Chapter VI: Part 6

Sec. 140. In this Species of the Disease, we must have Recourse to the general Method of treating inflammatory Disorders, and direct Bleeding, which often produces immediate Ease, if performed early. After Bleeding, the Patient should gargle with Barley Water, or Milk and Water; and apply an emollient Cataplasm to the Cheek. If an Abscess or little Imposthume appears, the Suppuration or ripening of it is to be promoted, by holding continually in the Mouth some hot Milk, or Figs boiled in some Milk: and as soon as ever it seems ripe, it should be opened, which may be done easily, and without any Pain. The Disorder, when depending on this Cause, is sometimes not so violent, but of a longer Duration, and returns whenever the Patient heats himself; when he goes to Bed; when he eats any heating Food, or Drink, Wine or Coffee. In this Case he should be bled, without which his other Medicines will have little Effect; and he should bathe his Feet in warm Water for some Evenings successively, taking one Dose of the Powder No. 20. Entire Abstinence from Wine and Meat, especially at Night, has cured several Persons of inveterate and obstinate Maladies of the Teeth.

In this Species of Tooth-ach, all hot Remedies are pernicious; and it often happens that Opium, Venice Treacle, and Storax Pills, are so far from producing the Relief expected from them, that they have aggravated the Pain.

Sec. 141. When the Disease arises from a cold Distillation, or Humour, tending to these Parts, it is commonly (though equally painful) attended with less violent Symptoms. The Pulse is neither strong, full nor quick; the Mouth is less heated, and less swelled. In such Cases, the afflicted should be purged with the Powder No. 21, which has sometimes perfectly cured very obstinate Complaints of this Sort. After purging they should make Use of the Diet Drink of the Woods No. 22. This has cured Tooth-achs, which have baffled other Attempts for many Years; but it must be added, this Drink would be hurtful in the Disease from a different Cause. Blisters to the Nape of the Neck, or [35] elsewhere, it matters not greatly where, have often extraordinary good Effects, by diverting the Humour, and restoring a compleat Perspiration. In short in this Species, we may employ, not only with Safety, but with Success (especially after due purging) Pills of Storax, Opium and Venice Treacle. Acrid sharp Remedies, such as hard spun [35] Tobacco, Root of Pellitory of _Spain_, &c. by exciting much Spitting, discharge part of the Humour which causes the Disease, and hence diminish the Pain. The Smoke of Tobacco also succeeds now and then in this Disorder, whether this happens from the Discharge of the Rheum or Spittle it occasions; or whether it is owing to any anodyne Efficacy of this Plant, in which it resembles Opium.

[35] A small Blister behind the Ear of the affected Side, or both Ears,
has very often removed the Pain, when from a Defluxion. It is
pretty common for the Subjects of this Disease to be very costive,
during the Exacerbations of it, which I have sometimes experienced
to be pretty regularly and severely quotidian, for a Week or two.
The Custom of smoking Tobacco very often, which the Violence of
this Pain has sometimes introduced, often disposes to a Blackened
and premature Decay of the Teeth, to which the Chewers of it are
less obnoxious: and this Difference may result from some particles
of its chemical Oil rising by Fumigation, and being retained in the
Teeth, which Particles are not extracted by Mastication. But with
Regard to the habitual Use of this very acrid and internally
violent Herb, for, but chiefly after, this Disease, it should be
considered well, whether in some Constitutions it may not pave the
Way to a more dangerous one, than it was introduced to remove. _K._

Sec. 142. As this last Cause is often the Consequence of a Weakness in the Stomach, it daily happens that we see some People, whose Disorder from this Cause is augmented, in Proportion as they indulge in a cooling, refreshing Way of living. The Increase of the Disorder disposes them to increase the Dose of what they mistake for its Remedy, in Proportion to which their Pain only increases. There is a Necessity that such Persons should alter this Method; and make use of such Medicines as are proper to strengthen the Stomach, and to restore Perspiration. The Powder No. 14. has often produced the best Consequences, when I have ordered it in these Cases; and it never fails to dissipate the Tooth-ach very speedily, which returns periodically at stated Days and Hours. I have also cured some Persons who never drank Wine, by advising them to the Use of it.

Sec. 143. But besides the Diseases of the Teeth, that are owing to these three principal Causes, which are the most common ones; there are some very tedious and most tormenting Disorders of them, that are occasioned by a general Acrimony, or great Sharpness, of the Mass of Blood, and which are never cured by any other Medicines but such, as are proper to correct that Acrimony. When it is of a scorbutic Nature, the wild Horse-radish (Pepperwort) Water Cresses, Brooklime, Sorrel, and Wood-sorrell correct and cure it. If it is of a different Nature, it requires different Remedies. But very particular Details do not come within the Plan of this Work. As the Malady is of the chronical or tedious kind, it allows Time to consider and consult more particularly about it.

The Gout and the Rheumatism are sometimes transferred to the Teeth, and give Rise to the most excruciating Pains; which must be treated like the Diseases from which they arise.

Sec. 144. From what has been said on this Disorder, the Reader will discern, in what that imaginary Oddness may consist, which has been ascribed to it, from the same Application's relieving one Person in it, and not affording the least Relief to another. Now the plain Reason of this is, that these Applications are always directed, without an exact Knowledge of the particular Cause of the Disease, in different Subjects and Circumstances; whence the Pain from a rotten Tooth, is treated like that from an Inflammation; that from an Inflammation, like the Pain from a cold Humour or Fluxion; and this last like a Pain caused by a scorbutic Acrimony: so that the Disappointment is not in the least surprizing. Perhaps Physicians themselves do not always attend distinctly enough to the Nature of each particular Disorder: and even when they do, they content themselves with directing some of the less potent Medicines, which may be inadequate to accomplish the necessary Effect. If the Distemper truly be of an inflammatory Disposition, Bleeding is indispensible to the Cure.

It happens in Fact, with Regard to the Diseases of the Teeth, as well as to all other Diseases, that they arise from different Causes; and if these Causes are not opposed by Medicines suited to them, the Disease, far from being cured, is aggravated.

I have cured violent Tooth-achs, of the lower Jaw, by applying a Plaister of Meal, the White of an Egg, Brandy and Mastich, at the Corner of that Jaw, over the Spot where the Pulsation of the Artery may be perceived: and I have also mitigated the most excruciating Pains of the Head, by applying the same Plaister upon the temporal Artery.

__Chapter IX.__

_Of the Apoplexy._

__Sect.__ 145.

Every Person has some Idea of the Disease termed an Apoplexy, which is a sudden Privation or Loss of all Sense, and of all voluntary Motion; the Pulse at the same Time being kept up, but Respiration or Breathing, being oppressed. I shall treat of this Disease only in a brief Manner, as it is not common in our Country Villages; and as I have expatiated on it in a different Manner in a Letter to Dr. _Haller_, published in 1761.

Sec. 146. This Disease is generally distinguished into two Kinds, the sanguineous and serous Apoplexy. Each of them results from an Overfulness of the Blood Vessels of the Brain, which presses upon, and prevents or impairs the Functions of the Nerves. The whole Difference between these two Species consists in this, that the sanguineous Apoplexy prevails among strong robust Persons, who have a rich, heavy, thick and inflammable Blood, and that in a large Quantity; in which Circumstance it becomes a genuine inflammatory Distemper. The serous, or humoral Apoplexy invades Persons of a less robust Constitution; whose Blood is more dilute or watery; and rather viscid, or lightly gelatinous, than heavy or rich; whole Vessels are in a more relaxed State; and who abound more in other Humours than in red Blood.

Sec. 147. When the first kind of this Disease exists in its most violent Degree, it is then sometimes termed, an apoplectic Stroke, or thundering Apoplexy, which kills in a Moment or instantaneously, and admits of no Remedies. When the Assault is less violent, and we find the Patient with a strong, full and raised Pulse, his Visage red and bloated, and his Neck swelled up; with an oppressed and loud hoarse Respiration; being sensible of nothing, and capable of no other Motions, except some Efforts to vomit, the Case is not always equally desperate. We must therefore immediately,

1. Entirely uncover the Patient's Head, covering the rest of his Body but very lightly; procure him instantly very fresh free Air, and leave his Neck quite unbound and open.

2. His Head should be placed as high as may be, with his Feet hanging down.

3. He must lose from twelve to fifteen Ounces of Blood, from a free open Orifice in the Arm: the Strength or Violence with which the Blood sallies out, should determine the Surgeon to take a few Ounces more or less. It should be repeated to the third or fourth Time, within the Space of three or four Hours; if the Symptoms seem to require it, either in the Arm, or in the Foot.

4. A Glyster should be given of a Decoction of the first emollient opening Herbs that can be got, with four Spoonfuls of Oil, one Spoonful of Salt: and this should be repeated every three Hours.

5. If it is possible, he should be made to swallow Water plentifully, in each Pot of which three Drams of Nitre are to be dissolved.

6. As soon as the Height and Violence of the Pulse abates; when his Breathing becomes less oppressed and difficult, and his Countenance less inflamed, he should take the Decoction No. 23; or, if it cannot be got ready in Time, he should take three Quarters of an Ounce of Cream of Tartar, and drink Whey plentifully after it. This Medicine succeeded extremely well with me in a Case, where I could not readily procure any other.

7. He should avoid all strong Liquor, Wine, distilled Spirit, whether inwardly or by outward Application, and should even be prevented from [36] smelling them.

[36] I have been very authentically assured of the Death of a hale Man,
which happened in the very Act of pouring out a large Quantity of
distilled Spirits, by Gallons or Bucketfulls, from one Vessel into
another. _K._

8. The Patient should be stirred, moved, or even touched, as little as it is possible: in a Word every Thing must be avoided that can give him the least Agitation. This Advice, I am sensible, is directly contrary to the common Practice; notwithstanding which it is founded in Reason, approved by Experience, and absolutely necessary. In Fact, the whole Evil results from the Blood being forced up with too much Force, and in too great a Quantity, to the Brain; which being thence in a State of Compression, prevents every Movement and every Influence of the Nerves. In Order, therefore, to re-establish these Movements, the Brain must be unloaded, by diminishing the Force of the Blood. But strong Liquors, Wines, Spirits, volatile Salts, all Agitation and Frictions augment it, and by that very Means increase the Load, the Embarrassment of the Brain, and thus heighten the Disease itself. On the contrary, every Thing that calms the Circulation, contributes to recall Sensation and voluntary Motion the sooner.

9. Strong Ligatures should be made about the Thighs under the Ham: By this Means the Blood is prevented in its Ascent from the Legs, and less is carried up to the Head.

If the Patient seems gradually, and in Proportion as he takes proper Medicines, to advance into a less violent State, there may be some Hopes. But if he rather grows worse after his earliest Evacuations, the Case is desperate.

Sec. 148. When Nature and Art effect his Recovery, his Senses return: though there frequently remains a little _Delirium_ or Wandering for some Time; and almost always a paralytic Defect, more or less, of the Tongue, the Arm, the Leg, and the Muscles of the same Side of the Face. This Palsy sometimes goes off gradually, by the Help of cooling Purges from Time to Time, and a Diet that is but very moderately and lightly nourishing. All hot Medicines are extremely hurtful in this Case, and may pave the Way to a repeated Attack. A Vomit might be even fatal, and has been more than once so. It should be absolutely forbidden; nor should we even promote, by Draughts of warm Water, the Efforts of the Patient to vomit. They do not any ways depend on any Humour or Mass in the Stomach; but on the Oppression and Embarrassment of the Brain: and the more considerable such Efforts are, the more such Oppression is increased: by Reason that as long as they continue, the Blood cannot return from the Head, by which Means the Brain remains overcharged.

Sec. 149. The other Species of Apoplexy is attended with the like Symptoms, excepting the Pulse not being so high nor strong; the Countenance being also less red, sometimes even pale; the Breathing seems less oppressed; and sometimes the Sick have a greater Facility to vomit, and discharge more upwards.

As this Kind of the Disease attacks Persons who abound less in Blood; who are less strong, and less heated or inflamed, Bleeding is not often at all necessary: at least the Repetition of it is scarcely ever so: and should the Pulse have but a small Fulness, and not the least unnatural Hardness, Bleeding might even be pernicious.

1. The Patient however should be placed as was directed in the former Mode of this Disease; though it seems not equally necessary here.

2. He should receive a Glyster, but without Oil, with double the Quantity of Salt, and a Bit of Soap of the Size of a small Egg; or with four or five Sprigs of Hedge Hyssop. It may be repeated twice a Day.

3. He should be purged with the Powder No. 4. [37]

[37] Vomits which are so pernicious in the sanguineous Apoplexy, where
the Patient's Countenance and Eyes are inflamed; and which are also
dangerous or useless, when a Person has been very moderate in his
Meals, or is weakened by Age or other Circumstances, and whole
Stomach is far from being overloaded with Aliment, are nevertheless
very proper for gross Feeders, who are accustomed to exceed at
Table, who have Indigestions, and have a Mass of viscid glairy
Humours in their Stomachs; more especially, if such a one has a
little while before indulged himself excessively, whence he has
vomited without any other evident Cause, or at least had very
Strong _Nauseas_, or Loathings. In brief, Vomits are the true
Specific for Apoplexies, occasioned by any narcotic or stupifying
Poisons, the pernicious Effects of which cease, the Moment the
Persons so poisoned vomit them up. An attentive Consideration of
what has occurred to the Patient before his Seizure; his small
natural Propensity to this Disease, and great and incessant
Loathings, render it manifest, whether it has been caused by such
Poisons, or such poisonous Excesses. In these two Last Cases a
double Dose of Tartar emetic should be dissolved in a Goblet or Cup
of Water, of which the Patient should immediately take a large
Spoonful; which should be repeated every Quarter of an Hour, till
it operates. _E. L._

4. His common Drink may be a Strong Infusion of Leaves of Balm.

5. The Purge should be repeated the third Day.

6. Blisters should immediately be applied to the fleshy Part of the Legs, or between the Shoulder Blades. [38]

[38] These Blisters may be preceded by Cupping with Scarification on the
Nape of the Neck. This Remedy, often used by the ancient
Physicians, but too little practiced in France, is one of the most
speedy, and not the least efficacious, Applications in both
sanguine and serous Apoplexies. _E. L._

7. Should Nature seem disposed to relieve herself by Sweatings, it should be encouraged; and I have often known an Infusion of the _Carduus benedictus_, or blessed Thistle, produce this Effect very successfully. If this Method be entered upon, the Sweat ought to be kept up (without stirring if possible) for many Days. It has then sometimes happened, that at the End of nine Days, the Patient has been totally freed from the Palsy, which commonly succeeds this Species of the Apoplexy, just as it does the other.

Sec. 150. Persons who have been attacked with either kinds of this Disease are liable to subsequent ones; each of which is more dangerous than that preceding: whence an Endeavour to obviate or prevent such Relapses becomes of the utmost Importance. This is to be effected in each Sort by a very exact, and rather severe Diet, even to diminishing the usual Quantity of the Patient's Food; the most essential Precaution, to be observed by any who have been once assaulted with it, being entirely to leave off Suppers. Indeed those, who have been once attacked with the _first_, the _sanguineous Apoplexies_, should be still more exact, more upon their Guard, than the others. They should deny themselves whatever is rich and juicy, hot or aromatic, sharp, Wine, distilled Liquors and Coffee. They should chiefly confine themselves to Garden-Stuff, Fruits and Acids; such should eat but little Flesh, and only those called white; taking every Week two or three Doses of the Powder No. 24, in a Morning fasting, in a Glass of Water. They should be purged twice or thrice a Year with the Draught No. 23; use daily Exercise; avoid very hot Rooms, and the violent Heat of the Sun. They should go to Bed betimes, rise early, never lie in Bed above eight Hours: and if it is observed that their Blood increases considerably, and has a Tendency towards the Head, they should be bled without Hesitation: and for some Days restrain themselves entirely to a thin and low Regimen, without taking any solid Food. In these Circumstances warm Bathings are hurtful. In the other, the serous, Apoplexy, instead of purging with No. 23, the Patient should take the Purge No. 21.

Sec. 151. The same Means, that are proper to prevent a Relapse, might also obviate or keep off a primary or first Assault, if employed in Time: for notwithstanding it may happen very suddenly, yet this Disease foreshews itself many Weeks, sometimes many Months, nay even Years beforehand, by Vertigos, Heaviness of the Head; small Defects of the Tongue or Speech; short and momentary Palsies, sometimes of one, sometimes of another, Part: sometimes by Loathings and Reachings to vomit; without supposing any Obstruction or Load in the first Passages, or any other Cause in the Stomach, or the adjoining Parts. There happens also some particular Change in the Looks and Visage not easy to be described: sharp and short Pains about the Region of the Heart; an Abatement of the Strength, without any discernible Cause of it. Besides there are still some other Signs, which signify the Ascent of the Humours too much to the Head, and shew, that the Functions of the Brain are embarrassed.

Some Persons are liable to certain Symptoms and Appearances, which arise from the same Cause as an Apoplexy; and which indeed may be considered as very light benign Apoplexies, of which they sustain many Attacks, and yet without any considerable Annoyance of their Health. The Blood, all at once as it were, flushes up to their Heads: they appear heedless or blundering; and have sometimes Disgusts and _Nauseas_, and yet without any Abatement of their Understanding, their Senses, or Motion of any Sort. Tranquillity of Mind and Body, once Bleeding, and a few Glysters usually carry it off soon after its Invasion. The Returns of it may be prevented by the Regimen directed Sec. 150; and especially by a frequent Use of the Powder No. 24. At the long Run however, one of these Attacks commonly degenerates into a mortal Apoplexy: though this may be retarded for a very long Time by an exact Regimen, and by avoiding all strong Commotions of the Mind, but especially that of Anger or violent Rage.

__Chapter X.__

_Of the violent Influence, or Strokes, of the Sun._

__Sect.__ 152.

This Appellation is applied to those Disorders, which arise from too violent an Influence of the Heat of the Sun, immediately upon the Head; and which in one Word may be termed _Insolation_.

If we consider that Wood, Stone and Metals, when long exposed to the Sun, become very hot, and that even in temperate Climates, to such a Degree, that they can scarcely be touched without some Sensation of burning, we may easily conceive the Risk a Person undergoes, in having his Head exposed to the same Degree of Heat. The Blood-Vessels grow dry, the Blood itself becomes condensed or thickened, and a real Inflammation is formed, which has proved mortal in a very little Time. It was this Distemper, a Stroke of the Sun, which killed _Manasses_ the Husband of _Judith_. 'For as he was among the Labourers who bound up the Sheafs in the Fields, the Heat struck upon his Head, and he was taken ill; he went to Bed and he died.' The Signs which precede and attend this Disease are, being exposed in a Place where the Sun shines forth with great Force and Ardour; a violent Head-ach, attended with a very hot and extremely dry Skin: the Eyes are also dry and red, being neither able to remain open, nor yet to bear the Light; and sometimes there is a kind of continual and involuntary Motion in the Eyelid; while some Degree of Relief is perceivable from the Application of any cooling Liquor. It often happens that some cannot possibly sleep; and at other times they have a great Drowsiness, but attended with outrageous Wakenings: there is a very strong Fever; a great Faintness, and a total Disrelish and Loathing. Sometimes the Patient is very thirsty, and at other times not at all: and the Skin of his Face often looks as though it were burnt.

Sec. 153. People may be affected with the Disease from this Cause, at two different Seasons of the Year; that is, either in the Spring, or during the very raging Heats; but their Events are very different. Country People and Labourers are but little liable to the former. They chiefly affect the Inhabitants of Cities, and delicate Persons, who have used very little Exercise in the Winter, and abound with superfluous Humours. If thus circumstanced they expose themselves to the Sun, as even in the Spring he attains a considerable Force; and, by the Course of Life they have led, their Humours are already much disposed to mount to the Head; while the Coolness of the Soil, especially when it has rained, prevents their Feet from being so easily warmed; the Power of the Sun acts upon their Head like a Blister, attracting a great Quantity of Humours to it. This produces excruciating Pains of the Head, frequently accompanied with quick and violent Shootings, and with Pain in the Eyes; notwithstanding this Degree of the Malady is seldom dangerous. Country People, and even such Inhabitants of Cities and Towns, as have not forbore to exercise themselves in Winter, have no Sort of Dread of these Strokes of the Sun, in the Spring of the Year. Its Summer Strokes are much more vehement and troublesome, and assault Labourers and Travellers, who are for a long Time exposed to the Fervour of it. Then it is that the Disease is aggravated to its highest Pitch, those who are thus struck often dying upon the Spot. In the hot Climates this Cause destroys many in the very Streets, and makes dreadful Havock among Armies on the March, and at Sieges. Some tragical Effects of it, on such Occasions, are seen even in the temperate Countries. After having marched a whole Day in the Sun, a Man shall fall into a Lethargy, and die within some Hours, with the Symptoms of raving Madness. I have seen a Tyler in a very hot Day, complaining to his Comrade of a violent Pain in his Head, which increased every Moment almost; and at the very Instant when he purposed to retire out of the Sun, he sunk down dead, and fell down from the House he was slating. This same Cause produces very often in the Country some most dangerous Phrenzies, which are called there hot or burning Fevers. Every Year furnishes but too many of them.

Sec. 154. The Vehemence of the Sun is still more dangerous to those, who venture to sleep exposed to it. Two Mowers who fell asleep on a Haycock, being wakened by some others, immediately on waking, staggered, and pronouncing a few incoherent unmeaning Words, died. When the Violence of Wine and that of the Sun are combined, they kill very suddenly: nor is there a single Year in which Peasants are not found dead on the Highroads; who being drunk endeavoured to lie down in some Corner, where they perished by an Apoplexy, from the Heat of the Sun and of strong Drink. Those of them who escape so speedy and premature a Death, are subject for the Remainder of their Lives, to chronical, or tedious Head-achs; and to suffer some little Disorder and Confusion in their Ideas. I have seen some Cases, when after violent Head-achs of some Days Continuance, the Disease has been transferred to the Eyelids, which continued a long Time red and distended, so that they could not be kept asunder or open. It has also been known, that some Persons have been struck by the Sun into a _Delirium_ or Raving, without a Fever, and without complaining of a Head-ach. Sometimes a _Gutta Serena_ has been its Consequence; and it is very common to see People, whose long Continuance under the strong Light and Influence of the Sun, has made such an Impression upon the Eyes, as presents them with different Bodies flying about in the Air, which distract and confuse their Sight.

A Man of forty two Years of Age, having been exposed for several Hours to the violent Heat of the Sun, with a very small Cap or Bonnet; and having past the following Night in the open Air, was attacked the next Day with a most severe Head-ach, a burning Fever, Reachings to vomit, great Anguish, and red and sparkling Eyes. Notwithstanding the best Assistance of several Physicians, he became phrenitic on the fifth Day, and died on the ninth. Suppurated Matter was discharged from his Mouth, one of his Nostrils, and his right Ear, a few Hours before his Death; upon Dissection a small Abscess was found within the Skull; and the whole Brain, as well as all the Membranes inclosing it, were entirely corrupted.

Sec. 155. In very young Children, who are not, or never should be, exposed for any long Time to such excessive Heat (and whom a slight Cause will often affect) this Malady discovers itself by a heavy deep Drowsiness, which lasts for several Days; also by incessant Ravings mingled with Rage and Terror, much the same as when they are affected with violent Fear: and sometimes by convulsive Twitchings; by Head-achs which returned at certain Periods, and continual Vomitings. I have seen Children, who, after a Stroke of the Sun, have been harrassed a long Time with a little Cough.

Sec. 156. Old Men who often expose themselves imprudently to the Sun, are little apprized of all the Danger they incur by it. A certain Person, who purposely sunned himself for a considerable Time, in the clear Day of an intermitting tertian Fever, underwent the Assault of an Apoplexy, which carried him off the following Day. And even when the Disease may not be so speedy and violent, yet this Custom (of sunning in hot Weather) certainly disposes to an Apoplexy, and to Disorders of the Head. One of the slightest Effects of much solar Heat upon the Head is, to cause a Defluxion from the Brain, a Swelling of the Glands of the Neck, and a Dryness of the Eyes, which sometimes continues for a considerable Term after it.

Sec. 157. The effect of too much culinary, or common Fire, is of the same Quality with that of the Sun. A Man who fell asleep with his Head directly opposite, and probably, very near to the Fire, went off in an Apoplexy, during his Nap.

Sec. 158. The Action of too violent a Sun is not only pernicious, when it falls upon the Head; but it is also hurtful to other Parts; and those who continue long exposed to it, though their Heads should not be affected, experience violent Pains, a disagreeable Sensation of Heat, and a considerable Stiffness in the Parts that have been, in some Manner, parched by it; as in the Legs, the Knees, the Thighs, Reins and Arms; and sometimes they prove feverish.

Sec. 159. In contemplating the Case of a Patient, _Sun-struck_, as we may term it, we must endeavour to distinguish, whether there may not be also some other joint Causes concurring to the Effect. A Traveller, a labouring Man, is often as much affected by the Fatigue of his Journey, or of his Labour, as he is by the Influence of solar Heat.

Sec. 160. It is necessary to set about the Cure of this Disease, as soon as ever we are satisfied of its Existence: for such as might have been easily preserved by an early Application, are considerably endangered by a Neglect of it. The Method of treating this is very much the same, with that of the inflammatory Diseases already mentioned; that is, by Bleeding, and cooling Medicines of various Kinds in their Drinks, by Bathings, and by Glysters. And 1. If the Disease be very high and urgent, a large Quantity of Blood should be taken away, and occasionally repeated. _Lewis_ the XIV. was bled nine Times to prevent the Fatality of a Stroke of the Sun, which he received in Hunting in 1658.

2. After Bleeding, the Patient's Legs should be plunged into warm Water. This is one of the Applications that affords the most speedy Relief; and I have seen the Head-ach go off and return again, in Proportion to the Repetition, and the Duration, of these Bathings of the Legs. When the Disorder is highly dangerous, it will be necessary to treat the Patient with _Semicupia_, or warm Baths, in which he may sit up to his Hips; and in the most dangerous Degrees of it, even to bathe the whole Body: but the Water in this Case, as well as in Bathings of the Feet, should be only sensibly warm: the Use of hot would be highly pernicious.

3. Glysters made from a Decoction of any of the emollient Herbs are also very effectual.

4. The Patient should drink plentifully of Almond Emulsion No. 4; of Limonade, which is a Mixture of the Juice of Lemons and Water, (and is the best Drink in this Disease) of Water and Vinegar, which is a very good Substitute for Limonade; and of, what is still more efficacious, very clear Whey, with the Addition of a little Vinegar. These various Drinks may all be taken cold; Linen Cloths dipt in cold Water and Vinegar of Roses may be applied to the Forehead, the Temples, or all over the Head, which is equivalent to every other Application used upon such Occasions. Those which are the most cried up, are the Juice of Purslain, of Lettuce, of Houseleek, and of Vervain. The Drink No. 32 is also serviceable, taken every Morning fasting.

Sec. 161. Cold Baths have sometimes recovered Persons out of such violent Symptoms, from this Cause, as have been almost quite despaired of.

A Man twenty Years of Age, having been a very long Time exposed to the scorching Sun, became violently delirious, without a Fever, and proved really mad. After repeated Bleedings, he was thrown into a cold Bath, which was also frequently repeated; pouring cold Water, at the same Time, upon his Head. With such Assistance he recovered, though very gradually.

An Officer who had rode Post for several Days successively, in very hot Weather, swooned away, immediately on dismounting; from which he could not be recovered by the ordinary Assistance in such Cases. He was saved however, in Consequence of being plunged into a Bath of freezing Water. It should be observed however, that in these Cases the cold Bath should never be recurred to, without previous Bleeding.

Sec. 162. It is past Doubt, that if a Person stands still in the violent Heat of the Sun, he is more liable to be struck with it, than if he walks about; and the Use of white Hats, or of some Folds of clean white Paper under a black one, may sensibly contribute to prevent any Injury from the considerable Heat of the Sun; though it is a very incompetent Defence against a violent Degree of it.

The natural Constitution, or even that Constitution, which has been formed from long Custom and Habit, make a very great Difference between the Effects of solar Heat on different Persons. People insensibly accustom themselves to the Impressions of it, as they do to those of all the other Bodies and Elements, which are continually acting upon us; and by Degrees we arrive at a Power of sustaining his violent Heat with Impunity: just as others arrive at the Hardiness of bearing the most rigid Colds, with very little Complaint or Inconvenience. The human Body is capable of supporting many more Violences and Extremes, than it commonly does. Its natural Force is scarcely ever ascertained among civilized Nations; because their Education generally tends to impair and lessen it, and always succeeds in this Respect. If we were inclined to consider a purely natural, a simply physical Man, we must look for him among savage Nations; where only we can discover what we are able to be, and to bear. We certainly could not fail of being Gainers, by adopting their corporal Education; neither does it seem as yet to have been infallibly demonstrated, that we should be great Losers in commuting our moral Education for theirs. [39]

[39] As some may think an Apology necessary for a Translation of this
Chapter on a Disease, which never, or very seldom, exists in this
or the adjacent Island, I shall observe here, that, abstracted from
the Immorality of a narrow and local Solicitude only for ourselves,
we are politically interested as a Nation always in Trade, and
often at War (and whose Subjects are extended into very distant and
different Climates) to provide against a sudden and acute
Distemper, to which our Armies, our Sailors and Colonies are
certainly often exposed. A Fatality from this Cause is not
restrained to our Islands within the Tropic, where several
Instances of it have occurred during the late War: but it has also
been known to prevail as far Northward as _Pensylvania_, in their
Summers, and even in their Harvests. I once received a sensible
Scald on the Back of my Thumb, from the Sun suddenly darting out
through a clear Hole, as it were, in a Cloud, after a short and
impetuous Shower in Summer; which Scald manifestly blistered within
some Minutes after. Had this concentrated Ray been darted on my
bare Head, the Consequence might have been more dangerous; or
perhaps as fatal as some of the Cases recorded by Dr. _Tissot_, in
this Chapter. _K._

__Chapter XI.__

_Of the Rheumatism._

__Sect.__ 163.

The Rheumatism may exist either with or without a Fever. The first of these may be classed among the Diseases, of which I have already treated; being an Inflammation which is manifested by a violent Fever, preceded by Shivering, a subsequent Heat, hard Pulse, and a Head-ach. Sometimes indeed an extraordinary Coldness, with general Uneasiness and Inquietude, exists several Days before the Fever is perceived. On the second or third Day, and sometimes even on the first, the Patient is seized with a violent Pain in some Part of his Body, but especially about the Joints, which entirely prevents their Motion, and which is often accompanied with Heat, Redness and a Swelling of the Part. The Knee is often the first Part attacked, and sometimes both the Knees at once. When the Pain is fixed, an Abatement of the Fever frequently happens; though in some other Persons it continues for several Days, and increases every Evening. The Pain diminishes in one Part after a Duration of some Days, and then invades some other. From the Knee it descends to the Foot, or mounts to the Hip, to the Loins, the Shoulder-blades, Elbow, Wrist, the Nape of the Neck, and frequently is felt in the intermediate Parts. Sometimes one Part is quite free from Pain, when another is attacked; at other Times many Parts are seized nearly at the same Instant; and I have sometimes seen every Joint afflicted at once. In this Case the Patient is in a very terrible Situation, being incapable of any Motion, and even dreading the Assistance of his Attendants, as he can scarcely admit of touching, without a sensible Aggravation of his Pains. He is unable to bear even the Weight of the Bed-clothes, which must be, as it were, arched over his Limbs by a proper Contrivance, to prevent their Pressure: and the very walking across the Chamber increases his Torments. The Parts in which they are the most excruciating, and obstinate, are the Region of the Loins, the Hips, and the Nape or hinder Part of the Neck.

Sec. 164. This Disease is also often extended over the Scalp and the Surface of the Head; and there the Pains are excessive. I have seen them affect the Eyelids and the Teeth with inexpressible Torment. As long as the Distemper is situated in the more external Parts, the Patient, however painful his Situation may prove, is in no great Danger, if he be properly treated: but if by some Accident, some Error, or by any latent Cause, the Disease be repelled upon an internal Part or Organ, his Case is extremely dangerous. If the Brain is attacked, a frantic raging _Delirium_ is the Consequence; if it falls upon the Lungs, the Patient is suffocated: and if it attacks the Stomach or the Bowels, it is attended with the most astonishing Pains, which are caused by the Inflammation of those Parts, and which Inflammation, if violent, is [40] speedily fatal. About two Years since I was called to a robust Man, whose Guts were already in a gangrenous State, which was the Consequence of a Rheumatism, that first attacked one Arm and one Knee; the Cure of which had been attempted by sweating the Patient with some hot Remedies. These indeed brought on a plentiful Sweat; but the inflammatory Humour seized the Intestines, whose Inflammation degenerated into a Gangrene, after a Duration of the most acute Pain for thirty-six Hours; his Torments terminating in Death two Hours after I saw him.

[40] See Note [16] to Page 59.

Sec. 165. This Malady however is often in a less violent Degree; the Fever is but moderate, and ceases entirely when the Pain begins; which is also confined to one, or not more than two Parts.

Sec. 166. If the Disease continues fixed, for a considerable Time, in one Joint, the Motion of it is impaired for Life. I have seen a Person, who has now a wry Neck, of twenty Years standing, in Consequence of a Rheumatism in the Nape of the Neck; and I also saw a poor young Man from _Jurat_, who was Bed-ridden, and who had lost the Motion of one Hip and both Knees. He could neither stand nor sit, and there were but a few Postures in which he could even lie in Bed.

Sec. 167. An obstructed Perspiration, an inflammatory Thickness of the Blood, constitute the most general Cause of the Rheumatism. This last concurring Cause is that we must immediately encounter; since, as long as that subsists, Perspiration cannot be perfectly re-established, which follows of Course, when the Inflammation is cured. For which Reason this Distemper must be conducted like the other inflammatory ones, of which I have already treated.

Sec. 168. As soon as it is sufficiently manifest, the Glyster No. 5, should be injected; and twelve Ounces of Blood be taken from the Arm an Hour after. The Patient is to enter upon a Regimen, and drink plentifully of the Ptisan No. 2, and of Almond Milk or Emulsion No. 4. As this last Medicine may be too costly in Country Places for the poor Peasantry; they may drink, in Lieu of it, very clear Whey, sweetened with a little Honey. I have known a very severe Rheumatism cured, after twice bleeding, without any other Food or Medicine, for the Space of thirteen Days. The Whey also may be happily used by Way of Glyster.

Sec. 169. If the Distemper is not considerably asswaged by the first Bleeding, it should be repeated some Hours after. I have ordered it four Times within the first two Days; and some Days after I have even directed a fifth Bleeding. But in general the Hardness of the Pulse becomes less after the second: and notwithstanding the Pains may continue as severe as before, yet the Patient is sensible of less Inquietude. The Glyster must be repeated every Day, and even twice a Day, if each of them is attended only with a small Discharge; and particularly if there be a violent Head-ach. In such Cases as are excessively painful, the Patient can scarcely dispose himself into a proper Attitude or Posture to receive Glysters: and in such Circumstances his Drinks should be made as opening as possible; and a Dose of the Cream of Tartar No. 24 should be given Night and Morning. This very Medicine, with the Assistance of Whey, cured two Persons I advised it to, of rheumatic Pains, of which they had been infested with frequent Returns for many Years, and which were attended with a small Fever.

Apples coddled, Prunes stewed, and well ripened Summer Fruits are the properest Nourishment in this Disease.

We may save the Sick a good deal of Pain, by putting one strong Towel always under their Back, and another under their Thighs, in order to move them the more easily. When their Hands are without Pain, a third Towel hung upon a Cord, which is fastened across the Bed, must considerably assist them in moving themselves.

Sec. 170. When the Fever entirely disappears, and the Hardness of the Pulse is removed, I have ordered the Purge No. 23 with a very good Effect; and if it is attended with five or six Motions, the Patient is very sensibly relieved. The Day but one after it may be repeated successfully, and a third Time, after an Interval of a greater Number of Days.

Sec. 171. When the Pains are extremely violent, they admit of no Application: Vapour-Baths however may be employed, and provided they are often used, and for a considerable Time, they prove very efficacious. The Purpose of these Baths is only to convey the Steam of boiling Water to the Parts affected; which may always easily be effected, by a Variety of simple and easy Contrivances; the Choice of which must depend on the different Circumstances and Situation of the Sick.

Whenever it is possible, some of the emollient Applications No. 9, should be continually employed. A half Bath, or an entire Bath of warm Water, in which the Patient should remain an Hour, after sufficient Bleedings and many Glysters, affords the greatest Relief. I have seen a Patient, under the most acute Pains of the Loins, of the Hips, and of one Knee, put into one. He continued still under extreme Torment in the Bath, and on being taken out of it: but an Hour after he had been put to Bed, he sweated, to an incredible Quantity, for thirty six Hours, and was cured. The Bath should never be made use of, until after repeated Bleedings, or at least other equivalent Evacuations: for otherwise timed, it would aggravate the Disease.

Sec. 172. The Pains are generally most severe in the Night; whence it has been usual to give composing soporific Medicines. This however has been very erroneous, as Opiates really augment the Cause of the Disease, and destroy the Efficacy of the proper Remedies: and, even not seldom, far from asswaging the Pains, they increase them. Indeed they agree so little in this Disease, that even the Patient's natural Sleep at the Invasion of this Complaint, is rather to his Detriment. They feel, the very Moment they are dropping asleep, such violent Jirks as awaken them with great Pain: or if they do sleep a few Minutes, the Pains are stronger when they awake.

Sec. 173. The Rheumatism goes off either by Stool, by turbid thick Urine which drops a great Proportion of a yellowish Sediment, or by Sweats: and it generally happens that this last Discharge prevails towards the Conclusion of the Disease. It may be kept up by drinking an Infusion of Elder Flowers. At the Beginning however Sweating is pernicious.

Sec. 174. It happens also, though but very seldom, that Rheumatisms determine by depositing a sharp Humour upon the Legs; where it forms Vesications, or a kind of Blisterings; which burst open and form Ulcers, that ought not to be healed and dried up too hastily; as this would occasion a speedy Return of the rheumatic Pains. They are disposed to heal naturally of themselves, by the Assistance of a temperate regular Diet, and a few gentle Purges.

Sec. 175. Sometimes again, an Abscess is formed either in the affected Part, or in some neighbouring one. I have seen a Vineyard Dresser, who after violent Pains of the Loins, had an Abscess in the upper Part of the Thigh, which he neglected for a long Time. When I saw him, it was of a monstrous Size. I ordered it to be opened, when at once above three Pots of [41] Matter rushed out of it: but the Patient, being exhausted, died some Time after it.

[41] This, according to our Author's Estimation of the Pot-Measure at
_Berne_, which is that he always means, and which he says contains
exactly (of Water we suppose) fifty one Ounces and a Quarter
(though without a material Error it may be computed at three Pounds
and a Quarter) will amount at least to nine Pounds and three
Quarters of Matter, supposing this no heavier than Water. By
Measure it will want but little of five of our Quarts: a very
extraordinary Discharge indeed of _Pus_ at once, and not unlikely
to be attended by the Event which soon followed. _K._

Another Crisis of the Rheumatism has happened by a kind of Itch, which breaks out upon all the Parts adjacent to the Seat of this Disease. Immediately after this Eruption the Pains vanish; but the Pustules sometimes continue for several Weeks.

Sec. 176. I have never observed the Pains to last, with considerable Violence, above fourteen Days, in this Species of the Rheumatism; though there remains a Weakness, Numbness, and some Inflation, or Puffing, of the adjoining Parts: and it will also be many Weeks, and sometimes even Months; especially if the Distemper attacked them in the Fall, before the Sick recover their usual Strength. I have known some Persons, who, after a very painful Rheumatism, have been troubled with a very disagreeable Sensation of Lassitude; which did not go off till after a great Eruption, all over the Body, of little Vesications or Blisterings, full of a watery Humour; many of them burst open, and others withered and dried up without bursting.

Sec. 177. The Return of Strength into the Parts affected may be promoted by Frictions Night and Morning, with Flannel or any other woollen Stuff; by using Exercise; and by conforming exactly to the Directions given in the Chapter on Convalescence, or Recovery from acute Diseases. The Rheumatism may also be prevented by the Means I have pointed out, in treating of Pleurisies and Quinsies.

Sec. 178. Sometimes the Rheumatism, with a Fever, invades Persons who are not so sanguine, or abounding in Blood; or whose Blood is not so much disposed to Inflammation; those whose Flesh and Fibres are softer; and in whose Humours there is more Thinness and Sharpness, than Viscidity and Thickness. Bleeding proves less necessary for Persons so constituted, notwithstanding the Fever should be very strong. Some Constitutions require more Discharges by Stool; and after they are properly evacuated, some Blisters should be applied, which often afford them a sensible Relief as soon as ever they begin to operate. Nevertheless they should never be used where the Pulse is hard. The Powder No. 25 answers very well in these Cases.

Sec. 179. There is another Kind of Rheumatism, called chronical, or lasting. It is known by the following Characters or Marks. 1. It is commonly unattended with a Fever. 2. It continues a very long Time. 3. It seldom attacks so many Parts at once as the former. 4. Frequently no visible Alteration appears in the affected Part, which is neither more hot, red, or swelled than in its healthy State; though sometimes one or other of these Symptoms is evident. 5. The former, the inflammatory, Rheumatism assaults strong, vigorous, robust Persons: but this rather invades People arrived at a certain Period of Life, or such as are weak and languishing.

Sec. 180. The Pain of the chronical Rheumatism, when left to itself, or injudiciously treated, lasts sometimes many Months, and even Years. It is particularly and extremely obstinate, when it is exerted on the Head, the Loins, or on the Hip, and along the Thighs, when it is called the _Sciatica_. There is no Part indeed which this Pain may not invade; sometimes it fixes itself in a small Spot, as in one Corner of the Head; the Angle of the Jaw; the Extremity of a Finger; in one Knee; on one Rib, or on the Breast, where it often excites Pains, which make the Patient apprehensive of a Cancer. It penetrates also to the internal Parts. When it affects the Lungs, a most obstinate Cough is the Consequence; which degenerates at length into very dangerous Disorders of the Breast. In the Stomach and Bowels it excites most violent Pains like a Cholic; and in the Bladder, Symptoms so greatly resembling those of the Stone, that Persons, who are neither deficient in Knowlege nor Experience, have been more than once deceived by them.

Sec. 181. The Treatment of this chronical Rheumatism does not vary considerably from that of the former. Nevertheless, in the first Place, if the Pain is very acute, and the Patient robust, a single Bleeding at the Onset is very proper and efficacious. 2. The Humours ought to be diluted, and their Acrimony or Sharpness should be diminished, by a very plentiful Use of a Ptisan of [42] Burdock Roots No. 26. 3. Four or five Days after drinking abundantly of this, the purging [43] Powder No. 21 may be taken with Success. In this Species of the Rheumatism, a certain Medicine is sometimes found serviceable. This has acquired some Reputation, particularly in the Country, where they bring it from, _Geneva_; under the Title of the Opiate for the Rheumatism, tho' I cannot say for what Reason; as it is indeed neither more nor less than the Electuary _Caryocostinum_, which may be procured at our Apothecaries. I shall observe however, that this Medicine has done Mischief in the inflammatory Rheumatism, and even in this, as often as the Persons afflicted with it are feeble, thin and of a hot Temperament; and either when they have not previously taken diluting Drinks, or when it has been used too long. For, in such a Circumstance, it is apt to throw the Patient into an irrecoverable Weakness. The Composition consists of the hottest Spices, and of very sharp Purgatives.

[42] Half a Pint of a pretty strong Infusion of the Leaves of Buckbean,
which grows wild here, taken once a Day rather before Noon, has
also been found very serviceable in that Species of a chronical
Rheumatism, which considerably results from a scorbutic State of
the Constitution. _K._