This disease prevails in the spring and autumn. It is most common in marshy countries, where, after hot and dry summers, it is apt to become epidemic. Persons are most liable to it who are much exposed to the night-air, or who live in places where the air is confined and unwholesome. Hence it often proves fatal in camps, on shipboard, in jails, hospitals, and such like places.

CAUSES.——The dysentery may be occasioned by any thing that obstructs the perforation, or renders the humours putrid; as damp beds, wet clothes, unwholesome diet, air, &c. But it is most frequently communicated by infection. This ought to make people extremely cautious in going near such persons as labour under the disease. Even the smell of the patient’s excrements has been known to communicate the infection.

SYMPTOMS.——It is known by a flux of the belly, attended with violent pain of the bowels, a constant inclination to go to stool, and generally more or less blood in the stools. It begins, like other fevers, with chillness, loss of strength, a quick pulse, great thirst, and an inclination to vomit. The stools are at first greasy and frothy, afterwards they are streaked with blood, and at last have frequently the appearance of pure blood, mixed with small filaments resembling bits of skin. Worms are sometimes passed both upwards and downwards through the whole course of the disease. When the patient goes to stool, he feels a bearing down, as if the whole bowels were falling out, and sometimes a part of the intestine is actually protruded, which proves exceeding troublesome, especially in children. Flatulency is likewise a troublesome symptom, especially towards the end of the disease.

This disease may be distinguished from a diarrhœa or looseness, by the acute pain of the bowels, and the blood which generally appears in the stools. It may be distinguished from the cholera morbus by its not being attended with such violent and frequent fits of vomiting, &c.

When the dysentery attacks the old, the delicate, or such as have been wasted by the gout, the scurvy, or other lingering diseases, it generally proves fatal. Vomiting and hiccuping are bad signs, as they shew an inflammation of the stomach. When the stools are green, black, or have an exceeding disagreeable cadaverous smell, the danger is very great, as it shows the disease to be of the putrid kind. It is an unfavourable symptom when clysters are immediately returned; but still more so, when the passage is so obstinately shut, that they cannot be injected. A feeble pulse, coldness of the extremities, with difficulty of swallowing, and convulsions, are signs of approaching death.

REGIMEN.——Nothing is of more importance in this disease than cleanliness. It contributes greatly to the recovery of the patient, and no less to the safety of such as attend him. In all contagious diseases the danger is increased, and the infection spread, by the neglect of cleanliness, but in no one more than this. Every thing about the patient should be frequently changed. The excrements should never be suffered to continue in his chamber, but removed immediately, and buried under ground. A constant stream of fresh air should be admitted into the chamber; and it ought frequently to be sprinkled with vinegar, juice of lemon, or some other strong acid.

The patient must not be discouraged, but his spirits kept up in hopes of a cure. Nothing tends more to render any putrid disease mortal, than the fears and apprehensions of the sick. All diseases of this nature have a tendency to sink and depress the spirits, and when that is increased by fears and alarms from those whom the patient believes to be persons of skill, it cannot fail to have the worst effects.

A flannel waistcoat worn next the skin has often a very good effect in the dysentery. This promotes the perspiration without overheating the body. Great caution however is necessary in leaving it off. I have often known a dysentery brought on by imprudently throwing off a flannel waistcoat before the season was sufficiently warm. For whatever purpose this piece of dress is worn, it should never be left off but in a warm season.

In this disease the greatest attention must be paid to the patient’s diet. Flesh, fish, and every thing that has a tendency to turn putrid or rancid on the stomach, must be abstained from. Apples boiled in milk, water-pap, and plain light pudding, with broth made of the gelatinous parts of animals, may constitute the principal part of the patient’s food. Gelatinous broth not only answers the purpose of food, but likewise of medicine. I have often known dysenteries, which were not of a putrid nature, cured by it after pompous medicines had proved ineffectual^[126].

Another kind of food very proper in the dysentery, which may be used by such as cannot take the broth mentioned above, is made by boiling a few handfuls of fine flour, tied in a cloth, for six or seven hours, till it becomes as hard as starch. Two or three table-spoonfuls of this may be grated down, and boiled in such a quantity of new milk and water as to be of the thickness of pap. This may be sweetened to the patient’s taste, and taken for his ordinary food^[127].

In a putrid dysentery the patient may be allowed to eat freely of most kinds of good ripe fruit; as apples, grapes, gooseberries, currant-berries, strawberries, &c. These may either be eaten raw or boiled, with or without milk, as the patient chuses. The prejudice against fruit in this disease is so great, that many believe it to be the common cause of dysenteries. This however is an egregious mistake. Both reason and experience shew, that good fruit is one of the best medicines, both for the prevention and cure of the dysentery. Good fruit is in every respect calculated to counteract that tendency to putrefaction, from whence the most dangerous kind of dysentery proceeds. The patient in such a case ought therefore be allowed to eat as much fruit as he pleases, provided it be ripe^[128].

The most proper drink in this disorder is whey. The dysentery has often been cured by the use of clear whey alone. It may be taken both for drink and in form of clyster. When whey cannot be had, barley-water sharpened with cream of tartar may be drank, or a decoction of barley and tamarinds; two ounces of the former and one of the latter may be boiled in two English quarts of water to one. Warm water, water-gruel, or water wherein hot iron has been frequently quenched, are all very proper, and may be drank in turns. Camomile-tea, if the stomach will bear it, is an exceeding proper drink. It both strengthens the stomach, and by its antiseptic quality tends to prevent a mortification of the bowels.

MEDICINE.——At the beginning of this disease it is always necessary to cleanse the first passages. For this purpose a vomit of ipecacuanha must be given, and wrought off with weak camomile-tea. Strong vomits are seldom necessary here. A scruple, or at most half a drachm of ipecacuanha, is generally sufficient for an adult, and sometimes a very few grains will suffice. The day after the vomit, half a drachm, or two scruples of rhubarb, must be taken; or, what will answer the purpose rather better, an ounce or an ounce and a half of Epsom salts. This dose may be repeated every other day for two or three times. Afterwards small doles of ipecacuanha may be taken for some time. Two or three grains of the powder may be mixed in a table-spoonful of the syrup of poppies, and taken three times a day.

These evacuations, and the regimen prescribed above, will often be sufficient to effect a cure. Should it however happen otherwise, the following astringent medicines may be used.

A clyster of starch or fat mutton-broth, with thirty or forty drops of liquid laudanum in it, may be administered twice a-day. At the same time an ounce of gum-arabic, and half an ounce of gum-tragacanth, may be dissolved in an English pint of barley-water, over a slow fire, and a table-spoonful of it taken every hour.

If these have not the desired effect, the patient may take, four times a-day, about the bulk of a nutmeg of the Japonic confection, drinking after it a tea-cupful of the decoction of logwood^[129].

Persons who have been cured of this disease are very liable to suffer a relapse; to prevent which, great circumspection with respect to diet is necessary. The patient must abstain from all fermented liquors, except now and then a glass of good wine; but he must drink no kind of malt-liquor. He should likewise abstain from animal food, as fish and flesh, and live principally on milk and vegetables.

Gentle exercise and wholesome air are likewise of importance. The patient should go to the country as soon as his strength will permit, and should take exercise daily on horseback, or in a carriage. He may likewise use bitters infused in wine or brandy, and may drink twice a-day a gill of lime-water mixed with an equal quantity of new milk.

When dysenteries prevail, we would recommend a strict attention to cleanliness, a spare use of animal food, and the free use of sound ripe fruits, and other vegetables. The night air is to be carefully avoided, and all communication with the sick. Bad smells are likewise to be shunned, especially those which arise from putrid animal substances. The necessaries where the sick go are carefully to be avoided.

When the first symptoms of the dysentery appear, the patient ought immediately to take a vomit, to go to bed, and drink plentifully of weak warm liquor, to promote a sweat. This, with a dose or two of rhubarb at the beginning, would often carry off the disease. In countries where dysenteries prevail, we would advise such as are liable to them, to take either a vomit or a purge every spring or autumn, as a preventive.

There are sundry other fluxes of the belly, as the LIENTERY and CŒLIAC PASSION, which, though less dangerous than the dysentery, yet merit consideration. These diseases generally proceed from a relaxed state of the stomach and intestines, which is sometimes so great, that the food passes through them without almost any sensible alterations; and the patient dies merely from the want of nourishment.

When the lientery or cœliac passion succeeds to a dysentery, the case is bad. They are always dangerous in old age, especially when the constitution has been broken by excess or acute diseases. If the stools be very frequent, and quite crude, the thirst great, with little urine, the mouth ulcerated, and the face marked with spots of different colours, the danger is very great.

The treatment of the patient is in general the same as in the dysentery. In all obstinate fluxes of the belly, the cure must be attempted, by first cleansing the stomach and bowels with gentle vomits and purges; afterwards such a diet as has a tendency to heal and strengthen the bowels, with opiates and astringent medicines, will generally perfect the cure.

The same observation holds with respect to a TENESMUS, or frequent desire of going to stool. This disease resembles the dysentery so much, both in its symptoms and method of cure, that we think it needless to insist upon it.

CHAP. XXXIV.
OF THE HEAD-ACH.

Aches and pains proceed from very different causes, and may affect any part of the body; but we shall point out those only which occur most frequently, and are attended with the greatest danger.

When the head-ach is slight, and affects a particular part of the head only, it is called cephalalgia; when the whole head is affected, cephalæa; and when on one side only, hemicrania. A fixed pain in the forehead, which may be covered with the end of the thumb, is called the clavis hystericus.

There are also other distinctions. Sometimes the pain is internal, sometimes external; sometimes it is an original disease, and at other times only symptomatic. When the head-ach proceeds from a hot bilious habit, the pain is very acute and throbbing, with a considerable heat of the part affected. When from a cold phlegmatic habit, the patient complains of a dull heavy pain, and has a sense of coldness in the part. This kind of head-ach is sometimes attended with a degree of stupidity or folly.

Whatever obstructs the free circulation of the blood through the vessels of the head, may occasion a head-ach. In persons of a full habit, who abound with blood, or other humours, the head-ach often proceeds from the suppression of customary evacuations; as bleeding at the nose, sweating of the feet, &c. It may likewise proceed from any cause that determines a great flux of blood towards the head; as coldness of the extremities, or hanging down the head for a long time. Whatever prevents the return of the blood from the head will likewise occasion a head-ach; as looking long obliquely at any object, wearing any thing tight about the neck, or the like.

When a head-ach proceeds from the stoppage of a running at the nose, there is a heavy, obtuse, pressing pain in the fore-part of the head, in which there seems to be such a weight, that the patient can scarce hold it up. When it is occasioned by the caustic matter of the venereal disease, it generally affects the skull, and often produces a caries of the bones.

Sometimes the head-ach proceeds from the repulsion or retrocession of the gout, the erysipelas, the small-pox, measles, itch, or other eruptive diseases. What is called a hemicrania generally proceeds from crudities or indigestion. Inanition, or emptiness, will often also occasion head-achs. I have often seen instances of this in nurses who gave suck too long, or who did not take a sufficient quantity of solid food.

There is likewise a most violent, fixed, constant, and almost intolerable head-ach, which occasions great debility both of body and mind, prevents sleep, destroys the appetite, causes a vertigo, dimness of sight, a noise in the ears, convulsions, epileptic fits, and sometimes vomiting, costiveness, coldness of the extremities, &c.

The head-ach is often symptomatic in continual and intermitting fevers, especially quartans. It is likewise a very common symptom in hysteric and hypochondriac complaints.

When a head-ach attends an acute fever, with pale urine, it is an unfavourable symptom. In excessive head-achs, coldness of the extremities is a bad sign.

When the disease continues long, and is very violent, it often terminates in blindness, an apoplexy, deafness, a vertigo, the palsy, epilepsy, &c.

In this disease the cool regimen in general is to be observed. The diet ought to consist of such emollient substances as will correct the acrimony of the humours, and keep the body open; as apples boiled in milk, spinage, turnips, and such like. The drink ought to be diluting; as barley-water, infusions of mild mucilaginous vegetables, decoctions of the sudorific woods, &c. The feet and legs ought to be kept warm, and frequently bathed in lukewarm water; the head should be shaved, and bathed with water and vinegar. The patient ought as much as possible to keep in an erect posture, and not to lie with his head too low.

When the head-ach is owing to excess of blood, or an hot bilious constitution, bleeding is necessary. The patient may be bled in the jugular vein, and the operation repeated if there be occasion. Cupping also, or the application of leeches to the temples, and behind the ears, will be of service. Afterwards a blistering-plaster may be applied to the neck behind the ears, or to any part of the head that is most affected. In some cases it will be proper to blister the whole head. In persons of a gross habit, issues or perpetual blisters will be of service. The body ought likewise to be kept open by gentle laxatives.

But when the head-ach proceeds from a copious vitiated serum stagnating in the membranes, either within or without the skull, with a dull, heavy, continual pain, which will neither yield to bleeding nor gentle laxatives, then more powerful purgatives are necessary, as pills made of aloes, resin of jalap, or the like. It will also be necessary in this case to blister the whole head, and to keep the back part of the neck open for a considerable time by a perpetual blister.

When the head-ach is occasioned by the stoppage of a running at the nose, the patient should frequently smell to a bottle of volatile salts; he may likewise take snuff, or any thing that will irritate the nose, so as to promote a discharge from it; as the herb mastich, ground-ivy, &c.

A hemicrania, especially a periodical one, is generally owing to a foulness of the stomach, for which gentle vomits must be administered, as also purges of rhubarb. After the bowels have been sufficiently cleared, chalybeate waters, and such bitters as strengthen the stomach, will be necessary. A periodical head-ach has been cured by wearing a piece of flannel over the forehead during the night.

When the head-ach arises from a vitiated state of the humours, as in the scurvy and venereal disease, the patient, after proper evacuations, must drink freely of the decoction of woods, or the decoction of sarsaparilla, with raisins and liquorice^[130]. These promote perspiration, sweeten the humours, and, if duly persisted in, will produce very happy effects. When a collection of matter is felt under the skin, it must be discharged by an incision, otherwise it will render the bone carious.

When the head-ach is so intolerable as to endanger the patient’s life, or is attended with continual watching, delirium, &c. recourse must be had to opiates. These, after proper evacuations by clysters or mild purgatives, may be applied both externally and internally. The affected part may be rubbed with Bate’s anodyne balsam, or a cloth dipped in it may be applied to the part. The patient may, at the same time, take twenty drops of laudanum, in a cup of valerian or penny-royal tea, twice or thrice a day. This is only to be done in case of extreme pain. Proper evacuations ought always to accompany and follow the use of opiates^[131].

When the patient cannot bear the loss of blood, his feet ought frequently to be bathed in lukewarm water, and well rubbed with a coarse cloth. Cataplasms with mustard or horse-radish ought likewise to be applied to them. This course is peculiarly necessary when the pain proceeds from a gouty humour affecting the head.

When the head-ach is occasioned by great heat, hard labour, or violent exercise of any kind, it may be allayed by cooling medicines; as the saline draughts with nitre, and the like.

A little of Ward’s essence, dropt into the palm of the hand, and applied to the forehead, will sometimes remove a violent head-ach; and so will æther, when applied in the same manner.

OF THE TOOTH-ACH.

This disease is so well known, that it needs no description. It has great affinity with the rheumatism, and often succeeds pains of the shoulders and other parts of the body.

It may proceed from obstructed perspiration, or any of the other causes of inflammation. I have often known the tooth-ach occasioned by neglecting some part of the usual coverings of the head, by sitting with the head bare near an open window, or exposing it any how to a draught of cold air. Food or drink taken either too hot or too cold is very hurtful to the teeth. Great quantities of sugar, or other sweetmeats, are likewise hurtful. Nothing is more destructive to the teeth than cracking nuts, or chewing any kind of hard substances. Picking the teeth with pins, needles, or any thing that may hurt the enamel with which they are covered, does great mischief, as the tooth is sure to be spoiled whenever the air gets into it. Breeding women are very subject to the tooth-ach, especially during the first three or four months of pregnancy. The tooth-ach often proceeds from scorbutic humours affecting the gums. In this case the teeth are sometimes wasted, and fall out without any considerable degree of pain. The more immediate cause of the tooth-ach is a rotten or carious tooth.

After all, when a tooth is carious, it is often impossible to remove the pain without extracting it; and, as a spoilt tooth never becomes sound again, it is prudent to draw it soon, lest it should affect the rest. Tooth-drawing, like bleeding, is very much practiced by mechanics, as well as persons of the medical profession. The operation however is not without danger, and ought always to be performed with care. A person unacquainted with the structure of the parts will be in danger of hurting the jaw-bone, or of drawing a sound tooth instead of a rotten one^[132].

When the tooth-ach returns periodically, and the pain chiefly affects the gums, it may be cured by the bark.

Some pretend to have found great benefit in the tooth-ach, from the application of an artificial magnet to the affected tooth. We shall not attempt to account for its mode of operation; but, if it be found to answer, though only in particular cases, it certainly deserves a trial, as it is attended with no expence, and cannot do any harm. Electricity has likewise been recommended, and particular instruments have been invented for sending a shock through the affected tooth.

Persons who have returns of the tooth-ach at certain seasons, as spring and autumn, might often prevent it by taking a purge at these times.

Keeping the teeth clean has no doubt a tendency to prevent the tooth-ach. The best method of doing this is to wash them daily with salt and water, a decoction of the bark, or with cold water alone. All brushing and scraping of the teeth is dangerous, and, unless it be performed with great care, does mischief.

OF THE EAR-ACH.

This disorder chiefly affects the membrane which lines the inner cavity of the ear called the meatus auditorius. It is often so violent as to occasion great restlessness, anxiety, and even delirium. Sometimes epileptic fits, and other convulsive disorders, have been brought on by extreme pain in the ear.

The ear-ach may proceed from any of the causes which produce inflammation. It often proceeds from a sudden suppression of perspiration, or from the head being exposed to cold when covered with sweat. It may also be occasioned by worms, or other insects getting into the ear, or being bred there; or from any hard body sticking in the ear. Sometimes it proceeds from the translation of morbific matter to the ear. This often happens in the decline of malignant fevers, and occasions deafness, which is generally reckoned a favourable symptom.

When the ear-ach proceeds from insects, or any hard body sticking in the ear, every method must be taken to remove them as soon as possible. The membranes may be relaxed by dropping into the ear oil of sweet almonds, or olive oil. Afterwards the patient should be made to sneeze, by taking snuff, or some strong sternutatory. If this should not force out the body, it must be extracted by art. I have seen insects, which had got into the ear, come out of their own accord upon pouring in oil, which is a thing they cannot bear.

When the pain of the ear proceeds from inflammation, it must be treated like other topical inflammations, by a cooling regimen, and opening medicines. Bleeding at the beginning, either in the arm or jugular vein, or cupping in the neck, will be proper. The ear may likewise be fomented with steams of warm water; or flannel bags filled with boiled mallows and camomile flowers may be applied to it warm; or bladders filled with warm milk and water. An exceeding good method of fomenting the ear is to apply it close to the mouth of a jug filled with warm water, or a strong decoction of camomile flowers.

The patient’s feet should be frequently bathed in lukewarm water, and he ought to take small doses of nitre and rhubarb, viz. a scruple of the former, and ten grains of the latter, three times a-day. His drink may be whey, or decoction of barley and liquorice with figs or raisins. The parts behind the ear ought frequently to be rubbed with camphorated oil, or a little of the volatile liniment.

When the inflammation cannot be discussed, a poultice of bread and milk, or roasted onions, may be applied to the ear, and frequently renewed, till the abscess breaks, or can be opened. Afterwards the humours may be diverted from the part by gentle laxatives, blisters, or issues; but the discharge must not be suddenly dried up by any external application.

PAIN OF THE STOMACH, &c.

This may proceed from various causes; as indigestion; wind; the acrimony of the bile; sharp, acrid, or poisonous substances taken into the stomach, &c. It may likewise be occasioned by worms; the stoppage of customary evacuations; a translation of gouty matter to the stomach, the bowels, &c.

Women in the decline of life are very liable to pains of the stomach and bowels, especially such as are afflicted with hysteric complaints. It is likewise very common to hypochondriac men of a sedentary and luxurious life. In such persons it often proves so extremely obstinate as to baffle all the powers of medicine.

When the pain of the stomach is most violent after eating, there is reason to suspect that it proceeds from some fault either in the digestion or the food. In this case the patient ought to change his diet, till he finds what kind of food agrees best with his stomach, and should continue chiefly to use it. If a change of diet does not remove the complaint, the patient may take a gentle vomit, and afterwards a dose or two of rhubarb. He ought likewise to take an infusion of camomile flowers, or some other stomachic bitter, either in wine or water. I have often known exercise remove this complaint, especially sailing, or a long journey on horseback, or in a carriage.

When a pain of the stomach proceeds from flatulency, the patient is constantly belching up wind, and feels an uneasy distention of the stomach after meals. This is a most deplorable disease, and is seldom thoroughly cured. In general, the patient ought to avoid all windy diet, and every thing that sours on the stomach, as greens, roots, &c. This rule however admits of some exceptions. There are many instances of persons very much troubled with wind, who have received great benefit from eating parched pease, though that grain is generally supposed to be of a windy nature^[133].

This complaint may likewise be greatly relieved by labour, especially digging, reaping, mowing, or any kind of active employment by which the bowels are alternately compressed and dilated. The most obstinate case of this kind I ever met with was in a person of a sedentary occupation, whom I advised, after he had tried every kind of medicine in vain, to turn gardener; which he did, and has ever since enjoyed good health.

When a pain of the stomach is occasioned by the swallowing of acrid or poisonous substances, they must be discharged by vomit; this may be excited by butter, oils, or other soft things, which sheath and defend the stomach from the acrimony of its contents.

When pain of the stomach proceeds from a translation of gouty matter, warm cordials are necessary, as generous wines, French brandy, &c. Some have drank a whole bottle of brandy or rum, in this case, in a few hours, without being in the least intoxicated, or even feeling the stomach warmed by it. It is impossible to ascertain the quantities necessary upon these occasions. This must be left to the feelings and discretion of the patient. The safer way however is, not to go too far. When there is an inclination to vomit, it may be promoted by drinking an infusion of camomile flowers, or carduus benedictus.

If a pain of the stomach proceed from the stoppage of customary evacuations, bleeding will be necessary, especially in sanguine and very full habits. It will likewise be of use to keep the body gently open by mild purgatives; as rhubarb or senna, &c. When this disease affects women, in the decline of life, after the stoppage of the menses, making an issue in the leg or arm will be of peculiar service.

When the disease is occasioned by worms, they must be destroyed, or expelled by such means as are recommended in the following section.

When the stomach is greatly relaxed and the digestion bad, which often occasion flatulencies, the elixir of vitriol will be of singular service. Fifteen or twenty drops of it may be taken in a glass of wine or water twice or thrice a-day.

Persons afflicted with flatulency are generally unhappy unless they be taking some purgative medicines; these, though they may give immediate ease, tend to weaken and relax the stomach and bowels, and consequently increase the disorder. Their best method is to mix purgatives and stomachics together. Equal parts of Peruvian bark and rhubarb may be infused in brandy or wine, and taken in such quantity as to keep the body gently open.

These are chiefly of three kinds, viz. the tænia, or tape-worm; the teres, or round and long worm; and the ascarides, or round and short worm. There are many other kinds of worms found in the human body; but as they proceed, in a great measure, from similar causes, have nearly the same symptoms, and require almost the same method of treatment as these already mentioned, we shall not spend time in enumerating them.

The tape-worm is white, very long, and full of joints. It is generally bred either in the stomach or small intestines. The round and long worm is likewise bred in the small guts, and sometimes in the stomach. The round and short worms commonly lodge in the rectum, or what is called the end gut, and occasion a disagreeable itching about the seat.

The long round worms occasion squeamishness, vomiting, a disagreeable breath, gripes, looseness, swelling of the belly, swoonings, loathing of food, and at other times a voracious appetite, a dry cough, convulsions, epileptic fits, and sometimes a privation of speech. These worms have been known to perforate the intestines, and get into the cavity of the belly. The effects of the tape-worm are nearly the same with those of the long and round, but rather more violent.

Andry says, the following symptoms particularly attend the solium, which is a species of the tape-worm, viz. swoonings, privation of speech, and a voracious appetite. The round worms called ascarides, besides an itching of the anus, cause swoonings, and tenesmus, or an inclination to go to stool.

CAUSES.——Worms may proceed from various causes; but they are seldom found except in weak and relaxed stomachs, where the digestion is bad. Sedentary persons are more liable to them than the active and laborious. Those who eat great quantities of unripe fruit, or who live much on raw herbs and roots, are generally subject to worms. There seems to be a hereditary disposition in some persons to this disease. I have often seen all the children of a family subject to worms of a particular kind. They seem likewise frequently to be owing to the nurse. Children of the same family, nursed by one woman, have often worms, when those nursed by another have none.

SYMPTOMS.——The common symptoms of worms are, paleness of the countenance, and at other times, an universal flushing of the face; itching of the nose; this however is doubtful, as children pick their noses in all diseases; starting, and grinding of the teeth in sleep; swelling of the upper lip; the appetite sometimes bad, at other times quite voracious; looseness; a sour or stinking breath; a hard swelled belly; great thirst; the urine frothy, and sometimes of a whitish colour; griping, or colic pains; an involuntary discharge of saliva, especially when asleep; frequent pains of the side, with a dry cough, and unequal pulse; palpitations of the heart; swoonings; drowsiness; cold sweats; palsy; epileptic fits, with many other unaccountable nervous symptoms, which were formerly attributed to witchcraft, or the influence of evil spirits. Small bodies in the excrements resembling melon or cucumber seeds are symptoms of the tape-worm.

I lately saw some very surprising effect of worms in a girl about five years of age, who used to lie for whole hours as if dead. She at last expired, and, upon opening her body, a number of the teres, or long round worms, were found in her guts, which were considerably inflamed; and what anatomists call an intus susceptio, or involving of one part of the gut within another, had taken place in no less than four different parts of the intestinal canal^[134].

MEDICINE.——Though numberless medicines are extolled for expelling and killing worms^[135], yet no disease more frequently baffles the physician’s skill. In general, the most proper medicines for their expulsion are strong purgatives; and to prevent their breeding, stomachic bitters, with now and then a glass of good wine.

The best purge for an adult is jalap and calomel. Five and twenty or thirty grains of the former with six or seven of the latter, mixed in syrup, may be taken early in the morning, for a dose. It will be proper that the patient keep the house all day, and drink nothing cold. The dose may be repeated once or twice a week, for a fortnight or three weeks. On the intermediate days the patient may take a drachm of the powder of tin, twice or thrice a-day, mixed with syrup, honey, or treacle.

Those who do not chuse to take calomel may make use of the bitter purgatives; as aloes, hiera picra, tincture of senna, and rhubarb, &c.

Oily medicines are sometimes found beneficial for expelling worms. An ounce of sallad oil and a table-spoonful of common salt may be taken in a glass of red port wine thrice a-day, or oftner, if the stomach will bear it. But the more common form of using oil is in clysters. Oily clysters, sweetened with sugar or honey, are very efficacious in bringing away the short round worms called ascarides, and likewise the teres.

The Harrowgate water is an excellent medicine for expelling worms, especially the ascarides. As this water is impregnated with sulphur, we may hence infer, that sulphur alone must be a good medicine in this case; which is found to be a fact. Many practitioners give flour of sulphur in very large doses, and with great success. It should be made into an electuary with honey or treacle, and taken in such quantity as to purge the patient.

Where Harrowgate water cannot be obtained, sea-water may be used, which is far from being a contemptible medicine in this case. If sea-water cannot be had, common salt dissolved in water may be drank. I have often seen this used by country nurses with very good effect. Some flour of sulphur may be taken over night, and the salt-water in the morning.

But worms, though expelled, will soon breed again, if the stomach remains weak and relaxed; to prevent which, we would recommend the Peruvian bark. Half a drachm of bark in powder may be taken in a glass of red port wine three or four times a-day, after the above medicines have been used. Lime-water is likewise good for this purpose, or a table-spoonful of the chalybeate wine taken twice or thrice a-day. Infusions or decoctions of bitter herbs may likewise be drank; as the infusion of tansy, water-trefoil, camomile flowers, tops of wormwood, the lesser centaury, &c.

For a child of four or five years old, six grains of rhubarb, five of jalap, and two of calomel, may be mixed in a spoonful of syrup or honey, and given in the morning. The child should keep the house all day, and take nothing cold. This dose may be repeated twice a-week for three or four weeks. On the intermediate days the child may take a scruple of powdered tin and ten grains of æthiops mineral in a spoonful of treacle twice a-day. This dose must be increased or diminished according to the age of the patient.

Bisset says, the great bastard black hellebore, or bear’s foot, is a most powerful vermifuge for the long round worms. He orders the decoction of about a drachm of the green leaves, or about fifteen grains of the dried leaves in powder for a dose to a child between four and seven years of age. This dose is to be repeated two or three times. He adds, that the green leaves made into a syrup with coarse sugar, is almost the only medicine he has used for round worms for three years past. Before pressing out the juice, he moistens the bruised leaves with vinegar, which corrects the medicine. The dose is a tea-spoonful at bed-time, and one or two next morning.

I have frequently known those big bellies, which in children are commonly reckoned a sign of worms, quite removed by giving them white soap in their pottage, or other food. Tansy, garlic, and rue, are all good against worms, and may be used various ways. We might here mention many other plants, both for external and internal use, as the cabbage-bark, &c. but think the powder of tin with æthiops mineral, and the purges of rhubarb and calomel, are more to be depended on.

Ball’s purging vermifuge powder is a very powerful medicine. It is made of equal parts of rhubarb, seammony, and calomel, with as much double refined sugar as is equal to the weight of all the other ingredients. These must be well mixed together, and reduced to a fine powder. The dose for a child is from ten grains to twenty, once or twice a-week. An adult may take a drachm for a dose^[136].

Parents who would preserve their children from worms ought to allow them plenty of exercise in the open air; to take care that their food be wholesome and sufficiently solid; and, as far as possible, to prevent their eating raw herbs, roots, or green trashy fruits. It will not be amiss to allow a child who is subject to worms, a glass of red wine after meals; as every thing that braces and strengthens the stomach is good both for preventing and expelling these vermin^[137].

CHAP. XXXVI.
OF THE JAUNDICE.

This disease is first observable in the white of the eye, which appears yellow. Afterwards the whole skin puts on a yellow appearance. The urine too is of a saffron hue, and dies a white cloth of the same colour. There is likewise a species of this disease called the Black Jaundice.

CAUSES.——The immediate cause of the jaundice is an obstruction of the bile. The remote or occasional causes are, the bites of poisonous animals, as the viper, mad dog, &c. the bilious or hysteric colic; violent passions, as grief, anger, &c. Strong purges or vomits will likewise occasion the jaundice. Sometimes it proceeds from obstinate agues, or from that disease being prematurely stopped by astringent medicines. In infants it is often occasioned by the meconium not being sufficiently purged off. Pregnant women are very subject to it. It is likewise a symptom in several kinds of fever. Catching cold, or the stoppage of customary evacuations, as the menses, the bleeding piles, issues, &c. will occasion the jaundice.

SYMPTOMS.——The patient at first complains of excessive weariness, and has great aversion to every kind of motion. His skin is dry, and he generally feels a kind of itching or pricking pain over the whole body. The stools are of a whitish or clay colour, and the urine, as was observed above, is yellow. The breathing is difficult, and the patient complains of an unusual load or oppression on his breast. There is a heat in the nostrils, a bitter taste in the mouth, loathing of food, sickness at the stomach, vomiting, flatulency, and other symptoms of indigestion.

If the patient be young, and the disease complicated with no other malady, it is seldom dangerous; but in old people, where it continues long, returns frequently, or is complicated with the dropsy or hypochondriac symptoms, it generally proves fatal. The black jaundice is more dangerous than the yellow.

REGIMEN.——The diet should be cool, light, and diluting, consisting chiefly of ripe fruits and mild vegetables; as apples boiled or roasted, stewed prunes, preserved plums, boiled spinage, &c. Veal or chicken-broth, with light bread, are likewise very proper. Many have been cured by living almost wholly for some days on raw eggs. The drink should be butter-milk, whey sweetened with honey, or decoctions of cool opening vegetables; or marsh-mallow roots, with liquorice, &c.

The patient should take as much exercise as he can bear, either on horseback, or in a carriage; walking, running, and even jumping, are likewise proper, provided he can bear them without pain, and there be no symptoms of inflammation. Patients have been often cured of this disease by a long journey, after medicines had proved ineffectual.

Amusements are likewise of great use in the jaundice. The disease is often occasioned by a sedentary life, joined to a dull melancholy disposition. Whatever therefore tends to promote the circulation, and to cheer the spirits, must have a good effect; as dancing, laughing, singing, &c.

MEDICINE.——If the patient be young, of a full sanguine habit, and complains of pain in the right side about the region of the liver, bleeding will be necessary. After this a vomit must be administered, and if the disease proves obstinate, it may be repeated once or twice. No medicines are more beneficial in the jaundice than vomits, especially where it is not attended with inflammation. Half a drachm of ipecacuanha in powder will be a sufficient dose for an adult. It may be wrought off with weak camomile-tea, or lukewarm water. The body must likewise be kept open by taking a sufficient quantity of Castile soap, or the pills for the jaundice recommended in the Appendix.

Fomenting the parts about the region of the stomach and liver, and rubbing them with a warm hand or flesh-brush, are likewise beneficial; but it is still more so for the patient to sit in a bath of warm water up to the breast. He ought to do this frequently, and should continue in it as long as his strength will permit.

Many dirty things are recommended for the cure of the jaundice; as lice, millepedes, &c. But these do more harm than good, as people trust to them, and neglect more valuable medicines; besides, they are seldom taken in sufficient quantity to produce any effects. People always expect that such things should act as charms, and consequently seldom persist in the use of them. Vomits, purges, fomentations, and exercise, will seldom fail to cure the jaundice when it is a simple disease; and when complicated with the dropsy, a scirrhous liver, or other chronic complaints, it is hardly to be cured by any means.

Numberless British herbs are extolled for the cure of this disease. The author of the Medicina Britannica mentions near a hundred, all famous for curing the jaundice. The fact is, the disease often goes off of its own accord; in which case the last medicine is always said to have performed the cure. I have sometimes however seen considerable benefit, in a very obstinate jaundice, from a decoction of hempseed. Four ounces of the seed may be boiled in two English quarts of ale, and sweetened with coarse sugar. The dose is half an English pint every morning. It may be continued for eight or nine days.

I have likewise known Harrowgate sulphur-water cure a jaundice of very long standing. It should be used for some weeks, and the patient must both drink and bathe.

The soluble tartar is a very proper medicine in the jaundice. A drachm of it may be taken every night and morning in a cup of tea or water-gruel. If it does not open the body, the dose may be increased.

Persons subject to the jaundice ought to take as much exercise as possible, and to avoid all heating and astringent aliments.

CHAP. XXXVII.
OF THE DROPSY.

The dropsy is a preternatural swelling of the whole body, or some part of it, occasioned by a collection of watery humour. It is distinguished by different names, according to the part affected, as the anasarca, or a collection of water under the skin; the ascites, or a collection of water in the belly; the hydrops pectoris, or dropsy of the breast; the hydrocephalus, or dropsy of the brain, &c.

CAUSES.——The dropsy is often owing to an hereditary disposition. It may likewise proceed from drinking ardent spirits, or other strong liquors. It is true almost to a proverb, that great drinkers die of a dropsy. The want of exercise is also a very common cause of the dropsy. Hence it is justly reckoned among the diseases of the sedentary. It often proceeds from excessive evacuations, as frequent and copious bleedings, strong purges often repeated, frequent salivations, &c. The sudden stoppage of customary or necessary evacuations, as the menses, the hæmorrhoids, fluxes of the belly, &c. may likewise cause a dropsy.

I have known the dropsy occasioned by drinking large quantities of cold, weak, watery liquor, when the body was heated by violent exercise. A low, damp, or marshy situation is likewise a frequent cause of it. Hence it is a common disease in moist, flat, fenny countries. It may also be brought on by a long use of poor watery diet, or of viscous aliment that is hard of digestion. It is often the effect of other diseases, as the jaundice, a scirrhus of the liver, a violent ague of long continuance, a diarrhœa, a dysentery, an empyema, or a consumption of the lungs. In short, whatever obstructs the perspiration, or prevents the blood from being duly prepared, may occasion a dropsy.

SYMPTOMS.——The anasarca generally begins with a swelling of the feet and ancles towards night, which for some time disappears in the morning. In the evening the parts, if pressed with the finger, will pit. The swelling gradually ascends, and occupies the trunk of the body, the arms, and the head. Afterwards the breathing becomes difficult, the urine is in small quantity, and the thirst great; the body is bound, and the perspiration is greatly obstructed. To these succeed torpor, heaviness, a slow wasting fever, and a troublesome cough. This last is generally a fatal symptom, as it shews that the lungs are affected.

In an ascites, besides the above symptoms, there is a swelling of the belly, and often a fluctuation, which may be perceived by striking the belly on one side, and laying the palm of the hand on the opposite. This may be distinguished from a tympany by the weight of the swelling, as well as by the fluctuation. When the anasarca and ascites are combined, the case is very dangerous. Even a simple ascites seldom admits of a radical cure. Almost all that can be done is, to let off the water by tapping, which seldom affords more than a temporary relief.

When the disease comes suddenly on, and the patient is young and strong, there is reason however to hope for a cure, especially if medicine be given early. But if the patient be old, has led an irregular or a sedentary life, or if there be reason to suspect that the liver, lungs, or any of the viscera are unsound, there is great reason to fear that the consequences will prove fatal.

REGIMEN.——The patient must abstain, as much as possible, from all drink, especially weak and watery liquors, and must quench his thirst with mustard-whey, or acids, as juice of lemons, oranges, sorrel, or such like. His aliment ought to be dry, of a stimulating and diuretic quality, as toasted bread, the flesh of birds, or other wild animals roasted; pungent and aromatic vegetables, as garlic, mustard, onions, cresses, horse-radish, rocambole, shalot, &c. He may also eat sea-biscuit dipt in wine or a little brandy. This is not only nourishing, but tends to quench thirst. Some have been actually cured of a dropsy by a total abstinence from all liquids, and living entirely upon such things as are mentioned above. If the patient must have drink, the Spa-water, or Rhenish wine, with diuretic medicines infused in it, are the best.

Exercise is of the greatest importance in a dropsy. If the patient be able to walk, dig, or the like, he ought to continue these exercises as long as he can. If he is not able to walk or labour, he must ride on horseback, or in a carriage, and the more violent the motion so much the better, provided he can bear it. His bed ought to be hard, and the air of his apartments warm and dry. If he lives in a damp country, he ought to be removed into a dry one, and, if possible, into a warmer climate. In a word, every method should be taken to promote the perspiration, and to brace the solids. For this purpose it will likewise be proper to rub the patient’s body, two or three times a day, with a hard cloth, or the flesh-brush; and he ought constantly to wear flannel next his skin.

MEDICINE.——If the patient be young, his constitution good, and the disease has come on suddenly, it may generally be removed by strong vomits, brisk purges, and such medicines as promote a discharge by sweat and urine. For an adult, half a drachm of ipecacuanha in powder, and half an ounce of oxymel of squills, will be a proper vomit. This may be repeated as often as is found necessary, three or four days intervening between the doses. The patient must not drink much after taking the vomit, otherwise he destroys its effect. A cup or two of camomile-tea will be sufficient to work it off.

Between each vomit, on one of the intermediate days, the patient may take the following purge: Jalap in powder half a drachm, cream of tartar, two drachms, calomel six grains. These may be made into a bolus with a little syrup of pale roses, and taken early in the morning. The less the patient drinks after it the better. If he be much griped, he may now and then take a cup of chicken-broth.

The patient may likewise take every night at bed-time the following bolus: To four or five grains of camphor add one grain of opium, and as much syrup of orange-peel as is sufficient to make them into a bolus. This will generally promote a gentle sweat, which should be encouraged by drinking now and then a small cup of wine-whey, with a tea-spoonful of the spirits of hartshorn in it. A tea-cupful of the following diuretic infusion may likewise be taken every four or five hours through the day:

Take juniper-berries, mustard-seed, and horse-radish, of each half an ounce, ashes of broom half a pound; infuse them in a quart of Rhenish wine or strong ale for a few days, and afterwards strain off the liquor. Such as cannot take this infusion, may use the decoction of seneka-root, which is both diuretic and sudorific. I have known an obstinate anasarca cured by an infusion of the ashes of broom in wine.

The above course will often cure an incidental dropsy, if the constitution be good; but when the disease proceeds from a bad habit, or an unsound state of the viscera, strong purges and vomits are not to be ventured upon. In this case, the safer course is to palliate the symptoms by the use of such medicines as promote the secretions, and to support the patient’s strength by warm and nourishing cordials.

The secretion of urine may be greatly promoted by nitre. Brookes says, he knew a young woman who was cured of a dropsy by taking a drachm of nitre every morning in a draught of ale, after she had been given over as incurable. The powder of squills is likewise a good diuretic. Six or eight grains of it, with a scruple of nitre, may be given twice a-day in a glass of strong cinnamon-water. Ball says, a large spoonful of unbruised mustard-seed taken every night and morning, and drinking half an English pint of the decoction of the tops of green broom after it, has performed a cure after other powerful medicines had proved ineffectual.

I have sometimes seen good effects from cream of tartar in this disease. It promotes the discharges by stool and urine, and will at least palliate, if it does not perform a cure. The patient may begin by taking an ounce every second or third day, and may increase the quantity to two or even to three ounces, if the stomach will bear it. This quantity is not however to be taken at once, but divided into three or four doses.

To promote perspiration, the patient may use the decoction of seneka-root, as directed above; or he may take two table-spoonfuls of Mindererus’s spirit in a cup of wine-whey three or four times a-day. To promote a discharge of urine, the following infusion of the London hospitals will likewise be beneficial:

Take of zedoary-root two drachms; dried squills, rhubarb, and juniper-berries bruised, of each a drachm; cinnamon in powder, three drachms; salt of wormwood, a drachm and a half; infuse in an English pint and a half of old hock-wine, and when fit for use, filter the liquor. A wine-glass of it may be taken three or four times a-day.

In the anasarca it is usual to scarify the feet and legs. By this means the water is often discharged; but the operator must be cautious not to make the incisions too deep; they ought barely to pierce through the skin, and especial care must be taken, by spirituous fomentations and proper digestives, to prevent a gangrene.

In an ascites, when the disease does not evidently and speedily give way to purgative and diuretic medicines, the water ought to be let off by tapping. This is a very simple and safe operation, and would often succeed, if it were performed in due time; but if it be delayed till the humours are vitiated, or the bowels spoiled, by long soaking in water, it can hardly be expected that any permanent relief will be procured^[138].

After the evacuation of the water, the patient is to be put on a course of strengthening medicines; as the Peruvian bark; the elixir of vitriol; warm aromatics, with a due proportion of rhubarb, infused in wine, and such like. His diet ought to be dry and nourishing, such as is recommended in the beginning of the Chapter; and he should take as much exercise as he can bear without fatigue. He should wear flannel next his skin, and make daily use of the flesh-brush.

CHAP. XXXVIII.
OF THE GOUT.

There is no disease which shews the imperfection of medicine, or sets the advantages of temperance and exercise in a stronger light, than the gout. Excess and idleness are the true sources from whence it originally sprung, and all who would avoid it must be active and temperate.

Though idleness and intemperance are the principal causes of the gout, yet many other things may contribute to bring on the disorder in those who are not, and to induce a paroxysm in those who are subject to it; as intense study; too free an use of acidulated liquors; night-watching; grief or uneasiness of mind; an obstruction or defect of any of the customary discharges, as the menses, sweating of the feet, perspiration, &c.

SYMPTOMS.——A fit of the gout is generally preceded by indigestion, drowsiness, belching of wind, a slight head-ach, sickness, and sometimes vomiting. The patient complains of weariness and dejection of spirits, and has often a pain in the limbs, with a sensation as if wind or cold water were passing down the thigh. The appetite is often remarkably keen a day or two before the fit, and there is a slight pain in passing urine, and sometimes an involuntary shedding of tears. Sometimes these symptoms are much more violent, especially upon the near approach of the fit; and some observe, that as is the fever which ushers in the gout, so will the fit be; if the fever be short and sharp, the fit will be so likewise; if it be feeble, long, and lingering, the fit will be such also. But this observation can only hold with respect to very regular fits of the gout.

The regular gout generally makes its attack in the spring, or beginning of winter, in the following manner: About two or three in the morning, the patient is seized with a pain in his great toe, sometimes in the heel, and at other times in the ancle or calf of the leg. This pain is accompanied with a sensation as if cold water were poured upon the part, which is succeeded by a shivering, with some degree of fever. Afterwards the pain increases, and fixing among the small bones of the foot, the patient feels all the different kinds of torture, as if the part were stretched, burnt, squeezed, gnawed, or torn in pieces, &c. The part at length becomes so exquisitely sensible, that the patient cannot bear to have it touched, or even suffer any person to walk across the room.

The patient is generally in exquisite torture for twenty-four hours, from the time of the coming on of the fit: he then becomes easier, the part begins to swell, appears red, and is covered with a little moisture. Towards morning he drops asleep, and generally falls into a gentle breathing sweat. This terminates the first paroxysm, a number of which constitutes a fit of the gout; which is longer or shorter according to the patient’s age, strength, the season of the year, and the disposition of the body to this disease.

The patient is always worse towards night, and easier in the morning. The paroxysms however generally grow milder every day, till at length the disease is carried off by perspiration, urine, and the other evacuations. In some patients this happens in a few days; in others, it requires weeks, and in some, months, to finish the fit. Those whom age and frequent fits of the gout have greatly debilitated, seldom get free from it before the approach of summer, and sometimes not till it be pretty far advanced.

REGIMEN.——As there are no medicines yet known that will cure the gout, we shall confine our observations chiefly to regimen, both in and out of the fit.

In the fit, if the patient be young and strong, his diet ought to be thin and cooling, and his drink of a diluting nature; but where the constitution is weak, and the patient has been accustomed to live high, this is not a proper time to retrench. In this case he must keep nearly to his usual diet, and should take frequently a cup of strong negus, or a glass of generous wine. Wine-whey is a very proper drink in this case, as it promotes the perspiration without greatly heating the patient. It will answer this purpose better if a tea-spoonful of sal volatile oleosum, or spirits of hartshorn, be put into a cup of it twice a-day. It will likewise be proper to give at bed-time a tea-spoonful of the volatile tincture of guaiacum in a large draught of warm wine-whey. This will greatly promote perspiration through the night.

As the most safe and efficacious method of discharging the gouty matter is by perspiration, this ought to be kept up by all means, especially in the affected part. For this purpose the leg and foot should be wrapt in soft flannel, fur, or wool. The last is most readily obtained, and seems to answer the purpose better than any thing else. The people of Lancashire look upon wool as a kind of specific in the gout. They wrap a great quantity of it about the leg and foot affected, and cover it with a skin of soft dressed leather. This they suffer to continue for eight or ten days, and sometimes for a fortnight or three weeks, or longer, if the pain does not cease. I never knew any external application answer so well in the gout. I have often seen it applied when the swelling and inflammation were very great, with violent pain, and have found all these symptoms relieved by it in a few days. The wool which they use is generally greased, and carded or combed. They chuse the softest which can be had, and seldom or never remove it till the fit be entirely gone off.

The patient ought likewise to be kept quiet and easy during the fit. Every thing that affects the mind disturbs the paroxysm, and tends to throw the gout upon the nobler parts. All external applications that repel the matter are to be avoided as death. They do not cure the disease, but remove it from a safer to a more dangerous part of the body, where it often proves fatal. A fit of the gout is to be considered as Nature’s method of removing something that might prove destructive to the body, and all that we can do, with safety, is to promote her intentions, and to assist her in expelling the enemy in her own way. Evacuations by bleeding, stool, &c. are likewise to be used with caution; they do not remove the cause of the disease, and sometimes by weakening the patient prolong the fit: but where the constitution is able to bear it, it will be of use to keep the body gently open by diet, or very mild laxative medicines.

Many things will indeed shorten a fit of the gout, and some will drive it off altogether: but nothing has yet been found which will do this with safety to the patient. In pain we eagerly grasp at any thing that promises immediate ease, and even hazard life itself for a temporary relief. This is the true reason why so many infallible remedies have been proposed for the gout, and why such numbers have lost their lives by the use of them. It would be as prudent to stop the small-pox from rising, and to drive them into the blood, as to attempt to repel the gouty matter after it has been thrown upon the extremities. The latter is as much an effort of Nature to free herself from an offending cause as the former, and ought equally to be promoted.

When the pain however is very great, and the patient is restless, thirty or forty drops of laudanum, more or less, according to the violence of the symptoms, may be taken at bed-time. This will ease the pain, procure rest, promote perspiration, and forward the crisis of the disease.

After the fit is over, the patient ought to take a gentle dose or two of the bitter tincture of rhubarb, or some other warm stomachic purge. He should also drink a weak infusion of stomachic bitters in small wine or ale, as the Peruvian bark, with cinnamon, Virginian snake-root, and orange-peel. The diet at this time should be light, but nourishing, and gentle exercise ought to be taken on horseback, or in a carriage.

Out of the fit, it is in the patient’s power to do many things towards preventing a return of the disorder, or rendering the fit, if it should return, less severe. This however is not to be attempted by medicine. I have frequently known the gout kept off for several years by the Peruvian bark and other astringent medicines; but in all the cases where I had occasion to see this tried, the persons died suddenly, and, to all appearance, for want of a regular fit of the gout. One would be apt, from hence, to conclude, that a fit of the gout, to some constitutions, in the decline of life, is rather salutary than hurtful.

Though it may be dangerous to stop a fit of the gout by medicine, yet if the constitution can be so changed by diet and exercise, as to lessen or totally prevent its return, there certainly can be no danger in following such a course. It is well known that the whole habit may be so altered by a proper regimen, as quite to eradicate this disease; and those only who have sufficient resolution to persist in such a course have reason to expect a cure.

The course which we would recommend for preventing the gout, is as follows: In the first place, universal temperance. In the next place sufficient exercise^[139]. By this we do not mean sauntering about in an indolent manner, but labour, sweat, and toil. These only can render the humours wholesome, and keep them so. Going early to bed, and rising betimes, are also of great importance. It is likewise proper to avoid night studies, and all intense thought. The supper should be light, and taken early. All strong liquors, especially generous wines and sour punch, are to be avoided.

We would likewise recommend some doses of magnesia alba and rhubarb to be taken every spring and autumn; and afterwards a course of stomachic bitters, as tansey or water-trefoil tea, an infusion of gentian and camomile flowers, or a decoction of burdock root, &c. Any of these, or an infusion of any wholesome bitter that is more agreeable to the patient, may be drank for two or three weeks in March and October twice a-day. An issue or perpetual blister has a great tendency to prevent the gout. If these were more generally used in the decline of life, they would not only often prevent the gout, but also other chronic maladies. Such as can afford to go to Bath, will find great benefit from bathing and drinking the water. It both promotes digestion, and invigorates the habit.

Though there is little room for medicine during a regular fit of the gout, yet when it leaves the extremities, and falls on some of the internal parts, proper applications to recal and fix it become absolutely necessary. When the gout affects the head, the pain of the joints ceases, and the swelling disappears, while either severe head-ach, drowsiness, trembling, giddiness, convulsions, or delirium come on. When it seizes the lungs, great oppression, with cough and difficulty of breathing, ensue. If it attacks the stomach, extreme sickness, vomiting, anxiety, pain in the epigastric region, and total loss of strength, will succeed.