It happens very fortunately for those who cannot be brought to take mercury inwardly, and likewise for persons whose bowels are too tender to bear it, that an external application of it will answer equally well, and in some respects better. It must be acknowledged, that mercury, taken inwardly for any length of time, greatly weakens and disorders the bowels; for which reason, when a plentiful use of it becomes necessary, we would prefer rubbing to the mercurial pills. The common mercurial or blue ointment will answer very well. Of that which is made by rubbing together equal quantities of hog’s lard and quicksilver, about a drachm may be used at a time. The best time for rubbing it on is at night, and the most proper place the inner side of the thighs. The patient should stand before the fire when he rubs, and should wear flannel drawers next his skin at the time he is using the ointment. If ointment of a weaker or stronger kind be used, the quantity must be increased or diminished in proportion.
If, during the use of the ointment, the inflammation of the genital parts, together with the heat and feverishness, should return, or if the mouth should grow sore, the gums tender, and the breath become offensive, a dose or two of Glauber’s salts, or some other cooling purge, may be taken, and the rubbing intermitted for a few days. As soon, however, as the signs of spitting are gone off, if the virulency be not quite corrected, the ointment must be repeated, but in smaller quantities, and at longer intervals than before. Whatever way mercury is administered, its use must be persisted in as long as any virulency is suspected to remain.
During this, which may be called the second stage of the disorder, though so strict a regimen is not necessary as in the first or inflammatory state, yet intemperance of every kind must be avoided. The food must be light, plain, and of easy digestion; and the greatest indulgence that may be allowed with respect to drink is, a little wine diluted with a sufficient quantity of water. Spirituous liquors are to be avoided in every shape. I have often known the inflammatory symptoms renewed and heightened, the running increased, and the cure rendered extremely difficult and tedious, by one fit of excessive drinking.
When the above treatment has removed the heat of urine, and soreness of the genital parts; when the quantity of running is considerably lessened, without any pain or swelling in the groin or testicle supervening; when the patient is free from involuntary erections; and lastly, when the running becomes pale, whitish, thick, void of ill smell, and tenacious or ropy; when all or most of these symptoms appear, the gonorrhœa is arrived at its last stage, and we may gradually proceed to treat it as a gleet with astringent and agglutinating medicines.
A gonorrhœa frequently repeated, or improperly treated, often ends in a gleet, which may either proceed from relaxation, or from some remains of the disease. It is however of the greatest importance in the cure of the gleet, to know from which of these causes it proceeds. When the discharge proves very obstinate, and receives little or no check from astringent remedies, there is ground to suspect that it is owing to the latter; but if the drain is inconstant, and is chiefly observable when the patient is stimulated by lascivious ideas, or upon straining to go to stool, we may reasonably conclude that it is chiefly owing to the former.
In the cure of a gleet proceeding from relaxation, the principal design is to brace, and restore a proper degree of tension to the debilitated and relaxed vessels. For this purpose, besides the medicines recommended in the gonorrhœa, the patient may have recourse to stronger and more powerful astringents, as the Peruvian bark[167], alum, vitriol, galls, tormentil, bistort, baldustines, tincture of gum kino, &c. The injections may be rendered more astringent by the addition of a few grains of alum, or increasing the quantity of vitriol as far as the parts are able to bear it.
The last remedy which we shall mention in this case is the cold bath, than which there is not perhaps a more powerful bracer in the whole compass of medicine. It ought never to be omitted in this species of gleet, unless there be something in the constitution of the patient which renders the use of it unsafe. The chief objections to the use of the cold bath are, a full habit, and an unsound state of the viscera. The danger from the former may always be lessened, if not removed, by purging and bleeding; but the latter is an insurmountable obstacle, as the pressure of the water, and the sudden contraction of the external vessels, by throwing the blood with too much force upon the internal parts, are apt to occasion ruptures of the vessels, or a flux of humours upon the diseased organs. But where no objection of this kind prevails, the patient ought to plunge over head in water every morning fasting, for three or four weeks together. He should not however stay long in the water, and should take care to have his skin dried as soon as he comes out.
The regimen proper in this case is the same as was mentioned in the last stage of the gonorrhœa: the diet must be drying and astringent, and the drink Spa, Pyrmont, or Bristol waters, with which a little claret or red wine may sometimes be mixed. Any person may now afford to drink these waters, as they can be every where prepared at almost no expence, by a mixture of common chalk and oil of vitriol.
When the gleet does not in the smallest degree yield to these medicines, there is reason to suspect that it proceeds from ulcers. In this case recourse must be had to mercury, and such medicines as tend to correct any predominant acrimony with which the juices may be affected, as the decoction of China, sarsaparilla, sassafras, or the like.
Mr. Fordyce says, he has seen many obstinate gleets of two, three, or four years standing, effectually cured by a mercurial inunction, when almost every other medicine has been tried in vain. Dr. Chapman seems to be of the same opinion; but says, he has always found the mercury succeed best in this case when joined with terebinthinate and other agglutinating medicines. For which reason the Doctor recommends pills made of calomel and Venice turpentine[168]; and desires that their use may be accompanied with a decoction of guaiacum or sarsaparilla.
The last kind of remedy which we shall mention for the cure of ulcers in the urinary passage, are the suppurating candles or bougies: as these are prepared various ways, and are generally to be bought ready made, it is needless to spend time in enumerating the different ingredients of which they are composed, or teaching the manner of preparing them. Before a bougie be introduced into the urethra, however, it should be smeared all over with sweet oil, to prevent it from stimulating too suddenly; it may be suffered to continue in from one to seven or eight hours, according as the patient can bear it. Obstinate ulcers are not only often healed, but tumours and excrescences in the urinary passages taken away, and an obstruction of urine removed by means of bougies. Obstinate gleets may be removed by the use of bougies.
The swelled testicle may either proceed from infection lately contracted, or from the venereal poison lurking in the blood: the latter indeed is not very common, but the former frequently happens both in the first and second stages of a gonorrhœa; particularly when the running is unseasonably checked, by cold, hard drinking, strong drastic purges, violent exercise, the too early use of astringent medicines, or the like.
In the inflammatory stage bleeding is necessary, which must be repeated according to the urgency of the symptoms[169]. The food must be light, and the drink diluting. High-seasoned food, flesh, wines, and every thing of a heating nature, are to be avoided. Fomentations are of singular service. Poultices of bread and milk, softened with fresh butter or oil, are likewise very proper, and ought constantly to be applied when the patient is in bed: when he is up, the testicles should be kept warm, and supported by a bag or truss, which may easily be contrived in such a manner as to prevent the weight of the testicle from having any effect.
If it should be found impracticable to clear the testicle by the cooling regimen now pointed out, and extended according to circumstances, it will be necessary to lead the patient through such a complete antivenereal course as shall ensure him against any future uneasiness. For this purpose, besides rubbing the mercurial ointment on the part, if free from pain, or on the thighs, as directed in the gonorrhœa, the patient must be confined to bed, if necessary, for five or six weeks, suspending the testicle all the while with a bag or truss, and plying him inwardly with strong decoctions of sarsaparilla.
When these means do not succeed, and there is reason to suspect a scrophulous or cancerous habit, either of which may support a scirrhous induration, after the venereal poison is corrected, the parts should be fomented daily with a decoction of hemlock, the bruised leaves of which may likewise be added to the poultice, and the extract at the same time taken inwardly[170]. This practice is strongly recommended by Dr. Stork in scirrhous and cancerous cases; and Mr. Fordyce assures us, that by this method he has cured diseased testicles of two or three years standing, even when ulcerated, and when the scirrhus had begun to be affected with pricking and lancing pains.
Venereal buboes are hard tumours seated in the groin, occasioned by the venereal poison lodged in this part. They are of two kinds; viz. such as proceed from a recent infection, and such as accompany a confirmed lues.
The cure of recent buboes, that is, such as appear soon after impure coition, may be first attempted by dispersion, and, if that should not succeed, by suppuration. To promote the dispersion of a bubo, the same regimen must be observed as was directed in the first stage of a gonorrhœa. The patient must likewise be bled, and take some cooling purges, as the decoction of tamarinds and senna, Glauber’s salts, and the like. If, by this course, the swelling and other inflammatory symptoms abate, we may safely proceed to the use of mercury, which must be continued till the venereal virus is quite subdued[171].
But if the bubo should, from the beginning, be attended with great heat, pain, and pulsation, it will be proper to promote its suppuration. For this purpose the patient may be allowed to use his ordinary diet, and to take now and then a glass of wine. Emollient cataplasms, consisting of bread and milk softened with oil or fresh butter, may be applied to the part; and, in cold constitutions, where the tumour advances slowly, white lily-roots boiled, or sliced onions raw, and a sufficient quantity of yellow basilicon, may be added to the poultice.
When the tumour is ripe, which may be known by its conical figure, the softness of the skin, and a fluctuation of matter plainly to be felt under the finger, it may be opened either by a caustic or a lancet, and afterwards dressed with digestive ointment.
It sometimes however happens, that buboes can neither be dispersed nor brought to a suppuration, but remain hard, indolent tumours. In this case the indurated glands must be consumed by caustic; if they should become scirrhous, they must be dissolved by the application of hemlock, both externally and internally, as directed in the scirrhous testicle.
Chancres are superficial, callous, eating ulcers; which may happen either with or without a gonorrhœa. They are commonly seated about the glans, and make their appearance in the following manner: First a little red pimple arises, which soon becomes pointed at top, and is filled with a whitish matter inclining to yellow. This pimple is hot, and itches generally before it breaks: afterwards it degenerates into an obstinate ulcer, the bottom of which is usually covered with a viscid mucus, and whose edges gradually become hard and callous. Sometimes the first appearance resembles a simple excoriation of the cuticle; which however, if the cause be venereal, soon becomes a true chancre.
A chancre is sometimes a primary affection, but it is much oftner symptomatic, and is the mark of a confirmed lues. Primary chancres discover themselves soon after impure coition, and are generally seated in parts covered with a thin cuticle, as the lips, the nipples of women, the glans penis of men, &c.[172].
When a chancre appears soon after impure coition, its treatment is nearly similar to that of the virulent gonorrhœa. The patient must observe the cooling regimen, lose a little blood, and take some gentle doses of salts and manna. The parts affected ought frequently to be bathed, or rather soaked, in warm milk and water, and, if the inflammation be great, an emollient poultice or cataplasm may be applied to them. This course will, in most cases, be sufficient to abate the inflammation, and prepare the patient for the use of mercury.
Symptomatic chancres are commonly accompanied with ulcers in the throat, nocturnal pains, scurfy eruptions about the roots of the hair, and other symptoms of a confirmed lues. Though they may be seated in any of the parts mentioned above, they commonly appear upon the private parts, or the inside of the thigh. They are also less painful, but frequently much larger and harder than primary chancres. As their cure must depend upon that of the pox, of which they are only a symptom, we shall take no further notice of them, till we come to treat of a confirmed lues[173].
Thus we have related most of the symptoms which accompany or succeed a violent gonorrhœa, and have also given a short view of their proper treatment; there are, however, several others which sometimes attend this disease, as a strangury or obstruction of urine, phymosis, paraphymosis, &c.
A strangury may be occasioned either by a spasmodic constriction, or an inflammation of the urethra and parts about the neck of the bladder. In the former case, the patient begins to void his urine with tolerable ease; but, as soon as it touches the galled or inflamed urethra, a sudden constriction takes place, and the urine is voided by spurts, and sometimes by drops only. When the strangury is owing to an inflammation about the neck of the bladder, there is a constant heat and uneasiness of the part, a perpetual desire to make water, while the patient can only render a few drops, and a troublesome tenesmus, or constant inclination to go to stool.
When the strangury is owing to spasm, such medicines as tend to dilute and blunt the salts of the urine will be proper. For this purpose, besides the common diluting liquors, soft and cooling emulsions, sweetened with the syrup of poppies, may be used. Should these not have the desired effect, bleeding, and emollient fomentations, will be necessary.
When the complaint is evidently owing to an inflammation about the neck of the bladder, bleeding must be more liberally performed, and repeated according to the urgency of the symptoms. After bleeding, if the strangury still continues, soft clysters, with a proper quantity of laudanum in them, may be administered, and emollient fomentations applied to the region of the bladder. At the same time, the patient may take every four hours a tea-cupful of barley-water, to an English pint of which six ounces of the syrup of marsh-mallows, four ounces of the oil of sweet almonds, and half an ounce of nitre, may be added. If these remedies should not relieve the complaint, and a total suppression of urine should come on, bleeding must be repeated, and the patient set in a warm bath up to the middle. It will be proper in this case to discontinue the diuretics, and to draw off the water with a catheter; but as the patient is seldom able to bear its being introduced, we would rather recommend the use of mild bougies. These often lubricate the passage, and greatly facilitate the discharge of urine. Whenever they begin to stimulate or give any uneasiness, they may be withdrawn.
The phymosis is such a constriction of the prepuce over the glans, as hinders it from being drawn backwards; the paraphymosis, on the contrary, is such a constriction of the prepuce behind the glans, as hinders it from being brought forward.
The treatment of these symptoms is so nearly the same with that of the virulent gonorrhœa, that we have no occasion to enlarge upon it. In general, bleeding, purging, poultices, and emollient fomentations are sufficient. Should these, however, fail of removing the stricture, and the parts be threatened with a mortification, twenty or thirty grains of ipecacuanha, and one grain of emetic tartar, may be given for a vomit, and may be worked off with warm water or thin gruel.
It sometimes happens, that, in spite of all endeavours to the contrary, the inflammation goes on, and symptoms of a beginning mortification appear. When this is the case, the prepuce must be scarified with a lancet, and, if necessary, divided, in order to prevent a strangulation, and set the imprisoned glans at liberty. We shall not describe the manner of performing this operation, as it ought always to be done by a surgeon. When a mortification has actually taken place, it will be necessary, besides performing the above operations, to foment the parts frequently with cloths wrung out of a strong decoction of camomile-flowers and bark, and to give the patient a drachm of the bark in powder every two or three hours.
With regard to the priapism, chordee, and other distortions of the penis, their treatment is no way different from that of the gonorrhœa. When they prove very troublesome, the patient may take a few drops of laudanum at night, especially after the operation of a purgative through the day.
We have hitherto treated of those affections in which the venereal poison is supposed to be confined chiefly to the particular part by which it was received, and shall next take a view of the lues in its confirmed state; that is, when the poison is actually received into the blood, and, circulating with it through every part of the body, mixes with the several secretions, and renders the whole habit tainted.
The symptoms of a confirmed lues are, buboes in the groin, pains of the head and joints, which are peculiarly troublesome in the night, or when the patient is warm in bed; scabs and scurfs in various parts of the body, especially on the head, of a yellowish colour, resembling a honey-comb; corroding ulcers in various parts of the body, which generally begin about the throat, from whence they creep gradually, by the palate, towards the cartilage of the nose, which they destroy; excrescences or exostoses arise in the middle of the bones, and their spongy ends become brittle, and break upon the least accident; at other times they are soft, and bend like wax; the conglobate glands become hard and callous, and form, in the neck, armpits, groin, and mesentery, hard moveable tumours, like the king’s evil; tumours of different kinds are likewise formed in the lymphatic vessels, tendons, ligaments, and nerves, as the gummata, ganglia, nodes, tophs, &c.; the eyes are affected with itching, pain, redness, and sometimes with total blindness, and the ears with a singing noise, pain, and deafness, whilst their internal substance is exulcerated and rendered carious; at length all the animal, vital, and natural functions are depraved; the face becomes pale and livid; the body emaciated and unfit for motion, and the miserable patient falls into an atrophy or wasting consumption.
Women have symptoms peculiar to the sex; as cancers of the breast; a suppression or overflowing of the menses; the whites; hysteric affections; an inflammation, abscess, scirrhus, gangrene, cancer, or ulcer of the womb; they are generally either barren or subject to abortion; or, if they bring children into the world, they have an universal erysipelas, are half rotten, and covered with ulcers.
Such is the catalogue of symptoms attending this dreadful disease in its confirmed state. Indeed they are seldom all to be met with in the same person, or at the same time; so many of them, however, are generally present as are sufficient to alarm the patient; and if he has reason to suspect the infection is lurking in his body, he ought immediately to set about the expulsion of it, otherwise the most tragical consequences will ensue.
The only certain remedy hitherto known in Europe, for the cure of this disease, is mercury, which may be used in a great variety of forms, with nearly the same success. Some time ago it was reckoned impossible to cure a confirmed lues without a salivation. This method is now however pretty generally laid aside, and mercury is found to be as efficacious, or rather more so, in expelling the venereal poison, when administered in such a manner as not to run off by the salivary glands.
Though many are of opinion, that the mercurial ointment is as efficacious as any other preparation of that mineral; yet experience has taught me to think otherwise. I have often seen the most obstinate venereal cases, where great quantities of mercurial ointment had been used in vain, yield to the saline preparations of mercury. Nor am I singular in this opinion. My ingenious friend, Mr. Clare, an eminent surgeon of this city, assures me, that for some time past he has employed, in venereal cases, a saline preparation of mercury with most happy success. This preparation, rubbed with a sufficient quantity of any mild powder, he applies, in small portions, to the tongue, where, with a gentle degree of friction, it is immediately absorbed, and produces its full effect; upon the system, without doing the least injury to the stomach or bowels; a matter of the greatest importance in the application of this most active and powerful remedy.
It is impossible to ascertain either the exact quantity of medicines that must be taken, or the time they ought to be continued, in order to perform a cure. These will ever vary according to the constitution of the patient, the season of the year, the degree of infection, the time it has lodged in the body, &c. But though it is difficult, as Astruc observes, to determine à priori, what quantity of mercury will, in the whole, be necessary to cure this distemper completely; yet it may be judged of à posteriori, from the abatement and ceasing of the symptoms. The same author adds, that commonly not less than two ounces of the strong mercurial ointment is sufficient, and not more than three or four ounces necessary.
The only chemical preparation of mercury which we shall take notice of, is the corrosive sublimate. This was some time ago brought into use for the venereal disease, in Germany, by the illustrious Baron Van Swieten; and was soon after introduced into Britain by the learned Sir John Pringle, at that time physician to the army. The method of giving it is as follows: One grain of corrosive sublimate is dissolved in two ounces of French brandy or malt spirits; and of this solution, an ordinary table-spoonful, or the quantity of half an ounce, is to be taken twice a-day, and to be continued as long as any symptoms of the disorder remain. To those whose stomach cannot bear the solution, the sublimate may be given in form of pill[174].
Several roots, woods, and barks, have been recommended for curing the venereal disease; but none of them have been found, upon experience, to answer the high encomiums which had been bestowed upon them. Though no one of these is to be depended upon alone, yet, when joined with mercury, some of them are found to be very beneficial in promoting a cure. One of the best we know yet is sarsaparilla, which may be prepared and taken according to the directions in the Appendix[175].
The mezereon root is likewise found to be a powerful assistant to the sublimate, or any other mercurial. It may either be used along with the sarsaparilla, as directed in the Appendix, or by itself. Those who chuse to use the mezereon by itself, may boil an ounce of the fresh bark, taken from the root, in twelve English pints of water to eight, adding towards the end an ounce of liquorice. The dose of this is the same as of the decoction of sarsaparilla.
We have been told that the natives of America cure the venereal disease, in every stage, by a decoction of the root of a plant called the Lobelia. It is used either fresh or dried; but we have no certain accounts with regard to the proportion. Sometimes they mix other roots with it, as those of the ranunculus, the ceanothus, &c.; but whether these are designed to disguise or assist it, is doubtful. The patient takes a large draught of the decoction early in the morning, and continues to use it for his ordinary drink through the day[176].
Many other roots and woods might be mentioned which have been extolled for curing the venereal disease, as the china-root, the roots of soap-wort, burdock, &c. as also the wood of guaiacum and sassafras; but as none of these have been found to possess virtues superior to those already mentioned, we shall, for the sake of brevity, pass them over, and shall conclude our observations on this disease with a few general remarks concerning the proper management of the patient, and the nature of the infection.
The condition of the patient ought always to be considered previous to his entering upon a course of mercury in any form. It would be equally rash and dangerous to administer mercury to a person labouring under any violent acute disease, as a putrid fever, pleurisy, peripneumony, or the like. It would likewise be dangerous in some chronic cases; as a slow hectic fever, or the last stage of a consumption. Sometimes, however, these diseases proceed from a confirmed lues; in which case it will be necessary to give mercury. In chronic diseases of a less dangerous nature, as the asthma, the gravel, and such like, mercury, if necessary, may be safely administered. If the patient’s strength has been greatly exhausted by sickness, labour, abstinence, or any other cause, the use of mercury must be postponed, till by time, rest, and a nourishing diet, it can be sufficiently restored.
Mercury ought not to be administered to women during the menstrual flux, or when the period is near at hand. Neither should it be given in the last stage of pregnancy. If, however, the woman be not near the time of her delivery, and circumstances render it necessary, mercury may be given, but in smaller doses, and at greater intervals than usual: with these precautions, both the mother and child may be cured at the same time; if not, the disorder will at least be kept from growing worse, till the woman be brought to bed, and sufficiently recovered, when a more effectual method may be pursued, which, if she suckles her child, will in all probability be sufficient for the cure of both.
Mercury ought always to be administered to infants with the greatest caution. Their tender condition unfits them for supporting a salivation, and makes it necessary to administer even the mildest preparations of mercury to them with a sparing hand. A similar conduct is recommended in the treatment of old persons, who have the misfortune to labour under a confirmed lues. No doubt the infirmities of age must render people less able to undergo the fatigues of a salivation; but this, as was formerly observed, is never necessary; besides, we have generally found, that mercury had much less effect upon very old persons than on those who were younger.
Hysteric and hypochondriac persons, and such as are subject to an habitual diarrhœa or dysentery, or to frequent and violent attacks of the epilepsy, or who are afflicted with the scrophula, or the scurvy, ought to be cautious in the use of mercury. Where any one of these disorders prevails, it ought either, if possible, to be cured, or at least palliated, before the patient enters upon a course of mercury. When this cannot be done, the mercury must be administered in smaller doses, and at longer intervals than usual.
The most proper seasons for entering upon a course of mercury, are the spring and autumn, when the air is of a moderate warmth. If the circumstances of the case, however, will not admit of delay, we must not defer the cure on account of the season, but must administer the mercury; taking care at the same time to keep the patient’s chamber warmer or cooler, according as the season of the year requires.
The next thing to be considered is the preparation necessary to be observed before we proceed to administer a course of mercury. Some lay great stress upon this circumstance, observing, that by previously relaxing the vessels, and correcting any disorder which may happen to prevail in the blood, not only the mercury will be disposed to act more kindly, but many other inconveniencies will be prevented.
We have already recommended bleeding and gentle purges, previous to the administration of mercury, and shall only now add, that these are always to be repeated according to the age, strength, constitution, and other circumstances of the patient. Afterwards, if it can be conveniently done, the patient ought to bathe once or twice a-day, for a few days, in lukewarm water. His diet in the mean time must be light, moist, and cooling. Wine, and all heating liquors, also violent bodily exercise, and all great exertions of the mind, are carefully to be avoided.
A proper regimen is likewise to be observed by such as are under a course of mercury. Inattention to this not only endangers the patient’s life but often also disappoints him of a cure. A much smaller quantity of mercury will be sufficient for the cure of a person who lives low, keeps warm, and avoids all manner of excess, than of one who cannot endure to put the smallest restraint upon his appetites: indeed it but rarely happens that such are thoroughly cured.
There is hardly any thing of more importance, either for preventing or removing venereal infection than cleanliness. By an early attention to this, the infection might often be prevented from entering the body; and, where it has already taken place, its effects may be greatly mitigated. The moment any person has reason to suspect that he has received the infection, he ought to wash the parts with water and spirits, sweet oil, or milk and water; a small quantity of the last may likewise be injected up the urethra, if it can be conveniently done. Whether this disease at first took its rise from dirtiness is hard to say; but wherever that prevails, the infection is found in its greatest degree of virulence, which gives ground to believe that a strict attention to cleanliness would go far towards extirpating it altogether[177].
When the venereal disease has been neglected, or improperly treated, it often becomes a disorder of the habit. In this case the cure must be attempted by restoratives, as a milk diet, the decoction of sarsaparilla, and such like, to which mercury may be occasionally added. It is a common practice in North Britain to send such patients to drink goat-whey. This is a very proper plan, provided the infection has been totally eradicated before-hand; but when that is not the case, and the patient trusts to the whey for finishing his cure, he will often be disappointed. I have frequently known the disease return with all its virulence after a course of goat-whey, even when that course had been thought quite sufficient for completing the cure.
One of the most unfortunate circumstances attending patients in this disease, is the necessity they are often laid under of being soon well. This induces them to take medicine too fast, and to leave it off too soon. A few grains more of medicine, or a few days longer confinement, would often be sufficient to perfect the cure; whereas, by neglect of these, a small degree of virulence is still left in the humours, which gradually vitiates, and at length contaminates the whole mass. To avoid this, we would advise, that the patient should never leave off taking medicine immediately upon the disappearing of the symptoms, but continue it for some time after, gradually lessening the quantity, till there is sufficient ground to believe that the disease is entirely eradicated.
It is not only difficult, but absolutely impossible, to ascertain the exact degree of virulence that may attend the disease; for which reason it will always be a much safer rule to continue the use of medicine too long, than to leave it off too soon. This seems to be the leading maxim of a modern practitioner of some note for the venereal disease, who always orders his patient to perform a quarantine of at least forty days, during which time he takes forty bottles of, I suppose, a strong decoction of sarsaparilla, or some other antivenereal simple. Whoever takes this method, and adds a sufficient quantity of corrosive sublimate, or some other active preparation of mercury to the decoction, will seldom fail to cure a confirmed lues.
It is peculiarly unfortunate for the cure of this disease, that not one in ten of those who contract it, are either able or willing to submit to a proper plan of regimen. The patient is willing to take medicine; but he must follow his business, and, to prevent suspicions, must eat and drink like the rest of the family. This is the true source of nine-tenths of all the mischief arising from the venereal disease. I never knew the cure attended with any great difficulty or danger where the patient strictly followed the physician’s advice: but a volume would not be sufficient to point out the dreadful consequences which proceed from an opposite conduct. Scirrhous testicles, ulcerous sore throats, madness, consumptions, carious bones, and a rotten progeny, are a few of the blessings derived from this source.
There is a species of false reasoning, with regard to this disease, which proves fatal to many. A person of a sound constitution contracts a slight degree of the disorder. He gets well without taking any great care, or using much medicine, and hence concludes that this will always be the case. The next time the disease occurs, though, ten times more virulent, he pursues the same course, and his constitution is ruined. Indeed, the different degrees of virulence in the small-pox are not greater than in this disease, though, as the learned Sydenham observes, in some cases the most skilful physicians cannot cure, and in others the most ignorant old woman cannot kill the patient in that disorder. Though a good constitution is always in favour of the patient, yet too great stress may be laid upon it. It does not appear from observation, that the most robust constitution is able to overcome the virulence of the venereal contagion, after it has got into the habit. In this case a proper course of medicine is always indispensably necessary.
Although it is impossible, on account of the different degrees of virulence, &c. to lay down fixed and certain rules for the cure of this disease, yet the following general plan will always be found safe, and often successful, viz. to bleed and administer gentle purges with diuretics during the inflammatory state, and as soon as the symptoms of inflammation are abated, to administer mercury, in any form that may be most agreeable to the patient. The same medicine, assisted by the decoction of sarsaparilla, and a proper regimen, will not only secure the constitution against the further progress of a confirmed pox, but will generally perform a complete cure.
Women, in all civilized nations, have the management of domestic affairs, and it is very proper they should, as Nature has made them less fit for the more active and laborious employments. This indulgence, however, is generally carried too far; and females, instead of being benefited by it, are greatly injured, from the want of exercise and free air. To be satisfied of this, one need only compare the fresh and ruddy looks of a milk-maid, with the pale complexion of those females whose whole time is spent within doors. Though Nature has made an evident distinction between the male and female with regard to bodily strength and vigour, yet she certainly never meant, either that the one should be always without, or the other always within doors.
The confinement of females, besides hurting their figure and complexion, relaxes their solids, weakens their minds, and disorders all the functions of the body. Hence proceed obstructions, indigestion, flatulence, abortions, and the whole train of nervous disorders. These not only unfit women for being mothers and nurses, but often render them whimsical and ridiculous. A sound mind depends so much upon a healthy body, that where the latter is wanting the former is rarely to be found.
I have always observed, that women who were chiefly employed without doors, in the different branches of husbandry, gardening, and the like, were almost as hardy as their husbands, and that their children were likewise strong and healthy. But as the bad effects of confinement and inactivity upon both sexes have been already shewn, we shall proceed to point out those circumstances in the structure and design of females, which subject them to peculiar diseases; the chief of which are, their monthly evacuations, pregnancy, and child-bearing. These indeed cannot properly be called diseases, but from the delicacy of the sex, and their being often improperly managed in such situations, they become the source of numerous calamities.
Females generally begin to menstruate about the age of fifteen, and leave it off about fifty, which renders these two periods the most critical of their lives. About the first appearance of this discharge, the constitution undergoes a very considerable change, generally indeed for the better, though sometimes for the worse. The greatest care is now necessary, as the future health and happiness of the female depends in a great measure upon her conduct at this period[178].
If a girl about this time of life be confined to the house, kept constantly sitting, and neither allowed to romp about, nor employed in any active business, which gives exercise to the whole body, she becomes weak, relaxed, and puny; her blood not being duly prepared, she looks pale and wan; her health, spirits, and vigour decline, and she sinks into a valetudinarian for life. Such is the fate of numbers of those unhappy females, who, either from too much indulgence, or their own narrow circumstances, are, at this critical period, denied the benefit of exercise and free air.
A lazy indolent disposition proves likewise very hurtful to girls at this period. One seldom meets with complaints from obstructions amongst the more active and industrious part of the sex; whereas the indolent and lazy are seldom free from them. These are in a manner eaten up by the chlorosis, or green-sickness, and other diseases of this nature. We would therefore recommend it to all who wish to escape these calamities, to avoid indolence and inactivity, as their greatest enemies, and to be as much abroad in the open air as possible.
Another thing which proves very hurtful to girls about this period of life, is unwholesome food. Fond of all manner of trash, they often indulge in it, till their whole humours are quite vitiated. Hence ensue indigestions, want of appetite, and a numerous train of evils. If the fluids be not duly prepared, it is utterly impossible that the secretions should go properly on. Accordingly we find, that such girls as lead an indolent life, and eat great quantities of trash, are not only subject to obstructions of the menses, but likewise to glandular obstructions; as the scrophula, or king’s evil, &c.
A dull disposition is also very hurtful to girls at this period. It is a rare thing to see a sprightly girl who does not enjoy good health, while the grave, moping, melancholy creature, proves the very prey of vapours and hysterics. Youth is the season for mirth and cheerfulness. Let it therefore be indulged. It is an absolute duty. To lay in a stock of health in time of youth, is as necessary a piece of prudence, as to make provision against the decays of old age. While, therefore, wise Nature prompts the happy youth to join in sprightly amusements, let not the severe dictates of hoary age forbid the useful impulse, nor damp, with serious gloom, the season destined to mirth and innocent festivity.
Another thing very hurtful to females about this period of life is strait clothes. They are fond of a fine shape, and foolishly imagine that this can be acquired by lacing themselves tight. Hence, by squeezing the stomach and bowels, they hurt the digestion, and occasion many incurable maladies. This error is not indeed so common as it has been; but, as fashions change, it may come about again: we therefore think it not improper to mention it. I know many females who, to this day, feel the direful effects of that wretched custom which prevailed some years ago, of squeezing every girl into as small a size in the middle as possible. Human invention could not possibly have devised a practice more destructive to health.
After a female has arrived at that period of life when the menses usually begin to flow, and they do not appear, but, on the contrary, her health and spirits begin to decline, we would advise, instead of shutting the poor girl up in the house, and dosing her with steel, asafœtida, and other nauseous drugs, to place her in a situation where she can enjoy the benefit of free air and agreeable company. There let her eat wholesome food, take sufficient exercise, and amuse herself in the most agreeable manner; and we have little reason to fear, but Nature, thus assisted, will do her proper work. Indeed she seldom fails, unless where the fault is on our side.
This discharge in the beginning is seldom so instantaneous as to surprise females unawares. It is generally preceded by symptoms which foretel its approach; as a sense of heat, weight, and dull pain in the loins; distension and hardness of the breasts; head-ach; loss of appetite; lassitude; paleness of the countenance; and sometimes a slight degree of fever. When these symptoms appear about the age at which the menstrual flux usually begins, every thing should be carefully avoided which may obstruct that necessary and salutary evacuation; and all means used to promote it; as sitting frequently over the steams of warm water, drinking warm diluting liquors, &c.
After the menses have once begun to flow, the greatest care should be taken to avoid every thing that may tend to obstruct them. Females ought to be exceeding cautious of what they eat or drink at the time they are out of order. Every thing that is cold, or apt to sour on the stomach, ought to be avoided; as fruit, butter-milk, and such like. Fish, and all kinds of food that are hard of digestion, are also to be avoided. As it is impossible to mention every thing that may disagree with individuals at this time, we would recommend it to every female to be very attentive to what disagrees with herself, and carefully to avoid it.
Cold is extremely hurtful at this particular period. More of the sex date their disorders from colds, caught while they are out of order, than from all other causes. This ought surely to put them upon their guard, and to make them very circumspect in their conduct at such times. A degree of cold that will not at the least hurt them at another time, will at this period be sufficient entirely to ruin their health and constitution.
The greatest attention ought likewise to be paid to the mind, which should be kept as easy and cheerful as possible. Every part of the animal economy is influenced by the passions, but none more so than this. Anger, fear, grief, and other affections of the mind, often occasion obstructions of the menstrual flux, which prove absolutely incurable.
From whatever cause this flux is obstructed, except in the state of pregnancy, proper means should be used to restore it. For this purpose we would recommend sufficient exercise, in a dry, open, and rather cool air; wholesome diet, and, if the body be weak and languid, generous liquors; also cheerful company and all manner of amusements. If these fail, recourse must be had to medicine.
When obstructions proceed from a weak relaxed state of the solids, such medicines as tend to promote digestion, to brace the solids, and assist the body in preparing good blood, ought to be used. The principal of these are iron and the Peruvian bark, with other bitter and astringent medicines. Filings of iron may be infused in wine or ale, two or three ounces to an English quart, and after it has stood for two or three weeks it may be filtered, and about half a wine-glass of it taken twice a-day: or prepared steel may be taken in the dose of half a drachm, mixed with a little honey or treacle, three or four times a-day. The bark and other bitters may either be taken in substance or infusion, as is most agreeable to the patient.
When obstructions proceed from a viscid state of the blood; or for women of a gross or full habit, evacuations, and such medicines as attenuate the humours, are necessary. The patient in this case ought to be bled, to bathe her feet frequently in warm water, to take now and then a cooling purge, and to live upon a spare thin diet. Her drink should be whey, water, or small beer, and she ought to take sufficient exercise. A tea-spoonful of the tincture of black hellebore may also be taken twice a-day in a cup of warm water.
When obstructions proceed from affections of the mind, as grief, fear, anger, &c. every method should be taken to amuse and divert the patient. And that she may the more readily forget the cause of her affliction, she ought, if possible, to be removed from the place where it happened. A change of place, by presenting the mind with a variety of new objects, has often a very happy influence in relieving it from the deepest distress. A soothing, kind, and affable behaviour to females in this situation is also of the last importance.
An obstruction of the menses is often the effect of other maladies. When this is the case, instead of giving medicines to force that discharge, which might be dangerous, we ought by all means to endeavour to restore the patient’s health and strength. When that is effected, the other will return of course.
But the menstrual flux may be too great as well as too small. When this happens, the patient becomes weak, the colour pale, the appetite and digestion are bad, and œdematous swellings of the feet, dropsies, and consumptions often ensue. This frequently happens to women about the age of forty-five or fifty, and is very difficult to cure. It may proceed from a sedentary life; a full diet, consisting chiefly of salted, high-seasoned, or acrid food; the use of spirituous liquors; excessive fatigue; relaxation; a dissolved state of the blood; violent passions of the mind, &c.
The treatment of this disease must be varied according to its cause. When it is occasioned by any error in the patient’s regimen, an opposite course to that which induced the disorder must be pursued, and such medicines taken as have a tendency to restrain the flux, and counteract the morbid affections of the system from whence it proceeds.
To restrain the flux, the patient should be kept quiet and easy both in body and mind. If it be very violent, she ought to lie in bed with her head low; to live upon a cool and slender diet, as veal or chicken broths with bread; and to drink decoctions of nettle-roots, or the greater comfrey. If these be not sufficient to stop the flux, stronger astringents may be used, as Japan earth, allum, elixir of vitriol, the Peruvian bark, &c.[179]
The uterine flux may offend in quality as well as in quantity. What is usually called the fluor albus, or whites, is a very common disease, and proves extremely hurtful to delicate women. This discharge, however, is not always white, but sometimes pale, yellow, green, or of a blackish colour; sometimes it is sharp and corrosive, sometimes foul and fœtid, &c. It is attended with a pale complexion, pain in the back, loss of appetite, swelling of the feet, and other signs of debility. It generally proceeds from a relaxed state of the body, arising from indolence, the excessive use of tea, coffee, or other weak and watery diet.
To remove this disease, the patient must take as much exercise as she can bear without fatigue. Her food should be solid and nourishing, but of easy digestion; and her drink rather generous, as red port or claret, mixed with Pyrmont, Bristol, or lime-water. Tea and coffee are to be avoided. I have often known strong broths have an exceeding good effect, and sometimes a milk diet alone will perform a cure. The patient ought not to lie too long a-bed. When medicine is necessary, we know none preferable to the Peruvian bark, which in this case ought always to be taken in substance. In warm weather, the cold bath will be of considerable service.
That period of life at which the menses cease to flow, is likewise very critical to the sex. The stoppage of any customary evacuation, however small, is sufficient to disorder the whole frame, and often to destroy life itself. Hence it comes to pass, that so many women either fall into chronic disorders, or die about this time. Such of them, however, as survive it, without contracting any chronic disease, often become more healthy and hardy than they were before, and enjoy strength and vigour to a very great age.
If the menses cease all of a sudden, in women of a full habit, they ought to abate somewhat of their usual quantity of food, especially of the more nourishing kind, as flesh, eggs, &c. They ought likewise to take sufficient exercise, and to keep the body open. This may be done by taking, once or twice a-week, a little rhubarb, or an infusion of hiera picra in wine or brandy.
It often happens that women of a gross habit, at this period of life, have ulcerous sores break out about their ancles, or in other parts of the body. Such ulcers ought to be considered as critical, and should either be suffered to continue open, or have artificial drains substituted in their stead. Women who will have such sores dried up, are often soon after carried off by acute diseases, or fall into those of a chronic nature.
Though pregnancy is not a disease, yet that state is often attended with a variety of complaints which merit attention, and which sometimes require the assistance of medicine. Some women indeed are more healthy during their pregnancy than at any other time; but this is by no means the general case: most of them breed in sorrow, and are frequently indisposed during the whole time of pregnancy. Few fatal diseases, however, happen during that period; and hardly any, except abortion, that can be called dangerous. We shall therefore pay particular attention to it, as it proves generally fatal to the child, and sometimes so to the mother.
Pregnant women are often afflicted with the heart-burn. The method of treating this complaint has been already pointed out. They are likewise, in the more early periods of pregnancy, often harassed with sickness and vomiting, especially in the morning. The method of relieving these complaints has also been shewn. Both the head-ach and tooth-ach are very troublesome symptoms of pregnancy. The former may generally be removed by keeping the body gently open, by the use of prunes, figs, roasted apples, and such like. When the pain is very violent, bleeding may be necessary. For the treatment of the latter, we must refer to that article. Several other complaints incident to pregnant women might be mentioned, as a cough and difficulty of breathing, suppression and incontinency of urine, &c.; but as all of these have been taken notice of before, it is needless to repeat them.
Every pregnant woman is more or less in danger of abortion. This should be guarded against with the greatest care, as it not only weakens the constitution, but renders the woman liable to the same misfortune afterwards[180]. Abortion may happen at any period of pregnancy, but it is most common in the second or third month. Sometimes, however, it happens in the fourth or fifth. If it happens within the first month, it is usually called a false conception; if after the seventh month, the child may often be kept alive by proper care.
The common causes of abortion are, the death of the child; weakness or relaxation of the mother; great evacuations; violent exercise; raising great weights; reaching too high; jumping, or stepping from an eminence; vomiting; coughing; convulsion fits; blows on the belly; falls; fevers; disagreeable smells; excess of blood; indolence; high living; or the contrary; violent passions or affections of the mind, as fear, grief, &c.
The signs of approaching abortion are, pain in the loins, or about the bottom of the belly; a dull heavy pain in the inside of the thighs; a slight degree of coldness, or shivering; sickness, palpitation of the heart; the breasts become flat and soft; the belly falls; and there is a discharge of blood or watery humours from the womb.
To prevent abortion, we would advise women of a weak or relaxed habit to use solid food, avoiding great quantities of tea, and other weak and watery liquors; to rise early and go soon to bed; to shun damp houses; to take frequent exercise in the open air, but to avoid fatigue; and never to go abroad in damp foggy weather, if they can shun it.
Women of a full habit ought to use a spare diet, avoiding strong liquors, and every thing that may tend to heat the body, or increase the quantity of blood. Their diet should be of an opening nature, consisting principally of vegetable substances. Every woman with child ought to be kept cheerful and easy in her mind. Her appetites, even though depraved, ought to be indulged as far as prudence will permit.
When any signs of abortion appear, the woman ought to be laid in bed on a mattrass, with her head low. She should be kept quiet, and her mind soothed and comforted. She ought not to be kept too hot, nor to take any thing of a heating nature. Her food should consist of broths, rice and milk, jellies, gruels made of oatmeal, and the like, all of which ought to be taken cold.
If she be able to bear it, she should lose at least half a pound of blood from the arm. Her drink ought to be barley-water sharpened with juice of lemon; or she may take half a drachm of powdered nitre, in a cup of water-gruel, every five or six hours. If the woman be seized with a violent looseness, she ought to drink the decoction of calcined hartshorn prepared. If she be affected with vomiting, let her take frequently two table-spoonfuls of the saline mixture. In general, opiates are of service; but they should always be given with caution.
Sanguine robust women, who are liable to miscarry at a certain time of pregnancy, ought always to be bled a few days before that period arrives. By this means, and observing the regimen above prescribed, they might often escape that misfortune.
Though we recommend due care for preventing abortion, we would not be understood as restraining pregnant women from their usual exercises. This would generally operate the quite contrary way. Want of exercise not only relaxes the body, but induces a plethora, or too great a fulness of the vessels, which are the two principal causes of abortion. There are, however, some women of so delicate a texture, that it is necessary for them to avoid almost every kind of exercise during the whole period of pregnancy.
Many diseases proceed from the want of due care in child-bed; and the more hardy part of the sex are most apt to despise the necessary precautions in this state. This is peculiarly the case with young wives. They think, when the labour-pains are ended, the danger is over; but in truth it may only then be said to be begun. Nature, if left to herself, will seldom fail to expel the fœtus; but proper care and management are certainly necessary for the recovery of the mother. No doubt mischief may be done by too much as well as by too little care. Hence females who have the greatest number of attendants in child-bed generally recover worst. But this is not peculiar to the state of child-bed. Excessive care always defeats its own intention, and is generally more dangerous than none at all[181].
During actual labour, nothing of a heating nature ought to be given. The woman may now and then take a little panado, and her drink ought to be toast and water, or thin groat-gruel. Spirits, wines, cordial waters, and other things which are given with a view to strengthen the mother, and promote the birth, for the most part tend only to increase the fever, inflame the womb, and retard the labour. Besides, they endanger the woman afterwards, as they often occasion violent and mortal hæmorrhages, or dispose her to eruptive and other fevers.
When the labour proves tedious and difficult, to prevent inflammations, it will be proper to bleed. An emollient clyster ought likewise frequently to be administered; and the patient should sit over the steams of warm water. The passage ought to be gently rubbed with a little soft pomatum or fresh butter, and cloths wrung out of warm water applied over the belly. If nature seems to sink, and the woman is greatly exhausted with fatigue, a draught of generous wine, or some other cordial, may be given, but not otherwise. These directions are sufficient in natural labours; and in all preternatural cases, a skilful surgeon, or man-midwife, ought to be called as soon as possible.
After delivery, the woman ought to be kept as quiet and easy as possible[182]. Her food should be light and thin, as gruel, panado, &c. and her drink weak and diluting. To this rule, however, there are many exceptions. I have known several women, whose spirits could not be supported in child-bed without solid food and generous liquors; to such, a glass of wine and a bit of chicken must be allowed.
Sometimes an excessive hæmorrhage or flooding happens after delivery. In this case the patient should be laid with her head low, kept cool, and be in all respects treated as for an excessive flux of the menses. If the flooding proves violent, linen cloths, which have been wrung out of a mixture of equal parts of vinegar and water, or red wine, should be applied to the belly, the loins, and the thighs: these must be changed as they grow dry; and may be discontinued as soon as the flooding abates[183].
If there be violent pains after delivery, the patient ought to drink plentifully of warm diluting liquors, as groat-gruel, or tea with a little saffron in it; and to take small broths, with carrawayseeds, or a bit of orange-peel in them; an ounce of the oil of sweet almonds may likewise be frequently taken in a cup of any of the above liquors; and if the patient be restless, a spoonful of the syrup of poppies may now and then be mixed with a cup of her drink. If she be hot or feverish, one of the following powders may be taken in a cup of her usual drink every five or six hours[184].
An inflammation of the womb is a dangerous and not unfrequent disease after delivery. It is known by pains in the lower part of the belly, which are greatly increased upon touching; by the tension or tightness of the parts; great weakness; change of countenance; a constant fever, with a weak and hard pulse; a slight delirium or raving; sometimes incessant vomiting; a hiccup; a discharge of reddish, stinking, sharp water from the womb; an inclination to go frequently to stool; a heat, and sometimes total suppression of urine.
This must be treated like other inflammatory disorders, by bleeding and plentiful dilution. The drink may be thin gruel or barley-water; in a cup of which half a drachm of nitre may be dissolved, and taken three or four times a-day. Clysters of warm milk and water must be frequently administered; and the belly should be fomented by cloths wrung out of warm water, or by applying bladders filled with warm milk and water to it.
A suppression of the lochia, or usual discharges after delivery, and the milk-fever, must be treated nearly in the same manner as an inflammation of the womb. In all these cases, the safest course is plentiful dilution, gentle evacuations, and fomentations of the parts affected. In the milk-fever, the breads may be embrocated with a little warm linseed oil, or the leaves of red cabbage may be applied to them. The child should be often put to the breast, or it should be drawn by some other person.
Nothing would tend more to prevent the milk-fever than putting the child early to the breast. The custom of not allowing children to suck for the first two or three days, is contrary to Nature and common sense, and is very hurtful both to the mother and child.
Every mother who has milk in her breasts, ought either to suckle her own child, or to have her breasts frequently drawn, at least for the first month. This would prevent many of the diseases which prove fatal to women in child-bed.
When an inflammation happens in the breast, attended with redness, hardness, and other symptoms of suppuration, the safest application is a poultice of bread and milk, softened with oil or fresh butter. This may be renewed twice a-day, till the tumour be either discussed or brought to suppuration. The use of repellents, in this case, is very dangerous; they often occasion fevers, and sometimes cancers; whereas a suppuration is seldom attended with any danger, and has often the most salutary effects.
When the nipples are fretted or chapt, they may be anointed with a mixture of oil and beeswax, or a little powdered gum-arabic may be sprinkled on them. I have seen Hungary water applied to the nipples have a very good effect. Should the complaint prove obstinate, a cooling purge may be given, which generally removes it.
The miliary fever is a disease incident to women in child-bed; but as it has been treated of already, we shall take no further notice of it. The celebrated Hoffman observes, That this fever of child-bed women might generally be prevented, if they, during their pregnancy, were regular in their diet, used moderate exercise, took now and then a gentle laxative of manna, rhubarb, or cream of tartar; not forgetting to bleed in the first months, and avoid all sharp air. When the labour is coming on, it is not to be hastened with forcing medicines, which inflame the blood and humours, or put them into unnatural commotions. Care should be taken, after the birth, that the natural excretions proceed regularly; and if the pulse be quick, a little nitrous powder, or some other cooling medicines, should be administered.
The most fatal disorder consequent upon delivery is the puerperal, or child-bed fever. It generally makes its attack upon the second or third day after delivery. Sometimes indeed it comes on sooner, and at other times, though rarely, it does not appear before the fifth or sixth day.
It begins, like most other fevers, with a cold or shivering fit, which is succeeded by restlessness, pain of the head, great sickness at stomach, and bilious vomiting. The pulse is generally quick, the tongue dry, and there is a remarkable depression of spirits and loss of strength. A great pain is usually felt in the back, hips, and region of the womb; a sudden change in the quantity or quality of the lochia also takes place; and the patient is frequently troubled with a tenesmus, or constant inclination to go to stool. The urine, which is very high-coloured, is discharged in small quantity, and generally with pain. The belly sometimes swells to a considerable bulk, and becomes susceptible of pain from the slightest touch. When the fever has continued for a few days, the symptoms of inflammation usually subside, and the disease acquires a more putrid form. At this period, if not sooner, a bilious or putrid looseness, of an obstinate and dangerous nature, comes on, and accompanies the disease through all its future progress.
There is not any disease that requires to be treated with more skill and attention than this; consequently the best assistance ought always to be obtained as soon as possible. In women of plethoric constitutions, bleeding will generally be proper at the beginning; it ought however to be used with caution, and not to be repeated unless where the signs of inflammation rise high; in which case it will also be necessary to apply a blistering-plaster to the region of the womb.
During the rigour, or cold fit, proper means should be used to abate its violence, and shorten its duration. For this purpose the patient may drink freely of warm diluting liquors, and, if low, may take now and then a cup of whine-whey; warm applications to the extremities, as heated bricks, bottles or bladders filled with warm water, and such like, may also be used with advantage.
Emollient clysters of milk and water, or of chicken water, ought to be frequently administered through the course of the disease. These prove beneficial by promoting a discharge from the intestines, and also by acting as a kindly fomentation to the womb and parts adjacent. Great care however is requisite in giving them, on account of the tenderness of the parts in the pelvis at this time.
To evacuate the offending bile from the stomach, a vomit is generally given. But as this is apt to increase the irritability of the stomach, already too great, it will be safer to omit it, and to give in its stead a gentle laxative, which will both tend to cool the body, and to procure a free discharge of the bile[185].
The medicine which I have always found to succeed best in this disease is the saline draught. This, if frequently repeated, will often put a stop to the vomiting, and at the same time lessen the violence of the fever. If it runs off by stool, or if the patient be restless, a few drops of laudanum, or some syrup of poppies, may occasionally be added.
If the stools should prove so frequent as to weaken and exhaust the patient, a starch clyster, with thirty or forty drops of laudanum in it, may be administered as occasion shall require; and the drink may be rice-water, in every English pint of which half an ounce of gum-arabic has been dissolved. Should these fail, recourse must be had to Columbo-root, or some other strong astringent.
Though in general the food ought to be light, and the drink diluting, yet when the disease has been long protracted, and the patient is greatly spent by evacuations, it will be necessary to support her with nourishing diet and generous cordials.
It was observed that this fever, after continuing for some time, often acquires a putrid form. In this case the Peruvian bark must be given, either by itself, or joined with cordials, as circumstances may require. As the bark in substance will be apt to purge, it may be given in decoction or infusion mixed with the tincture of roses, or other gentle astringents; or, a scruple of the extract of bark with half an ounce of spirituous cinnamon-water, two ounces of common water, and ten drops of laudanum, may be made into a draught, and given every second, third, or fourth hour, as shall be found necessary.
When the stomach will not bear any kind of nourishment, the patient may be supported for some time by clysters of beef tea, or chicken water.
To avoid this fever, every woman in child-bed ought to be kept perfectly easy; her food should be light and simple, and her bed-chamber cool, and properly ventilated. There is not any thing more hurtful to a woman in this situation than being kept too warm. She ought not to have her body bound too tight, nor to rise too soon from bed, after delivery; catching cold is also to be avoided; and a proper attention should be paid to cleanliness.