Chapter V: Part 5

If the _injection_, No. XXI. is made use of in time, all this will be prevented; but sometimes it is of a very stubborn nature. If the inflammation is very great, the poultice, No. II. should immediately be applied, to which it will yield; being of a very powerful quality, particularly, if to the poultice _mercurial ointment_ (P) two drachmes is added, by which it becomes an immediate antidote to the venereal virus.

_Of the Chordee, and Priapism._

A priapism is an involuntary erection; and the chordee is a stricture in the urethra, by which the penis is bent either ways, according to the seat of the contraction, this however is generally downwards; whereby it makes the involuntary erection prodigiously painful.

It proceeds from some imprisoned virus in the urethra; which together with its contraction, irritates the penis to erection.

The _antacrid injection_ No. XXI. will generally, if timely applied, prevent this; but if by neglect, or the great virulence of the venom, it has actually commenced, recourse should be had to mercurial ointment; which should three or four times of the day be rubbed on the penis. Should the priapism be very violent, the poultice, No. II. with the addition of _mercurial ointment_ (P) must be applied.

_Of the Dysuria._

The dysuria is a scalding of the urine in the urethra; this likewise is obviated by timely using the _injection_, No. XXI. or No. VIII. But when it is actually become troublesome, drink plentifully of diluting drinks, such as _balm tea_, &c. and take a few fever powders which will soon set this to right again; particularly as that is a symptom which generally vanishes, as the disease becomes milder.

_Of Shankers._

These are little ulcers coming upon the glans, the frænum, and the præpuce of the yard. They are not only troublesome, but sometimes tedious in the cure; the _antacrid injection_ No. XXI. if timely applied, will generally prevent them.

But sometimes these very unwelcome visitors will appear even without a clap; and then they generally gain great ground, before timely remedies can be applied.

The _injection_ No. XXI. should in this case be injected betwixt the præpuce and glans; but if this is not sufficient, apply the following.

No. XXII

_Take mercurial ointment, two drachmes; calomel_ (N), _two
scruples; precipitate_ (O), _ten grains. Mix it into an
ointment._

By the dressing with this, all the shankers will speedily heal up.

If warts sprout out, they should immediately be cut off, with a pair of good sharp scissars, and then dressed with the above ointment.

Shankers, when they appear, without a previous gonorrhœa or clap, ought always to be taken as a forerunner of the pox itself; and the patient must have immediately recourse to the _mercurial pills_, No. X. one to be taken night and morning, in order to prevent the threatening evil consequences.

_Of the Bubo._

A Bubo is a swelling that appears on a venereal infection, sometimes in one, sometimes in both groins. This swelling proceeds either from a transposed virus, or comes as the first messenger of a venereal infection.

A bubo appears with symptoms of a heavy dull pain in the groin, which on examination discovers itself with a little kernel that is painful to the touch: If left to itself it gradually encreases both in bulk as well as in pain, and at length forms a collection of matter.

The moment a bubo appears, take a purge, No. IX. rub the part in the groin with _mercurial ointment_, and spread a _mercurial plaister_ the bigness of a crown-piece, which, (the hair being removed,) lay on the part; let it remain on, till it separates from the skin, and the swelling is dispersed; the patient should be kept warm, and not have much exercise; at the same time the body should be kept open.

By this means the bubo will soon disperse, and the virus be destroyed in its first bud. But if it has already gained too much head to be dispersed, and matter is formed, it becomes larger and soft, and a fluctuation of matter is felt, then suppuration must be promoted; and when ripe be opened as soon as possible, for an outlet of the matter.

When it is come to its maturity, (that is the matter plainly perceived,) open it and dress it like an ulcer, first with the ointment, No. I. and when it discharges pretty well, dress it with the ointment, No. XXII.

By this management, though easy, you will not fail of success.

_Of Swelled Testicles._

The venereal virus is liable to attack the testicles, which makes one of the most disagreeable circumstances of all venereal diseases; sometimes one, and sometimes both will be the seat of this complaint.

It begins with a heavy dull pain, attended with a disagreeable tightness in the spermatic vessels, leading from the testicle into the bowels. Gradually the testicle swells, becomes hard and grows very painful, and if not timely remedied, a suppuration, or a scirrhus, or even a gangrene and sphacelus, may be the consequences.

The moment the pain in the testicles is perceived, remove the hair all round the scrotum, and apply a mercurial plaister spread upon leather; over which put a suspensorium, and tie it up to the body as tight as it can be borne; which together with a purge, No. IX. will not fail of giving immediate relief.

The patient should be kept as quiet as possible; for hard labour not only retards the cure, but becomes very painful. Should this not be sufficient, apply the poultice, No. II. with the mercurial addition as warm as sufferable, and repeat it as often as it is necessary for keeping it warm to the part. By this method it will not fail of dispersing.

Should it however against all expectation come to a suppuration, it must be opened the same as another aposthume, and treated accordingly. But should a scirrhus, or a mortification ensue, extirpation is the only recourse. For which see my treatise.

_Of Venereal Excrescences._

Besides all these disorders before mentioned that are the consequence of impure coition, there is one more to be mentioned, and that is a variety of disagreeable excrescences, which sometimes arise about the penis, the scrotum perinæum, and about the fundament.

When these appear, I generally take it for granted, that the pox is in the blood, and the patient ought to be treated accordingly.

If there is a possibility of extirpating them, either by a bistoury, or a pair of good sharp scissars, it ought to be done, and dressed with the following ointment.

No. XXII

_Take mercurial ointment_ (P), _and precipitate_ (O) _equal
parts: mix them._

The roots of these stubborn companions are frequently seated very deep; if this is particularly taken notice of, together with proper internal medicines, the excrescences taken away at the root, and the ointment applied, they may all of them soon be drove off from the field.

_Of the second Infection._

In regard to the second infection, this is too tedious here to enter into, and to do properly justice, I must refer the reader to the treatise itself.

All I have at present to say, is, that my method of cure is particularly easy and simple, in itself; and I am happy to think at the same time, that it is more efficacious, than any former method, or practice, made use of.

The _antacrid injection_ No. XXI. is the most efficacious for subduing the gonorrhœa, and all the evil consequences in that part; and the other mercurial preparations in the manner I have recommended them, is equally powerful.

I am utterly averse to salivation; it is using mercury as a poison; very few have ever been cured by it, and those few have been more indebted to their good constitution, than the treatment which they have with so much danger undergone. But many, very many, have had their constitutions ruined by salivation, past the art of man to recover; and thousands have been sent miserable objects to the grave.

I am also averse to bleeding in venereal cases, unless the greatest necessity requires it; for in general it serves only to infect all the fluids, since the veins emptied, will naturally absorb from all parts of the body, and thence liable to infect the whole mass of blood. Purging needs but be used very sparingly.

Mercury inwardly taken, should be used with the greatest moderation, and taken in very small doses; for with such judicious management it becomes one of the best medicines in the whole Materia Medica; but if abused, it is converted into a poison. The decoction of the sassafras should be plentifully made use of during the whole course of the venereal disease.

And lastly, from the real effect that the mercury has on the blood, I must add, that the same gentle method with respect to its internal use, as is recommended for the first infection, must also be pursued for the second infection; let the malignities be ever so bad, even in the most inveterate diseases of the bones themselves; with this difference, that in proportion as the disease is engrafted, time must be allowed for the cure.

Nature may be led by the gentle hand of assistance, and tenderness; but he who attempts to do good by main force, acts as a fool, and deceives not only himself, but those who are so unfortunate, as to trust to his pretended skill.

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SECT. VI.

_Of the Bite of Venomous Animals_

It has been observed by all diligent inquirers into nature, that poisons are of two kinds, with respect to their effect in the animal œconomy. One kind will destroy if taken inwardly, but not have such ill consequences in wounded parts, externally. Another kind will be fatal in wounds; at the same time it does not affect the viscera.

The first which destroys internally, are poisons, either from corrosive minerals, or vegetables; but of the latter, namely what seems inoffensive taken in the mouth, is the poison that follows the bite of most venomous animals whose poison are natural; such is the scorpion, the adder, the rattle snake, &c. whose poison have by various experiments, been found to be attended with no ill consequences internally taken. This was known to the ancients, as well as to us; for we find Celsus,[13] to have spoken of this in his medical works.

Footnote 13:

_Nam venenum serpentis, ut quaedam etiam venatoria venena, quibus
Galli præcipue utuntur non gusto, sed in vulnere nocent. Ergo
quisquis, exemplum Psylli secutus, it vulnus exsuxerit, et ipse tutus
erit, et tutum hominem præstabit. Medicin. lib. v. c. 27._

Without any farther preface, I shall proceed to give the immediate remedies for such unfortunate accidents as happen by the bite of these animals.

_To Cure the Bite of a Rattle Snake._

The poison from this venomous beast, is more deadly than any other of the serpentine tribe. If its venom by a wound is infused into the blood, a mortification, and speedy death must follow.

The part bit, should immediately be sucked with the mouth, either of the patient itself, or one who will risk himself to be so much the friend of the wounded. Dr. Mead has recommended, that oil should be held in the mouth all the time of sucking, but we have it from good authority, that the spittle itself is an antidote to that kind of poison.

It is needless to say, that the person who sucks the poison, should frequently spit out, as not to run the risk of swallowing it; and care should be taken, that his mouth is free from sores, or wounds.

When this is performed for a quarter of an hour, the part should be dressed with _mercurial ointment_ (P). Sweet oil is much recommended, and may be plentifully used as an embrocation to the inflamed part; particularly if the oil is impregnated with camphor.

No. XXII

_Take oil_ (C) _two ounces; camphor, one scruple; mercurial
ointment, one drachm; mix it._

The patient should take a vomit of _ipecacuanha_ (S) _one scruple_; and a few drops of the essential _oil_ of _peppermint_ (U), on a lump of sugar, and dissolved in water, which should be repeated after the operation of the vomit as often as occasion requires. The fat of a rattle snake, is accounted a sovereign specific, if applied immediately to the wounded part, and the patient drinking a decoction made of _snakeroot_.

The same remedy here recommended to the bite of a rattle snake, (namely, sucking the fresh made wound) is also recommended to all other venomous bites. The _viper_, the _adder_, the _santapea_ or _scolopandra_, the _scorpion_, _tarantula_, &c.

That oil is an antidote, (or as we may say a poison) to all these venomous animals is evident from their expiring in great agony, when oil is poured on them; but whether this effect is because of the penetration it has on their bodies, or annihilating their poison, is as yet undetermined.

I was once told a secret for the sting of a scorpion, avered to have been experienced, by a commander of a ship, trading to the bay of Honduras, viz. that the part stung by a scorpion should be touched with the glans of the penis, which would immediately draw out the poison, without effecting the glans that touched it; and it differs not, whether the patient himself or any other person does it.——If there is any virtue in this, I own it is beyond my comprehension.——I thought proper however to mention it, though I cannot advise it as a safe experiment, unless farther confirmed by those who have actually experienced it.

I have however a great opinion of mercurials in such exigencies; and would advise recourse to be had to it immediately, both external as well as internal; this we are at least assured of, it cannot be attended with danger.

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SECT. VII.

_Of the Bite of a mad Dog_

There are many surprizing things in nature, in so much, that ocular demonstration can only convince us of their existence. Amongst those wonderful phenomenons, the direful effect of the bite of a mad dog is equally astonishing as it is melancholy.

That dogs and wolves are more liable to madness of this kind, called the _Rabies_, is because of their deficiency of external perspiration; and are obliged to supply that defect with their open mouth and their lolling-out the tongue; whence their blood is subject to become overheated, and thence generate a malignant inflammation, which infects the saliva with this direful poison. But the astonishment is, why it should have so very powerful a contagion as to infect the mass of blood of every animal that receives the least atom of it? Yet so it is, confirmed by sad experience.

From frequent observation we are able however to communicate such signs, which attend the symptoms of madness in a dog, whereby we may the better avoid the danger of being plunged into the most deplorable misery by this wretched animal.

_The Signs of a mad Dog._

The dog with symptoms of madness evidently discovers a malignant fever; he runs confusedly forwards; the tongue hangs out of the mouth with much slabber; his head hangs downwards; his eyes look dull and heavy; his tail is drawn up between his legs; and in every respect he has all the sign of confused wildness and pain; he runs confusedly forward, and snaps about him without distinction of persons or fear. He is always restless; will neither eat nor drink; and is terrified at the sight of water; the tongue hanging out of his mouth, grows black; and at last expires a spectacle of horror, unless the poor beast is put out of his misery, and thereby many dreadful consequences prevented.

_The Effect of the Bite of a mad Dog._

So subtile is this fatal poison, that the symptoms do not appear immediately; but the part bitten will sometimes even heal up, the same as any other wound; and two, four, or six months after the injury, the symptoms of the malady will appear and gradually reduce the patient to the most deplorable state in nature.

The first symptoms of the disease are, a pain in the part where he was bit, which gradually spreads all around; the whole body in general is attended with a dull heavy pain, a lassitude and weariness. The mind grows depressed and anxious, together with a loss of appetite and a nausea at the stomach; and, in particular, a difficulty of swallowing, sore throat, and accumulation of spittle.

Soon these symptoms encrease. The peculiar soreness of the throat, which renders the swallowing liquids very painful, begins to create the utmost horror and dread of every thing that is liquid; and this first gives rise to the _Hydrophobia_, or dread of water, which compleats the patient’s misery in this terrible disorder.

The eyes become full and staring, the face bloated, florid intermixed with lividness; the mind is impaired; rage, lust and mischief, agitates the confused will; at length, convulsions, foaming of the mouth, priapisms, and seminal emissions, barking, howling, and endeavouring to bite every thing near, ends the wretched life of the most deplorable object in nature.

_Of the Cure of the Bite of a mad Dog._

With respect to the remedies, we have had many delivered to us; but few indeed with success. Before I enter on the best method that I know, by experiment, to recommend, I must beg leave to mention a peculiar successful instance, in the course of my practice, in this deplorable case.

A mad dog on shore, in the West-Indies, bit two men, one belonged to my ship’s crew, the other to a ship in the same harbour; both were bit in the calf of the leg. It happened that the surgeon of the other ship and myself were immediately at hand at the time of the accident. I was for cutting the part bitten fairly out without delay; to which the man of my ship readily contented; and it was done accordingly upon the spot, having fortunately my pocket instruments about me. But this operation was not approved of by Mr. E——; nor suited it the timidity of the man belonging to his care; it was therefore omitted.

When I had performed the operation, viz. (as near as I can guess) I cut more than an ounce and a half of flesh out of the gastrocnemius muscle (every where round the bitten part) I spread a pledget with basilicon, mixed with precipitate, and laid it on the wound, having first let it bleed, perhaps six or eight ounces; over the pledget I laid plenty of dry lint; and when he was carried on board, I fomented it with spirits of wine and camphor, in which _sublimate mercury_ was dissolved (about one grain to about four ounces of the spirit). Inwardly I gave him one grain of calomel every morning and night for at least a fortnight. The sore I continued to dress with mercurial ointment; which within a month healed up perfectly sound. From the mercurial treatment, the patient had a small ptyalism, which I checked by gentle cathartics. My patient, by this severe, though efficacious method, recovered perfectly well, and remained so at least three months after the accident, when we parted. The other unfortunate man, however, had not so good luck; for, as I was afterwards informed (the ship going soon to sea after the accident) the unhappy sufferer died a horrible object, raving mad in the _hydrophobia_.

Mercury is certainly the greatest antacrid we have; and I am firmly of opinion, that in this case it is the most powerful of any medicine that is yet known.

The cold bath is strenuously recommended by Dr. Mead; and since his recommending it, is generally practised on suspicion of this misfortune; but in real cases, very seldom with the wished-for success. Yet, Reason says much in its favour, and should by all means be had recourse to. Others have recommended strong salt brine, which also is not to be rejected.

Before I lay down the method to be observed, I shall first give Dr. Mead’s recipe in his own words.

“Let the patient be blooded at the arm nine or ten ounces. Take of the herb called in Latin, _lichen cinereus terrestris_; in English _ash-coloured ground liverwort_, cleaned, dried, and powdered half an ounce. Of _black pepper powdered, two drachmes_, mix these well together, and divide the powder into four doses, one of which must be taken every morning fasting, for four mornings successively in half a pint of cow’s milk warm. After these four doses are taken, the patient must go into the cold bath, or a cold spring, or river, every morning fasting for a month: he must be dipt all over, but not stay in (with his head above water) longer than half a minute, if the water be very cold. After this he must go in three times a week a fortnight longer.”

But to speak my real sentiments, I have no great opinion of this recipe; yet as other methods may be pursued along with it, I thought proper to insert it, as in a malady of this consequence, nothing should be left undone that is practicable with propriety.

Celsus I think was the first who recommended cold bathing[14]; but indeed to a degree of drowning and reviving the patient again alternately. In the mania itself, it carries much reason with it in this miserable extremity, for the poor wretch at the eve of expiring, a spectacle of horror, may as well run the risque of drowning; and besides, the shock that plunging gives to the whole system, may probably work an alteration in the malignant habit.—But alas! when the hydrophobia has actually commenced; Death, and death only—can give relief! Yet let it ever be a maxim, (and especially with a seaman) _never_ to forsake _hope_; for _despair_ is only a punishment reserved for the damned. I repeat it; no means should be left untried, that has the least prospect of recovery.

Footnote 14:

_Unicum remedium est, nec opinantem in piscinam non ante ei provisam
projicere, et, si natandi scientiam non habet, modo mersum bibere
pati, modo attollere; si habet, interdum deprimere, ut invitus quoque
aqua satietur: sic enim simul et sitis, et aquæ metus tollitur. Lib.
v. cap. 27._

But to avoid being tedious, I will proceed to the method I would have pursued in an accident of that terrible kind.

If you by the before description find that the dog who gave the wound is actually mad, then without a moment’s delay let the piece bit, be cut fairly out; if that is not practicable, apply immediately the ointment made of _mercurial ointment_ and _precipitate_, No. XXI. Over which apply _mercurial plaister_. Give one of the pills No. X. every morning and night, and continue this course for a whole month. Let the plaister remain on the place a good while after the sore is healed up.

This method I pursued with a gentleman, and a little boy in New-York, who both were bit by the same dog, without provocation, the dog having never attempted the like before; upon which he was immediately shot, and was found to have all the signs of madness.——The accident happened at noon, and I was immediately sent for; but not being in the way, my assistant dressed it with basilicon, and laid over it a compress with _spirit of wine and Camphor_, supposing it of no consequence, as the wound was but very small. But on my hearing of it in the evening, I went that moment to their assistance, removed the dressing and applied what I have before mentioned.

I was not mistaken, for the sore and all around, after some time grew angry, and had an unfavourable appearance; but with diligent attendance gradually became better.—— The little boy was bit deeper than the gentleman; His wounds were on both sides of the _tendo achillis_: But the gentleman’s wound was a little above the _maleolus externus_ on the right leg, inclining to the _tendo achillis_.

It was in the month of July—I ordered bathing every morning and night, which suited the season. In the mean time, during three months, I gave one grain of calomel every morning and night; and every thing succeeded to our wishes.

But to return; should the mercurial medicines go to the mouth, a gentle cathartic will divert this, for I am an utter enemy to salivation. If however these remedies are administered too late, so that, notwithstanding all those applications, the patient should grow melancholy, have a difficulty in breathing, and a sore throat; but especially a pain in the sore, or bitten part, recourse should be had to frequent cold bathing, or rather plunging; mercurials should be continued, and every method pursued as will be advised in the putrid malignant fevers.

Should the patient however be seized with madness, care should be taken that those about him have no wounds where the least of his spittle may be introduced; and that the deplorable patient is rendered incapable to make any wounds or mischief on himself, or those who attend him; as he will be apt to snap and bite about him like a dog. He should be sewed up in a hammock, to which his arms should also be confined: in this method he may, by help of a tackle, be plunged up and down in the sea, but not his head under water. This is far superior to the unnatural and cruel way of smothering with beds, where the patient has no chance at all left.

The subject is melancholy; but, willing to contribute all the relief in my power to the distressed, I have been insensibly led on; and summed up all that might promise success. Innumerable are the remedies delivered to us, but few prove successful if the case be real.

Of all, I never knew any meet with better success than where mercury was concerned; and as I have been so fortunate as to have experienced the exalted virtue of that great medicine, in this and other deplorable cases, I stand so much upon the firmer grounds, to recommend it beyond any other medicine that I am acquainted with at present.

To conclude, I think it requisite to observe, that, dreadful as the bite of a mad dog is, when the poison has infected the unfortunate patient, yet this unlucky accident happens much seldomer, than mankind from the dread of the misfortune, are apt to apprehend it does. Many nostrums are published as specifics, and their virtue artfully confirmed, with cases of being bit by dogs, that had however not the least symptom of madness; and thence cures enumerated, that could have no foundation on reality; by which artifices much mischief has been done in real cases. Due observance should therefore be had to the state of the dog that has given the wound, and the circumstances attending; that either the patient may not be brought into unnecessary pain, or that proper and substantial remedies may not be neglected.

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LECTURE V.

OF

FEVERS AND
INFLAMMATORY DISEASES,

AND

THEIR PROPER METHOD OF TREATMENT.

We now proceed to the more internal diseases; in which, the various steps that we intend to take of restoring health again, must be guided with the greatest caution, as the seat of the malady is hid from our external examination.

It is for this very reason I designed previously to prepare the reader with the two first lectures; particularly the second, I must beg the reader thoroughly to examine, and to understand; for on this will in a great measure depend the proper application of the various experienced remedies, which I here mean to unfold.

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SECT. I.

_Of Fevers in General_

Hippocrates, the father of physic, was wont to say, “A fever is so universal, that no patient dies without it.” This is so true, that there is hardly an exception to it, even in the most momentary apoplexy itself.

To conceive this properly, we must observe, that every diminutive part in the animal fabric, like in a commonwealth, is endued with a sense of self-preservation; and the whole fabric is in so strict a conjunction with all its various particles, both solids and fluids, that nothing which may cause the least disturbance can pass unnoticed; but, let the injury be where it will, every individual particle, as a member of the whole animal state, feels the shock, and is immediately concerned for its own preservation.

This then is the cause of a fever in the general sense; and thence we shall be led to understand what this disturbance in its nature actually is; namely, an unnatural action of the solids upon the fluids.

Now as the fluids are the most yielding parts, that must submit to the pressing motion of the solids, we may without much difficulty, see one principle reason of its being set into a disturbed commotion, when the irritability of the nervous fibrillæ are acted upon.

Again, when we consider that the blood is liable to become acrimonious, and thence by its stimulus apt to act upon the coats of its containing vessels, we see demonstratively plain, how the solids are subject to be excited to act upon the very blood that stimulates them.

Moreover, as motion must naturally produce heat, and heat motion, and motion expansion, and expansion rarefaction, we at once bring to view the principal laws of mechanism, that governs the human automaton in the various degrees of health as well as disease. However, let me not forget to whom I write, but haste to the point I am at.

A fever may proceed from many different causes, and may affect many different constitutions, and also produce many different effects; it is therefore just that a proper distinction should be made.

Indeed, it is a subject that cannot be too minutely handled; because it is scarce possible that there is a disease void of a fever in some degree or other.—But preciseness and utility is the object I have in view.

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SECT. II.

_Of Accidental Fevers._

How uncertain is human life! One moment in a perfect state of health, the next perhaps no more; or confined under the painful sensations both of body and mind!

Every accident is liable, and unavoidably must bring on a fever; and this, like fire, should be extinguished in its earliest commencement. But in that, as I have before observed, the constitution should principally be consulted.

I have in the lecture of accidents, at every opportunity, recommended bleeding, but always with a proviso, _if requisite_; and, as this is of more consequence than generally is supposed, I find it necessary here to expatiate farther on it.

In the first place, no man should be bled who has lost a considerable quantity of blood, unless indeed he was known in his state of health to be very strong and robust; and that the fever sets on with such fury, that the system requires absolutely to be reduced; for the solids and fluids have such a strict dependance amongst themselves, that they keep each other in an equipoise. If therefore the blood is of an acrimonious nature, and at the same time impoverished by lessening its quantity, the coats of the arteries and veins will be the more stimulated; thence the fever will naturally encrease, and generate more acrimony; which at length will destroy the patient. I have been an eye witness more than once, that the fever has actually increased upon every repeated bleeding, till the whole supply of life was spent; and all my persuasions have not been listened to till too late. Nay, a fever is sometimes absolutely necessary; and proves to some constitutions a remedy on its own account, provided it is properly treated, and kept within due bounds.

Secondly, If the constitution of the patient before the accident was but slender, and of a phlegmatic nature, bleeding should be very little or cautiously performed; for the blood of itself being but poor, must naturally be impoverished by being lessened; and whilst the tenseness of the fibres is lost, it is the more acted upon and rendered more acrimonious, and still unable to strengthen the tone of the irritated fibres; whence a relaxed body, together with a poor acrimonious blood, and all its evil tendencies must be the consequence.

Let it once for all be observed, that all the benefit we can possibly hope and expect from bleeding, is to lessen the whole system, to reduce the quantity of the fluids, and to relax the solids. This lessening of the system I must own is very often highly necessary; But, let us not fall into the ridiculous notion to suppose that bleeding will draw off the bad blood, and leave the good behind; far otherwise; the quantity of the blood is soon replenished, but the quality becomes impoverished.

The principle intention in fevers of whatever kind, should be to promote perspiration. This is the grand restorative of nature; and I cannot recommend it too much. Nature designed this evacuation in the formation of man; and by that, fevers were cured in time of yore, many ages before art contrived either lance or lancets.

But here let me not forget another great caution; namely, not to mistake profuse sweating for perspiration; for this is an extreme into which many have erroneously fallen. Nature frequently produces a sweat without force or compulsion; and if so, it should be favoured, but never brought on by stimulants, or strong forcing medicines.

Perspiration, sweat and urine, are the natural evacuations intended, for the purifying the system from animal acrimony; and when these excretions are in a just balance with the secretions of the fluids and motion in the system, without pain or fatigue; then nature is at peace with itself.

Lastly, I must observe, that the stomach is an organ which, by the nervous consent, carries on an immediate correspondence with every part in the human fabric; whence this viscera should likewise ever be consulted in fevers; that is, never to impose on it any aliment against its own inclination and appetite.

The want of appetite in a fever is a natural cause, and very often is in the patient’s favour; but the mistaken notion, that a patient must eat, even against his inclination, in order to recover strength, is not only highly absurd, but has been the destruction of many, who otherwise would have recovered, had they with patience waited the kind dictates of Nature.

Let the system be free from diseases, and the stomach will soon crave food, when there is a probability that the aliment may be converted into good blood; but whatever is forced into the stomach before that time, will instead of nourishing the body, only add fuel to the destructive fire, and encrease the already malignant blood.

Upon the principles of these observations, I shall lay down the rules that should be religiously observed in accidental fevers; and when they are well considered, we shall find that they will hold good also in all other kind of fevers, notwithstanding they arise from internal acrimony of the body; for the difference is barely this, whether the fire is kindled within or from without;—but to proceed.

Whatever then be the accident, a fall, a wound, a fracture, dislocation, bruise, &c. observe what the patient was before the accident.

If the patient was a stout hearty man, it naturally follows, that the fibres of his body were also in a rigid robust state; and the quantity and richness of the blood was in a due proportion; for this very reason, health being at such an _acmé_, a fever is the more to be feared, and ought studiously to be avoided.

If this patient has not lost any blood by the accident, by all means bleed him; but never exceed eight ounces at farthest; it is as much as the strongest man ought to lose at once.

In the next place, perspiration should be the principal object in view. To this end, let the patient immediately after bleeding go to rest, and take a dose of the _Fever Powder_ (L); upon which let him drink plenty of _Balm Tea_ (12); which will generally bring on a perspiration.

If however the fever increases, the pulse continues to beat hard and full, the head-ach, difficulty of breathing, a great draught and delirium should ensue, bleeding indeed may be repeated, provided it is within the same twenty-four hours; but if the symptoms come on beyond that time, then bleeding will seldom prevail, or do any good, but rather mischief; for by this time, the fever is generally agitated by acrimony, and the blood is of its own accord poor enough without being made more so by bleeding.

In the symptoms which I mentioned, regard should be had to the body being gently kept open, not by purges but by clysters; for purges in fevers are precarious, and liable to bring on heavy fluxes. If the patient under this high fever is costive, give him the following clyster.

No. XXIII

_Take warm water one pint, or something more; in which scrape
about one ounce of castile or hard soap, and let it perfectly
dissolve; then add a spoonful of honey to it, and let it be as
warm as that it may be easily borne to your cheek._

Let the patient keep this clyster within him as long as he can, till it comes away with a stool.

If the patient is sick at the stomach, a vomit of _ipecacuanha_ (S) or No. XXVI, will be very proper, and nothing in such a case can be given more safety and better advantage; for it is not only the stomach that gets relieved, but the whole body is brought thereby into perspiration, by the universal strain it occasions. After the vomit, or after the clyster, give the following draught.

No. XXIV

_Take of fever powder_ (L) _one scruple; common water or balm
tea, one ounce or half a tea cup full; then take a lump of
sugar, on which pour essential oil of peppermint_ (U) _three
drops; liquid laudanum_ (T) _eight drops; sweet spirit of nitre_
(D) _thirty drops; and mix them with a tea spoon._

This draught will not only promote perspiration, but it will comfort the stomach, and incline the patient to an agreeable rest; by which he will be greatly refreshed. If occasion requires, it may be repeated every six hours.

If rest comes of its own accord, the _liquid laudanum_ (T) may be omitted; and if the stomach does not stand in need of any carminatives, the _oil of peppermint_ (U) may also be omitted, &c. The constant drink when dry may be balm tea; in which, if it suits the palate of the patient, a slice of lemon may be put, and then sweetened with sugar.

The diet, as I have before observed, should be sparing; and the patient’s palate in this should principally be consulted. The following water gruel, or rather wine soup, or whatever other name it may acquire, I have often ordered to my patients at sea; and which has suited most stomachs, and proved an agreeable mess.

No. XXV

_Take oatmeal, or pounded biscuit, a couple of spoonfuls; water,
a quart; a small handful of raisins; a little allspice, a little
mace, tied up in a fine rag; which boil together in a tin
saucepan till consumed to a pint and a half; then add a gill of
good wine, red or white, and sweeten it with sugar to suit the
palate. You may put a little lemon peel in, to give it an
agreeable flavour._

A little roasted fresh meat will hurt nobody; and broths most certainly are good, particularly if the body is costive; but when the body is inclined to looseness, I have known the best broth to produce a dangerous flux; and this should be taken notice of.

If the patient however who has met with the accident is of a puny weak constitution, or has lost a sufficient quantity of blood by the wounds, bleeding then is not so requisite as in the former case; though the treatment otherwise must be equally the same.

By this method of proceeding, there is little fear but that the patient will soon perfectly recover, even in the highest fever that may suddenly befall a man from an accident; provided the injury is not of a dangerous tendency. But as an acrimonious habit of body is liable on its own accord to diseases, it is easily imagined that an accident may become accessory, and heighten the malignity; hence often a fever of that kind is liable to degenerate into a malignant one, or even from the accident itself, when of a dangerous nature; and this I shall explain as I proceed. I shall therefore leave the accidental fever that proceeds from an external cause, and proceed to those which take their origin internally.

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SECT. III.

_Of a Cold_.

The fever now to be treated of is the most common amongst mankind; especially seamen, who are ever exposed, to have the perspiration obstructed. It however would save many from the grave, and almost as many from being food for the fish, was it a little more regarded than what it actually is.

The sound of a cold is so gentle, that custom has almost made it effeminacy to pay any regard to it; and yet, if we maturely examine, we shall find the most malignant, acute, and mortal diseases, first make their appearances by the symptoms of a cold,——But let us proceed to particulars. A cold is an obstruction of perspiration; which may become destructive to the animal œconomy if neglected, in so much, that it may be considered as the first foundation of most diseases.

In my treatise on diseases of the lungs, I have enumerated the many causes of a cold to which mankind are liable, and their precautions to avoid them. To sea-faring men, I have one principal cause to mention whereby they make themselves subject to colds, and sow the seed of many dangerous diseases in their system, and that is their carelessness in shifting, after getting wet; in this respect, I have however a remedy to offer, which is as valuable and as efficacious to their preservation, as it is easily put in execution. The remedy is simply this:

A man who has been exposed on duty in the rain, and is become thorough wet, should not only shift himself in dry cloaths, but previously wash all over with sea water: if he carefully observes this, he will never get cold on that account. I have not only experienced this personally many times, but ever found it productive of salutary effects to those I have persuaded to it.——If we but make some observations on the accidental occurrences that happen at sea, we shall see the just foundation of this. When do we find a man who is continually washed by the sea to have a cold? while on the contrary a foul rainy day, will almost breed a general sickness.——These observations first brought me on the notion of washing the body with salt water, and having verified it by experiment, I soon saw the propriety of it; namely, that the fresh water being of a sluggish nature, and having a tendency to putrefaction, is not only apt to infuse a putrescency into the system, but from its slimy nature apt to clog up the pores, and thus obstruct perspiration; whilst on the contrary, salt water is not only antiseptic, but stimulates the pores of the skin to their secretory and excretory functions.——Nay so perfectly have I experienced this remedy, that I have persuaded the people to salute one another by way of play with buckets of sea water on a foul rainy day, and with pleasure I have experienced that they have all remained brisk and hearty after it, and evidently seen the difference, that on a similar day the sea water play being omitted, scarce one who has been thorough wet, escaped a cold in some degree or other.——I must not forget, that a draught of grog is likewise no bad preservative. But this is best taken when the watch is out, and that rest and sleep can be indulged upon it, as that will then be apt to throw them into a gentle perspiration; whilst however their watch is upon deck, the best warmth is that which is produced by exercise; except liquors is taken with the greatest moderation.

But when a cold has actually commenced, care should be taken immediately to have it subdued in time. The term cold however is a very vague expression, that includes a great many disorders, occasioned by an obstruction of perspiration, which all in turn shall be taken notice of: But as I am now on the subject of fevers, I shall confine myself to that at present, and consider the cold as it affects the body universally; namely headaches, a weakness in all the limbs; intermittent fevers, intermixed sometimes with flushes of heat, and at other times shivering, chilling, &c.

These are not only the symptoms of a cold, but of almost all inflammatory fevers; which in fact, the cold is a commencement of. Now all that nature requires is a perspiration; for thereby the imprisoned acrimony is expelled, and which nature is always engaged to throw off from the system.—To this intention, if the patient is rich of blood, bleeding should be performed; but with such caution, as I have before recommended. Next give the _fever powder_ (I), together with a good quantity of balm tea, or if the constitution is of a phlegmatic habit, sage tea, or even sage punch ( No. V.) will not be improper; but care should be taken, that if there is much fever, all those things should be omitted, as it is liable to increase the fever. If there is a nausea at the stomach, give a vomit: take the following:

No. XXVI

_Take Ipecacuanha_ (S), _one scruple: sugar a little lump: water
half a Tea cup full, and make it up into a draught._

This vomit should be well worked off with chamomile tea, or even common luke warm water; first letting the vomit operate, and then drinking plenty of the water after every operation. When this is over, the patient should keep his bed or hammock, and take either the _fever powder_ (L), or the before mentioned draught, No. XXIV.

The catarrhal fever, and all the other symptoms of cold, viz. cold in the head, cough, hoarseness, &c. generally keep one another company, leave the patient generally at one time; and in fact, one method of cure, namely, promoting a perspiration, serves for all; for thereby the obstructions become removed, and nature is restored to its primitive tranquillity again.

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SECT. IV.

_Of Intermitting fevers, and Agues_.

There is scarce a disease that makes a patient more wretched, and unhappy, than the fever and ague. The causes of these kind of fevers is principally from a pituitous, or slimy blood, together with its being loaded with acrimony; and a flacidity of the moving fibres.

They are divided into various classes; though in fact all of one nature. When the ague with its succeeding fever comes on regularly every day, it is called _quotidian_, or every day’s ague; when every second day, _tertian_, or third day’s ague, and when every third day; a _quartan_, or fourth day’s ague. There are many other classes as subdivisions of these, but they are the mere speculations of physical pedants, who are ever sworn enemies to plain understanding, and delight in perplexities; which therefore, we shall neither spend paper nor time upon to recount.

Suffice it, let their paroxysms return at what stated period of time they will, either regularly or irregularly, they differ in nothing but this, that the farther the fits are distanced, the severer they generally are, when they come on; and the more regular, the more obstinate in their cure; though in this even there are exceptions.

It is surprizing to imagine, how many different opinions have been sent into the world concerning the returns of the periodical fits of the ague; and equally astonishing, how few with any probability of truth or reason.

I shall not here enter into an enquiry of this nature; certain it is, that at the stated times of these returning fits of the ague, there is an obstruction in some particular part of the system, that corresponds with the dated time of the circulation of fluids in such parts—which when disturbed, effects by the nervous consent, the whole animal structure.

The principal intention in all intermitting fevers, should be to correct the petuity and acrimony of the blood; to remove the obstructions; and to strengthen the solids.

With respect to the blood, it is an inevitable consequence, that when it is loaded with a vicidity and lentor, that it will ever occasion a depraved nutrition; and hence we see, that people labouring under agues, and intermittent fevers of any kind, have a depraved appetite, and many disagreeablenesses in the first passages.

The intermittent fever and ague approach with the following symptoms, viz. a heavy dull head-ach, a shivering chill all over the body, with a yawning, &c. pain in all the limbs attended with weariness, a nausea at the stomach, a depressed pulse; which after it has lasted for half an hour, changes into a burning heat, a throbbing head-ach, pain in the loins, and in every limb, a great draught, a _full hard pulse_, and which at last terminates in a profuse sweat; this seems to give the patient ease, for one, two, or three days; and then attacks the patient with the same symptom, increasing every time, and reduces the patient both in body and spirit.

The first thing to be done is to give a vomit, like No. XV. and XXVI. This is best taken at the approach of the cold fit, and worked well off with plenty of luke warm water. After the operation of the vomit is over, let the patient take the following draught.

No. XXVII

_Take fever powder_ (L), _thirty grains; calomel_ (N), _one
grain; elixir of vitriol_ (G), _sixty, or seventy drops;
essential oil of peppermint_ (U), _four drops upon a little lump
of sugar; to which add water, half a tea cup full._

This draught will not only promote perspiration, but help to dissolve the siziness in the blood; and may therefore be repeated every six hours, for a few days. But the patient should always be kept moderately warm upon it, that it may work by perspiration.—This simple method I have known put the patient to rights again, after a severe onset.

But sometimes this wretched disorder will require more powerful medicines to keep it in subjection. When the fibres are debilitated, and the blood still retains its viscid corruptive quality, the ague is apt to hang on the patient a long time, the succeeding fever apt to melt the patient down to a mere skeleton, and even destroy him. In this it is requisite to brace up the solids, and to infuse an astringency into the blood.

To this intent, the Peruvian bark is now frequently prescribed, and if judiciously administered it is an excellent medicine; but as it is liable however, to be improperly given, and then productive of irreparable mischief, I have purposely omitted it in this catalogue; nevertheless, I shall give in its stead a medicine, superior both in virtue, and by far more safe in the application; not only in this kind of complaint, but in scorbutic cases, as I shall hereafter take notice of. The medicine is this,

No. XXVIII

_Elixir of Iron._

_Take a quantity of rusty iron, the smaller the pieces are, the
better, for the less quantity will do_; pour on it good strong
vinegar, sufficient to cover it; _let them steep till the
vinegar becomes of a deep brown colour, which it soon will, and
at length acquire a consistence of a black elixir. The vessel
should be either stone or glass; but what is yet better is an
iron pot, which of itself will contribute to the medicine._

If the patient therefore, after the vomit, and the above draught, is attacked again with the fit of the ague, and succeeding fever, have immediate recourse to your elixir of iron.——Let him take after the fever is off, every three hours, a table spoonful of the elixir, and should it seem to come up again at first (which it sometimes will, particularly if the stomach is yet foul) give immediately another spoonful, and repeat this at least three times of the day.

A little gentle exercise upon taking the elixir is highly beneficial; and if it throws a gentle warmth over the body, and brings it into a gentle perspiration, you are sure of success.

The quantity of it should be adapted to the condition of the patient, and the strength of the stomach; if it sits easy, a larger quantity may be taken, and seldomer; and if it is more nauseous, a smaller dose and oftener.—Should the fits seem obstinate, the following electuary may be used; and is a powerful specific.

No. XXIX

_Take stomach powder_ (M), _two drachmes; nutmeg powdered, one
drachm; powdered alum_ (17), _half a drachm; essential oil of
peppermint_ (U), _twenty drops; calomel_ (N), _ten grains;
honey_ (E), _one ounce: the whole well mixed._