Chapter XV: Part II: Of Diseases (5)

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 gruel with milk, &c. Patients have often been supported by these for Several days, till the tumour has broke; and afterwards they have recovered.

Not only the swallowing, but the breathing, is often prevented by the tumour. In this case nothing can save the patient’s life, but opening the _trachea_ or wind-pipe. As that has been often done with success, no person, in such desperate circumstances, ought to hesitate a moment about the operation; but as it can only be performed by a surgeon, it is not necessary here to give any directions about it.

When a difficulty of swallowing is not attended with an acute pain or inflammation, it is generally owing to an obstruction of the glands about the throat, and only requires that the part be kept warm, and the throat frequently gargled with something that may gently stimulate the glands, as a decoction of figs with vinegar and honey; to which may be added a little mustard, or a small quantity of spirits. But this gargle is never to be used where there are signs of an inflammation. This species of _angina_ has various names among the common people, as _the pap of the throat_, the falling down of the _almonds of the ears_, &c. Accordingly, to remove it, they lift the patient up by the hair of the head, and thrust their fingers under his jaws, &c. all which practices are at best useless, and often hurtful.

Those who are subject to inflammations of the throat, in order to avoid that disease, ought to live temperate. Such as do not chuse to observe this rule, must have frequent recourse to purging and other evacuations, to discharge the superfluous humours. They ought likewise to beware of catching cold, and should abstain from aliment and medicines of an astringent or stimulating nature.

Violent exercise, by increasing the motion and force of the blood, is apt to occasion an inflammation of the throat, especially if cold liquor be drank immediately after it, or the body suffered suddenly to cool. Those who would avoid this disease ought therefore, after speaking aloud, singing, running, drinking warm liquor, or doing any thing that may strain the throat, or increase the circulation of the blood towards it, to take care to cool gradually, and to wrap some additional coverings about their necks.

I have often known persons who had been subject to sore throats, entirely freed from that complaint by only wearing a riband, or a bit of flannel, constantly about their necks, or by wearing thicker shoes, a flannel waistcoat, or the like. These may seem trifling, but they have great effect. There is danger indeed in leaving them off after persons have been accustomed to them; but surely the inconveniency of using such things for life, is not to be compared with the danger which may attend the neglect of them.

Sometimes, after an inflammation, the glands of the throat continue swelled, and become hard and callous. This complaint is not easily removed, and is often rendered dangerous by the too frequent application of strong stimulating and styptic medicines. The best method is to keep it warm, and to gargle it twice a-day with a decoction of figs sharpened a little with the elixir or spirit of vitriol.

OF THE MALIGNANT QUINSEY, OR PUTRID, ULCEROUS SORE THROAT.

This kind of quinsey is but little known in the northern parts of Britain, though, for some time past, it has been fatal in the more southern counties. Children are more liable to it than adults, females than males, and the delicate than those who are hardy and robust. It prevails chiefly in autumn, and is most frequent after a long course of damp or sultry weather.

CAUSES.——This is evidently a contagious distemper, and is generally communicated by infection. Whole families, and even entire villages, often receive the infection from one person. This ought to put people upon their guard against going near such patients as labour under the disorder; as by that means they endanger not only their own lives, but likewise those of their friends and connexions. Whatever tends to produce putrid or malignant fevers, may likewise occasion the putrid ulcerous sore throat, as unwholesome air, damaged provisions, neglect of cleanliness, &c.

SYMPTOMS.——It begins with alternate fits of shivering and heat. The pulse is quick, but low and unequal, and generally continues so through the whole course of the disease. The patient complains greatly of weakness and oppression of the breast, his spirits are low, and he is apt to faint away when set upright; he is troubled with a nausea, and often with a vomiting or purging. The two latter are most common in children. The eyes appear red and watery, and the face swells. The urine is at first pale and crude; but, as the disease advances, it turns more of a yellowish colour. The tongue is white, and generally moist, which distinguishes this from an inflammatory disease. Upon looking into the throat it appears swelled, and of a florid red colour. Pale or ash-coloured spots, however, are here and there interspersed, and sometimes one broad patch or spot, of an irregular figure, and pale white colour, surrounded with florid red, only appears. These whitish spots or sloughs cover so many ulcers.

An efflorescence, or eruption upon the neck, arms, breast, and fingers, about the second or third day, is a common symptom of this disease. When it appears, the purging and vomiting generally cease.

There is often a slight degree of delirium, and the face frequently appears bloated, and the inside of the nostrils red and inflamed. The patient complains of a disagreeable putrid smell, and his breath is very offensive.

The putrid, ulcerous sore throat may be distinguished from the inflammatory by the vomiting and looseness with which it is generally ushered in; the foul ulcers in the throat covered with a white or livid coat; and by the excessive weakness of the patient; with other symptoms of a putrid fever.

Unfavourable symptoms are, an obstinate purging, extreme weakness, dimness of the sight, a livid or black colour of the spots, and frequent shiverings, with a weak, fluttering pulse. If the eruption upon the skin suddenly disappears, or becomes of a livid colour, with a discharge of blood from the nose or mouth, the danger is very great.

If a gentle sweat break out about the third or fourth day, and continue with a slow, firm, and equal pulse; if the sloughs cast off in a kindly manner, and appear clean and florid at the bottom; and if the breathing is soft and free, with a lively colour of the eyes, there is reason to hope for a salutary crisis.

REGIMEN.——The patient must be kept quiet, and for the most part in bed, as he will be apt to faint when taken out of it. His food must be nourishing and restorative; as sago-gruel with red wine, jellies, strong broths, &c. His drink ought to be generous, and of an antiseptic quality; as red-wine negus, white-wine whey, and such like.

MEDICINE.——The medicine in this kind of quinsey is entirely different from that which is proper in the inflammatory. All evacuations, as bleeding, purging, &c. which weaken the patient, must be avoided. Cooling medicines, as nitre and cream of tartar, are likewise hurtful. Strengthening cordials alone can be used with safety; and these ought never to be neglected.

If at the beginning there is a great nausea, or inclination to vomit, the patient must drink an infusion of green tea, camomile flowers, or _carduus benedictus_, in order to cleanse the stomach. If these are not sufficient, he may take a few grains of the powder of ipecacuanha, or any other gentle vomit.

If the disease is mild, the throat may be gargled with an infusion of sage and rose leaves, to a gill of which may be added a spoonful or two of honey, and as much vinegar as will make it agreeably acid; but when the symptoms are urgent, the sloughs large and thick, and the breath very offensive, the following gargle may be used:

To six or seven ounces of the pectoral decoction, when boiling, add half an ounce of contrayerva-root; let it boil for some time, and afterwards strain the liquor; to which add two ounces of white-wine vinegar, an ounce of fine honey, and an ounce of the tincture of myrrh. This ought not only to be used as a gargle, but a little of it should frequently be injected with a syringe to clean the throat, before the patient takes any meat or drink. This method is peculiarly necessary for children, who cannot use a gargle.

It will be of great benefit if the patient frequently receives into his mouth, through an inverted funnel, the steams of warm vinegar, myrrh, and honey.

But when the putrid symptoms run high, and the disease is attended with danger, the only medicine that can be depended upon is the Peruvian bark. It may be taken in substance, if the patient’s stomach will bear it. If not, an ounce of bark grossly powdered, with two drachms of Virginian snake-root, may be boiled in an English pint and a half of water to half a pint; to which a tea-spoonful of the elixir of vitriol may be added, and an ordinary tea-cupful of it taken every three or four hours. Blistering-plasters are very beneficial in this disease, especially when the patient’s pulse and spirits are low. They may be applied to the throat, behind the ears, or upon the back part of the neck.

Should the vomiting prove troublesome, it will be proper to give the patient two table-spoonfuls of the saline julep every hour. Tea made of mint and a little cinnamon will be very proper for his ordinary drink, especially if an equal quantity of red-wine be mixed with it.

In case of a violent looseness, the size of a nutmeg of _diascordium_, or the japonic confection, may be taken two or three times a-day, or oftener if necessary.

If a discharge of blood from the nose happens, the steams of warm vinegar may be received up the nostrils frequently; and the drink must be sharpened with spirits of vitriol, or tincture of roses.

In case of a strangury, the belly must be fomented with warm water, and emollient clysters given three or four times a-day.

After the violence of the disease is over, the body should still be kept open with mild purgatives; as manna, senna, rhubarb, or the like.

If great weakness and dejection of spirits, or night-sweats, with other symptoms of a consumption, should ensue, we would advise the patient to continue the use of the Peruvian bark, with the elixir of vitriol, and to take frequently a glass of generous wine. These, together with a milk diet, and riding on horseback, are the most likely means for recovering his strength.

CHAP. XXIX.
OF COLDS AND COUGHS.

It has already been observed, that colds are the effect of an obstructed perspiration; the common causes of which we have likewise endeavoured to point out, and shall not here repeat them. Neither shall we spend time in enumerating all the various symptoms of colds, as they are pretty generally known. It may not however be amiss to observe, that almost every cold is a kind of fever, which only differs in degree from some of those that have already been treated of.

No age, sex, or constitution, is exempted from this disease; neither is it in the power of any medicine or regimen to prevent it. The inhabitants of every climate are liable to catch cold, nor can even the greatest circumspection defend them at all times from its attacks. Indeed, if the human body could be kept constantly in an uniform degree of warmth, such a thing as catching cold would be impossible: but as that cannot be effected by any means, the perspiration must be liable to many changes. Such changes, however, when small, do not affect the health; but, when great, they must prove hurtful.

When oppression of the breast, a stuffing of the nose, unusual weariness, pain of the head, &c. give ground to believe that the perspiration is obstructed, or, in other words, that the person has caught cold, he ought immediately to lessen his diet, at least the usual quantity of his solid food, and to abstain from all strong liquors. Instead of flesh, fish, eggs, milk, and other nourishing diet, he may eat light bread-pudding, veal or chicken broth, panado, gruels, and such like. His drink may be water-gruel sweetened with a little honey; an infusion of balm, or linseed sharpened with the juice of orange or lemon; a decoction of barley and liquorice, with tamarinds, or any other cool, diluting, acid liquor.

Above all, his supper should be light; as small posset, or water-gruel sweetened with honey, and a little toasted bread in it. If honey should disagree with the stomach, the gruel may be sweetened with treacle or coarse sugar, and sharpened with the jelly of currants. Those who have been accustomed to generous liquors may take wine-whey instead of gruel, which may be sweetened as above.

The patient ought to lie longer than usual a-bed, and to encourage a gentle sweat, which is easily brought on towards morning, by drinking tea, or any kind of warm diluting liquor. I have often known this practice carry off a cold in one day, which in all probability, had it been neglected, would have cost the patient his life, or have confined him for some months. Would people sacrifice a little time to ease and warmth, and practice a moderate degree of abstinence when the first symptoms of a cold appear, we have reason to believe, that most of the bad effects which flow from an obstructed perspiration might be prevented. But, after the disease has gathered strength by delay, all attempts to remove it often prove vain. A pleurisy, a peripneumony, or a fatal consumption of the lungs, are the common effects of colds which have either been totally neglected or treated improperly.

Many attempt to cure a cold, by getting drunk. But this, to say no worse of it, is a very hazardous experiment. No doubt it may sometimes succeed, by suddenly restoring the perspiration; but when there is any degree of inflammation, which is frequently the case, strong liquors, instead of removing the malady, will increase it. By this means a common cold may be converted into an inflammatory fever.

When those who labour for their daily bread have the misfortune to catch cold, they cannot afford to lose a day or two, in order to keep themselves warm, and take a little medicine; by which means the disorder is often so aggravated as to confine them for a long time, or even to render them ever after unable to sustain hard labour. But even such of the labouring poor as can afford to take care of themselves, are often too hardy to do it; they affect to despise colds, and as long as they can crawl about, scorn to be confined by what they call a _common cold_. Hence it is, that colds destroy such numbers of mankind. Like an enemy despised, they gather strength from delay, till at length they become invincible. We often see this verified in travellers, who, rather than lose a day in the prosecution of their business, throw away their lives by pursuing their journey, even in the severest weather, with this disease upon them.

It is certain, however, that colds may be too much indulged. When a person, for every slight cold, shuts himself up in a warm room, and drinks great quantities of warm liquor, it may occasion such a general relaxation of the solids as will not be easily removed. It will therefore be proper, when the disease will permit, and the weather is mild, to join to the regimen mentioned above gentle exercise; as walking, riding on horseback, or in a carriage, &c. An obstinate cold, which no medicine can remove, will yield to gentle exercise and a proper regimen of the diet.

Bathing the feet and legs in warm water has a great tendency to restore the perspiration. But care must be taken that the water be not too warm, otherwise it will do hurt. It should never be much warmer than the blood, and the patient should go immediately to bed after using it. Bathing the feet in warm water, lying in bed, and drinking warm water-gruel, or other weak liquors, will sooner take off a spasm, and restore the perspiration, than all the hot sudorific medicines in the world. This is all that is necessary for removing a common cold; and if this course be taken at the beginning, it will seldom fail.

But when the symptoms do not yield to abstinence, warmth, and diluting liquors, there is reason to fear the approach of some other disease, as an inflammation of the breast, an ardent fever, or the like. If the pulse therefore be hard and frequent, the skin hot and dry, and the patient complains of his head or breast, it will be necessary to bleed, and to give the cooling powders recommended in the scarlet fever every three or four hours, till they give a stool.

It will likewise be proper to put a blistering-plaster on the back, to give two table-spoonfuls of the saline mixture every two hours, and in short to treat the patient in all respects as for a slight fever. I have often seen this course, when observed at the beginning, remove the complaint in two or three days, when the patient had all the symptoms of an approaching ardent fever, or an inflammation of the breast.

The chief secret of preventing colds lies in avoiding, as far as possible, all extremes either of heat or cold, and in taking care, when the body is heated, to let it cool gradually. These and other circumstances relating to this important subject, are so fully treated of under the article _Obstructed Perspiration_, that it is needless here to resume the consideration of them.

OF A COMMON COUGH.

A cough is generally the effect of a cold, which has either been improperly treated, or entirely neglected. When it proves obstinate, there is always reason to fear the consequences, as this shews a weak state of the lungs, and is often the forerunner of a consumption.

If the cough be violent, and the patient young and strong, with a hard quick pulse, bleeding will be proper; but in weak and relaxed habits, bleeding rather prolongs the disease. When the patient spits freely, bleeding is unnecessary, and sometimes hurtful, as it tends to lessen that discharge.

When the cough is not attended with any degree of fever, and the spittle is viscid and tough, sharp pectoral medicines are to be administered; as gum ammoniac, squills, &c. Two table-spoonfuls of the solution of gum ammoniac may be taken three or four times a-day, more or less, according to the age and constitution of the patient. Squills may be given various ways; two ounces of the vinegar, the oxymel, or the syrup, may be mixed with the same quantity of simple cinnamon water, to which may be added an ounce of common water and an ounce of balsamic syrup. Two table-spoonfuls of this mixture may be taken three or four times a-day.

A syrup made of equal parts of lemon-juice, honey, and sugar-candy, is likewise very proper in this kind of cough. A table-spoonful of it may be taken at pleasure.

But when the defluxion is sharp and thin, these medicines rather do hurt. In this case gentle opiates, oils, and mucilages, are more proper. A cup of an infusion of wild poppy leaves, and marsh-mallow roots, or the flowers of coltsfoot, may be taken frequently; or a tea-spoonful of the paregoric elixir may be put into the patient’s drink twice a-day. Fuller’s Spanish infusion is also a very proper medicine in this case, and may be taken in the quantity of a tea-cupful three or four times a-day[108].

When a cough is occasioned by acrid humours tickling the throat and _fauces_, the patient should keep some soft pectoral lozenges almost constantly in his mouth; as the Pontefract liquorice cakes, barley-sugar, the common balsamic lozenges, Spanish juice, &c. These blunt the acrimony of the humours, and by taking off their stimulating quality, help to appease the cough[109].

In obstinate coughs, proceeding from a flux of humours upon the lungs, it will often be necessary, besides expectorating medicines, to have recourse to issues, setons, or some other drain. In this case I have often observed the most happy effects from a Burgundy-pitch plaster applied between the shoulders. I have ordered this simple remedy in the most obstinate coughs, in a great number of cases, and in many different constitutions, without ever knowing it fail to give relief, unless where there were evident signs of an ulcer in the lungs.

About the bulk of a nutmeg of Burgundy-pitch may be spread thin upon a piece of soft leather, about the size of the hand, and laid between the shoulder-blades. It may be taken off and wiped every three or four days, and ought to be renewed once a fortnight or three weeks. This is indeed a cheap and simple medicine, and consequently apt to be despised; but we will venture to affirm, that the whole _materia medica_ does not afford an application more efficacious in almost every kind of cough. It has not indeed always an immediate effect; but, if kept on for some time, it will succeed where most other medicines fail.

The only inconveniency attending this plaster is the itching which it occasions; but surely this may be dispensed with, considering the advantage which the patient may expect to reap from the application; besides, when the itching becomes very uneasy, the plaster may be taken off, and the part rubbed with a dry cloth, or washed with a little warm milk and water. Some caution indeed is necessary in discontinuing the use of such a plaster; this however may be safely done by making it smaller by degrees, and at length quitting it altogether in a warm season[110].

But coughs proceed from many other causes besides defluxions upon the lungs. In these cases the cure is not to be attempted by pectoral medicines. Thus, in a cough proceeding from a foulness and debility of the stomach, syrups, oils, mucilages, and all kinds of balsamic medicines do hurt. The _stomach cough_ may be known from one that is owing to a fault in the lungs by this, that in the latter the patient coughs whenever he inspires, or draws in his breath fully; but in the former that does not happen.

The cure of this cough depends chiefly upon cleansing and strengthening the stomach; for which purpose gentle vomits and bitter purgatives are most proper. Thus, after a vomit or two, the sacred tincture, as it is called, may be taken for a considerable time in the dose of one or two table-spoonfuls twice a-day, or as often as it is found necessary, to keep the body gently open. People may make this tincture themselves, by infusing an ounce of _hiera picra_[111] in an English pint of white wine, letting it stand a few days, and then draining it.

In coughs which proceed from a debility of the stomach, the Peruvian bark is likewise of considerable service. It may either be chewed, taken in powder, or made into a tincture along with other stomachic bitters.

_A nervous cough_ can only be removed by change of air and proper exercise; to which may be added the use of gentle opiates. Instead of the saponaceous pill, the paregoric elixir, &c. which are only opium disguised, ten, fifteen, twenty, or twenty-five drops of liquid laudanum, more or less, as circumstances require, may be taken at bed-time, or when the cough is most troublesome. Immersing the feet and hands in warm water will often appease the violence of a nervous cough.

When a cough is only the symptom of some other malady, it is in vain to attempt to remove it without first curing the disease from which it proceeds. Thus when a cough is occasioned by _teething_, keeping the body open, scarifying the gums, or whatever facilitates the cutting of the teeth, likewise appeases the cough. In like manner, when _worms_ occasion a cough, such medicines as remove these vermin will generally cure the cough; as bitter purgatives, oily clysters, and such like.

Women, during the last months of pregnancy, are often greatly afflicted with a cough, which is generally relieved by bleeding, and keeping the body gently open. They ought to avoid all flatulent food, and to wear a loose easy dress.

A cough is not only a symptom, but is often likewise the forerunner of diseases. Thus, the gout is frequently ushered in by a very troublesome cough, which affects the patient for some days before the coming on of the fit. This cough is generally removed by a paroxysm of the gout, which should therefore be promoted, by keeping the extremities warm, drinking warm liquors, and bathing the feet and legs frequently in lukewarm water.

OF THE HOOPING-COUGH, OR CHIN-COUGH.

This cough seldom affects adults, but proves often fatal to children. Such children as live upon thin watery diet, who breathe unwholesome air, and have too little exercise, are most liable to this disease, and generally suffer most from it.

The chin-cough is so well known, even to nurses, that a description of it is unnecessary. Whatever hurts the digestion, obstructs the perspiration, or relaxes the solids, disposes to this disease: consequently its cure must depend upon cleansing and strengthening the stomach, bracing the solids, and at the same time promoting perspiration and the different secretions.

The diet must be light, and of easy digestion; for children, good bread made into pap or pudding, chicken-broth, with other light spoon meats, are proper; but those who are farther advanced may be allowed sago-gruel, and if the fever be not high, a little boiled chicken, or other white meats. The drink may be hyssop, or penny-royal tea, sweetened with honey or sugar-candy, small wine-whey; or, if the patient be weak, he may sometimes be allowed a little negus.

One of the most effectual remedies in the chin-cough is change of air. This often removes the malady, even when the change seems to be from a purer to a less wholesome air. This may in some measure depend on the patient’s being removed from the place where the infection prevails. Most of the diseases of children are infectious; nor is it at all uncommon to find the chin-cough prevailing in one town or village, when another, at a very small distance, is quite free from it. But whatever be the cause, we are sure of the fact. No time ought therefore to be lost in removing the patient at some distance from the place where he caught the disease, and, if possible, into a more pure and warm air[112].

When the disease proves violent, and the patient is in danger of being suffocated by the cough, he ought to be bled, especially if there be a fever with a hard full pulse. But as the chief intention of bleeding is to prevent an inflammation of the lungs, and to render it more safe to give vomits, it will seldom be necessary to repeat the operation; yet if there are symptoms of an inflammation of the lungs, a second or even a third bleeding may be requisite.

It is generally reckoned a favourable symptom when a fit of coughing makes the patient vomit. This cleanses the stomach, and greatly relieves the cough. It will therefore be proper to promote this discharge, either by small doses of ipecacuanha, or the vomiting julep recommended in the Appendix[113].

It is very difficult to make children drink after a vomit. I have often seen them happily deceived, by infusing a scruple or half a drachm of the powder of ipecacuanha in a tea-pot, with half an English pint of boiling water. If this be disguised with a few drops of milk and a little sugar, they will imagine it tea, and drink it very greedily. A small tea-cupful of this may be given every quarter of an hour, or rather every ten minutes, till it operates. When the child begins to puke, there will be no occasion for drinking any more, as the water already on the stomach will be sufficient.

Vomits not only cleanse the stomach, which in this disease is generally loaded with viscid phlegm, but they likewise promote the perspiration and other secretions, and ought therefore to be repeated according to the obstinacy of the disease. They should not however be strong; gentle vomits frequently repeated are both less dangerous, and more beneficial than strong ones.

The body ought to be kept gently open. The best medicines for this purpose are rhubarb and its preparations, as the syrup, tincture, &c. Of these a tea-spoonful or two may be given to an infant twice or thrice a-day, as there is occasion. To such as are farther advanced, the dose must be proportionally increased, and repeated till it has the desired effect. Those who cannot be brought to take the bitter tincture, may have an infusion of senna and prunes, sweetened with manna, coarse sugar, or honey; or a few grains of rhubarb mixed with a tea-spoonful or two of syrup, or currant jelly, so as to disguise the taste. Most children are fond of syrups and jellies, and seldom refuse even a disagreeable medicine when mixed with them.

Many people believe that oily, pectoral, and balsamic medicines possess wonderful virtues for the cure of the chin-cough, and accordingly exhibit them plentifully to patients of every age and constitution, without considering that every thing of this nature must load the stomach, hurt the digestion, and of course aggravate the disorder[114].

The _millepedes_, or woodlice, are greatly recommended for the cure of a chin-cough. Those who chuse to make use of these insects, may infuse two ounces of them bruised in an English pint of small white-wine for one night. Afterwards the liquor may be drained through a cloth, and a table-spoonful of it given to the patient three or four times a-day.

Opiates are sometimes necessary to allay the violence of the cough. For this purpose a little of the syrup of poppies, or five, six, or seven drops of laudanum, according to the age of the patient, may be taken in a cup of hyssop or penny-royal-tea, and repeated occasionally[115].

The garlic ointment is a well-known remedy in North Britain for the chin-cough. It is made by beating in a mortar garlic with an equal quantity of hogs lard. With this the soles of the feet may be rubbed twice or thrice a-day; but the best method is to spread it upon a rag, and apply it in the form of plaster. It should be renewed every night and morning at least, as the garlic soon loses its virtue. This is an exceeding good medicine both in the chin-cough, and in most other coughs of an obstinate nature. It ought not however to be used when the patient is very hot or feverish, lest it should increase these symptoms.

The feet should be bathed once every two or three days in lukewarm water; and a Burgundy-pitch plaster kept constantly between the shoulders. But when the disease proves very violent, it will be necessary, instead of it, to apply a blistering-plaster, and to keep the part open for some time with issue ointment.

When the disease is prolonged, and the patient is free from a fever, the Peruvian bark, and other bitters, are the most proper medicines. The bark may either be taken in substance, or in a decoction or infusion, as is most agreeable. For a child, ten, fifteen, or twenty grains, according to the age of the patient, may be given three or four times a day. For an adult, half a drachm or two scruples will be proper. Some give the extract of the bark with cantharides; but to manage this requires a considerable attention. It is more safe to give a few grains of castor along with the bark. A child of six or seven years of age may take seven or eight grains of castor, with fifteen grains of powdered bark, for a dose. This may be made into a mixture with two or three ounces of any simple distilled water, and a little syrup, and taken three or four times a-day.

CHAP. XXX.
INFLAMMATION OF THE STOMACH, AND OTHER VISCERA.

All inflammations of the bowels are dangerous, and require the most speedy assistance; as they frequently end in a suppuration, and sometimes in a mortification, which is certain death.

CAUSES.——An inflammation of the stomach may proceed from any of the causes which produce an inflammatory fever; as cold liquor drank while the body is warm, obstructed perspiration, or the sudden striking in of any eruption. It may likewise proceed from the acrimony of the bile, or from acrid and stimulating substances taken into the stomach; as strong vomits or purges, corrosive poisons, and such like. When the gout has been repelled from the extremities, either by cold or improper applications, it often occasions an inflammation of the stomach. Hard or indigestible substances taken into the stomach, as bones, the stones of fruit, &c. may likewise have that effect.

SYMPTOMS.——It is attended with a fixed pain and burning heat in the stomach; great restlessness and anxiety; a small, quick, and hard pulse; vomiting, or, at least, a nausea and sickness; excessive thirst; coldness of the extremities; difficulty of breathing; cold clammy sweats; and sometimes convulsions and fainting fits. The stomach is swelled, and often feels hard to the touch. One of the most certain signs of this disease is the sense of pain, which the patient feels upon taking any kind of food or drink, especially if it be either too hot or too cold.

When the patient vomits every thing he eats or drinks, is extremely restless, has a hiccup, with an intermitting pulse, and frequent fainting fits, the danger is very great.

REGIMEN.——All acrimonious, heating, and irritating food and drink are carefully to be avoided. The weakness of the patient may deceive the bystanders, and induce them to give him wines, spirits, or other cordials; but these never fail to increase the disease, and often occasion sudden death. The inclination to vomit may likewise impose on the attendants, and make them think a vomit necessary; but that too is almost certain death.

The food must be light, thin, cool, and easy of digestion. It must be given in small quantities, and should neither be quite cold nor too hot. Thin gruel made of barley or oatmeal, light toasted bread dissolved in boiling water, or very weak chicken broth, are the most proper. The drink should be clear whey, barley-water, water in which toasted bread has been boiled, or decoctions of emollient vegetables; as liquorice and marsh-mallow roots, sarsaparilla, &c.

MEDICINE.——Bleeding in this disease is absolutely necessary, and is almost the only thing that can be depended on. When the disease proves obstinate, it will often be proper to repeat this operation several times, nor must the low state of the pulse deter us from doing so. The pulse indeed generally rises upon bleeding, and as long as that is the case, the operation is safe.

Frequent fomentations with lukewarm water, or a decoction of emollient vegetables, are likewise beneficial. Flannel cloths dipped in these must be applied to the region of the stomach, and removed as they grow cool. They must neither be applied too warm, nor be suffered to continue till they become quite cold, as either of these extremities would aggravate the disease.

The feet and legs ought likewise to be frequently bathed in lukewarm water, and warm bricks or poultices may be applied to the soles of the feet. The warm bath, if it can be conveniently used, will be of great service.

In this, and all other inflammations of the bowels, an epispastic, or blistering-plaster, applied over the part affected, is one of the best remedies I know. I have often used it, and do not recollect one instance wherein it did not give relief to the patient.

The only internal medicines which we shall venture to recommend in this disease, are mild clysters. These may be made of warm water, or thin water-gruel; and if the patient is costive, a little sweet oil, honey, or manna, may be added. Clysters answer the purpose of an internal fomentation, while they keep the body open, and at the same time nourish the patient, who is often in this disease unable to retain any food upon his stomach. For these reasons they must not be neglected, as the patient’s life may depend on them.

INFLAMMATION OF THE INTESTINES.

This is one of the most painful and dangerous diseases that mankind is liable to. It generally proceeds from the same _causes_ as the inflammation of the stomach; to which may be added costiveness, worms, eating unripe fruits, or great quantities of nuts, drinking hard windy malt liquors, as stale bottled beer or ale, sour wine, cyder, &c. It may likewise be occasioned by a rupture, by schirrous tumours of the intestines, or by their opposite sides growing together.

The inflammation of the intestines is denominated _Iliac passion, Enteritis, &c._ according to the name of the parts affected. The treatment however is nearly the same whatever part of the intestinal canal be the seat of the disease; we shall therefore omit these distinctions, lest they should perplex the reader.

The _symptoms_ here are nearly the same as in the foregoing disease; only the pain, if possible, is more acute, and is situated lower. The vomiting is likewise more violent, and sometimes even the excrements, together with the clysters, are discharged by the mouth. The patient is continually belching up wind, and has often an obstruction of his urine.

While the pain shifts, and the vomiting only returns at certain intervals, and while the clysters pass downwards, there is ground for hope; but when the clysters and _fæces_ are vomited, and the patient is exceeding weak, with a low fluttering pulse, a pale countenance, and a disagreeable or stinking breath, there is great reason to fear that the consequences will prove fatal. Clammy sweats, black fœtid stools, with a small intermitting pulse, and a total cessation of pain, are signs of a mortification already begun, and of approaching death.

REGIMEN.——The regimen in this disease is in general the same as in an inflammation of the stomach. The patient must be kept quiet, avoiding cold, and all violent passions of the mind. His food ought to be very light, and given in small quantities; his drink weak and diluting; as clear whey, barley-water, and such like.

MEDICINE.——Bleeding in this, as well as in the inflammation of the stomach, is of the greatest importance. It should be performed as soon as the symptoms appear, and must be repeated according to the strength of the patient, and the violence of the disease.

A blistering plaster is here likewise to be applied immediately over the part where the most violent pain is. This not only relieves the pain of the bowels, but even clysters and purgative medicines, which before had no effect, will operate when the blister begins to rise.

Fomentations and laxative clysters are by no means to be omitted. The patient’s feet and legs should frequently be bathed in warm water; and cloths dipped in it applied to his belly. Bladders filled with warm water may likewise be applied to the region of the navel, and warm bricks, or bottles filled with warm water, to the soles of the feet. The clysters may be made of barley-water or thin gruel with salt, and softened with sweet oil or fresh butter. These may be administered every two or three hours, or oftener, if the patient continues costive.

If the disease does not yield to clysters and fomentations, recourse must be had to pretty strong purgatives; but as these, by irritating the bowels, often increase their contraction, and by that means frustrate their own intention, it will be necessary to join them with opiates, which, by allaying the pain, and relaxing the spasmodic contractions of the guts, greatly assist the operation of purgatives in this case.