be done in the cure of an intermitting
fever, is to cleanse the stomach and bowels. This not only renders the
application of other medicines more safe, but likewise more efficacious. In
this disease, the stomach is generally loaded with cold viscid phlegm, and
frequently great quantities of bile are discharged by vomit; which plainly
points out the necessity of such evacuations. Vomits are therefore to be
administered before the patient takes any other medicine. A dose of
ipecacuanha will generally answer this purpose very well. A scruple or half
a dram of the powder will be sufficient for an adult, and for a younger
person the dose must be less in proportion. After the vomit begins to
operate, the patient ought to drink plentifully of weak camomile-tea. The
vomit should be taken two or three hours before the return of the fit, and

may be repeated at the distance of two or three days. Vomits not only
cleanse the stomach, but increase the perspiration, and all the other
secretions, which render them of such importance, that they often cure
intermitting fevers without the assistance of any other medicine.
Purging medicines are likewise useful and often necessary in intermitting
fevers. A smart purge has been known to cure an obstinate ague, after the
Peruvian bark and other medicines had been used in vain. Vomits however
are more suitable in this disease, and render purging less necessary; but if
the patient be afraid to take a vomit, he ought in this case to cleanse the
bowels by a dose or two of Glauber’s salt, jalap, or rhubarb.
Bleeding may sometimes be proper at the beginning of an intermitting
fever, when excessive heat, a delirium, &c. give reason to suspect an
inflammation; but as the blood is seldom in an inflammatory slate in
intermitting fevers, this operation is rarely necessary. When frequently
repeated, it tends to prolong the disease.
After proper evacuations the patient may safely use the Peruvian bark,
which may be taken in any way that is most agreeable to him. No
preparation of the bark seems to answer better than the most simple form in
which it can be given, viz. in powder.
Two ounces of the best Peruvian bark, finely powdered, may be divided
into twenty-four doses. These may either be made into boluses as they are
used, with a little syrup of lemon, or mixed in a glass of red wine, a cup of
camomile-tea, water-gruel, or any other drink that is more agreeable to the
patient[59].
In an ague which returns every day, one of the above doses may be taken
every two hours during the interval of the fits. By this method the patient
will be able to take five or six doses between each paroxysm. In a tertian or
third-day ague it will be sufficient to take a dose every third hour during the
interval, and in a quartan every fourth. If the patient cannot take so large a
dose of the bark, he may divide each of the powders into two parts, and take
one every hour, &c. For a young person a smaller quantity of this medicine
will be sufficient, and the dose must be adapted to the age, constitution, and
violence of the symptoms[60].
The above quantity of bark will frequently cure an ague; the patient,
however, ought not to leave off taking the medicine as soon as the
paroxysms are stopped, but should continue to use it till there is reason to

believe the disease is entirely overcome. Most of the failures in the cure of
this disease are owing to patients not continuing to use the medicine long
enough. They are generally directed to take it till the fits are stopped, then
to leave it off, and begin again at some distance of time; by which means
the disease gathers strength, and often returns with as much violence as
before. A relapse may always be prevented by the patient’s continuing to
take small doses of the medicine for some time after the symptoms
disappear. This is both the most safe and effectual method of cure.
An ounce of gentian root, calamus aromaticus, and orange-peel, of each
half an ounce, with three or four handfuls of camomile-flowers, and an
handful of coriander-seed, all bruised together in a mortar, may be used in
form of infusion or tea. About half an handful of these ingredients may be
put into a tea-pot, and an English pint of boiling water poured on them. A
cup of this infusion drank three or four times a day will greatly promote the
cure. Such patients as cannot drink the watery infusion, may put two
handfuls of the same ingredients into a bottle of white wine, and take a
glass of it twice or thrice a day. If patients drink freely of the above, or any
other proper infusion of bitters, a smaller quantity of bark than is generally
used, will be sufficient to cure an ague[61].
Those who cannot swallow the bark in substance, may take it in
decoction or infusion. An ounce of bark in powder may be infused in a
bottle of white wine for four or five days, frequently shaking the bottle,
afterwards let the powder subside, and pour off the clear liquor. A wine
glass may be drank three or four times a day, or oftener, as there is
occasion. If a decoction be more agreeable, an ounce of the bark, and two
drams of snake-root bruised, with an equal quantity of salt of wormwood,
may be boiled in a quart of water, into an English pint. To the strained
liquor may be added an equal quantity of red wine, and a glass of it taken
frequently.
In obstinate agues, the bark will be found much more efficacious when
assisted by brandy, or other warm cordials, than taken alone. This I have
had frequently occasion to observe in a country where intermittent fevers
were endemical. The bark seldom succeeded unless assisted by snake-root,
ginger, canella alba, or some other warm aromatic. When the fits are very
frequent and violent, in which case the fever often approaches towards an
inflammatory nature, it will be safer to keep out the aromatics, and to add

salt of tartar in their stead. But in an obstinate tertian or quartan, in the end
of autumn or beginning of winter, warm and cordial medicines are
absolutely necessary[62].
As autumnal and winter agues generally prove much more obstinate than
those which attack the patient in spring or summer, it will be necessary to
continue the use of medicines longer in the former than in the latter. A
person who is seized with an intermitting fever in the beginning of winter,
ought frequently, if the season proves rainy, to take a little medicine,
although the disease may seem to be cured, to prevent a relapse, till the
return of the warm season. He ought likewise to take care not to be much
abroad in wet weather, especially in cold easterly winds.
When agues are not properly cured, they often degenerate into obstinate
chronical diseases, as the dropsy, jaundice, &c. For this reason all possible
care should be taken to have them radically cured, before the constitution
has been too much weakened.
Though nothing is more rational than the method of treating intermitting
fevers, yet, by some strange infatuation, more charms and whimsical
remedies are daily used for removing this than any other disease. There is
hardly an old woman who is not in possession of a nostrum for stopping an
ague; and it is amazing with what readiness their pretensions are believed.
Those in distress eagerly grasp at any thing that promises sudden relief; but
the shortest way is not always the best in the treatment of diseases. The only
method to obtain a safe and lasting cure, is gradually to assist Nature in
removing the cause of the disorder.
Some indeed try bold, or rather fool-hardy experiments to cure agues, as
drinking great quantities of strong liquors, jumping into a river, &c. These
may sometimes have the desired effect, but must always be attended with
danger[63]. When there is any degree of inflammation, or the least tendency
to it, such experiments may prove fatal. The only patient whom I remember
to have lost in an intermittent fever, evidently killed himself by drinking
strong liquor, which some person had persuaded him would prove an
infallible remedy.
Many dirty things are extolled for the cure of intermitting fevers, as
spiders, cobwebs, snuffings of candles, &c. Though these may sometimes
succeed, yet their very nastiness is sufficient to set them aside, especially
when cleanly medicines will answer the purpose better. The only medicine

that can be depended upon, for thoroughly curing an intermittent fever, is
the Peruvian bark. It may always be used with safety: and I can honestly
declare, that in all my practice I never knew it fail, when combined with the
medicines mentioned above, and duly persisted in.
Where agues are endemical, even children are often afflicted with that
disease. Such patients are very difficult to cure, as they can seldom be
prevailed upon to take the bark, or any other disagreeable medicine. One
method of rendering this medicine more palatable, is to make it into a
mixture with distilled waters and syrup, and afterwards to give it an
agreeable sharpness with the elixir or spirit of vitriol. This both improves
the medicine, and takes off the nauseous taste. In cases where the bark
cannot be administered, the saline mixture may be given with advantage to
children[64].
Wine-whey is a very proper drink for a child in an ague; to half an
English pint of which may be put a tea-spoonful of the spirit of hartshorn.
Exercise is likewise of considerable service; and when the disease proves
obstinate, the child ought, if possible, to be removed to a warm dry air. The
food ought to be nourishing, and sometimes a little generous wine should be
allowed.
To children, and such as cannot swallow the bark, or when the stomach
will not bear it, it may be given by clyster. Half an ounce of the extract of
bark, dissolved in four ounces of warm water, with the addition of half an
ounce of sweet oil, and six or eight drops of laudanum, in the form
recommended by Dr. Lind for an adult, and this to be repeated every fourth
hour, or oftener, as the occasion shall require. For children the quantity of
extract and laudanum must be proportionally lessened. Children have been
cured of agues by making them wear a waistcoat with powdered bark
quilted between the folds of it; by bathing them frequently in a strong
decoction of the bark, and by rubbing the spine with strong spirits, or with a
mixture of equal parts of laudanum and the saponaceous liniment.
We have been the more full upon this disease, because it is very common,
and because few patients in an ague apply to physicians unless in
extremities. There are, however, many cases in which the disease is very
irregular, being complicated with other diseases, or attended with symptoms
which are both very dangerous and very difficult to understand. All these
we have purposely passed over, as they would only bewilder the generality

of readers. When the disease is very irregular, or the symptoms dangerous,
the patient ought immediately to apply to a physician, and strictly to follow
his advice.
To prevent agues, people must endeavour to avoid their causes. These
have been already pointed out in the beginning of this section; we shall
therefore only add one preventive medicine, which may be of use to such as
are obliged to live in low marshy countries, or who are liable to frequent
attacks of this disease.
Take an ounce of the best Peruvian bark; Virginian snake-root, and
orange-peel, of each half an ounce; bruise them all together, and infuse for
five or six days in a bottle of brandy, Holland gin, or any good spirit;
afterwards pour off the clear liquor; and take a wine glass of it twice or
thrice a day. This indeed is recommending a dram; but the bitter ingredients
in a great measure take off the ill effects of the spirit. Those who do not
chuse it in brandy, may infuse it in wine; and such as can bring themselves
to chew the bark, will find that method succeed very well. Gentian root, or
calamus aromaticus, may also be chewed by turns for the same purpose. All
bitters seem to be antidotes to agues, especially those that are warm and
astringent.

CHAP. XV.
OF AN ACUTE CONTINUAL FEVER.

This fever is denominated acute, ardent, or inflammatory. It most
commonly attacks the young, or persons about the prime or vigour of life,
especially such as live high, abound with blood, and whose fibres are strong
and elastic. It seizes people at all seasons of the year; but is most frequent in
the spring and beginning of summer.
CAUSES.——An ardent fever may be occasioned by any thing that
overheats the body, or produces plethora, as violent exercise, sleeping in the
sun, drinking strong liquors, eating spiceries, a full diet, with little exercise,
&c. It may likewise be occasioned by whatever obstructs the perspiration,
as lying on the damp ground, drinking cold liquor when the body is hot,
night-watching, or the like.
SYMPTOMS.—A rigour or chilliness generally ushers in this fever,
which is soon succeeded by great heat, a frequent and full pulse, pain of the
head, dry skin, redness of the eyes, a florid countenance, pains in the back,
loins, &c. To these succeed difficulty of breathing, sickness, with an
inclination to vomit. The patient complains of great thirst, has no appetite
for solid food, is restless, and his tongue generally appears black and rough.
A delirium, excessive restlessness, great oppression of the breast, with
laborious respiration, starting of the tendons, hiccup, cold clammy sweats,
and an involuntary discharge of urine, are very dangerous symptoms.
As this disease is always attended with danger, the best medical
assistance ought to be procured as soon as possible. A physician may be of
use at the beginning, but his skill is often of no avail afterwards. Nothing
can be more unaccountable than the conduct of those who have it in their
power, at the beginning of a fever, to procure the best medical assistance,
yet put it off till things come to an extremity. When the disease, by delay or
wrong treatment, has become incurable, and has exhausted the strength of
the patient, it is in vain to hope for relief from medicine. Physicians may

indeed assist Nature; but their attempts must ever prove fruitless, when she
is no longer able to co-operate with their endeavours.
REGIMEN.—From the symptoms of this disease, it is evident, that the
blood and other humours require to be diluted; that the perspiration, urine,
saliva, and all the other secretions, are in too small quantity; that the vessels
are rigid, and the heat of the whole body too great: all these clearly point
out the necessity of a regimen calculated to dilute the blood, correct the
acrimony of the humours, allay the excessive heat, remove the spasmodic
stricture of the vessels, and promote the secretions.
These important purposes may be greatly promoted by drinking
plentifully of diluting liquors; as water-gruel, or oatmeal-tea, clear whey,
barley-water, balm-tea, apple-tea, &c. These may be sharpened with juice
of orange, jelly of currants, raspberries, and such like: orange-whey is
likewise an excellent cooling drink. It is made by boiling among milk and
water a bitter orange sliced, till the curd separates. If no orange can be had,
a lemon, a little cream of tartar, or a few spoonfuls of vinegar, will have the
same effect. Two or three spoonfuls of white wine may occasionally be
added to the liquor when boiling.
If the patient be costive, an ounce of tamarinds, with two ounces of
stoned raisins of the sun, and a couple of figs, may be boiled in three
English pints of water to a quart. This makes a very pleasant drink, and may
be used at discretion. The common pectoral decoction is likewise a very
proper drink in this disease. A tea-cupful of it may be taken every two
hours, or oftener, if the patient’s heat and thirst be very great[65].
The above liquids must all be drank a little warm. They may be used in
smaller quantities at the beginning of a fever, but more freely afterwards, in
order to assist in carrying off the disease by promoting the different
excretions. We have mentioned a variety of drinks, that the patient may
have it in his power to chuse those which are most agreeable; and that when
tired of one, he may have recourse to another.
The patient’s diet must be very spare and light. All sorts of flesh-meats,
and even chicken-broths, are to be avoided. He may be allowed groat-gruel,
panado, or light bread boiled in water; to which may be added a few grains
of common salt, and a little sugar, which will render it more palatable. He
may eat roasted apples with a little sugar, toasted bread with jelly of
currants, boiled prunes, &c.

It will greatly relieve the patient, especially in an hot season, to have
fresh air frequently let into his chamber. This, however, must always be
done in such a manner as not to endanger his catching cold.
It is too common in fevers to load the patient with bed-clothes, under the
pretence of making him sweat, or defending him from the cold. This custom
has many ill effects. It increases the heat of the body, fatigues the patient,
and retards, instead of promoting, the perspiration.
Sitting upright in bed, if the patient is able to bear it, will often have a
good effect. It relieves the head, by retarding the motion of the blood to the
brain. But this posture ought never to be continued too long: and if the
patient is inclined to sweat, it will be more safe to let him lie, only raising
his head a little with pillows.
Sprinkling the chamber with vinegar, juice of lemon, or vinegar and rose-
water, with a little nitre dissolved in it, will greatly refresh the patient. This
ought to be done frequently, especially if the weather is hot.
The patient’s mouth should be often washed with a mixture of water and
honey, to which a little vinegar may be added, or with a decoction of figs in
barley-water. His feet and hands ought likewise frequently to be bathed in
lukewarm water; especially if the head is affected.
The patient should be kept as quiet and easy as possible. Company, noise,
and every thing that disturbs the mind, is hurtful. Even too much light, or
any thing that affects the senses, ought to be avoided. His attendants should
be as few as possible, and they ought not to be too often changed. His
inclinations ought rather to be soothed than contradicted; even the promise
of what he craves will often satisfy him as much as its reality.
MEDICINE.——In this and all other fevers, attended with a hard, full,
quick pulse, bleeding is of the greatest importance. This operation ought
always to be performed as soon as the symptoms of an inflammatory fever
appear. The quantity of blood to be taken away, however, must be in
proportion to the strength of the patient and the violence of the disease. If
after the first bleeding the fever should increase, and the pulse become more
frequent and hard, there will be a necessity for repeating it a second, and
perhaps a third, or even a fourth time, which may be done at the distance of
twelve, eighteen, or twenty-four hours from each other, as the symptoms
require. If the pulse continues soft, and the patient is tolerably easy after the
first bleeding, it ought not to be repeated.

If the heat and fever be very great, forty or fifty drops of the dulcified or
sweet spirit of nitre may be made into a draught, with an ounce of rose-
water, two ounces of common water, and half an ounce of simple syrup, or
a bit of loaf-sugar. This draught may be given to the patient every three or
four hours while the fever is violent; afterwards once in five or six hours
will be sufficient.
If the patient be afflicted with retching, or an inclination to vomit, it will
be right to assist Nature’s attempts, by giving him weak camomile-tea, or
lukewarm water to drink.
If the body is bound, a clyster of milk and water with a little salt, and a
spoonful of sweet oil or fresh butter in it, ought daily to be administered.
Should this not have the desired effect, a tea-spoonful of magnesia alba, or
cream of tartar, may be frequently put into his drink. He may likewise eat
tamarinds, boiled prunes, roasted apples, and the like.
If about the tenth, eleventh, or twelfth day, the pulse becomes more soft,
the tongue moister, and the urine begins to let fall a reddish settlement,
there is reason to expect a favourable issue to the disease. But if, instead of
these symptoms, the patient’s spirits grow languid, his pulse sinks, and his
breathing becomes difficult; with a stupor, trembling of the nerves, starting
of the tendons, &c. there is reason to fear that the consequences will be
fatal. In this case blistering plasters must be applied to the head, ancles,
inside of the legs or thighs, as there may be occasion; poultices of wheat-
bread, mustard, and vinegar, may likewise be applied to the soles of the
feet, and the patient must be supported with cordials, as strong wine-whey,
negus, sago-gruel with wine in it, and such like.
A proper regimen is not only necessary during the fever, but likewise
after the patient begins to recover. By neglecting this, many relapse, or fall
into other diseases, and continue valetudinary for life. Though the body is
weak after a fever, yet the diet for some time ought to be rather light than of
too nourishing a nature. Too much food, drink, exercise, company, &c. are
carefully to be avoided. The mind ought likewise to be kept easy, and the
patient should not attempt to pursue study, or any business that requires
intense thinking.
If the digestion is bad, or the patient is seized at times with feverish
heats, an infusion of Peruvian bark in cold water will be of use. It will
strengthen the stomach, and help to subdue the remains of the fever.

When the patient’s strength is pretty well recovered, he ought to take
some gentle laxative. An ounce of tamarinds and a dram of sena may be
boiled for a few minutes in an English pint of water, and an ounce of manna
dissolved in the decoction; afterwards it may be strained, and a tea-cupful
drank every hour till it operates. This dose may be repeated twice or thrice,
five or six days intervening between each dose.
Those who follow laborious employments ought not to return too soon to
their labour after a fever, but should keep easy till their strength and spirits
are sufficiently recruited.

CHAP. XVI.
OF THE PLEURISY.

The true pleurisy is an inflammation of that membrane called the pleura,
which lines the inside of the breast. It is distinguished into the moist and
dry. In the former the patient spits freely; in the latter, little or none at all.
There is likewise a species of this disease, which is called the spurious or
bastard pleurisy, in which the pain is more external, and chiefly affects the
muscles between the ribs. The pleurisy prevails among labouring people,
especially such as work without doors, and are of a sanguine constitution. It
is most frequent in the spring season.
CAUSES.——The pleurisy may be occasioned by whatever obstructs the
perspiration; as cold northerly winds; drinking cold liquors when the body
is hot; sleeping without doors on the damp ground; wet clothes; plunging
the body into cold water, or exposing it to the cold air, when covered with
sweat, &c. It may likewise be occasioned by drinking strong liquors; by the
stoppage of usual evacuations; as old ulcers, issues, sweating of the feet or
hands, &c. the sudden striking in of any eruption, as the itch, the measles,
or the small-pox. Those who have been accustomed to bleed at a certain
season of the year are apt, if they neglect it, to be seized with a pleurisy.
Keeping the body too warm by means of fire, clothes, &c. renders it more
liable to this disease. A pleurisy may likewise be occasioned by violent
exercise, as running, wrestling, leaping, or by supporting great weight,
blows on the breast, &c. A bad conformation of the body renders persons
more liable to this disease, as a narrow chest, a straitness of the arteries of
the pleura, &c.
SYMPTOMS.—This, like most other fevers, generally begins with
chillness and shivering, which are followed by heat, thirst, and restlessness.
To these succeeds a violent pricking pain in one of the sides among the ribs.
Sometimes the pain extends towards the back bone, sometimes towards the
fore-part of the breast, and at other times towards the shoulder blades. The
pain is generally most violent when the patient draws his breath.

The pulse in this disease is commonly quick and hard, the urine high-
coloured; and if blood be let, it is covered with a tough crust, or buffy coat.
The patient’s spittle is at first thin, but afterwards it becomes grosser, and is
often streaked with blood.
REGIMEN.——Nature generally endeavours to carry off this disease by
a critical discharge of blood from some part of the body, by expectoration,
sweat, loose stools, thick urine, or the like. We ought therefore to second
her intentions by lessening the force of the circulation, relaxing the vessels,
diluting the humours, and promoting expectoration.
For these purposes the diet, as in the former disease, ought to be cool,
slender, and diluting. The patient must avoid all food that is viscid, hard of
digestion, or that affords much nourishment; as flesh, butter, cheese, eggs,
milk, and also every thing that is of a heating nature. His drink may be
whey, or an infusion of pectoral and balsamic vegetables[66].
Barley-water, with a little honey or jelly of currants mixed with it, is
likewise a very proper drink in this disease. It is made by boiling an ounce
of pearl-barley in three English pints of water to two, which must
afterwards be strained. The decoction of figs, raisins, barley, recommended
in the preceding disease, is here likewise very proper. These and other
diluting liquors are not to be drank in large quantities at a time, but the
patient ought to keep continually sipping them, so as to render his mouth
and throat always moist. All his food and drink should be taken a little
warm.
The patient should be kept quiet, cool, and every way easy, as directed
under the foregoing disease. His feet and hands ought daily to be bathed in
lukewarm water; and he may sometimes sit up in bed for a short space, in
order to relieve his head.
MEDICINE.——Almost every person knows, when a fever is attended
with a violent pain of the side, and a quick hard pulse, that bleeding is
necessary. When these symptoms come on, the sooner this operation is
performed the better; and the quantity at first must be pretty large, provided
the patient is able to bear it. A large quantity of blood let at once, in the
beginning of a pleurisy, has a much better effect than repeated small
bleedings. A man may lose twelve or fourteen ounces of blood as soon as it
is certainly known that he is seized with a pleurisy. For a younger person, or
one of a delicate constitution, the quantity must be less.

If, after the first bleeding, the stitch, with the other violent symptoms,
should still continue, it will be necessary, at the distance of twelve or
eighteen hours, to let eight or nine ounces more. If the symptoms do not
then abate, and the blood shews a strong buffy coat, a third or even a fourth
bleeding may be requisite. If the pain of the side abates, the pulse becomes
softer, or the patient begins to spit freely, bleeding ought not to be repeated.
This operation is seldom necessary after the third or fourth day of the fever,
and ought not then to be performed, unless in the most urgent
circumstances.
The blood may be many ways attenuated without bleeding. There are
likewise many things that may be done to ease the pain of the side without
this operation, as fomenting, blistering, &c. Fomentations may be made by
boiling a handful of the flowers of elder, camomile, and common mallows,
or any other soft vegetables, in a proper quantity of water. The herbs may be
either put into a flannel bag, and applied warm to the side, or flannels may
be dipped in the decoction, afterwards wrung out, and applied to the part
affected, with as much warmth as the patient can easily bear. As the clothes
grow cool, they must be changed, and great care taken that the patient do
not catch cold. A bladder may be filled with warm milk and water, and
applied to the side, if the above method of fomenting be found
inconvenient. Fomentations not only ease the pain, but relax the vessels,
and prevent the stagnation of the blood and other humours. The side may
likewise be frequently rubbed with a little of the volatile liniment[67].
Topical bleeding has often a very good effect in this disease. It may either
be performed by applying a number of leeches to the part affected, or by
cupping, which is both a more certain and expeditious method than the
other.
Leaves of various plants might likewise be applied to the patient’s side
with advantage. I have often seen great benefit from young cabbage-leaves
applied warm to the side in a pleurisy. These not only relax the parts, but
likewise draw off a little moisture, and may prevent the necessity of
blistering-plasters; which however, when other things fail, must be applied.
If the stitch continues after repeated bleedings, fomentations, &c. a
blistering-plaster must be applied over the part affected, and suffered to
remain for two days. This not only procures a discharge from the side, but
takes off the spasm, and by that means assists in removing the cause of the

disease. To prevent a strangury when the blistering-plaster is on, the patient
may drink freely of the Arabic emulsion[68].
If the patient is costive, a clyster of thin water-gruel, or of barley-water,
in which a handful of mallows, or any other emollient vegetable has been
boiled, may be daily administered. This will not only empty the bowels, but
have the effect of a warm fomentation applied to the inferior viscera, which
will help to make a derivation from the breast.
The expectoration of spitting may be promoted by sharp, oily, and
mucilaginous medicines. For this purpose an ounce of the oxymel, or the
vinegar of squills, may be added to six ounces of the pectoral decoction,
and two table-spoonfuls of it taken every two hours.
Should the squill disagree with the stomach, the oily emulsion may be
administered[69]; or, in place of it, two ounces of the oil of sweet almonds, or
oil of olives, and two ounces of the syrup of violets, may be mixed with as
much sugar-candy powdered, as will make an electuary of the consistence
of honey. The patient may take a tea-spoonful of this frequently, when the
cough is troublesome. Should oily medicines prove nauseous, which is
sometimes the case, two table-spoonfuls of the solution of gum ammoniac
in barley-water may be given three or four times a-day[70].
If the patient does not perspire, but has a burning heat upon his skin, and
passes very little water, some small doses of purified nitre and camphire
will be of use. Two drams of the former may be rubbed with five or six
grains of the latter in a mortar, and the whole divided into six doses, one of
which may be taken every five or six hours, in a little of the patient’s
ordinary drink.
We shall only mention one medicine more, which some reckon almost a
specific in the pleurisy, viz. the decoction of the seneka rattle-snake root[71].
After bleeding and other evacuations have been premised, the patient may
take two, three, or four table-spoonfuls of this decoction, according as his
stomach will bear it, three or four times a-day. If it should occasion
vomiting, two or three ounces of simple cinnamon-water may be mixed
with the quantity of decoction here directed, or it may be taken in smaller
doses. As this medicine promotes perspiration and urine, and likewise keeps
the body easy, it may be of some service in a pleurisy, or any other
inflammation of the breast.

No one will imagine that these medicines are all to be used at the same
time. We have mentioned different things, on purpose that people may have
it in their power to chuse; and likewise, that when one cannot be obtained,
they may make use of another. Different medicines are no doubt necessary
in the different periods of a disorder; and where one fails of success, or
disagrees with the patient, it will be proper to try another.
What is called the crisis, or height of the fever, is sometimes attended
with very alarming symptoms, as difficulty of breathing, an irregular pulse,
convulsive motions, &c. These are apt to frighten the attendants, and induce
them to do improper things, as bleeding the patient, giving him strong
stimulating medicines, or the like. But they are only the struggles of Nature
to overcome the disease, in which she ought to be assisted by plenty of
diluting drink, which is then peculiarly necessary. If the patient’s strength
however be much exhausted by the disease, it will be necessary at this time
to support him with frequent small draughts of wine-whey, negus, or the
like.
When the pain and fever are gone, it will be proper, after the patient has
recovered sufficient strength, to give him some gentle purges, as those
directed towards the end of the acute continual fever. He ought likewise to
use a light diet, of easy digestion, and his drink should be butter-milk,
whey, and other things of a cleansing nature.
Of the BASTARD PLEURISY.
That species of pleurisy which is called the bastard or spurious, generally
goes off by keeping warm for a few days, drinking plenty of diluting
liquors, and observing a cooling regimen.
It is known by a dry cough, a quick pulse, and a difficulty of lying on the
affected side, which last does not always happen in the true pleurisy.
Sometimes indeed this disease proves obstinate, and requires bleeding, with
cupping, and scarifications of the part affected. These, together with the use
of nitrous and other cooling medicines, seldom fail to effect a cure.
Of the PARAPHRENITIS.
The paraphrenitis, or inflammation of the diaphragm, is so nearly
connected with the pleurisy, and resembles it so much in the manner of
treatment, that it is scarce necessary to consider it as a separate disease.

It is attended with a very acute fever, and an extreme pain in the part
affected, which is generally augmented by coughing, sneezing, drawing in
the breath, taking food, going to stool, making water, &c. Hence the patient
breathes quick, and draws in his bowels to prevent the motion of the
diaphragm; is restless, anxious, has a dry cough, a hiccup, and often a
delirium. A convulsive laugh, or rather a kind of involuntary grin, is no
uncommon symptom of this disease.
Every method must be taken to prevent a suppuration, as it is impossible
to save the patient’s life when this happens. The regimen and medicine are
in all respects the same as in the pleurisy. We shall only add, that in this
disease emollient clysters are peculiarly useful, as they relax the bowels,
and by that means make a derivation from the part affected.

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

As this disease affects an organ which is absolutely necessary to life, it must
always be attended with danger. Persons who abound with thick blood,
whose fibres are tense and rigid, who feed upon gross aliment, and drink
strong viscid liquors, are most liable to a peripneumony. It is generally fatal
to those who have a flat breast, or narrow chest, and to such as are afflicted
with an asthma, especially in the decline of life. Sometimes the
inflammation reaches to one lobe of the lungs only, at other times the whole
of the organ is affected; in which case the disease can hardly fail to prove
fatal.
When the disease proceeds from a viscid pituitous matter obstructing the
vessels of the lungs, it is called a spurious or bastard peripneumony. When
it arises from a thin acrid defluxion on the lungs, it is denominated a
catarrhal peripneumony, &c.
CAUSES.——An inflammation of the lungs is sometimes a primary
disease, and sometimes it is the consequence of other diseases, as a quinsey,
a pleurisy, &c. It proceeds from the same causes as the pleurisy, viz. an
obstructed perspiration from cold, wet clothes, &c. or from an increased
circulation of the blood by violent exercise, the use of spiceries, ardent
spirits, and such like. The pleurisy and peripneumony are often
complicated; in which case the disease is called a pleuro-peripneumony.
SYMPTOMS.——Most of the symptoms of a pleurisy likewise attend an
inflammation of the lungs; only in the latter the pulse is more soft, and the
pain less acute; but the difficulty of breathing, and oppression of the breast,
are generally greater.
REGIMEN.——As the regimen and medicine are in all respects the same
in the true peripneumony as in the pleurisy, we shall not here repeat them,
but refer the reader to the treatment of that disease. It may not however be
improper to add, that the aliment ought to be more slender and thin in this

than in any other inflammatory disease. The learned Dr. Arbuthnot asserts,
that even common whey is sufficient to support the patient, and that
decoctions of barley, and infusions of fennel roots in warm water with milk,
are the most proper both for drink and nourishment. He likewise
recommends the steam of warm water taken in by the breath, which serves
as a kind of internal fomentation, and helps to attenuate the impacted
humours. If the patient has loose stools, but is not weakened by them, they
are not to be stopped, but rather promoted by the use of emollient clysters.
It has already been observed, that the spurious or bastard peripneumony
is occasioned by a viscid pituitous matter obstructing the vessels of the
lungs. It commonly attacks the old, infirm, and phlegmatic, in winter and
wet seasons.
The patient at the beginning is cold and hot by turns, has a small quick
pulse, feels sense of weight upon his breast, breathes with difficulty, and
sometimes complains of a pain and giddiness of his head. His urine is
usually pale, and his colour very little changed.
The diet in this, as well as in the true peripneumony, must be very
slender, as weak broths, sharpened with the juice of orange or lemon, and
such like. His drink may be thin water-gruel sweetened with honey, or a
decoction of the roots of fennel, liquorice, and quick grass. An ounce of
each of these may be boiled in three English pints of water to a quart, and
sharpened with a little currant-jelly, or the like.
Bleeding and purging are generally proper at the beginning of this
disease; but if the patient’s spittle is pretty thick, or well concocted, neither
of them are necessary. It will be sufficient to assist the expectoration by
some of the sharp medicines recommended for that purpose in the pleurisy,
as the solution of gum ammoniac with oxymel of squills, &c. Blistering
plasters have generally a good effect, and ought to be applied pretty early.
If the patient does not spit, he must be bled according as his strength will
permit, and have a gentle purge administered. Afterwards his body may be
kept open by clysters, and the expectoration promoted, by taking every four
hours two table-spoonfuls of the solution mentioned above.
When an inflammation of the breast does not yield to bleeding, blistering,
and other evacuations, it commonly ends in a suppuration, which is more or
less dangerous, according to the part where it is situated. When this happens

in the pleura, it sometimes breaks outwardly, and the matter is discharged
by the wound.
When the suppuration happens within the substance or body of the lungs,
the matter may be discharged by expectoration; but if the matter floats in
the cavity of the breast, between the pleura and the lungs, it can only be
discharged by an incision made betwixt the ribs.
If the patient’s strength does not return after the inflammation is to all
appearance removed; if his pulse continues quick though soft, his breathing
difficult and oppressed; if he has cold shiverings at times, his cheeks
flushed, his lips dry; and if he complains of thirst, and want of appetite,
there is reason to fear a suppuration, and that a phthisis or consumption of
the lungs will ensue. We shall therefore next proceed to consider the proper
treatment of that disease.

CHAP. XVIII.
OF CONSUMPTIONS.

A consumption is a wasting or decay of the whole body from an ulcer,
tubercles, or concretions of the lungs, an empyema, a nervous atrophy, or a
cachexy.
Dr. Arbuthnot observes, that in his time consumptions made up above
one-tenth part of the bills of mortality in and about London. There is reason
to believe they have rather increased since, and we know from experience,
that they are not less fatal in some other towns of England than in London.
Young persons, between the age of fifteen and thirty, of a slender make,
long neck, high shoulders, and flat breasts, are most liable to this disease.
Consumptions prevail more in England than in any other part of the
world, owing perhaps to the great use of animal food and malt liquors, the
general application to sedentary employments, and the great quantity of pit-
coal which is there burnt; to which we may add the perpetual changes in the
atmosphere, or variableness of the weather.
CAUSES.——It has already been observed, that an inflammation of the
breast often ends in an imposthume: consequently whatever disposes people
to this disease, must likewise be considered as a cause of consumption.
Other diseases, by vitiating the habit, may likewise occasion
consumptions; as the scurvy, the scrophula, or king’s evil, the venereal
disease, the asthma, small-pox, measles, &c.
As this disease is seldom cured, we shall endeavour the more particularly
to point out its causes, in order that people may be enabled to avoid it.
These are:
——Confined or unwholesome air. When this fluid is impregnated with
the fumes of metals or minerals, it proves extremely hurtful to the lungs,
and often corrodes the tender vessels of that necessary organ.

——Violent passions, exertions, or affections of the mind; as grief,
disappointment, anxiety, or close application to the study of abstruse arts or
sciences.
——Great evacuations; as sweating, diarrhœas, diabetes, excessive
venery, the fluor albus, an over-discharge of the menstrual flux, giving suck
too long, &c.
——The sudden stoppage of customary evacuations; as the bleeding
piles, sweating of the feet, bleeding at the nose, the menses, issues, ulcers,
or eruptions of any kind.
——Injuries done to the lungs, calculi, &c. I lately saw the symptoms of
a phthisis occasioned by a small bone sticking in the bronchæ. It was
afterwards vomited along with a considerable quantity of purulent matter,
and the patient, by a proper regimen, and the use of the Peruvian bark,
recovered.
——Making a sudden transition from a hot to a very cold climate,
change of apparel, or whatever greatly lessens the perspiration.
——Frequent and excessive debaucheries. Late watching, and drinking
strong liquors, which generally go together, can hardly fail to destroy the
lungs. Hence the bon companion generally falls a sacrifice to this disease.
——Infection. Consumptions are likewise caught by sleeping with the
diseased; for which reason this should be carefully avoided. It cannot be of
great benefit to the sick, and must hurt those in health.
——Occupations in life. Those artificers who sit much, and are
constantly leaning forward, or pressing upon the stomach and breast, as
cutlers, taylors, shoemakers, seamstresses, &c. often die of consumptions.
They likewise prove fatal to singers, and all who have occasion to make
frequent and violent exertions of the lungs.
——Cold. More consumptive patients date the beginning of their
disorders from wet feet, damp beds, night air, wet clothes, or catching cold
after the body had been heated, than from all other causes.
Sharp, saline, and aromatic aliments, which heat and inflame the blood,
are likewise frequently the cause of consumptions.
We shall only add, that this disease is often owing to an hereditary taint,
or a scrophulous habit; in which case it is generally incurable.

SYMPTOMS.——This disease generally begins with a dry cough, which
often continues for some months. If a disposition to vomit after eating be
excited by it, there is still greater reason to fear an approaching
consumption. The patient complains of a more than usual degree of heat, a
pain and oppression of the breast, especially after motion; his spittle is of a
saltish taste, and sometimes mixed with blood. He is apt to be sad; his
appetite is bad, and his thirst great. There is generally a quick, soft, small
pulse; though sometimes the pulse is pretty full, and rather hard. These are
the common symptoms of a beginning consumption.
Afterwards the patient begins to spit a greenish, white, or bloody matter.
His body is extenuated by the hectic fever, and colliquative sweats, which
mutually succeed one another, viz. the one towards night, and the other in
the morning. A looseness, and an excessive discharge of urine, are often
troublesome symptoms at this time, and greatly weaken the patient. There is
a burning heat in the palms of the hands, and the face generally flushes after
eating; the fingers become remarkably small, the nails are bent inwards, and
the hairs fall off.
At last the swelling of the feet and legs, the total loss of strength, the
sinking of the eyes, the difficulty of swallowing, and the coldness of the
extremities, shew the immediate approach of death, which however the
patient seldom believes to be so near. Such is the usual progress of this fatal
disease, which, if not early checked, commonly sets all medicine at
defiance.
REGIMEN.——On the first appearance of a consumption, if the patient
lives in a large town, or any place where the air is confined, he ought
immediately to quit it, and to make choice of a situation in the country,
where the air is pure and free. Here he must not remain inactive, but take
every day as much exercise as he can bear.
The best method of taking exercise is to ride on horseback, as this gives
the body a great deal of motion without much fatigue. Such as cannot bear
this kind of exercise, must make use of a carriage. A long journey, as it
amuses the mind by a continual change of objects, is greatly preferable to
riding the same ground over and over. Care however must be taken to avoid
catching cold from wet clothes, damp beds, or the like. The patient ought
always to finish his ride in the morning, or at least before dinner; otherwise
it will oftener do harm than good.

It is pity those who attend the sick seldom recommend riding in this
disease, till the patient is either unable to bear it, or the malady has become
incurable. Patients are likewise apt to trifle with everything that is in their
own power. They cannot see how one of the common actions of life should
prove a remedy in an obstinate disease, and therefore they reject it, while
they greedily hunt after relief from medicine, merely because they do not
understand it.
Those who have strength and courage to undertake a pretty long voyage,
may expect great advantage from it. This, to my knowledge, has frequently
cured a consumption after the patient was, to all appearance, far advanced
in that disease, and where medicine had proved ineffectual. Hence it is
reasonable to conclude, that if a voyage were undertaken in due time, it
would seldom fail to perform a cure[72].
Such as try this method of cure ought to carry as much fresh provisions
along with them as will serve for the whole time they are at sea. As milk is
not easily obtained in this situation, they ought to live upon fruits, and the
broth of chickens, or other young animals which can be kept alive on board.
It is scarce necessary to add, that such voyages should be undertaken, if
possible, in the mildest season, and that they ought to be towards a warmer
climate[73].
Those who have not courage for a long voyage may travel into a more
southern climate, as the south of France, Spain, or Portugal; and if they find
the air of these countries agree with them, they should continue there, at
least till their health be confirmed.
Next to proper air and exercise, we would recommend a due attention to
diet. The patient should eat nothing that is either heating or hard of
digestion, and his drink must be of a soft and cooling nature. All the diet
ought to be calculated to lessen the acrimony of the humours, and to
nourish and support the patient. For this purpose he must keep chiefly to the
use of vegetables and milk. Milk alone is of more value in this disease than
the whole materia medica.
Asses milk is commonly reckoned preferable to any other; but it cannot
always be obtained; besides, it is generally taken in a very small quantity;
whereas, to produce any effects, it ought to make a considerable part of the
patient’s diet. It is hardly to be expected, that a gill or two of asses milk,
drank in the space of twenty-four hours, should be able to produce any

considerable change in the humours of an adult; and when people do not
perceive its effects soon, they lose hope, and so leave it off. Hence it
happens that this medicine, however valuable, very seldom performs a cure.
The reason is obvious; it is commonly used too late, is taken in too small
quantities, and is not duly persisted in.
I have known very extraordinary effects from asses milk in obstinate
coughs, which threatened a consumption of the lungs; and do verily believe,
if used at this period, that it would seldom fail; But if it be delayed till an
ulcer is formed, which is generally the case, how can it be expected to
succeed?
Asses milk ought to be drank, if possible, in its natural warmth, and, by a
grown person, in the quantity of half an English pint at a time. Instead of
taking this quantity night and morning only, the patient ought to take it four
times, or at least thrice a-day, and to eat a little light bread along with it, so
as to make it a kind of meal.
If the milk should happen to purge, it may be mixed with old conserve of
roses. When that cannot be obtained, the powder of crabs claws may be
used in its stead. Asses milk is usually ordered to be drank warm in bed; but
as it generally throws the patient in a sweat when taken in this way, it would
perhaps be better to give it after he rises.
Some extraordinary cures in consumptive cases have been performed by
women’s milk. Could this be obtained in sufficient quantity, we would
recommend it in preference to any other. It is better if the patient can suck it
from the breast, than to drink it afterwards. I knew a man who was reduced
to such a degree of weakness in a consumption, as not to be able to turn
himself in bed. His wife was at that time giving suck, and the child
happening to die, he sucked her breasts, not with a view to reap any
advantage from the milk, but to make her easy. Finding himself however
greatly benefited by it, he continued to suck her till he became perfectly
well, and is at present a strong and healthy man.
Some prefer butter-milk to any other, and it is indeed a very valuable
medicine, if the stomach be able to bear it. It does not agree with every
person at first; and is therefore often laid aside without a sufficient trial. It
should at first be taken sparingly, and the quantity gradually increased, until
it comes to be almost the sole food. I never knew it succeed unless where
the patient almost lived upon it.

Cows milk is most readily obtained of any, and though it be not so easily
digested as that of asses or mares, it may be rendered lighter by adding to it
an equal quantity of barley-water, or allowing it to stand for some hours,
and afterwards taking off the cream. If it should notwithstanding prove
heavy on the stomach, a small quantity of brandy or rum, with a little sugar,
may be added, which will render it both more light and nourishing.
It is not to be wondered, that milk should for some time disagree with a
stomach that has not been accustomed to digest any thing but flesh and
strong liquors, which is the case with many of those who fall into
consumptions. We do not however advise those have been accustomed to
animal food and strong liquors, to leave them off all at once. This might be
dangerous. It will be necessary for such to eat a little once a-day of the flesh
of some young animal, or rather to use the broth made of chickens, veal,
lamb, or such like. They ought likewise to drink a little wine made into
negus, or diluted with twice or thrice its quantity of water, and to make it
gradually weaker till they can leave it off altogether.
These must be used only as preparatives to a diet consisting chiefly of
milk and vegetables, which the sooner the patient can be brought to bear,
the better. Rice and milk, or barley and milk, boiled with a little sugar, is
very proper food. Ripe fruits roasted, baked, or boiled, are likewise proper,
as goose or currant berry tarts, apples roasted, or boiled in milk, &c. The
jellies, conserves, and preserves, &c. of ripe subacid fruits, ought to be
eaten plentifully, as the jelly of currants, conserve of roses, preserved
plums, cherries, &c.
Wholesome air, proper exercise, and a diet consisting chiefly of these and
other vegetables, with milk, is the only course that can be depended on in a
beginning consumption. If the patient has strength and sufficient resolution
to persist in this course, he will seldom be disappointed of a cure.
In a populous town in England[74], where consumptions are very common,
I have frequently seen consumptive patients, who had been sent to the
country with orders to ride, and live upon milk and vegetables, return in a
few months quite plump, and free from any complaint. This indeed was not
always the case, especially when the disease was hereditary, or far
advanced; but it was the only method in which success was to be expected:
where it failed, I never knew medicine succeed.

If the patient’s strength and spirits flag, he must be supported by strong
broths, jellies, and such like. Some recommend shell-fish in this disorder,
and with some reason, as they are nourishing and restorative[75]. All the food
and drink ought however to be taken in small quantities, lest an overcharge
of fresh chyle should oppress the lungs, and too much accelerate the
circulation of the blood.
The patient’s mind ought to be kept as easy and cheerful as possible.
Consumptions are often occasioned, and always aggravated, by a
melancholy cast of mind; for which reason music, cheerful company, and
every thing that inspires mirth, are highly beneficial. The patient ought
seldom to be left alone, as brooding over his calamities is sure to render
them worse.
MEDICINE.——Though the cure of this disease depends chiefly upon
regimen and the patient’s own endeavours, yet we shall mention a few
things which may be of service in relieving some of the more violent
symptoms.
In the first stage of a consumption, the cough may sometimes be
appeased by bleeding; and the expectoration may be promoted by the
following medicines. Take fresh squills, gum-ammoniac, and powdered
cardamum seeds, of each a quarter of an ounce; beat them together in a
mortar, and if the mass proves too hard for pills, a little of any kind of syrup
may be added to it. This may be formed into pills of a moderate size, and
four or five of them taken twice or thrice a-day, according as the patient’s
stomach will bear them.
The lac ammoniacum, or milk of gum-ammoniac, as it is called, is
likewise a proper medicine in this stage of the disease. It may be used as
directed in the pleurisy.
A mixture made of equal parts of lemon-juice, fine honey, and syrup of
poppies, may likewise be used. Four ounces of each of these may be
simmered together in a sauce-pan, over a gentle fire, and a table-spoonful of
it taken at any time when the cough is troublesome.
It is common in this stage of the disease to load the patient’s stomach
with oily and balsamic medicines. These, instead of removing the cause of
the disease, tend rather to increase it, by heating the blood, while they pall
the appetite, relax the solids, and prove every way hurtful to the patient.
Whatever is used for removing the cough, besides riding and other proper

regimen, ought to be medicines of a sharp and cleaning nature; as oxymel,
syrup of lemon, &c.
Acids seem to have peculiarly good effects in this disease; they both tend
to quench the patient’s thirst and to cool the blood. The vegetable acids, as
apples, oranges, lemons, &c. appear to be the most proper. I have known
patients suck the juice of several lemons every day with manifest
advantage, and would for this reason recommend acid vegetables to be
taken in as great quantity as the stomach will bear them.
For the patient’s drink, we would recommend infusions of the bitter
plants, as ground-ivy, the lesser centaury, camomile flowers, or water-
trefoil. These infusions may be drank at pleasure. They strengthen the
stomach, promote digestion, rectify the blood, and at the same time answer
all the purposes of dilution, and quench thirst much better than things that
are luscious or sweet. But if the patient spits blood, he ought to use, for his
ordinary drink, infusions or decoctions of the vulnerary roots, plants, &c.[76]
There are many other mucilaginous plants and seeds, of a healing and
agglutinating nature, from which decoctions or infusions may be prepared
with the same intention; as the orches, the quince-seed, coltsfoot, linseed,
sasaparilla, &c. It is not necessary to mention the different ways in which
these may be prepared. Simple infusion or boiling is all that is necessary,
and the dose may be at discretion.
The conserve of roses is here peculiarly proper. It may either be put into
the decoction above prescribed, or eaten by itself. No benefit is to be
expected from trifling doses of this medicine. I never knew it of any
service, unless where three or four ounces at least were used daily for a
considerable time. In this way I have seen it produce very happy effects,
and would recommend it wherever there is a discharge of blood from the
lungs.
When the spitting up of gross matter, oppression of the breast, and the
hectic symptoms, shew that an imposthume is formed in the lungs, we
would recommend the Peruvian bark, that being the only drug which has
any chance to counteract the general tendency which the humours then have
to putrefaction.
An ounce of the bark in powder may be divided into eighteen or twenty
doses, of which one may be taken every three hours through the day, in a
little syrup, or a cup of horehound tea.

If the bark should happen to purge, it may be made into an electuary, with
the conserve of roses, thus: Take old conserve of roses a quarter of a pound,
Peruvian bark in powder an ounce, syrup of orange or lemon, as much as
will make it of the consistence of honey. This quantity will serve the patient
four or five days, and may be repeated as there is occasion.
Such as cannot take the bark in substance, may infuse it in cold water.
This seems to be the best menstruum for extracting the virtues of that drug.
Half an ounce of bark in powder may be infused for twenty-four hours in
half an English pint of water. Afterwards let it be passed through a fine
strainer, and an ordinary tea-cupful of it taken three or four times a-day.
We would not recommend the bark while there are any symptoms of an
inflammation of the breast; but when it is certainly known that matter is
collected there, it is one of the best medicines which can be used. Few
patients indeed have resolution enough to give the bark a fair trial at this
period of the disease, otherwise we have reason to believe that some benefit
might be reaped from it.
When it is evident that there is an imposthume in the breast, and the
matter can neither be spit up nor carried off by absorption, the patient must
endeavour to make it break inwardly, by drawing in the steams of warm
water or vinegar with his breath, coughing, laughing, or bawling aloud, &c.
When it happens to burst within the lungs, the matter may be discharged by
the mouth. Sometimes indeed the bursting of the vomica occasions
immediate death, by suffocating the patient. When the quantity of matter is
great, and the patient’s strength exhausted, this is commonly the case. At
any rate the patient is ready to fall into a swoon, and should have volatile
salts or spirits held to his nose.
If the matter discharged be thick, and the cough and breathing become
easier, there may be some hopes of a cure. The diet at this time ought to be
light, but restorative, as chicken-broths, sago-gruel, rice-milk, &c. the
drink, butter-milk, or whey, sweetened with honey. This is likewise a proper
time for using the Peruvian bark, which may be taken as directed above.
If the vomica or imposthume should discharge itself into the cavity of the
breast, betwixt the pleura and the lungs, there is no way of getting the
matter out but by an incision, as has already been observed. As this
operation must always be performed by a surgeon, it is not necessary here
to describe it. We shall only add, that it is not so dreadful as people are apt

to imagine, and that it is the only chance the patient in this case has for his
life.

A nervous consumption is a wasting or decay of the whole body, without
any considerable degree of fever, cough, or difficulty of breathing. It is
attended with indigestion, weakness, and want of appetite, &c.
Those who are of a fretful temper, who indulge in spirituous liquors, or
who breathe an unwholesome air, are most liable to this disease.
We would chiefly recommend, for the cure of a nervous consumption, a
light and nourishing diet, plenty of exercise in a free open air, and the use of
such bitters as brace and strengthen the stomach; as the Peruvian bark,
gentian root, camomile, horehound, &c. These may be infused in water or
wine, and a glass of it drank frequently.
It will greatly assist the digestion, and promote the cure of this disease, to
take twice-a-day twenty or thirty drops of the elixir of vitriol in a glass of
wine or water. The chalybeate wine is likewise an excellent medicine in this
case. It strengthens the solids, and powerfully assists Nature in the
preparation of good blood[77].
Agreeable amusements, cheerful company, and riding about, are however
preferable to all medicines in this disease. For which reason, when the
patient can afford it, we would recommend a long journey of pleasure, as
the most likely means to restore his health.
What is called a symptomatic consumption cannot be cured without first
removing the disease by which it is occasioned. Thus, when a consumption
proceeds from, the scrophula or king’s evil, from the scurvy, the asthma, the
venereal disease, &c. a due attention must be paid to the malady from
whence it arises, and the regimen and medicine directed accordingly.
When excessive evacuations of any kind occasion a consumption, they
must not only be restrained, but the patient’s strength must be restored by
gentle exercise, nourishing diet, and generous cordials. Young and delicate
mothers often fall into consumptions, by giving suck too long. As soon as
they perceive their strength and appetite begin to fail, they ought
immediately to wean the child, or provide another nurse, otherwise they
cannot expect a cure.

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

CHAP. XIX.
OF THE SLOW OR NERVOUS FEVER.

Nervous fevers have increased greatly of late years in this island, owing
doubtless to our different manner of living, and the increase of sedentary
employments; as they commonly attack persons of a weak relaxed habit,
who neglect exercise, eat little solid food, study hard, or indulge in
spirituous liquors.
CAUSES.——Nervous fevers may be occasioned by whatever depresses
the spirits, or impoverishes the blood; as grief, fear, anxiety, want of sleep,
intense thought, living on poor watery diet, unripe fruits, cucumbers,
melons, mushrooms, &c. They may likewise be occasioned by damp,
confined, or unwholesome air. Hence they are very common in rainy
seasons, and prove most fatal to those who live in dirty low houses,
crowded streets, hospitals, jails, or such-like places.
Persons whose constitutions have been broken by excessive venery,
frequent salivations, too free an use of purgative medicines, or any other
excessive evacuations, are most liable to this disease.
Keeping on wet clothes, lying on the damp ground, excessive fatigue,
and whatever obstructs the perspiration, or causes a spasmodic stricture of
the solids, may likewise occasion nervous fevers. We shall only add,
frequent and great irregularities in diet. Too great abstinence, as well as
excess, is hurtful. Nothing tends so much to preserve the body in a sound
state as a regular diet; nor can any thing contribute more to occasion fevers
of the worst kind than its opposite.
SYMPTOMS.——Low spirits, want of appetite, weakness, weariness
after motion, watchfulness, deep sighing, and dejection of mind, are
generally the forerunners of this disease. These are succeeded by a quick
low pulse, a dry tongue without any considerable thirst, chillness and
flushing in turns, &c.

After some time the patient complains of a giddiness and pain of the
head, has a nausea, with reachings and vomiting; the pulse is quick, and
sometimes intermitting; the urine pale, resembling dead small-beer, and the
breathing is difficult, with oppression of the breast, and slight alienations of
mind.
If towards the ninth, tenth, or twelfth day, the tongue becomes more
moist, with a plentiful spitting, a gentle purging, or a moisture upon the
skin; or if a suppuration happens in one or both ears, or large pustules break
out about the lips and nose, there is reason to hope for a favourable crisis.
But if there is an excessive looseness, or wasting sweats, with frequent
fainting fits; if the tongue, when put out, trembles excessively, and the
extremities feel cold, with a fluttering or slow creeping pulse; if there is a
starting of the tendons, an almost total loss of sight and hearing, and an
involuntary discharge by stool and urine, there is great reason to fear that
death is approaching.
REGIMEN.——It is very necessary in this disease to keep the patient
cool and quiet. The least motion would fatigue him, and will be apt to
occasion weariness, and even faintings. His mind ought not only to be kept
easy, but soothed and comforted with the hopes of a speedy recovery.
Nothing is more hurtful in low fevers of this kind than presenting to the
patient’s imagination gloomy or frightful ideas. These of themselves often
occasion nervous fevers, and it is not to be doubted but they will likewise
aggravate them.
The patient must not be kept too low. His strength and spirits ought to be
supported by nourishing diet and generous cordials. For this purpose his
gruel, panado, or whatever food he takes, must be mixed with wine
according as the symptoms may require. Pretty strong wine-whey, or small
negus, sharpened with the juice of orange or lemon, will be proper for his
ordinary drink. Mustard-whey is likewise a very proper drink in this fever,
and may be rendered an excellent cordial medicine by the addition of a
proper quantity of white-wine[78].
Wine in this disease, if it could be obtained genuine, is almost the only
medicine that would be necessary. Good wine possesses all the virtues of
the cordial medicines, while it is free from many of their bad qualities. I say
good wine; for however common this article of luxury is now become, it is

rarely to be obtained genuine, especially by the poor, who are obliged to
purchase it in small quantities.
I have often seen patients in low nervous fevers where the pulse could
hardly be felt, with a constant delirium, coldness of the extremities, and
almost every other mortal symptom, recover by using in whey, gruel, and
negus, a bottle or two of strong wine every day. Good old sound claret is the
best, and may be made into negus, or given by itself, as circumstances
require.
In a word, the great aim in this disease is to support the patient’s strength,
by giving him frequently small quantities of the above, or other drinks of a
warm and cordial nature. He is not however to be overheated either with
liquor or clothes; and his food ought to be light, and given in small
quantities.
MEDICINE.——Where a nausea, load, and sickness at stomach, prevail
at the beginning of the fever, it will be necessary to give the patient a gentle
vomit. Fifteen or twenty grains of ipecacuanha in fine powder, or a few
spoonfuls of the vomiting julep[79], will generally answer this purpose very
well. This may be repeated any time before the third or fourth day, if the
above symptoms continue. Vomits not only clean the stomach, but, by the
general shock which they give, promote the perspiration, and have many
other excellent effects in slow fevers, where there are no signs of
inflammation, and nature wants rousing.
Such as dare not venture upon a vomit, may clean the bowels by a small
dose of Turkey rhubarb, or an infusion of senna and manna.
In all fevers, the great point is to regulate the symptoms, so as to prevent
them from going to either extreme. Thus, in fevers of the inflammatory
kind, where the force of the circulation is too great, or the blood dense, and
the fibres too rigid, bleeding and other evacuations are necessary. But in
nervous fevers, where nature flags, where the blood is vapid and poor, and
the solids relaxed, the lancet must be spared, and wine, with other cordials,
plentifully administered.
It is the more necessary to caution people against bleeding in this disease,
as there is generally at the beginning an universal stricture upon the vessels,
and sometimes an oppression and difficulty of breathing, which suggest the
idea of a plethora, or too great a quantity of blood. I have known even some
of the faculty deceived by their own feelings in this respect, so far as to

insist upon being bled, when it was evident from the consequences that the
operation was improper.
Though bleeding is generally improper in this disease, yet blistering is
highly necessary. Blistering-plasters may be applied at all times of the fever
with great advantage. If the patient is delirious, he ought to be blistered on
the neck or head, and it will be the safest course, when the insensibility
continues, as soon as the discharge occasioned by one blistering-plaster
abates, to apply another to some other part of the body, and by that means
keep up a continual succession of them till he be out of danger.
I have been more sensible of the advantage of blistering in this than in
any other disease. Blistering-plasters not only stimulate the solids to action,
but likewise occasion a continual discharge, which may in some measure
supply the want of critical evacuations, which seldom happen in this kind of
fever. They are most proper, however, either towards the beginning, or after
some degree of stupor has come on, in which last case it will always be
proper to blister the head.
If the patient is costive through the course of the disease, it will be
necessary to procure a stool, by giving him every other day a clyster of milk
and water, with a little sugar, to which may be added a spoonful of common
salt, if the above does not operate.
Should a violent looseness come on, it may be checked by small
quantities of Venice treacle, or giving the patient for his ordinary drink the
white decoction[80].
A miliary eruption sometimes breaks out about the ninth or tenth day. As
eruptions are often critical, great care should be taken not to retard Nature’s
operation in this particular. The eruption ought neither to be checked by
bleeding nor other evacuations, nor pushed out by a hot regimen; but the
patient should be supported by gentle cordials, as wine-whey, small negus,
sago-gruel with a little wine in it, and such like. He ought not to be kept too
warm; yet a kindly breathing sweat should by no means be checked.
Though blistering and the use of cordial liquors are the chief things to be
depended on in this kind of fever; yet, for those who may chuse to use
them, we shall mention one or two of the forms of medicine which are
commonly prescribed in it[81].
In desperate cases, where the hiccup and starting of the tendons have
already come on, we have sometimes seen extraordinary effects from large

doses of musk frequently repeated. Musk is doubtless an antispasmodic,
and may be given to the quantity of a scruple three or four times a-day, or
oftener if necessary. Sometimes it may be proper to add to the musk a few
grains of camphire, and salt of hartshorn, as these tend to promote
perspiration and the discharge of urine. Thus fifteen grains of musk, with
three grains of camphire, and six grains of salt of hartshorn, may be made
into a bolus with a little syrup, and given as above.
If the fever should happen to intermit, which it frequently does towards
the decline, or if the patient’s strength should be wasted with colliquative
sweats, &c. it will be necessary to give him the Peruvian bark. Half a
drachm, or a whole drachm, if the stomach will bear it, of the bark in fine
powder, may be given four or five times a-day in a glass of red port or
claret. Should the bark in substance not sit easy on the stomach, an ounce of
it in powder may be infused in a bottle of Lisbon or Rhenish wine for two
or three days, afterwards it may be strained, and a glass of it taken
frequently[82].
Some give the bark in this and other fevers, where there are no symptoms
of inflammation, without any regard to the remission or intermission of the
fever. How far future observations may tend to establish this practice, we
will not pretend to say; but we have reason to believe that the bark is a very
universal febrifuge, and that it may be administered with advantage in most
fevers where bleeding is not necessary, or where there are no symptoms of
topical inflammation.

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

This may be called the pestilential fever of Europe, as in many of its
symptoms it bears a great resemblance to that dreadful disease the plague.
Persons of a lax habit, a melancholy disposition, and those whose vigour
has been wasted by long fasting, watching, hard labour, excessive venery,
frequent salivations, &c. are most liable to it.
CAUSES.——This fever is occasioned by foul air, from a number of
people being confined in a narrow place, not properly ventilated; from
putrid animal and vegetable effluvia, &c. Hence it prevails in camps, jails,
hospitals and infirmaries, especially where such places are too much
crowded, and cleanliness is neglected.
A close constitution of the air, with long rainy or foggy weather, likewise
occasions putrid fevers. They often succeed great inundations in low and
marshy countries, especially when these are preceded or followed by a hot
and sultry season.
Living too much upon animal food, without a proper mixture of
vegetables, or eating fish or flesh that has been kept too long, are likewise
apt to occasion this kind of fever. Hence sailors on long voyages, and the
inhabitants of besieged cities, are very often visited with putrid fevers.
Corn that has been greatly damaged by rainy seasons, or long keeping,
and water which has become putrid by stagnation, &c. may likewise
occasion this fever.
Dead carcases tainting the air, especially in hot seasons, are very apt to
occasion putrid diseases. Hence this kind of fever often prevails in countries
which are the scenes of war and bloodshed. This shews the propriety of
removing burying grounds, slaughterhouses, &c. at a proper distance from
great towns.
Want of cleanliness is a very general cause of putrid fevers. Hence they
prevail amongst the poor inhabitants of large towns, who breathe a confined

unwholesome air, and neglect cleanliness. Such mechanics as carry on dirty
employments, and are constantly confined within doors, are likewise very
liable to this disease.
We shall only add, that putrid, malignant, or spotted fevers, are highly
infectious, and are therefore often communicated by contagion. For which
reason all persons ought to keep at a distance from those affected with such
diseases, unless their attendance is absolutely necessary.
SYMPTOMS.——The malignant fever is generally preceded by a
remarkable weakness or loss of strength, without any apparent cause. This
is sometimes so great, that the patient can scarce walk, or even sit upright,
without being in danger of fainting away. His mind too is greatly dejected;
he sighs, and is full of dreadful apprehensions.
There is a nausea, and sometimes a vomiting of bile; a violent pain of the
head, with a strong pulsation or throbbing of the temporal arteries; the eyes
often appear red and inflamed, with a pain at the bottom of the orbit; there
is a noise in the ears, the breathing is laborious, and often interrupted with a
sigh; the patient complains of a pain about the region of the stomach, and in
his back and loins; his tongue is at first white, but afterwards it appears
black and chaped; and his teeth are covered with a black crust. He
sometimes passes worms both upwards and downwards, is affected with
tremors or shaking, and often becomes delirious.
If blood is let, it appears dissolved, or with a very small degree of
cohesion, and soon becomes putrid; the stools smell extremely fœtid, and
are sometimes of a greenish, black, or reddish cast. Spots of a pale purple,
dun, or black colour, often appear upon the skin, and sometimes there are
violent hæmorrhages, or discharges of blood from the mouth, eyes, nose,
&c.
Putrid fevers may be distinguished from the inflammatory, by the
smallness of the pulse, the great dejection of mind, the dissolved state of the
blood, the petechiæ, or purple spots, and the putrid smell of the excrements.
They may likewise be distinguished from the low or nervous fever by the
heat and thirst being greater, the urine of a higher colour, and the loss of
strength, dejection of mind, and all the other symptoms more violent.
It sometimes happens, however, that the inflammatory, nervous, and
putrid symptoms are so blended together, as to render it very difficult to
determine to which class the fever belongs. In this case the greatest caution

and skill are requisite. Attention must be paid to those symptoms which are
most prevalent, and both the regimen and medicines adapted to them.
Inflammatory and nervous fevers may be converted into malignant and
putrid, by too hot a regimen or improper medicines.
The duration of putrid fevers is extremely uncertain; sometimes they
terminate between the seventh and fourteenth day, and at other times they
are prolonged for five or six weeks. Their duration depends greatly upon the
constitution of the patient, and the manner of treating the disease.
The most favourable symptoms are, a gentle looseness after the fourth or
fifth day, with a warm mild sweat. These, when continued for a
considerable time, often carry off the fever, and should never be
imprudently stopped. Small miliary pustules appearing between the
petechiæ or purple spots are likewise favourable, as also hot scabby
eruptions about the mouth and nose. It is a good sign when the pulse rises
upon the use of wine, or other cordials, and the nervous symptoms abate;
deafness coming on towards the decline of the fever, is likewise often a
favourable symptom[83], as are abscesses in the groin or parotid glands.
Among the unfavourable symptoms may be reckoned an excessive
looseness, with a hard swelled belly; large black or livid blotches breaking
out upon the skin; apthæ in the mouth; cold clammy sweats; blindness;
change of the voice; a wild flaring of the eyes; difficulty of swallowing;
inability to put out the tongue; and a constant inclination to uncover the
breast. When the sweat and saliva are tinged with blood, and the urine is
black, or deposits a black sooty sediment, the patient is in great danger.
Starting of the tendons, and fœtid, ichorous, involuntary stools, attended
with coldness of the extremities, are generally the forerunners of death.
REGIMEN.——In the treatment of this disease we ought to endeavour as
far as possible to counteract the putrid tendency of the humours; to support
the patient’s strength and spirits; and to assist Nature in expelling the cause
of this disease, by gently promoting perspiration and the other evacuations.
It has been observed, that putrid fevers are often occasioned by
unwholesome air, and of course they must be aggravated by it. Care should
therefore be taken to prevent the air from stagnating in the patient’s
chamber, to keep it cool, and renew it frequently, by opening the doors or
windows of some adjacent apartment. The breath and perspiration of
persons in perfect health soon render the air of a small apartment noxious;

but this will sooner happen from the perspiration and breath of a person
whose whole mass of humours are in a putrid state.
Besides the frequent admission of fresh air, we would recommend the use
of vinegar, verjuice, juice of lemon, Seville orange, or any kind of vegetable
acid that can be most readily obtained. These ought frequently to be
sprinkled upon the floor, the bed, and every part of the room. They may also
be evaporated with a hot iron, or by boiling, &c. The fresh skins of lemons
or oranges ought likewise to be laid in different parts of the room, and they
should be frequently held to the patient’s nose. The use of acids in this
manner would not only prove very refreshing to the patient, but would
likewise tend to prevent the infection from spreading among those who
attend him. Strong scented herbs, as rue, tansy, rosemary, wormwood, &c.
may likewise be laid in different parts of the house, and smelled to by those
who go near the patient.
The patient must not only be kept cool, but likewise quiet and easy. The
least noise will affect his head, and the smallest fatigue will be apt to make
him faint.
Few things are of greater importance in this disease than acids, which
ought to be mixed with all the patient’s food as well as drink. Orange,
lemon, or vinegar whey, are all very proper, and may be drank by turns,
according to the patient’s inclination. They may be rendered cordial by the
addition of wine in such quantity as the patient’s strength seems to require.
When he is very low, he may drink negus, with only one half water, and
sharpened with the juice of orange or lemon. In some cases a glass of wine
may now and then be allowed. The most proper wine is Rhenish; but if the
body be open, red port or claret is to be preferred.
When the body is bound, a tea-spoonful of the cream of tartar may be put
into a cup of the patient’s drink, as there is occasion; or he may drink a
decoction of tamarinds, which will both quench his thirst, and promote a
discharge by stool.
If camomile-tea will sit upon his stomach, it is a very proper drink in this
disease. It may be sharpened by adding to every cup of the tea ten or fifteen
drops of the elixir of vitriol.
The food must be light, as panado or groat-gruel, to which a little wine
may be added, if the patient be weak and low; and they ought all to be
sharpened with the juice of orange, the jelly of currants, or the like. The

patient ought likewise to eat freely of ripe fruits, as roasted apples, currant
or gooseberry tarts, preserved cherries, or plums, &c.
Taking a little food or drink frequently, not only supports the spirits, but
counteracts the putrid tendency of the humours; for which reason the patient
ought frequently to be sipping small quantities of some of the acid liquors
mentioned above, or any that may be more agreeable to his palate, or more
readily obtained.
If he is delirious, his feet and hands ought to be frequently fomented with
a strong infusion of camomile flowers. This, or an infusion of the bark, to
such as can afford it, cannot fail to have a good effect. Fomentations of this
kind not only relieve the head, by relaxing the vessels in the extremities, but
as their contents are absorbed, and taken into the system, they may assist in
preventing the putrescency of the humours.
MEDICINE.——If a vomit be given at the beginning of this fever, it will
hardly fail to have a good effect; but if the fever has gone on for some days,
and the symptoms are violent, vomits are not quite so safe. The body
however is always to be kept gently open by clysters, or mild laxative
medicines.
Bleeding is seldom necessary in putrid fevers. If there be signs of an
inflammation, it may sometimes be permitted at the first onset; but the
repetition of it generally proves hurtful.
Blistering plasters are never to be used unless in the greatest extremities.
If the petechiæ or spots should suddenly disappear, the patient’s pulse sink
remarkably, and a delirium, with other bad symptoms, come on, blistering
may be permitted. In this case the blistering plasters are to be applied to the
head, and inside of the legs or thighs. But as they are sometimes apt to
occasion a gangrene, we would rather recommend warm cataplasms or
poultices of mustard and vinegar to be applied to the feet, having recourse
to blisters only in the utmost extremities.
It is common in the beginning of this fever to give the emetic tartar in
small doses, repeated every second or third hour, till it shall either vomit,
purge, or throw the patient into a sweat. This practice is very proper,
provided it be not pushed so far as to weaken the patient.
A very ridiculous notion has long prevailed, of expelling the poisonous
matter of malignant diseases by trifling doses of cordial or alexipharmic
medicines. In consequence of this notion, the contrayerva-root, the cordial

confection, the mithridate, &c. have been extolled as infallible remedies.
There is reason however to believe, that these seldom do much good. Where
cordials are necessary, we know none that is superior to good wine; and
therefore again recommend it both as the safest and best. Wine, with acids
and antiseptics, are the only things to be relied on in the cure of malignant
fevers.
In the most dangerous species of this disease, when it is attended with
purple, livid, or black spots, the Peruvian bark must be administered. I have
seen it, when joined with acids, prove successful, even in cases where the
petechiæ had the most threatening aspect. But, to answer this purpose, it
must not only be given in large doses, but duly persisted in.
The best method of administering the bark is certainly in substance. An
ounce of it in powder may be mixed with half an English pint of water, and
the same quantity of red wine, and sharpened with the elixir or the spirit of
vitriol, which will both make it sit easier on the stomach, and render it more
beneficial. Two or three ounces of the syrup of lemon may be added, and
two table-spoonfuls of the mixture taken every two hours, or oftener, if the
stomach is able to bear it.
Those who cannot take the bark in substance may infuse it in wine, as
recommended in the preceding disease.
If there be a violent looseness, the bark must be boiled in red wine with a
little cinnamon, and sharpened with the elixir of vitriol, as above. Nothing
can be more beneficial in this kind of looseness than plenty of acids, and
such things as promote a gentle perspiration.
If the patient be troubled with vomiting, a dram of the salt of wormwood,
dissolved in an ounce and half of fresh lemon-juice, and made into a
draught with an ounce of simple cinnamon water, and a bit of sugar, may be
given and repeated as often as it is necessary.
If swellings of the glands appear, their suppuration is to be promoted by
the application of poultices, ripening cataplasms, &c. And as soon as there
is any appearance of matter in them, they ought to be laid open, and the
poultices continued.
I have known large ulcerous sores break out in various parts of the body,
in the decline of this fever, of a livid gangrenous appearance, and a most
putrid cadaverous smell. These gradually healed, and the patient recovered,

by the plentiful use of Peruvian bark and wine, sharpened with the spirits of
vitriol.
For preventing putrid fevers we would recommend a strict regard to
cleanliness; a dry situation; sufficient exercise in the open air; wholesome
food, and a moderate use of generous liquors. Infection ought above all
things to be avoided. No constitution is proof against it. I have known
persons seized with a putrid fever, by only making a single visit to a patient
in it; others have caught it by lodging for one night in a town where it
prevailed; and some by attending the funerals of such as died of it[84].
When a putrid fever seizes any person in a family, the greatest attention
is necessary to prevent the disease from spreading. The sick ought to be
placed in a large apartment, as remote from the rest of the family as
possible; he ought likewise to be kept extremely clean, and should have
fresh air frequently let into his chamber; whatever comes from him should
be immediately removed, his linen should be frequently changed, and those
in health ought to avoid all unnecessary communication with him.
Any one who is apprehensive of having caught the infection, ought
immediately to take a vomit, and to work it off by drinking plentifully of
camomile-tea. This may be repeated in a day or two, if the apprehensions
still continue, or any unfavourable symptoms appear.
The person ought likewise to take an infusion of the bark and camomile
flowers for his ordinary drink; and before he goes to bed, he may drink an
English pint of pretty strong negus, or a few glasses of generous wine. I
have been frequently obliged to follow this course, when malignant fevers
prevailed, and have likewise recommended it to others with constant
success.
People generally fly to bleeding and purging as antidotes against
infection; but these are so far from securing them, that they often, by
debilitating the body, increase the danger.
Those who wait upon the sick in putrid fevers, ought always to have a
piece of spunge or a handkerchief dipt in vinegar, or juice of lemon, to
smell to while near the patient. They ought likewise to wash their hands,
and, if possible, to change their clothes, before they go into company.

CHAP. XXI.
OF THE MILIARY FEVER.

This fever takes its name from the small pustules or bladders which appear
on the skin, resembling, in shape and size, the seeds of millet. The pustules
are either red or white, and sometimes both are mixed together.
The whole body is sometimes covered with pustules; but they are
generally more numerous where the sweat is most abundant, as on the
breast, the back, &c. A gentle sweat, or moisture on the skin, greatly
promotes the eruption; but, when the skin is dry, the eruption is both more
painful and dangerous.
Sometimes this is a primary disease; but it is much oftener only a
symptom of some other malady, as the small-pox, measles, ardent, putrid,
or nervous fever, &c. In all these cases it is generally the effect of too hot a
regimen or medicines.
The miliary fever chiefly attacks the idle and the phlegmatic, or persons
of a relaxed habit. The young and the aged are more liable to it than those in
the vigour and prime of life. It is likewise more incident to women than
men, especially the delicate and the indolent, who, neglecting exercise,
keep continually within doors, and live upon weak watery diet. Such
females are extremely liable to be seized with this disease in child-bed, and
often lose their lives by it.
CAUSES.——The miliary fever is sometimes occasioned by violent
passions or affections of the mind; as excessive grief, anxiety,
thoughtfulness, &c. It may likewise be occasioned by excessive watching,
great evacuations, a weak watery diet, rainy seasons, eating too freely of
cold, crude, unripe fruits, as plums, cherries, cucumbers, melons; &c.
Impure waters, or provisions which have been spoiled by rainy seasons,
long keeping, &c. may likewise cause miliary fevers. They may also be
occasioned by the stoppage of any customary evacuation, as issues, setons,
ulcers, the bleeding piles in men, or the menstrual flux in women, &c.

This disease in child-bed-women is sometimes the effect of great
costiveness during pregnancy; it may likewise be occasioned by their
excessive use of green trash, and other unwholesome things, in which
pregnant women are too apt to indulge. But its most general cause is
indolence. Such women as lead a sedentary life, especially during
pregnancy, and at the same time live grossly, can hardly escape this disease
in child-bed. Hence it proves extremely fatal to women of fashion, and
likewise to those women in manufacturing towns, who, in order to assist
their husbands, sit close within doors for almost the whole of their time. But
among women who are active and laborious, who live in the country, and
take sufficient exercise without doors, this disease is very little known.
SYMPTOMS.——When this is a primary disease, it makes its attack,
like most other eruptive fevers, with a slight shivering, which is succeeded
by heat, loss of strength, faintishness, sighing, a low quick pulse, difficulty
of breathing, with great anxiety and oppression of the breast. The patient is
restless, and sometimes delirious; the tongue appears white, and the hands
shake, with often a burning heat in the palms; and in child-bed-women the
milk generally goes away, and the other discharges stop.
The patient feels an itching or pricking pain under the skin, after which
innumerable small pustules of a red or white colour begin to appear. Upon
this the symptoms generally abate, the pulse becomes more full and soft,
the skin grows moister, and the sweat, as the disease advances, begins to
have a peculiar fœtid smell; the great load on the breast, and oppression of
the spirits, generally go off, and the customary evacuations gradually return.
About the sixth or seventh day from the eruption, the pustules begin to dry
and fall off, which occasions a very disagreeable itching in the skin.
It is impossible to ascertain the exact time when the pustules will either
appear or go off. They generally come out on the third or fourth day, when
the eruption is critical; but, when symptomatic, they may appear at any time
of the disease.
Sometimes the pustules appear and vanish by turns. When that is the
case, there is always danger; but when they go in all of a sudden, and do not
appear again, the danger is very great.
In child-bed-women the pustules are commonly at first filled with clear
water, afterwards they grow yellowish. Sometimes they are interspersed

with pustules of a red colour. When these only appear the disease goes by
the name of a rash.
REGIMEN.——In all eruptive fevers, of whatever kind, the chief point
is to prevent the sudden disappearing of the pustules, and to promote their
maturation. For this purpose the patient must be kept in such a temperature,
as neither to push out the eruption too fast, nor to cause it to retreat
prematurely. The diet and drink ought therefore to be in a moderate degree
nourishing and cordial; but neither strong nor heating. The patient’s
chamber ought neither to be kept too hot nor cold; and he should not be too
much covered with clothes. Above all, the mind is to be kept easy and
cheerful. Nothing so certainly makes an eruption go in as fear, or the
apprehension of danger.
The food must be weak chicken-broth with bread, panado, sago, or groat
gruel, &c. to a gill of which may be added a spoonful or two of wine, as the
patient’s strength requires, with a few grains of salt and a little sugar. Good
apples roasted or boiled, with other ripe fruits of an opening cooling nature,
may be eaten.
The drink may be suited to the state of the patient’s strength and spirits. If
these be pretty high, the drink ought to be weak; as water-gruel, balm-tea,
or the decoction mentioned below[85].
When the patient’s spirits are low, and the eruption does not rise
sufficiently, his drink must be a little more generous; as wine-whey, or
small negus, sharpened with the juice of orange or lemon, and made
stronger or weaker as circumstances may require.
Sometimes the miliary fever approaches towards a putrid nature, in
which case the patient’s strength must be supported with generous cordials,
joined with acids; and, if the degree of putrescence be great, the Peruvian
bark must be administered. If the head be much affected, the body must be
kept open by emollient clysters[86].
MEDICINE.——If the food and drink be properly regulated, there will
be little occasion for medicine in this disease. Should the eruption however
not rise, or the spirits flag, it will not only be necessary to support the
patient with cordials, but likewise to apply blistering plasters. The most
proper cordial, in this case, is good wine, which may either be taken in the
patient’s food or drink; and if there be signs of putrescence, the bark and
acids may be mixed with wine, as directed in the putrid fever.

Some recommend blistering through the whole course of this disease;
and where Nature flags, and the eruption comes and goes, it may be
necessary to keep up a stimulus, by a continual succession of small
blistering plasters; but we would not recommend above one at a time. If
however the pulse should sink remarkably, the pustules fall in, and the head
be affected, it will be necessary to apply several blistering plasters to the
most sensible parts, as the inside of the legs and thighs, &c.
Bleeding is seldom necessary in this disease, and sometimes it does much
hurt, as it weakens the patient, and depresses his spirits. It is therefore never
to be attempted unless by the advice of a physician. We mention this,
because it has been customary to treat this disease in child-bed-women by
plentiful bleeding, and other evacuations, as if it were highly inflammatory.
But this practice is generally very unsafe. Patients in this situation bear
evacuations very ill. And indeed the disease seems often to be more of a
putrid than of an inflammatory nature.
Though this fever is often occasioned in child-bed-women by too hot a
regimen, yet it would be dangerous to leave that off all of a sudden, and
have recourse to a very cool regimen, and large evacuations. We have
reason to believe, that supporting the patient’s spirits, and promoting the
natural evacuations, is here much safer than to have recourse to artificial
ones, as these, by sinking the spirits, seldom fail to increase the danger.
If the disease proves tedious, or the recovery slow, we would recommend
the Peruvian bark, which may either be taken in substance, or infused in
wine or water, as the patient inclines.
The miliary fever, like other eruptive diseases, requires gentle purging,
which should not be neglected, as soon as the fever is gone off, and the
patient’s strength will permit.
To prevent this disease, a pure dry air, sufficient exercise, and wholesome
food, are necessary. Pregnant women should guard against costiveness, and
take daily as much exercise as they can bear, avoiding all green trashy
fruits, and other unwholesome things; and when in child-bed, they ought
strictly to observe a cool regimen.

CHAP. XXII.
OF THE REMITTING FEVER.

This fever takes its name from a remission of the symptoms, which happens
sometimes sooner, and sometimes later, but generally before the eighth day.
The remission is commonly preceded by a gentle sweat, after which the
patient seems greatly relieved, but in a few hours the fever returns. These
remissions return at very irregular periods, and are sometimes of longer,
sometimes of shorter duration; the nearer however that the fever approaches
to a regular intermittent, the danger is the less.
CAUSES.——Remitting fevers prevail in low marshy countries
abounding with wood and stagnating water; but they prove most fatal in
places where great heat and moisture are combined, as in some parts of
Africa, the province of Bengal in the East Indies, &c. where remitting
fevers are generally of a putrid kind, and prove very fatal. They are most
frequent in close calm weather, especially after rainy seasons, great
inundations, or the like. No age, sex, or constitution, is exempted from the
attack of this fever; but it chiefly seizes persons of a relaxed habit, who live
in low dirty habitations, breathe an impure stagnating air, take little
exercise, and use unwholesome diet.
SYMPTOMS.——The first symptoms of this fever are generally
yawning, stretching, pain, and giddiness in the head, with alternate fits of
heat and cold. Sometimes the patient is affected with a delirium at the very
first attack. There is a pain, and sometimes a swelling, about the region of
the stomach; the tongue is white, the eyes and skin frequently appear
yellow, and the patient is often afflicted with bilious vomitings. The pulse is
sometimes a little hard, but seldom full, and the blood, when let, rarely
shews any signs of inflammation. Some patients are exceedingly costive,
and others are afflicted with a very troublesome looseness.
It is impossible to describe all the symptoms of this disease, as they vary
according to the situation, the season of the year, and the constitution of the

patient. They may likewise be greatly changed by the method of treatment,
and by many other circumstances too tedious to mention. Sometimes the
bilious symptoms predominate, sometimes the nervous, and at other times
the putrid. Nor is it at all uncommon to find a succession of each of these,
or even a complication of them at the same time, in the same person.
REGIMEN.——The regimen must be adapted to the prevailing
symptoms. When there are any signs of inflammation, the diet must be
slender, and the drink weak and diluting. But when nervous or putrid
symptoms occur, it will be necessary to support the patient with food and
liquors of a more generous nature, such as are recommended in the
immediately preceding fevers. We must however be very cautious in the use
of things of a heating quality, as this fever is frequently changed into a
continual by an hot regimen, and improper medicines.
Whatever the symptoms are, the patient ought to be kept cool, quiet, and
clean. His apartment, if possible, should be large, and frequently ventilated
by letting in fresh air at the doors or windows. It ought likewise to be
sprinkled with vinegar, juice of lemon, or the like. His linen, bed-clothes,
&c. should be frequently changed, and all his excrements immediately
removed. Though these things have been recommended before, we think it
necessary to repeat them here, as they are of more importance to the sick
than practitioners are apt to imagine[87].
MEDICINE.——In order to cure this fever, we must endeavour to bring
it to a regular intermission. This intention may be promoted by bleeding, if
there be any signs of inflammation; but when that is not the case, bleeding
ought by no means to be attempted, as it will weaken the patient and
prolong the disease. A vomit however will seldom be improper, and is
generally of great service. Twenty or thirty grains of ipecacuanha will
answer this purpose very well; but, where it can be obtained, we would
rather recommend a grain or two of tartar emetic, with five or six grains of
ipecacuanha, to be made into a draught, and given for a vomit. This may be
repeated once or twice at proper intervals, if the sickness or nausea
continues.
The body ought to be kept open either by clysters or gentle laxatives, as
weak infusions of senna and manna, small doses of the lenitive electuary,
cream of tartar, tamarinds, stewed prunes, or the like; but all strong or
drastic purgatives are to be carefully avoided.

By this course the fever in a few days may generally be brought to a
pretty regular or distinct intermission, in which case the Peruvian bark may
be administered, and it will seldom fail to perfect the cure. It is needless
here to repeat the methods of giving the bark, as we have already had
occasion frequently to mention them.
The most likely way to avoid this fever is to use a wholesome and
nourishing diet, to pay the most scrupulous attention to cleanliness, to keep
the body warm, to take sufficient exercise, and in hot countries to avoid
damp situations, night air, evening dews, and the like. In countries where it
is endemical, the best preventive medicine which we can recommend, is the
Peruvian bark, which may either be chewed, or infused in brandy or wine,
&c. Some recommend smoking tobacco as very beneficial in marshy
countries, both for the prevention of this and intermitting fevers.

CHAP. XXIII.
OF THE SMALL-POX.

This disease, which originally came from Arabia, is now become so
general, that very few escape it at one time of life or another. It is a most
contagious malady; and has for many years proved the scourge of Europe.
The small-pox generally appear towards the spring. They are very
frequent in summer, less so in autumn, and least of all in winter. Children
are most liable to this disease; and those whose food is unwholesome, who
want proper exercise, and abound with gross humours, run the greatest
hazard from it.
The disease is distinguished into the distinct and confluent kind; the latter
of which is always attended with danger. There are likewise other
distinctions of the small-pox; as the crystalline, the bloody, &c.
CAUSES.——The small-pox is commonly caught by infection. Since the
disease was first brought into Europe, the infection has never been wholly
extinguished, nor have any proper methods, as far as I know, been taken for
that purpose; so that now it has become in a manner constitutional. Children
who have overheated themselves by running, wrestling, &c. or adults after a
debauch, are most apt to be seized with the small-pox.
SYMPTOMS.——This disease is so generally known, that a minute
description of it is unnecessary. Children commonly look a little dull, seem
lifeless and drowsy for a few days before the more violent symptoms of the
small-pox appear. They are likewise more inclined to drink than usual, have
little appetite for solid food, complain of weariness, and, upon taking
exercise, are apt to sweat. These are succeeded by slight fits of cold and
heat in turns, which, as the time of the eruption approaches, become more
violent, and are accompanied with pains of the head and loins, vomiting,
&c. The pulse is quick, with a great heat of the skin, and restlessness. When
the patient drops asleep, he wakes in a kind of horror, with a sudden start,

which is a very common symptom of the approaching eruption; as are also
convulsion-fits in very young children.
About the third or fourth day from the time of sickening, the small-pox
generally begin to appear; sometimes indeed they appear sooner, but that is
no favourable symptom. At first they very nearly resemble flea-bites, and
are soonest discovered on the face, arms, and breast.
The most favourable symptoms are a slow eruption, and an abatement of
the fever as soon as the pustules appear. In a mild distinct kind of small-pox
the pustules seldom appear before the fourth day from the time of
sickening, and they generally keep coming out gradually for several days
after. Pustules which are distinct, with a florid red basis, and which fill with
thick purulent matter, first of a whitish, and afterwards of a yellowish
colour, are the best.
A livid brown colour of the pustules is an unfavourable symptom; as also
when they are small and flat, with black specks in the middle. Pustules
which contain a thin watery ichor are very bad. A great number of pox on
the face is always attended with danger. It is likewise a very bad sign when
they run into one another.
It is a most unfavourable symptom when petechiæ, or purple, brown, or
black spots are interspersed among the pustules. These are signs of a putrid
dissolution of the blood, and shew the danger to be very great. Bloody
stools or urine, with a swelled belly, are bad symptoms; as is also a
continual strangury. Pale urine and a violent throbbing of the arteries of the
neck are signs of an approaching delirium, or of convulsion-fits. When the
face does not swell, or falls before the pox come to maturity, it is very
unfavourable. If the face begins to fall about the eleventh or twelfth day,
and at the same time the hands and feet begin to swell, the patient generally
does well; but when these do not succeed to each other, there is reason to
apprehend danger. When the tongue is covered with a brown crust, it is an
unfavourable symptom. Cold shivering fits coming on at the height of the
disease are likewise unfavourable. Grinding of the teeth, when it proceeds
from an affection of the nervous system, is a bad sign; but sometimes it is
occasioned by worms, or a disordered stomach.
REGIMEN.——When the first symptoms of the small-pox appear,
people are ready to be alarmed, and often fly to the use of medicine, to the
great danger of the patient’s life. I have known children, to appease the

anxiety of their parents, bled, blistered, and purged, during the fever which
preceded the eruption of the small-pox, to such a degree, that Nature was
not only disturbed in her operation, but rendered unable to support the
pustules after they were out; so that the patient, exhausted by mere
evacuations, sunk under the disease.
When convulsions appear, they give a dreadful alarm. Immediately some
nostrum is applied, as if this were a primary disease; whereas it is only a
symptom, and far from being an unfavourable one, of the approaching
eruption. As the fits generally go off before the actual appearance of the
small-pox, it is attributed to the medicine, which by this means acquires a
reputation without any merit[88].
All that is, generally speaking, necessary during the eruptive fever, is to
keep the patient cool and easy, allowing him to drink freely of some weak
diluting liquors; as balm-tea, barley-water, clear whey, gruels, &c. He
should not be confined to bed, but should sit up as much as he is able, and
should have his feet and legs frequently bathed in lukewarm water. His food
ought to be very light; and he should be as little disturbed with company as
possible.
Much mischief is done at this period by confining the patient too soon to
his bed, and plying him with warm cordials or sudorific medicines. Every
thing that heats and inflames the blood increases the fever, and pushes out
the pustules prematurely. This has numberless ill effects. It not only
increases the number of pustules, but likewise tends to make them run into
one another; and when they have been pushed out with too great violence,
they generally fall in before they come to maturity.
The good women, as soon as they see the small-pox begin to appear,
commonly ply their tender charge with cordials, saffron, and marigold-teas,
wine, punch, and even brandy itself. All these are given with a view, as they
term it, to throw out the eruption from the heart. This, like most other
popular mistakes, is the abuse of a very just observation, that when there is
a moisture on the skin, the pox rise better, and the patient is easier, than
when it continues dry and parched. But that is no reason for forcing the
patient into a sweat. Sweating never relieves unless where it comes
spontaneously, or is the effect of drinking weak diluting liquors.
Children are often so peevish, that they will not lie a-bed without a nurse
constantly by them. Indulging them in this, we have reason to believe, has

many bad effects both upon the nurse and child. Even the natural heat of the
nurse cannot fail to augment the fever of the child, but if she too proves
feverish, which is often the case, the danger must be increased[89].
Laying several children who have the small-pox in the same bed has
many ill consequences. They ought if possible never to be in the same
chamber, as the perspiration, the heat, the smell, &c. all tend to augment the
fever, and to heighten the disease. It is common among the poor to see two
or three children lying in the same bed, with such a load of pustules that
even their skins stick together. One can hardly view a scene of this kind
without being sickened by the sight. But how must the effluvia affect the
poor patients, many of whom perish by this usage[90]!
A very dirty custom prevails among the lower class of people, of
allowing children in the small-pox to keep on the same linen during the
whole period of that loathsome disease. This is done lest they should catch
cold; but it has many ill consequences. The linen becomes hard by the
moisture which it absorbs, and frets the tender skin. It likewise occasions a
bad smell, which is very pernicious both to the patient and those about him;
besides, the filth and sordes which adhere to the linen being resorbed, or
taken up again into the body, greatly augment the disease.
A patient should not be suffered to be dirty in an internal disease, far less
in the small-pox. Cutaneous disorders are often occasioned by nastiness
alone, and are always increased by it. Were the patient’s linen to be changed
every day, it would greatly refresh him. Care indeed is to be taken that the
linen be thoroughly dry. It ought likewise to be put on when the patient is
most cool.
So strong is the vulgar prejudice in this country, notwithstanding all that
has been said against the hot regimen in the small-pox, that numbers still
fall a sacrifice to that error. I have seen poor women travelling in the depth
of winter, and carrying their children along with them in the small-pox, and
have frequently observed others begging by the way-side, with infants in
their arms covered with the pustules; yet I could never learn that one of
these children died by this sort of treatment. This is certainly a sufficient
proof of the safety at least, of exposing patients in the small-pox to the open
air. There can be no reason however for exposing them to public view. It is
now very common in the environs of great towns to meet patients in the
small-pox on the public walks. This practice, however well it may suit the

purposes of boasting inoculators, is dangerous to the citizens, and contrary
to the laws of humanity and sound policy.
The food in this disease ought to be very light, and of a cooling nature, as
panado, or bread boiled with equal quantities of milk and water, good
apples roasted or boiled with milk, and sweetened with a little sugar, or
such like.
The drink may be equal parts of milk and water, clear sweet whey,
barley-water, or thin gruel, &c. After the pox are full, butter-milk, being of
an opening and cleansing nature, is a very proper drink.
MEDICINE.——This disease is generally divided into four different
periods, viz. the fever which precedes the eruption, the eruption itself, the
suppuration, or maturation of the pustules, and the secondary fever.
It has already been observed, that little more is necessary during the
primary fever than to keep the patient cool and quiet, allowing him to drink
diluting liquors, and bathing his feet frequently in warm water. Though this
be generally the safest course that can be taken with infants, yet adults of a
strong constitution and plethoric habit sometimes require bleeding. When a
full pulse, a dry skin, and other symptoms of inflammation render this
operation necessary, it ought to be performed; but, unless these symptoms
are urgent, it is safer to let it alone; if the body is bound, emollient clysters
may be thrown in.
If there is a great nausea or inclination to vomit, weak camomile-tea or
lukewarm water may be drank, in order to clean the stomach. At the
beginning of a fever, Nature generally attempts a discharge, either upwards
or downwards, which, if promoted by gentle means, would tend greatly to
abate the violence of the disease.
Though every method is to be taken during the primary fever, by a cool
regimen, &c. to prevent too great an eruption; yet after the pustules have
made their appearance, our business is to promote the suppuration, by
diluting drink, light food, and, if Nature seems to flag, by generous cordials.
When a low, creeping pulse, faintishness, and great loss of strength, render
cordials necessary, we would recommend good wine, which may be made
into negus, with an equal quantity of water, and sharpened with the juice of
orange, the jelly of currants, or the like. Wine-whey, sharpened as above, is
likewise a proper drink in this case; great care however must be taken not to

overheat the patient by any of these things. This, instead of promoting,
would retard the eruption.
The rising of the small-pox is often prevented by the violence of the
fever; in this case the cool regimen is strictly to be observed. The patient’s
chamber must not only be kept cool, but he ought likewise frequently to be
taken out of bed, and to be lightly covered with clothes while in it.
Excessive restlessness often prevents the rising and filling of the small-
pox. When this happens, gentle opiates are necessary. These however ought
always to be administered with a sparing hand. To an infant, a tea-spoonful
of the syrup of poppies may be given every five or six hours till it has the
desired effect. An adult will require a table-spoonful in order to answer the
same purpose.
If the patient be troubled with a strangury, or suppression of urine, which
often happens in the small-pox, he should be frequently taken out of bed,
and, if he be able, should walk across the room with his feet bare. When he
cannot do this, he may be frequently set on his knees in bed, and should
endeavour to pass his urine as often as he can. When these do not succeed, a
tea-spoonful of the sweet spirits of nitre may be occasionally mixed with
his drink. Nothing more certainly relieves the patient, or is more beneficial
in the small-pox, than a plentiful discharge of urine.
If the mouth be foul, and the tongue dry and chapped, it ought to be
frequently washed, and the throat gargled with water and honey, sharpened
with a little vinegar or currant jelly.
During the rising of the small-pox, it frequently happens that the patient
is eight or ten days without a stool. This not only tends to heat and inflame
the blood, but the fæces, by lodging so long in the body, become acrid, and
even putrid; from whence bad consequences must ensue. It will therefore be
proper, when the body is bound, to throw in an emollient clyster every
second or third day, through the whole course of the disease. This will
greatly cool and relieve the patient.
When petechiæ, or purple, black, or livid spots appear among the small-
pox, the Peruvian bark must immediately be administered in as large doses
as the patient’s stomach can bear. For a child, two drachms of the bark in
powder may be mixed in three ounces of common water, one ounce of
simple cinnamon-water, and two ounces of the syrup of orange or lemon.
This may be sharpened with the spirits of vitriol, and a table-spoonful of it

given every hour. If it be given to an adult in the same form, he may take at
least three or four spoonfuls every hour. This medicine ought not to be
trifled with, but must be administered as frequently as the stomach can bear
it; in which case it will often produce very happy effects. I have frequently
seen the petechiæ disappear, and the small-pox, which had a very
threatening aspect, rise and fill with laudable matter, by the use of the bark
and acids.
The patient’s drink ought likewise in this case to be generous, as wine or
strong negus acidulated with spirits of vitriol, vinegar, the juice of lemon,
jelly of currants, or such like. His food must consist of apples roasted or
boiled, preserved cherries, plums, and other fruits of an acid nature.
The bark and acids are not only necessary when the petechiæ or putrid
symptoms appear, but likewise in the lymphatic or crystalline small-pox,
where the matter is thin, and not duly prepared. The Peruvian bark seems to
possess a singular power of assisting Nature in preparing laudable pus, or
what is called good matter; consequently it must be beneficial both in this
and other diseases, where the crisis depends on a suppuration. I have often
observed where the small-pox were flat, and the matter contained in them
quite clear and transparent, and where at first they had the appearance of
running into one another, that the Peruvian bark, acidulated as above,
changed the colour and consistence of the matter, and produced the most
happy effects.
When the eruption subsides suddenly, or, as the good women term it,
when the small-pox strike in, before they have arrived at maturity, the
danger is very great. In this case blistering-plasters must be immediately
applied to the wrists and ancles, and the patient’s spirits supported with
cordials.
Sometimes bleeding has a surprising effect in raising the pustules after
they have subsided; but it requires skill to know when this is proper, or to
what length the patient can bear it. Sharp cataplasms however may be
applied to the feet and hands, as they tend to promote the swelling of these
parts, and by that means to draw the humours towards the extremities.
The most dangerous period of this disease is what we call the secondary
fever. This generally comes on when the small-pox begin to blacken, or turn
on the face; and most of those who die of the small-pox are carried off by
this fever.

Nature generally attempts, at the turn of the small-pox, to relieve the
patient by loose stools. Her endeavours this way are by no means to be
counteracted, but promoted, and the patient at the same time supported by
food and drink of a nourishing and cordial nature.
If, at the approach of the secondary fever, the pulse be very quick, hard,
and strong, the heat intense, and the breathing laborious, with other
symptoms of an inflammation of the breast, the patient must immediately
be bled. The quantity of blood to be let must be regulated by the patient’s
strength, age, and the urgency of the symptoms.
But, in the secondary fever, if the patient be faintish, the pustules become
suddenly pale, and if there be great coldness of the extremities, blistering
plasters must be applied, and the patient must be supported with generous
cordials. Wine and even spirits have sometimes been given in such cases
with amazing success.
As the secondary fever is in great measure, if not wholly, owing to the
absorption of the matter, it would seem highly consonant to reason, that the
pustules, as soon as they come to maturity, should be opened. This is every
day practiced in other phlegmons which tend to suppuration; and there
seems to be no cause why it should be less proper here. On the contrary, we
have reason to believe, that by this means the secondary fever might always
be lessened, and often wholly prevented.
The pustules should be opened when they begin to turn of a yellow
colour. Very little art is necessary for this operation. They may either be
opened with a lancet or a needle, and the matter absorbed by a little dry lint.
As the pustules are generally first ripe on the face, it will be proper to begin
with opening these, and the others in course as they become ripe. The
pustules generally fill again, a second or even a third time; for which cause
the operation must be repeated, or rather continued as long as there is any
considerable appearance of matter in the pustules.
We have reason to believe that this operation, rational as it is, has been
neglected from a piece of mistaken tenderness in parents. They believe that
it must give great pain to the poor child; and therefore would rather see it
die than have it thus tortured. This notion however is entirely without
foundation. I have frequently opened the pustules when the patient did not
see me, without his being in the least sensible of it; but suppose it were

attended with a little pain, that is nothing in comparison to the advantages
which arise from it.
Opening the pustules not only prevents the resorption of the matter into
the blood, but likewise takes off the tension of the skin, and by that means
greatly relieves the patient. It likewise tends to prevent the pitting, which is
a matter of no small importance. Acrid matter, by lodging long in the
pustules, cannot fail to corrode the tender skin; by which many a handsome
face becomes so deformed as hardly to bear a resemblance to the human
figure[91].
It is generally necessary, after the small-pox are gone off, to purge the
patient. If however the body has been open through the whole course of the
disease, or if butter-milk and other things of an opening nature have been
drank freely after the height of the small-pox, purging becomes less
necessary; but it ought never wholly to be neglected.
For very young children, an infusion of senna and prunes, with a little
rhubarb, may be sweetened with coarse sugar, and given in small quantities
till it operates. Those who are farther advanced must take medicines of a
sharper nature. For example, a child of five or six years of age may take
eight or ten grains of fine rhubarb in powder over night, and the same
quantity of jalap in powder next morning. This may be wrought off with
fresh broth or water-gruel, and may be repeated three or four times, five or
six days intervening between each dose. For children further advanced, and
adults, the dose must be increased in proportion to the age and
constitution[92].
When imposthumes happen after the small-pox, which is not seldom the
case, they must be brought to suppuration as soon as possible, by means of
ripening poultices; and when they have been opened, or have broke of their
own accord, the patient must be purged. The Peruvian bark and a milk diet
will likewise be useful in this case.
When a cough, a difficulty of breathing, or other symptoms of a
consumption, succeed to the small-pox, the patient must be sent to a place
where the air is good, and put upon a course of asses milk, with such
exercise as he can bear. For further directions in this case, see the article
Consumptions.

OF INOCULATION.

Though no disease, after it is formed, baffles the powers of medicine
more effectually than the small-pox, yet more may be done before-hand to
render this disease favourable than any one we know, as almost all the
danger from it may be prevented by inoculation. This salutary invention has
been known in Europe above half a century; but, like most other useful
discoveries, it has till of late made but slow progress. It must however be
acknowledged, to the honour of this country, that inoculation has met with a
more favourable reception here, than among any of our neighbours. It is
still however far from being general, which we have reason to fear will be
the case, as long as the practice continues in the hands of the faculty.
No discovery can be of general utility, while the practice of it is kept in
the hands of a few. Had the inoculation of the small-pox been introduced as
a fashion, and not as a medical discovery, or had it been practiced by the
same kind of operators here, as it is in those countries from whence we
learned it, it had long ago been universal. The fears, the jealousies, the
prejudices, and the opposite interests of the faculty, are, and ever will be,
the most effectual obstacles to the progress of any salutary discovery. Hence
it is that the practice of inoculation never became in any measure general,
even in England, till taken up by men not bred to physic. These have not
only rendered the practice more extensive, but likewise more safe, and by
acting under less restraint than the regular practitioners, have taught them
that the patient’s greatest danger arose, not from the want of care, but from
the excess of it.
They know very little of the matter, who impute the success of modern
inoculators to any superior skill, either in preparing the patient or
communicating the disease. Some of them indeed, from a sordid desire of
engrossing the whole practice to themselves, pretend to have extraordinary
secrets or nostrums for preparing persons for inoculation, which never fail
of success. But this is only a pretence calculated to blind the ignorant and
inattentive. Common sense and prudence alone are sufficient both in the
choice of the subject and management of the operation. Whoever is
possessed of these may perform this office for his children whenever he
finds it convenient, provided they be in a good state of health.

This sentiment is not the result of theory, but of observation. Though few
physicians have had more opportunities of trying inoculation in all its
different forms, so little appears to me to depend on those, generally
reckoned important circumstances, of preparing the body, communicating
the infection by this or the other method, &c. that for several years past I
have persuaded the parents or nurses to perform the whole themselves, and
have found that method followed with equal success, while it is free from
many inconveniences that attend the other[93].
The small-pox may be communicated in a great variety of ways with
nearly the same degree of safety and success. In Turkey, from whence we
learned the practice, the women communicate the disease to children, by
opening a bit of the skin with a needle, and putting into the wound a little
matter taken from a ripe pustule. On the coast of Barbary they pass a thread
wet with the matter through the skin between the thumb and fore-finger;
and in some of the states of Barbary, inoculation is performed by rubbing in
the variolous matter between the thumb and fore-finger, or on other parts of
the body. The practice of communicating the small-pox, by rubbing the
variolous matter upon the skin, has been long known in many parts of Asia
and Europe, as well as in Barbary, and has generally gone by the name of
buying the small-pox.
The present method of inoculating in Britain is to make two or three
slanting incisions in the arm, so superficial as not to pierce quite through
the skin, with a lancet wet with fresh matter taken from a ripe pustule;
afterwards the wounds are closed up, and left without any dressing. Some
make use of a lancet covered with the dry matter; but this is less certain,
and ought never to be used unless where fresh matter cannot be obtained:
when this is the case, the matter ought to be moistened by holding the lancet
for some time in the steam of warm water[94].
Indeed, if fresh matter be applied long enough to the skin, there is no
occasion for any wound at all. Let a bit of thread, about half an inch long,
wet with the matter, be immediately applied to the arm, midway between
the shoulder and the elbow, and covered with a piece of the common
sticking-plaster, and kept on for eight or ten days. This will seldom fail to
communicate the disease. We mention this method, because many people
are afraid of a wound; and doubtless the more easily the operation can be
performed, it has the greater chance to become general. Some people

imagine, that the discharge from a wound lessens the eruption; but there is
no great stress to be laid upon this notion; besides, deep wounds often
ulcerate, and become troublesome.
We do not find that inoculation is at all considered as a medical operation
in those countries from whence we learned it. In Turkey it is performed by
the women, and in the East Indies by the Brachmins or priests. In this
country the custom is still in its infancy; we make no doubt, however, but it
will soon become so familiar, that parents will think no more of inoculating
their children, than at present they do of giving them a purge.
No set of men have it so much in their power to render the practice of
inoculation general as the clergy, the greatest opposition to it still arising
from some scruples of conscience, which they alone can remove. I would
recommend it to them not only to endeavour to remove the religious
objections which weak minds may have to this salutary practice, but to
enjoin it as a duty, and to point out the danger of neglecting to make use of
a mean which Providence has put in our power for saving the lives of our
offspring. Surely such parents as wilfully neglect the means of saving their
children’s lives, are as guilty as those who put them to death. I wish this
matter were duly weighed. No one is more ready to make allowance for
human weakness and religious prejudices, yet I cannot help recommending
it, in the warmest manner, to parents, to consider how great an injury they
do their children, by neglecting to give them this disease in the early period
of life.
The numerous advantages arising from the inoculation of the small-pox
have been pretty fully pointed out by the learned Dr. M‘Kenzie, in his
History of Health[95]. To those mentioned by the Doctor we shall only add,
that such as have not had the small-pox in the early period of life, are not
only rendered unhappy, but likewise in a great measure unfit for sustaining
many of the most useful and important offices. Few people would chuse
even to hire a servant who had not had the small-pox, far less to purchase a
slave who had the chance of dying of this disease. How could a physician or
a surgeon, who had never had the small-pox himself, attend others under
that malady? How deplorable is the situation of females, who arrive at
mature age without having had the small-pox! A woman with child seldom
survives this disease: and if an infant happen to be seized with the small-
pox upon the mother’s breast, who has not had the disease herself the scene

must be distressing! If she continue to suckle the child, it is at the peril of
her own life; and if she wean it, in all probability it will perish. How often
is the affectionate mother forced to leave her house, and abandon her
children, at the very time when her care is most necessary? Yet should
parental affection get the better of her fears, the consequences would often
prove fatal. I have known the tender mother and her sucking infant laid in
the same grave, both untimely victims to this dreadful malady. But these are
scenes too shocking even to mention. Let parents who run away with their
children to avoid the small-pox, or who refuse to inoculate them in infancy,
consider to what deplorable situations, they may be reduced by this
mistaken tenderness!
As the small-pox is now become an epidemical disease in most parts of
the known world, no other choice remains but to render the malady as mild
as possible. This is the only manner of extirpation now left in our power;
and though it may seem paradoxical, the artificial method of
communicating the disease, could it be rendered universal, would amount to
nearly the same thing as rooting it out. It is a matter of small consequence,
whether a disease be entirely extirpated, or rendered so mild as neither to
destroy life nor hurt the constitution; but that this may be done by
inoculation, does not now admit of a doubt. The numbers who die under
inoculation hardly deserve to be named. In the natural way, one in four or
five generally dies; but by inoculation not one of a thousand. Nay, some can
boast of having inoculated ten thousand without the loss of a single patient.
I have often wished to see some plan established for rendering this
salutary practice universal; but am afraid I shall never be so happy. The
difficulties indeed are many; yet the thing is by no means impracticable.
The aim is great; no less than saving the lives of one-fourth part of
mankind. What ought not to be attempted in order to accomplish so
desirable an end?
The first step towards rendering the practice universal, must be to remove
the religious prejudices against it. This, as already observed, can only be
done by the clergy. They must not only recommend it as a duty to others,
but likewise practise it on their own children. Example will ever have more
influence than precept.
The next thing requisite is to put it in the power of all. For this purpose
we would recommend it to the Faculty to inoculate the children of the poor

gratis. It is hard that so useful a part of mankind should by their poverty be
excluded from such a benefit.
Should this fail, it is surely in the power of any State to render the
practice general, at least as far as their dominion extends. We do not mean
that it ought to be enforced by a law. The best way to promote it would be
to employ a sufficient number of operators at the public expence to
inoculate the children of the poor. This would only be necessary till the
practice became general; afterwards custom, the strongest of all laws,
would oblige every individual to inoculate his children to prevent
reflections.
It may be objected to this scheme, that the poor would refuse to employ
the inoculators: this difficulty is easily removed. A small premium to enable
mothers to attend their children while under the disease, would be a
sufficient inducement; besides, the success attending the operation would
soon banish all objections to it. Even considerations of profit would induce
the poor to embrace this plan. They often bring up their children to the age
of ten or twelve, and when they come to be useful, they are snatched away
by this malady, to the great loss of their parents, and detriment of the public.
The British legislature has of late years shewn great attention to the
preservation of infant lives, by supporting the foundling hospital, &c. But
we will venture to say, if one-tenth part of the sums laid out in supporting
that institution, had been bestowed towards promoting the practice of
inoculation of the small-pox among the poor, that not only more useful lives
had been saved, but the practice ere now rendered quite universal in this
island. It is not to be imagined what effect example and a little money will
have upon the poor; yet, if left to themselves, they would go on for ever in
the old way, without thinking of any improvement. We only mean this as a
hint to the humane and public-spirited. Should such a scheme be approved,
a proper plan might easily be laid down for the execution of it.
But as public plans are very difficult to bring about, and often, by the
selfish views and misconduct of those intrusted with the execution of them,
fail of answering the noble purposes for which they were designed; we shall
therefore point out some other method by which the benefits of inoculation
may be extended to the poor.
There is no doubt but inoculators will daily become more numerous. We
would therefore have every parish in Britain to allow one of them a small

annual salary for inoculating all the children of the parish at a proper age.
This might be done at a very trifling expence, and it would enable every one
to enjoy the benefit of this salutary invention.
Two things chiefly operate to prevent the progress of inoculation. The
one is a wish to put the evil day as far off as possible. This is a principle in
our nature; and as inoculation seems rather to be anticipating a future evil, it
is no wonder mankind are so averse to it. But this objection is sufficiently
answered by the success. Who in his senses would not prefer a lesser evil
to-day to a greater to-morrow, provided they were equally certain?
The other obstacle is the fear of reflections. This has very great weight
with the bulk of mankind. Should the child die, they think the world would
blame them. This they cannot bear. Here lies the difficulty; and till that be
removed, inoculation will make but small progress. Nothing however can
remove it but custom. Make the practice fashionable, and all objections will
soon vanish. It is fashion alone that has led the multitude since the
beginning of the world, and will lead them to the end. We must therefore
call upon the more enlightened part of mankind to set a pattern to the rest.
Their example, though it may for some time meet with opposition, will at
length prevail.
I am aware of an objection to this practice from the expence with which
it may be attended: this is easily obviated. We do not mean that every parish
ought to employ a Sutton or a Dimsdale as inoculators. These have by their
success already recommended themselves to crowned heads, and are
beyond the vulgar reach; but have not others an equal chance to succeed?
They certainly have. Let them make the same trial, and the difficulties will
soon vanish. There is not a parish, and hardly a village in Britain, destitute
of some person who can bleed. But this is a far more difficult operation, and
requires both more skill and dexterity than inoculation.
The persons to whom we would chiefly recommend the performance of
this operation are the clergy. Most of them know something of medicine.
Almost all of them bleed, and can order a purge, which are all the
qualifications necessary for the practice of inoculation. The priests among
the less enlightened Indians perform this office, and why should a Christian
teacher think himself above it? Surely the bodies of men, as well as their
souls, merit a part of the pastor’s care; at lead the greatest Teacher who ever
appeared among men seems to have thought so.

Should all other methods fail, we would recommend it to parents to
perform the operation themselves. Let them take any method of
communicating the disease they please; provided the subjects be healthy,
and of a proper age, they will seldom fail to succeed to their wish. I have
known many instances even of mothers performing the operation, and never
so much as heard of one bad consequence. A planter in one of the West
India islands is said to have inoculated, with his own hand, in one year,
three hundred of his slaves, who, notwithstanding the warmth of the
climate, and other unfavourable circumstances, all did well. Common
mechanics have often, to my knowledge, performed the operation with as
good success as physicians. We do not however mean to discourage those
who have it in their power, from employing people of skill to inoculate their
children, and attend them while under the disease, but only to shew, that
where such cannot be had, the operation ought not upon that account to be
neglected.
Instead of multiplying arguments to recommend this practice, I shall just
beg leave to mention the method which I took with my own son, then an
only child. After giving him two gentle purges, I ordered the nurse to take a
bit of thread which had been previously wet with fresh matter from a pock,
and to lay it upon his arm, covering it with a piece of sticking-plaster. This
remained on six or seven days, till it was rubbed off by accident. At the
usual time the small-pox made their appearance, and were exceedingly
favourable. Surely this, which is all that is generally necessary, may be done
without any skill in medicine.
We have been the more full upon this subject because the benefits of
inoculation cannot be extended to society by any other means than making
the practice general. While it is confined to a few, it must prove hurtful to
the whole. By means of it the contagion is spread, and is communicated to
many who might otherwise never have had the disease. Accordingly it is
found that more die of the small-pox now than before inoculation was
introduced; and this important discovery, by which alone more lives might
be saved than by all the endeavours of the Faculty, is in a great measure lost
by its benefits not being extended to the whole community[96].
The spring and autumn have been usually reckoned the most proper
seasons for inoculation, on account of the weather being then most
temperate; but it ought to be considered that these are generally the most

unhealthy seasons of the whole year. Undoubtedly the best preparation for
the disease is a previous good state of health. I have always observed that
children in particular are more sickly towards the end of spring and autumn
than at any other time of the year. On this account, as well as for the
advantage of cool air, I would propose winter as the most proper season for
inoculation; though, on every other consideration, the spring would seem to
be preferable.
The most proper age for inoculation is between three and five. Many
approve of inoculating on the breast, and where no circumstances forbid
this practice, I have no objection to it. Children, however, are more liable to
convulsions at this time than afterwards; besides, the anxiety of the mother
or nurse, should the child be in danger, would not fail to heighten it by
spoiling the milk.
Children who have constitutional diseases must nevertheless be
inoculated. It will often mend the habit of body; but ought to be performed
at a time when they are most healthy. Accidental diseases should always be
removed before inoculation.
It is generally thought necessary to regulate the diet for some time before
the disease be communicated. In children, however, great alteration in diet
is seldom necessary, their food being commonly of the most simple and
wholesome kind, as milk, water-pap, weak broths, bread, light pudding,
mild roots, and white meats.
But children who have been accustomed to a hotter diet, who are of a
gross habit, or abound with bad humours, ought to be put upon a spare diet
before they are inoculated. Their food should be of a light cooling nature,
and their drink whey, butter-milk, and such like.
We would recommend no other medicinal preparation but two or three
mild purges, which ought to be suited to the age and strength of the patient.
The success of inoculators does not depend on the preparation of their
patients, but on their management of them while under the disease. Their
constant care is to keep them cool, and their bodies gently open, by which
means the fever is kept low, and the eruption greatly lessened. The danger is
seldom great when the pustules are few; and their number is generally in
proportion to the fever which precedes and attends the eruption. Hence the
chief secret of inoculation consists in regulating the eruptive fever, which
generally may be kept sufficiently low by the methods mentioned above.

The regimen during the disease is in all respects the same as under the
natural small-pox. The patient must be kept cool, his diet should be light,
and his drink weak and diluting, &c. Should any bad symptoms appear,
which is seldom the case, they must be treated in the same way as directed
in the natural small-pox. Purging is not less necessary after the small-pox
by inoculation than in the natural way, and ought by no means to be
neglected.

CHAP. XXIV.
OF THE MEASLES.

The measles appeared in Europe about the same time with the small-pox,
and have a great affinity to that disease. They both came from the same
quarter of the world, are both infectious, and seldom attack the same person
more than once. The measles are most common in the spring season, and
generally disappear in summer. The disease itself, when properly managed,
seldom proves fatal; but its consequences are often very troublesome.
CAUSE.——This disease, like the small-pox, proceeds from infection,
and is more or less dangerous according to the constitution of the patient,
the season of the year, the climate, &c.
SYMPTOMS.——The measles, like other fevers, are preceded by
alternate fits of heat and cold, with sickness, and loss of appetite. The
tongue is white, but generally moist. There is a short cough, a heaviness of
the head and eyes, drowsiness, and a running at the nose. Sometimes indeed
the cough does not come before the eruption has appeared. There is an
inflammation and heat in the eyes, accompanied with a defluxion of sharp
rheum, and great acuteness of sensation, so that they cannot bear the light
without pain. The eye-lids frequently swell so as to occasion blindness. The
patient generally complains of his throat; and a vomiting or looseness often
precedes the eruption. The stools in children are commonly greenish; they
complain of an itching of the skin, and are remarkably peevish. Bleeding at
the nose is common, both before and in the progress of the disease.
About the fourth day, small spots, resembling flea-bites, appear, first
upon the face; then upon the breast, and afterwards on the extremities: these
may be distinguished from the small pox by their scarcely rising above the
skin. The fever, cough, and difficulty of breathing, instead of being
removed by the eruption as in the small pox, are rather increased; but the
vomiting generally ceases.

About the sixth or seventh day from the time of sickening, the measles
begin to turn pale on the face, and afterwards upon the body; so that by the
ninth day they entirely disappear. The fever; however, and difficulty of
breathing, often continue, especially if the patient has been kept upon too
hot a regimen. Petechiæ, or purple spots, may likewise be occasioned by
this error.
A violent looseness sometimes succeeds the measles; in which case the
patient’s life is in imminent danger.
Such as die of the measles generally expire about the ninth day from the
invasion, and are commonly carried off by a peripneumony, or
inflammation of the lungs.
The most favourable symptoms are a moderate looseness, a moist skin,
and a plentiful discharge of urine.
When the eruption suddenly falls in, and the patient is seized with a
delirium, he is in the greatest danger. If the measles turn too soon of a pale
colour, it is an unfavourable symptom, as are also great weakness,
vomiting, restlessness, and difficulty of swallowing. Purple or black spots
appearing among the measles are very unfavourable. When a continual
cough, with hoarseness, succeeds the disease, there is reason to suspect an
approaching consumption of the lungs.
Our business in this disease is to assist Nature, by proper cordials, in
throwing out the eruption, if her efforts be too languid; but when they are
too violent they must be restrained by evacuations, and cool diluting
liquors, &c. We ought likewise to endeavour to appease the most urgent
symptoms, as the cough, restlessness, and difficulty of breathing.
REGIMEN.——The cool regimen is necessary here as well as in the
small-pox. The food too must be light, and the drink diluting. Acids
however do not answer so well in the measles as in the small-pox, as they
tend to exasperate the cough. Small beer likewise, though a good drink in
the small-pox, is here improper. The most suitable liquors are decoctions of
liquorice with marsh-mallow roots and sarsaparilla, infusions of linseed, or
of the flowers of elder, balm-tea, clarified whey, barley-water, and such
like. These, if the patient be costive, may be sweetened with honey; or, if
that should disagree with the stomach, a little manna may occasionally be
added to them.

MEDICINE.——The measles being an inflammatory disease, without
any critical discharge of matter, as in the small-pox, bleeding is commonly
necessary, especially when the fever runs high, with difficulty of breathing,
and great oppression of the breast. But if the disease be of a mild kind,
bleeding may be omitted[97].
Bathing the feet and legs frequently in lukewarm water both tends to
abate the violence of the fever, and to promote the eruption.
The patient is often greatly relieved by vomiting. When there is a
tendency this way, it ought to be promoted by drinking lukewarm water, or
weak camomile-tea.
When the cough is very troublesome, with dryness of the throat, and
difficulty of breathing, the patient may hold his head over the steam of
warm water, and draw the steam into his lungs.
He may likewise lick a little sperma-ceti and sugar-candy pounded
together; or take now and then a spoonful of the oil of sweet almonds, with
sugar-candy dissolved in it. These will soften the throat, and relieve the
tickling cough.
If at the turn of the disease the fever assumes new vigour, and there
appears great danger of suffocation, the patient must be bled according to
his strength, and blistering-plasters applied, with a view to prevent the load
from being thrown on the lungs, where if an inflammation should fix itself,
the patient’s life will be in imminent danger.
In case the measles should suddenly disappear, it will be necessary to
pursue the same method which we have recommended when the small-pox
recede. The patient must be supported with wine and cordials. Blistering-
plasters must be applied to the legs and arms, and the body rubbed all over
with warm flannels. Warm poultices may likewise be applied to the feet and
palms of the hands.
When purple or black spots appear, the patient’s drink should be
sharpened with spirits of vitriol; and if the putrid symptoms increase, the
Peruvian bark must be administered in the same manner as directed in the
small-pox.
Opiates are sometimes necessary, but should never be given except in
cases of extreme restlessness, a violent looseness, or when the cough is very
troublesome. For children, the syrup of poppies is sufficient. A tea-spoonful

or two may be occasionally given, according to the patient’s age, or the
violence of the symptoms.
After the measles are gone off, the patient ought to be purged. This may
be conducted in the same manner as directed in the small-pox.
If a violent looseness succeeds the measles, it may be checked by taking
for some days a gentle dose of rhubarb in the morning, and an opiate over
night; but if these do not remove it, bleeding will seldom fail to have that
effect.
Patients recovering after the measles should be careful what they eat or
drink. Their food for some time ought to be light, and in small quantities,
and their drink diluting, and rather of an opening nature, as butter-milk,
whey, and such like. They ought also to beware of exposing themselves too
soon to the cold air, lest a suffocating catarrh, an asthma, or a consumption
of the lungs, should ensue.
Should a cough, with difficulty of breathing, and other symptoms of a
consumption, remain after the measles, small quantities of blood may be
frequently let at proper intervals, as the patient’s strength and constitution
will permit. He ought likewise to drink asses milk, to remove to a free air, if
in a large town, and to ride daily on horseback. He must keep close to a diet
consisting of milk and vegetables; and lastly, if these do not succeed, let
him remove to a warmer climate[98].

OF THE SCARLET FEVER.

The scarlet fever is so called from the colour of the patient’s skin, which
appears as if it were tinged with red wine. It happens at any season of the
year, but is most common towards the end of summer; at which time it
often seizes whole families; children and young persons are most subject to
it.
It begins like other fevers, with coldness and shivering, without any
violent sickness. Afterwards the skin is covered with red spots, which are
broader, more florid, and less uniform than the measles. They continue two
or three days, and then disappear; after which the cuticle, or scarf-skin, falls
off.

There is seldom any occasion for medicine in this disease. The patient
ought however to keep within doors, to abstain from flesh, strong liquors,
and cordials, and to drink freely of cool diluting liquors. If the fever runs
high, the body must be kept gently open by emollient clysters, or small
doses of nitre and rhubarb. A scruple of the former, with five grains of the
latter, may be taken thrice a-day, or oftener, if necessary.
Children and young persons are sometimes seized at the beginning of this
disease with a kind of stupor and epileptic fits. In this case the feet and legs
should be bathed in warm water, a large blistering-plaster applied to the
neck, and a dose of the syrup of poppies given every night till the patient
recovers[99].
The scarlet fever however is not always of so mild a nature. It is
sometimes attended with putrid or malignant symptoms, in which case it is
always dangerous. In the malignant scarlet fever the patient is not only
affected with coldness and shivering, but with languor, sickness, and great
oppression, to these succeed excessive heat, nausea and vomiting, with a
soreness of the throat; the pulse is extremely quick, but small and
depressed; the breathing frequent and laborious; the skin hot, but not quite
dry; the tongue moist, and covered with a whitish mucus; the tonsils
inflamed and ulcerated. When the eruption appears, it brings no relief: on
the contrary, the symptoms generally grow worse, and fresh ones come on,
as purging, delirium, &c.
When this disease is mistaken for a simple inflammation, and treated
with repeated bleedings, purging and cooling medicines, it generally proves
fatal. The only medicines that can be depended on in this case are cordials
and antiseptics, as the Peruvian bark, wine, snake-root, and the like. The
treatment must be in general similar to that of the putrid fever, or of the
malignant ulcerous sore throat[100].

OF THE BILIOUS FEVER.

When a continual, remitting, or intermitting fever is accompanied with a
frequent or copious evacuation of bile, either by vomit or stool, the fever is
denominated bilious. In Britain the bilious fever generally makes its
appearance about the end of summer, and ceases towards the approach of
winter. It is most frequent and fatal in warm countries, especially where the

soil is marshy, and when great rains are succeeded by sultry heats. Persons
who work without doors, lie in camps, or who are exposed to the night air,
are most liable to this kind of fever.
If there are symptoms of inflammation at the beginning of this fever, it
will be necessary to bleed, and to put the patient upon the cool diluting
regimen recommended in the inflammatory fever. The saline draught may
likewise be frequently administered, and the patient’s body kept open by
clysters or mild purgatives. But if the fever should remit or intermit,
bleeding will seldom be necessary. In this case a vomit may be
administered, and, if the body be bound, a gentle purge; after which the
Peruvian bark will generally complete the cure.
In case of a violent looseness, the patient must be supported with chicken
broth, jellies of hartshorn, and the like; and he may use the white decoction
for his ordinary drink[101]. If a bloody flux should accompany this fever, it
must be treated in the manner recommended under the article Dysentery.
When there is a burning heat, and the patient does not sweat, that
evacuation may be promoted by giving him, three or four times a day, a
table-spoonful of Mindererus’s spirit[102] mixed in a cup of his ordinary
drink.
If the bilious fever be attended with the nervous, malignant, or putrid
symptoms, which is sometimes the case, the patient must be treated in the
same manner as directed under these diseases.
After this fever, proper care is necessary to prevent a relapse. For this
purpose the patient, especially towards the end of autumn, ought to continue
the use of the Peruvian bark for some time after he is well. He should
likewise abstain from all trashy fruits, new liquors, and every kind of
flatulent aliment.

CHAP. XXV.
OF THE ERYSIPELAS, or St. ANTHONY’S FIRE.

This disease, which in some parts of Britain is called the rose, attacks
persons at any period of life, but is most common between the age of thirty
and forty. Persons of a sanguine or plethoric habit are most liable to it. It
often attacks young people, and pregnant women; and such as have once
been afflicted with it are very liable to have it again. Sometimes it is a
primary disease, and at other times only a symptom of some other malady.
Every part of the body is liable to be attacked by an erysipelas, but it most
frequently seizes the legs or face, especially the latter. It is most common in
autumn, or when hot weather is succeeded by cold and wet.
CAUSES.——The erysipelas may be occasioned by violent passions or
affections of the mind; as fear, anger, &c. When the body has been heated to
a great degree, and is immediately exposed to the cold air, so that the
perspiration is suddenly checked, an erysipelas will often ensue[103]. It may
also be occasioned by drinking to excess, by continuing too long in a warm
bath, or by any thing that overheats the blood. If any of the natural
evacuations be obstructed, or in too small quantity, it may cause an
erysipelas. The same effect will follow from the stoppage of artificial
evacuations; as issues, setons, or the like.
SYMPTOMS.——The erysipelas attacks with shivering, thirst, loss of
strength, pain in the head and back, heat, restlessness, and a quick pulse; to
which may be added vomiting, and sometimes a delirium. On the second,
third, or fourth day, the part swells, becomes red, and small pustules appear
at which time the fever generally abates.
When the erysipelas seizes the foot, the parts contiguous swell, the skin
shines; and, if the pain be violent, it will ascend to the leg, and will not bear
to be touched.
When it attacks the face, it swells, appears red, and the skin is covered
with small pustules filled with clear water. One or both eyes are generally

closed with the swelling; and there is a difficulty of breathing. If the mouth
and nostrils be very dry, and the patient drowsy, there is reason to suspect
an inflammation of the brain.
If the erysipelas affects the breast, it swells and becomes exceedingly
hard, with great pain, and is apt to suppurate. There is a violent pain in the
arm-pit on the side affected, where an abscess is often formed.
If in a day or two the swelling subsides, the heat and pain abate, the
colour of the part turns yellow, and the cuticle breaks and falls off in scales,
the danger is over.
When the erysipelas is large, deep, and affects a very sensible part of the
body, the danger is great. If the red colour changes into a livid or black, it
will end in a mortification. Sometimes the inflammation cannot be
discussed, but comes to a suppuration; in which case fistulas, a gangrene, or
mortification, often ensue.
Such as die of this disease are commonly carried off by the fever, which
is attended with difficulty of breathing, and sometimes with a delirium and
great drowsiness. They generally die about the seventh or eighth day.
REGIMEN.——In the erysipelas the patient must neither be kept too hot
nor too cold, as either of these extremes will tend to make it retreat, which
is always to be guarded against. When the disease is mild, it will be
sufficient to keep the patient within doors, without confining him to his bed,
and to promote the perspiration by diluting liquors, &c.
The diet ought to be slender, and of a moderately cooling and moistening
quality, as groat-gruel, panado, chicken or barley-broth, with cooling herbs
and fruits, &c. avoiding flesh, fish, strong drink, spices, pickles, and all
other things that may heat and inflame the blood; the drink may be barley-
water, an infusion of elder-flowers, common whey, and such like.
But if the pulse be low, and the spirits sunk, the patient must be
supported with negus, and other things of a cordial nature. His food may be
sago-gruel with a little wine, and nourishing broths taken in small
quantities, and often repeated. Great care however must be taken not to
overheat him.
MEDICINE.——In this disease much mischief is often done by
medicine, especially by external applications. People, when they see an
inflammation, immediately think that something ought to be applied to it.

This indeed is necessary in large phlegmons; but in an erysipelas the safer
course is to apply nothing. Almost all ointments, salves, and plasters, being
of a greasy nature, tend rather to obstruct and repel, than promote any
discharge from the part. At the beginning of this disease it is neither safe to
promote a suppuration, nor to repel the matter too quickly. The erysipelas in
many respects resembles the gout, and is to be treated with the greatest
caution. Fine wool, or very soft flannel, are the safest applications to the
part. These not only defend it from the external air, but likewise promote
the perspiration, which has a great tendency to carry off the disease. In
Scotland the common people generally apply a mealy cloth to the parts
affected, which is far from being improper.
It is common to bleed in the erysipelas; but this likewise requires caution.
If however the fever be high, the pulse hard and strong, and the patient
vigorous, it will be proper to bleed; but the quantity must be regulated by
these circumstances, and the operation repeated as the symptoms may
require. If the patient has been accustomed to strong liquors, and the disease
attacks his head, bleeding is absolutely necessary.
Bathing the feet and legs frequently in lukewarm water, when the disease
attacks the face or brain, has an excellent effect. It tends to make a
derivation from the head, and seldom fails to relieve the patient. When
bathing proves ineffectual, poultices, or sharp sinapisms, may be applied to
the soles of the feet, for the same purpose.
In cases where bleeding is requisite, it is likewise necessary to keep the
body open. This may be effected by emollient clysters, or small doses of
nitre and rhubarb. Some indeed recommend very large doses of nitre in the
erysipelas; but nitre seldom sits easy on the stomach when taken in large
doses. It is however one of the best medicines when the fever and
inflammation run high. Half a drachm of it, with four or five grains of
rhubarb, may be taken in the patient’s ordinary drink, four times a day.
When the erysipelas leaves the extremities, and seizes the head so as to
occasion a delirium or stupor, it is absolutely necessary to open the body. If
clysters and mild purgatives fail to have this effect, stronger ones must be
given. Blistering plasters must likewise be applied to the neck, or behind
the ears, and sharp cataplasms laid to the soles of the feet.
When the inflammation cannot be discussed, and the part has a tendency
to ulcerate, it will then be proper to promote suppuration, which may be

done by the application of ripening poultices with saffron, warm
fomentations, and such like.
When the black, livid, or blue colour of the part shews a tendency to
mortification, the Peruvian bark must be administered. It may be taken
along with acids, as recommended in the small-pox, or in any other form
more agreeable to the patient. It must not however be trifled with, as the
patient’s life is at stake. A drachm may be given every two hours, if the
symptoms be threatening, and cloths dipped in warm camphorated spirits of
wine, or the tincture of myrrh and aloes, may be applied to the part, and
frequently renewed. It may likewise be proper in this case to apply poultices
of the bark, or to foment the part affected with a strong decoction of it.
In what is commonly called the scorbutic erysipelas, which continues for
a considerable time, it will only be necessary to give gentle laxatives, and
such things as purify the blood and promote the perspiration. Thus, after the
inflammation has been checked by opening medicines, the decoction of
woods[104] may be drank, after which a course of bitters will be proper.
Such as are liable to frequent attacks of the erysipelas ought carefully to
guard against all violent passions; to abstain from strong liquors, and all fat,
viscid, and highly nourishing food. They should likewise take sufficient
exercise, carefully avoiding the extremes of heat or cold. Their food should
consist chiefly of milk, and such fruits, herbs, and roots, as are of a cooling
quality; and their drink ought to be small-beer, whey, butter-milk, and such
like. They should never suffer themselves to be long costive. If that cannot
be prevented by suitable diet, it will be proper to take frequently a gentle
dose of rhubarb, cream of tartar, the lenitive electuary, or some other mild
purgative.

CHAP. XXVI.
OF THE PHRENITIS, OR INFLAMMATION OF THE BRAIN.

This is sometimes a primary disease, but oftener only a symptom of some
other malady; as the inflammatory, eruptive, or spotted fever, &c. It is very
common however as a primary disease in warm climates, and is most
incident to persons about the prime or vigour of life. The passionate, the
studious, and those whose nervous system is irritable in a high degree, are
most liable to it.
CAUSES.——This disease is often occasioned by night-watching,
especially when joined with hard study: it may likewise proceed from hard
drinking, anger, grief, or anxiety. It is often occasioned by the stoppage of
usual evacuations; as the bleeding piles in men, the customary discharges of
women, &c. Such as imprudently expose themselves to the heat of the sun,
especially by sleeping without doors in a hot season with their heads
uncovered, are often suddenly seized with an inflammation of the brain, so
as to awake quite delirious. When repellents are imprudently used in an
erysipelas, an inflammation of the brain is sometimes the consequence. It
may likewise be occasioned by external injuries, as blows or bruises upon
the head, &c.
SYMPTOMS.——The symptoms which usually precede a true
inflammation of the brain are pain of the head, redness of the eyes, a violent
flushing of the face, disturbed sleep, or a total want of it, great dryness of
the skin, costiveness, a retention of urine, a small dropping of blood from
the nose, singing of the ears, and extreme sensibility of the nervous system.
When the inflammation is formed, the symptoms in general are similar to
those of the inflammatory fever. The pulse indeed is often weak, irregular,
and trembling; but sometimes it is hard and contracted. When the brain
itself is inflamed, the pulse is always soft and low; but when the
inflammation only affects the integuments of the brain, viz. the dura and pia
mater, it is hard. A remarkable quickness of hearing is a common symptom

of this disease; but that seldom continues long. Another usual symptom is a
great throbbing or pulsation in the arteries of the neck and temples. Though
the tongue is often black and dry, yet the patient seldom complains of thirst,
and even refuses drink. The mind chiefly runs upon such objects as have
before made a deep impression on it; and sometimes, from a sullen silence,
the patient becomes all of a sudden quite outrageous.
A constant trembling and starting of the tendons is an unfavourable
symptom, as are also a suppression of urine; a total want of sleep; a
constant spitting; a grinding of the teeth, which last may be considered as a
kind of convulsion. When a phrenitis succeeds an inflammation of the
lungs, of the intestines, or of the throat, &c. it is owing to a translation of
the disease from these parts to the brain, and generally proves fatal. This
shews the necessity of proper evacuations, and the danger of repellents in
all inflammatory diseases.
The favourable symptoms are, a free perspiration, a copious discharge of
blood from the nose, the bleeding piles, a plentiful discharge of urine,
which lets fall a copious sediment. Sometimes the disease is carried off by a
looseness, and in women by an excessive flow of the menses.
As this disease often proves fatal in a few days, it requires the most
speedy applications. When it is prolonged, or improperly treated, it
sometimes ends in madness, or a kind of stupidity which continues for life.
In the cure, two things are chiefly to be attended to, viz. to lessen the
quantity of blood in the brain, and to retard the circulation towards the head.
REGIMEN.——The patient ought to be kept very quiet. Company, noise,
and every thing that affects the senses, or disturbs the imagination,
increases the disease. Even too much light is hurtful: for which reason the
patient’s chamber ought to be a little darkened, and he should neither be
kept too hot nor cold. It is not however necessary to exclude the company
of an agreeable friend, as this has a tendency to sooth and quiet the mind.
Neither ought the patient to be kept too much in the dark, lest it should
occasion a gloomy melancholy, which is too often the consequence of this
disease.
The patient must, as far as possible, be soothed and humoured in every
thing. Contradiction will ruffle his mind, and increase his malady. Even
when he calls for things which are not to be obtained, or which might prove
hurtful, he is not to be positively denied them, but rather put off with the

promise of having them as soon as they can be obtained, or by some other
excuse. A little of any thing that the mind is set upon, though not quite
proper, will hurt the patient less than a positive refusal. In a word, whatever
he was fond of, or used to be delighted with when in health, may here be
tried, as pleasing stories, soft music, or whatever has a tendency to sooth
the passions and compose the mind. Boerhaave proposes several
mechanical experiments for this purpose; as the soft noise of water distilling
by drops into a bason, and the patient trying to reckon them, &c. Any
uniform sound, if low and continued, has a tendency to procure sleep, and
consequently may be of service.
The aliment ought to be light, consisting chiefly of farinaceous
substances; as panado, and water-gruel sharpened with jelly of currants, or
juice of lemons, ripe fruits roasted or boiled, jellies, preserves, &c. The
drink small, diluting, and cooling; as whey, barley-water, or decoctions of
barley and tamarinds, which latter not only render the liquor more palatable,
but likewise more beneficial, as they are of an opening nature.
MEDICINE.——In an inflammation of the brain, nothing more certainly
relieves the patient than a free discharge of blood from the nose. When this
comes of its own accord, it is by no means to be stopped, but rather
promoted, by applying cloths dipped in warm water to the part. When
bleeding at the nose does not happen spontaneously, it may be provoked, by
putting a straw, or any other sharp body, up the nostril.
Bleeding in the temporal arteries greatly relieves the head: but as this
operation cannot always be performed, we would recommend in its stead
bleeding in the jugular veins. When the patient’s pulse and spirits are so
low, that he cannot bear bleeding with the lancet, leeches may be applied to
the temples. These not only draw off the blood more gradually, but by being
applied nearer to the part affected, generally give more immediate relief.
A discharge of blood from the hæmorrhoidal veins is likewise of great
service, and ought by all means to be promoted. If the patient has been
subject to the bleeding piles, and that discharge has been stopped, every
method must be tried to restore it; as the application of leeches to the parts,
sitting over the steams of warm water, sharp clysters, or suppositories made
of honey, aloes, and rock-salt.
If the inflammation of the brain be occasioned by the stoppage of
evacuations either natural or artificial, as the menses, issues, setons, or such

like, all means must be used to restore them as soon as possible, or to
substitute others in their stead.
The patient’s body must be kept open by stimulating clysters or smart
purges; and small quantities of nitre ought frequently to be mixed with his
drink. Two or three drachms, or more, if the case be dangerous, may be
used in the space of twenty-four hours.
The head should be shaved and frequently rubbed with vinegar and rose-
water. Cloths dipped in this mixture may likewise be applied to the temples.
The feet ought frequently to be bathed in lukewarm water, and soft
poultices of bread and milk may be kept constantly applied to them.
If the disease proves obstinate, and does not yield to these medicines, it
will be necessary to apply a blistering-plaster to the whole head.

CHAP. XXVII.
OF THE OPHTHALMIA, OR INFLAMMATION OF THE EYES.

This disease may be occasioned by external injuries; as blows, burns,
bruises, and the like. It may likewise proceed from dust, quicklime, or other
substances, getting into the eyes. It is often caused by the stoppage of
customary evacuations; as the healing of old sores, drying up of issues, the
suppressing of gentle morning sweats, or of the sweating of the feet, &c.
Long exposure to the night air, especially in cold northerly winds, or
whatever suddenly checks the perspiration, especially after the body has
been much heated, is very apt to cause an inflammation of the eyes.
Viewing snow or other white bodies for a long time, or looking stedfastly at
the sun, a clear fire, or any bright object, will likewise occasion this malady.
A sudden transition from darkness to very bright light will often have the
same effect.
Nothing more certainly occasions an inflammation of the eyes than night-
watching, especially reading or writing by candle-light. Drinking spirituous
liquors, and excess of venery, are likewise very hurtful to the eyes. The
acrid fumes of metals, and of several kinds of fuel, are also pernicious.
Sometimes an inflammation of the eyes proceeds from a venereal taint, and
often from a scrophulous or gouty habit. It may likewise be occasioned by
hairs in the eye-lids turning inwards, and hurting the eyes. Sometimes the
disease is epidemic, especially after wet seasons; and I have frequently
known it prove infectious, particularly to those who lived in the same house
with the patient. It may be occasioned by moist air, or living in low damp
houses, especially in persons who are not accustomed to such situations. In
children it often proceeds from imprudently drying up of scabbed heads, a
running behind the ears, or any other discharge of that kind. Inflammations
of the eyes often succeed the small-pox or measles, especially in children of
a scrophulous habit.
SYMPTOMS.——An inflammation of the eyes is attended with acute
pain, heat, redness, and swelling. The patient is not able to bear the light,

and sometimes he feels a pricking pain, as if his eyes were pierced with a
thorn. Sometimes he imagines his eyes are full of motes, or thinks he sees
flies dancing before him. The eyes are filled with a scalding rheum, which
rushes forth in great quantities, whenever the patient attempts to look up.
The pulse is generally quick and hard, with some degree of fever. When the
disease is violent, the neighbouring parts swell, and there is a throbbing or
pulsation in the temporal arteries, &c.
A slight inflammation of the eyes, especially from an external cause, is
easily cured; but when the disease is violent, and continues long, it often
leaves specks upon the eyes, or dimness of sight, and sometimes total
blindness.
If the patient be seized with a looseness, it has a good effect; and when
the inflammation passes from one eye to another, as it were by infection, it
is no unfavourable symptom. But when the disease is accompanied with a
violent pain of the head, and continues long, the patient is in danger of
losing his sight.
REGIMEN.——The diet, unless in scrophulous cases, can hardly be too
spare, especially at the beginning. The patient must abstain from every
thing of a heating nature. His food should consist chiefly of mild
vegetables, weak broths, and gruels. His drink may be barley-water, balm-
tea, common whey, and such like.
The patient’s chamber must be darkened, or his eyes shaded by a cover,
so as to exclude the light, but not to press upon the eyes. He should not look
at a candle, the fire, or any luminous object, and ought to avoid all smoke,
as the fumes of tobacco, or any thing that may cause coughing, sneezing, or
vomiting. He should be kept quiet, avoiding all violent efforts, either of
body or mind, and encouraging sleep as much as possible.
MEDICINE.——This is one of those diseases wherein great hurt is often
done by external applications. Almost every person pretends to be
possessed of a remedy for the cure of sore eyes. These remedies generally
consist of eye-waters and ointments, with other external applications, which
do mischief twenty times for once they do good. People ought therefore to
be very cautious how they use such things, as even the pressure upon the
eyes often increases the malady.
Bleeding, in a violent inflammation of the eyes, is always necessary. This
should be performed as near the part affected as possible. An adult may lose

ten or twelve ounces of blood from the jugular vein, and the operation may
be repeated according to the urgency of the symptoms. If it should not be
convenient to bleed in the neck, the same quantity may be let from the arm,
or any other part of the body.
Leeches are often applied to the temples, or under the eyes, with good
effect. The wounds must be suffered to bleed for some hours, and if the
bleeding stop soon, it may be promoted by the application of cloths dipt in
warm water. In obstinate cases, it will be necessary to repeat this operation
several times.
Opening and diluting medicines are by no means to be neglected. The
patient may take a small dose of Glauber’s salts, and cream of tartar, every
second or third day, or a decoction of tamarinds with senna. If these be not
agreeable, gentle doses of rhubarb and nitre, a little of the lenitive electuary,
or any other mild purgative, will answer the same end. The patient at the
same time must drink freely of water-gruel, tea, whey, or any other weak
diluting liquor. He ought likewise to take, at bed-time, a large draught of
very weak wine-whey, in order to promote perspiration. His feet and legs
must frequently be bathed in lukewarm water, and his head shaved twice or
thrice a-week, and afterwards washed in cold water. This has often a
remarkably good effect.
If the inflammation does not yield to these evacuations, blistering-
plasters must be applied to the temples, behind the ears, or upon the neck,
and kept open for some time by the mild blistering ointment. I have seldom
known these, if long enough kept open, fail to remove the most obstinate
inflammation of the eyes; but for this purpose it is often necessary to
continue the discharge for several weeks.
When the disease has been of long standing, I have seen very
extraordinary effects from a seton in the neck, or between the shoulders,
especially the latter. It should be put upwards and downwards, or in the
direction of the spine, and in the middle between the shoulder-blades. It
may be dressed twice a-day with yellow basilicon. I have known patients,
who had been blind for a considerable time, recover sight by means of a
seton placed as above. When the seton is put across the neck, it soon wears
out, and is both more painful and troublesome than between the shoulders;
besides, it leaves a disagreeable mark, and does not discharge so freely.

When the heat and pain of the eyes are very great, a poultice of bread and
milk, softened with sweet oil or fresh butter, may be applied to them, at
least all night; and they may be bathed with lukewarm milk and water in the
morning.
If the patient cannot sleep, which is sometimes the case, he may take
twenty or thirty drops of laudanum, or two spoonfuls of the syrup of
poppies, over night, more or less according to his age, or the violence of the
symptoms.
After the inflammation is gone off, if the eyes still remain weak and
tender, they may be bathed every night and morning with cold water and a
little brandy, six parts of the former to one of the latter. A method should be
contrived by which the eye can be quite immersed in the brandy and water,
where it should be kept for some time. I have generally found this, or cold
water and vinegar, as good a strengthener of the eyes as any of the most
celebrated collyriums.
When an inflammation of the eyes proceeds from a scrophulous habit, it
generally proves very obstinate. In this case the patient’s diet must not be
too low, and he may be allowed to drink small negus, or now and then a
glass of wine, The most proper medicine is the Peruvian bark, which may
either be given in substance, or prepared in the following manner:
Take an ounce of the bark in powder, with two drachms of Winter’s bark,
and boil them in an English quart of water to a pint; when it has boiled
nearly long enough, add half an ounce of liquorice-root sliced. Let the
liquor be strained. Two, three, or four table-spoonfuls, according to the age
of the patient, may be taken three or four times a-day, It is impossible to say
how long this medicine should be continued, as the cure is sooner
performed in some than in others; but in general it requires a considerable
time to produce any lasting effects.
Dr. Cheyne says, ‘That Æthiops mineral never fails in obstinate
inflammations of the eyes, even scrophulous ones, if given in a sufficient
dose, and duly persisted in.’ There is no doubt but this and other
preparations of mercury may be of singular service in ophthalmias of long
continuance, but they ought always to be administered with the greatest
caution, or by persons of skill in physic.
It will be proper frequently to look into the eyes, to see if any hairs be
turned inwards, or pressing upon them[105]. These ought to be removed by

plucking them out with a pair of small pincers.
Those who are liable to frequent returns of this disease, ought constantly
to have an issue in one or both arms. Bleeding or purging in the spring and
autumn, will be very beneficial to such persons. They ought likewise to live
with the greatest regularity, avoiding strong liquor, and every thing of a
heating quality. Above all, let them avoid the night-air and late studies[106].

CHAP. XXVIII.
OF THE QUINSEY, OR INFLAMMATION OF THE THROAT.

This disease is very common in Britain, and is frequently attended with
great danger. It prevails in the winter and spring, and is most fatal to young
people of a sanguine temperament.
CAUSES.——In general it proceeds from the same causes as other
inflammatory disorders, viz. an obstructed perspiration, or whatever heats or
inflames the blood. An inflammation of the throat is often occasioned by
omitting some part of the covering usually worn about the neck, by drinking
cold liquor when the body is warm, by riding or walking against a cold
northerly wind, or any thing that greatly cools the throat, and parts adjacent.
It may likewise proceed from the neglect of bleeding, purging, or any
customary evacuation.
Singing, speaking loud and long, or whatever strains the throat, may
likewise cause an inflammation of that organ. I have often known the
quinsey prove fatal to jovial companions, who, after sitting long in a warm
room, drinking hot liquors, and singing with vehemence, were so imprudent
as to go abroad in the cold night-air. Sitting with wet feet, or keeping on wet
clothes, are very apt to occasion, this malady. It is likewise frequently
occasioned by continuing long in a moist place, sitting near an open
window, sleeping in a damp bed, sitting in a room that has been newly
plastered, &c. I know people who never fail to have a sore throat if they sit
even but a short time in a room that has been lately washed.
Acrid or irritating food may likewise inflame the throat, and occasion a
quinsey. It may also proceed from bones, pins, or other sharp substances
sticking in the throat, or from the caustic fumes of metals or minerals, as
arsenic, antimony, &c. taken in by the breath. This disease is sometimes
epidemic and infectious.
SYMPTOMS.——The inflammation of the throat is evident from
inspection, the parts appearing red and swelled; besides, the patient

complains of pain in swallowing. His pulse is quick and hard, with other
symptoms of a fever. If blood be let, it is generally covered with a tough
coat of a whitish colour, and the patient spits a tough phlegm. As the
swelling and inflammation increase, the breathing and swallowing become
more difficult; the pain affects the ears; the eyes generally appear red; and
the face swells. The patient is often obliged to keep himself in an erect
posture, being in danger of suffocation; there is a constant nausea, or
inclination to vomit, and the drink, instead of passing into the stomach, is
often returned by the nose. The patient is sometimes starved at last, merely
from an inability to swallow any kind of food.
When the breathing is laborious, with straitnesss of the breast, and
anxiety, the danger is great. Though the pain in swallowing be very great,
yet while the patient breathes easy, there is not so much danger· An external
swelling is no unfavourable symptom; but if it suddenly falls, and the
disease affects the breast, the danger is very great. When a quinsey is the
consequence of some other disease, which has already weakened the
patient, his situation is dangerous. A frothing at the mouth, with a swelled
tongue, a pale, ghastly countenance, and coldness of the extremities, are
fatal symptoms.
REGIMEN.——The regimen in this disease is in all respects the same as
in the pleurisy, or peripneumony. The food must be light, and in small
quantity, and the drink plentiful, weak, and diluting, mixed with acids.
It is highly necessary that the patient be kept easy and quiet. Violent
affections of the mind, or great efforts of the body, may prove fatal. He
should not even attempt to speak but in a low voice. Such a degree of
warmth as to promote a constant, gentle sweat, is proper. When the patient
is in bed, his head ought to be raised a little higher than usual.
It is peculiarly necessary that the neck be kept warm; for which purpose
several folds of soft flannel may be wrapt round it. That alone will often
remove a slight complaint of the throat, especially if applied in due time.
We cannot here omit observing the propriety of a custom which prevails
among the peasants of Scotland. When they feel any uneasiness of the
throat, they wrap a stocking about it all night. So effectual is this remedy,
that in many places it passes for a charm, and the stocking is applied with
particular ceremonies: the custom, however, is undoubtedly a good one, and
should never be neglected. When the throat has been thus wrapped up all

night, it must not be exposed to the cold air through the day, but a
handkerchief or a piece of flannel kept about it till the inflammation be
removed.
The jelly of black currants is a medicine very much in esteem for
complaints of the throat; and indeed it is of some use. It should be almost
constantly kept in the mouth, and swallowed down leisurely. It may
likewise be mixed in the patient’s drink, or taken any other way. When it
cannot be obtained, the jelly of red currants, or of mulberries, may be used
in its stead.
Gargles for the throat are very beneficial, They may be made of sage-tea,
with a little vinegar and honey, or by adding to half an English pint of the
pectoral decoction two or three spoonfuls of honey, and the same quantity
of currant-jelly. This may be used three or four times a-day; and if the
patient be troubled with tough viscid phlegm, the gargle may be rendered
more sharp and cleansing, by adding to it a tea-spoonful of the spirit of sal
ammoniac. Some recommend gargles made of a decoction of the leaves or
bark of the black currant-bush; but where the jelly can be had, these are
unnecessary.
There is no disease wherein the benefit of bathing the feet and legs in
lukewarm water is more apparent: that practice ought therefore never to be
neglected. If people were careful to keep warm, to wrap up their throats
with flannel, to bathe their feet and legs in warm water, and to use a spare
diet, with diluting liquors, at the beginning of this disease, it would seldom
proceed to a great height, or be attended with any danger; but when these
precautions are neglected, and the disease becomes violent, more powerful
medicines are necessary.
MEDICINE.——An inflammation of the throat being a most acute and
dangerous distemper, which sometimes takes off the patient very suddenly,
it will be proper, as soon as the symptoms appear, to bleed in the arm, or
rather in the jugular vein, and to repeat the operation if circumstances
require.
The body should likewise be kept gently open. This may either be done
by giving the patient for his ordinary drink a decoction of figs and
tamarinds, or small doses of rhubarb and nitre, as recommended in the
erysipelas. These may be increased according to the age of the patient, and
repeated till they have the desired effect.

I have often known very good effects from a bit of sal prunel, or purified
nitre, held in the mouth, and swallowed down as it melted. This promotes
the discharge of saliva, by which means it answers the end of a gargle,
while at the same time it abates the fever, by promoting the discharge of
urine, &c.
The throat ought likewise to be rubbed twice or thrice a-day with a little
of the volatile liniment. This seldom fails to produce some good effects. At
the same time the neck ought to be carefully covered with wool or flannel,
to prevent the cold from penetrating the skin, as this application renders it
very tender. Many other external applications are recommended in this
disease, as a swallow’s nest, poultices made of the fungus called Jew’s ears,
album Græcum, &c. But as we do not look upon any of these to be
preferable to a common poultice of bread and milk, we shall take no farther
notice of them.
Some recommend the gum guaiacum as a specific in this disease. Half a
dram of the gum in powder may be made into an electuary with the rob of
elderberries, or the jelly of currants for a dose, and repeated
occasionally[107].
Blistering upon the neck or behind the ears in violent inflammations of
the throat is very beneficial; and in bad cases it will be necessary to lay a
blistering-plaster quite across the throat, so as to reach from ear to ear. After
the plasters are taken off, the parts ought to be kept running by the
application of issue ointment, till the inflammation is gone; otherwise, upon
their drying up, the patient will be in danger of a relapse.
When the patient has been treated as above, a suppuration seldom
happens. This however is sometimes the case, in spite of all endeavours to
prevent it. When the inflammation and swelling continue, and it is evident
that a suppuration will ensue, it ought to be promoted by drawing the steam
of warm water into the throat through a tunnel, or the like. Soft poultices
ought likewise to be applied outwardly, and the patient may keep a roasted
fig constantly in his mouth.
It sometimes happens, before the tumour breaks, that the swelling is so
great, as entirely to prevent any thing from getting down into the stomach.
In this case the patient must inevitably perish, unless he can be supported in
some other way. This can only be done by nourishing clysters of broth, or