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i .A.

COMMENTARIES

ON-

THE HISTORY AND CURE

OF

DISEASES.

*Y

WILLIAM HEBERDEN, M.D.

THE THIRD EDITION,

ALEX. TRALL. Lib. XIL

LONDON:

PRINTED FOE T.PAYNE, PALL-MALL,

1806,

Lnke Ilatuarc!, printer. Great Turpiiik;, Luicoln'i-lnii. Fiel*^

WILLIAM HEBERDEN

Was born in London in the year 1710, and received the early part of his education in that city. At the close of the year 17^4 he was sent to Saint John's College in Cambridge, and six years after was elected a Fellow. From that time he directed his attention to the study of medi- cine, which he pursued partly at Cambridge and partly in London, Having taken his degree of Doctor of Physic he practised in the Uni- versity for about ten years, and during that time read every year a A 2 course

IV

course of lectures on the Materia Meclica. In the year 1746 he be- came a Fellow of the Royal College of Physicians, and two years after- wards leaving Cambridge he settled in London, and was elected mto the Royal Society. He very soon got into great business, which he fol- lowed with unremitting attention above thirty years, till it seemed prudent to withdraw a little from the fatigues of his profession. He therefore purchased a house at Windsor, to which he used ever afterwards to retire during some of the summer months; but returned to London in the winter, and still con- tinued to visit the sick for many years.

In 1766 he recommended to the College of Physicians the first design of the Medical Transactions, in whicli he proposed to collect toge- ther

ther such observations as might have m^urred to any of their body, and were hkely to illustrate the history or core of diseases. The plan was soon adopted, and three volumes have successively been laid before the piibhc. In 177^ ^'^^ Royal Society of Medicine in Paris chose him into the number of their Asso- ciates. Besides the observations contained in the present volume. Doctor Hebekden was the author of several papers in the Medical Transactions, and of some in the Phdosophical 'Transactions of the Royal Society. He declined all pro- fessional business several years be- fore his death, which was mercifully postponed till the year 1801, v/hen he was advancing to the age of ninety-one.

From his early youth he had always entertained a deep sense of

A $ reli"

VI

religion, a consummate love of vir- tue, an ardent thirst after knowledge, and an earnest desire to promote the welfare and happiness of all man- kind. By these qualities, accom- panied with great sweetness of man- ners, he acc[uired the love and esteem of all good men, in a degree which perhfips very few have experienced ; and after passing an active life with the uniform testimony of a good con- science, he became an eminent ex- ample of its influence, in the cheer- fulness and serenity of his latest

ao*e.

VJi

PREFACE.

Plutarch says*, that the nfe of a vestal virgin was divided into three portions; in the first of which she learned the duties of her profession, in the second she practised them, and in the third she taught them to others. This is no bad model for the life of a phy- sician: and, as I have now passed through the two first of these times, I am wilhng to employ the remainder of my days in teach- ing what I know to any of my sons who may choose the profession of physic ; and to him I desire that these papers may be given.

The notes, from which the following obser- yations were collejcted, were taken in the

f Plutarch in Numa_, et « Tr^tt^QuTts^a ttoaitsut.

chambers

VIU PREPACE.

chambers of tlie sick, from themselves, or from their attendants, \vhere several things mio[ht occasion the omission of some mate- rial circumstances. These notes were read over every month, and such facts, as tended to throw any light upon the history of a dis- temper, or the effects of a remedy, were en- tered under the title of the distemper in another book, from which were extracted all the particulars here given, relating to the nature and cure of diseases. It appeared more adviseable to give such focts only, as were justified by the original papers, however imperfect, than either to supply their defects from memory, except in a very few instances, or than to borrow any thing from other writers.

The collections from the notes, as well as the notes themselves, were written in Latin, the diseases being arranged alphabetically; and this is the reason that the titles are here in that language. In making the extracts it w^as not only more easy to follow the order in which the observations had been ranged, but there was likewise less danger of any

confusion

PREFACE. IX

confusion or omission ; and little or no in- convenience can arise from preserving the Latin names of the distempers.

An useful addition might have been made to these papers bj comparing them with the current doctrine of diseases and remedies, as also with what is laid down in practical writers, and with the accounts of those who treat of the dissections of morbid bodies ; but at my advanced age it would be to no purpose to think of such an undertaking.

Auguft 1782.

CONTENTS.

CHAP.

PAGE

1. Of Diet - - - 1

2. Ratio Medendi - 5

3. Jbdomcn - - 13

4. Jbortus - - - 15

5. Alvus - - - - 16

6. Aneurysma - - 18

7. yliigitui, and Scarlet

Fever - - - 18

8. Jphtltce - - - 31

9. Arthritis - - - 32

10. Ascarides - - - 60

11. Asthma - - - 62

12. Aurium Morhi - 6q

13. Of the BaihlVater 71 a '4. ()/■ /Ad Bristol Jla-

ier - - - - 79

15. Bronchoccle - - 70

16. Calculus Urincc - 80 37. Capitis Dolor - 91 18. Cajiitis Dolores inter-

tnittcrites " - 99 39. CarbtiueuJus - - 102

20. Chorea Snncti Viii 103

2 1 . Cojr<£ Morbus ei End-

ccraiio - - 106

22. Cruruni Dolor, Tumor,

luflarnmatio, et L l- cus - - - - jo; Cutis iltia - ~ 111 Destillatio - - 134 Devor-utio - - 138 Diabetes - - 141 Diai'rltQ'.a - - 144 Digitorura Nodi 148 7Jo/o;- - - - 149

1^,2

23- 24.

2 ri- 27. 28. 29.

so-

CHAP.

PAGfe

Dolores vagi

31- 32- 33. 34. 35-

36.

37- 38-

39- 40.

41,

42.

43- 44.

46.

4/.

48,

49'

50. 51-

53' 54.

55' 57

353 155 156

Dysentei'ia - Fbrietas - - Epilepsia

Erysipelas - - 167 Esseru, or Nettle-Rash

Expergefacti cum Cla- more et Terrore 1 74 Febris - - - 175 Febris Intermittens

181 Fibris Ilectica - Fistula Afii - - Fluor A lb us (jouorrhaa Mttis (iraviditas - - Hcrmorrho'ides - Hernia - - - Hydrocephalus - Tij/drophobia - Hydi ops - - Ili/pochondriacus et Eli/St eric us Affectus

224 Ic terus,a liique Hepatis AJj'ectus - - 236 Ileus - - _ - 261 lujhitio et Rue I us 274 Lisania - - - 275 Intestinorum Dolores 27S Ischuria - - 283 Lingua: et Oris Dolor 286 Upothymia, or Faint- ing - - - 287 58. Lum-

186

199 201

205 207 2og 214 214

215 216

CONTENTS.

XI

tllA

60.

61.

62.

63-

64.

65. 66.

67.

68. 69.

70.

71-

72.

/i3- 74.

75- 70.

77-

78,

P. PAGE

Lumborum Dolar 289 Lumbriei - - 290 Lymphatka. Glandulce. 292 Mamma, - - 293 Menstrua - - 299 Morbiia - - 2^13 Narium Ilamorrha-

gia- - - - 323 I^lausea - -■ - 325 Oculorum Morbi 326 OfthcNi/etahpia, or Night-blindness 334 Ozana, or a Suppura- tion of the Antrum liighmori - - 336 Paipitdiio Cordis ib. Paralysis et Apoplexia

338 ^ Case o/' Catalepsy

301 Pectoris Dolor - 362 PediailarisMorbus2,Sg PhthisisPul/nonumS'/O Pietonum Colica 384 Pituita ~ - - 390 Prostatcd Seirrhus 391 Pruritus Cutis - 393 Puerperium - 394 Purpurea: Macula 395

CHAP. P

AGE

79. Rheumatismus -

397

80. Semen J irile

404

81. Singultus - -

405

82. .S?7/s - - - -

406

83. Spasmus - - -

407

84. Sputa cruenta -

4ir

85. Steatomata - -

414

86. Stranguria - -

435

87. Struma - - -

418

88. Tenesmus - ~

424

89. 'Testictilus - -

425

90. Torpor - - -

426

Q]. Tremor - - -

429

92. Tussis - - -

430

93. Tussis convulsiva

433

04. Valetudo conquassata

435

05. Variolce. - - -

43(5

96. Variola Pusillac.

7'/^«

Chicken- Pox

. 445

97. Ventriculi Morb

8 :

§ I. Jrdor et Acor

452

1 2. 7Jo/or - -

454

§ 3. Lienis Morbi

45S

§ 4. P ancrtatisMorl

/460

98. f-'ertigo - -

461

QQ. Vomitus - -

465

100. /^oa: - - -

470

101. (7nV/a - - -

471

102. Uterus - - -

47^-

TAe Conclusion

48 s

APPENDIX.

sii CONTENTS,

APPENDIX.

1. A Sketch of a Preface, designed for the Medical

Transactions, i/^Z --------p. 485

2. Observations on the Chronical Rheumatism - - 496.

3. Remarks on the Pulse ----.---- 502

4. On opening a Vein in Haemorrhages - - - - 512

English Index ------------517

COMMENTARIES

COMMENTARIES

ON THE HISTORY AND CURE OF DISEASES.

Chapter I. Of Diet

JVI AN Y Physicians appear to be too strict and particular in the rules of diet and regimen, which the}^ deliver as proper to be observed by all who are solicitous either to preserve or re- cover their health. The too anxious attention to these rules hath often hurt those who are vrell, and added unnecessarily to the distresses of the sick. The common experience of mankind will sufficiently acquaint anyone with the sorts of food which are wholesome to the generality of men; and his own experience will teach him which of these agrees best with his parti- cular constitution. Scarcely any other direct tions beside these are wanted, except that, as variety of food at the same meal, and poignant

B saucesj

t COMMEXTAllIES ON THE

sauces, will tempt most persons to eat more than they can well digest, they ought therefore to be avoided by all who are afflicted with any chronical disorder, or wish to keep free from them. But whether meat should be boiled, or roasted, or dressed in any other plain way, and what sort of vegetables should be eaten with it, I never yet met with any person of common sense (except in an acute illness) whom I did not think much fitter to choose for himself, than I was to determine for him. Small beer, where it agrees, or water alone, are the properest liquors at meals. AVine or spi- rits mixed with water have graduall}^ led on several to be sots, and have ruined more con- stitutions than ever were hurt by small beer from its first invention.

In fevers a little more restraint is necessary, but not so much as is often enjoined. The stronger sorts ofmeat and fish are most usually loathed by the sick themselves, nor could they be eaten without offending the stomach, and increasing the distemper, while it is at all considerable; but in its decline, the sick are often desirous of some of the milder sorts of meat, inid no harm follows from indulo;incr their desire. The English nation are said to eat more meat when they are ^vell than most

others;

niSTOKY AND CURE OF DISEASE^. 3

others; but were remarkable, so long ago as the time of Erasmus, for avoiding it more scru- pulous! j when they are sick, than any other people. How higti s^c.-^r the fever be, the sick may safely be nourished with w^..^ broths and gellics, and with any vegetablesubstanceSj if we except tha acrid and aromatic, or with the infusions or decoctions prepared from them; and I know no reason for preferring any of these to the rest. Eggs and milk have been, I know not by Mhat authority, forbid- den in all fevers; but, as far as my experience goes, they both afford innocent food in the worst, where they are grateful to the patients. The feverish thirst is best allayed by pure Water, which may be drunk either warm, or cold, at the option of the sick person, and he may drink as much as he pleases; but 1 see no advantage in persuading him to gorge himself with liquids, as is often done, against his incli^ nation and stomach. If vvater be deemed too insipid, currant gelly, and a variety of syrupSj may be dissolved in it; or apples sliced or roasted, tamarinds, sage, or balm, or toasted bread, may be infused m it; or decoctions may bemadeof oatmeal, barley, or rice ; or the water may be made into an emulsion with the oily seeds; ail which, with a variety of similai'

B % substances,

4 COMMENTARIES ON THE

substances, merely correct its insipidness, but in other respects leave it just what it was.

There is scarcely any distempc. "i every stage of which it ma.v «-<^ f^e safely left to the patient'* ^^^i^ choice, if he be perfectly in his senses, whether he will sit up, or keep his bed. His strength and his ease are chiefly to be attended to in settling this point ; and who can tell so well as himself, what his ease re- quires, and what his strength will bear?

Doubts are often raised about the propriety of changing the linen in sickness, just as there have been about changing the foul air of the sick- chamber by any of the nieans which could refresh and purity it. There can be very little reason to fear any mischief from the cold which the sick may feel while their clean linen is putting on; for their attendants, with common care, will do this as safely as many other things which must necessarily be done for them. ]3ut some have a strangx^ opinion of harm from the smell of the soap -perceivable in linen after it lias been washed*, and therefore allow not theirpatients, when they changetheirlinen, ever to put on fresh, but such onl^' as has been worn, or lain in, by other persons. By this con- trivance indeed Uie smell of tiie soap might bo * Diemerbrocck de Pe^te_, i. ii, c. 3, annot. 6.

taken

HISTORY AND CURE OF DISEASES. 5

taken off, but few cleanly people would think they gained an}^ advantage by the change. Now, if a faint smell of soap were noxious, then soap-makers, and laundry-servants, must be remarkable unhealthy; Avhich is contrary to experience: nor is it less so, that the sick are injured by tlie cleanness of wdiat they wear; on the contrary, the removing of their foul thino;s has often diffused over them a sense of ease and comfort, which has soon lulled them into a quiet and refreshing sleep.

Chap. 2. Ratio Medendl.

One of the first considerations in the cure of a disease is, whether it require any evacu- ations; that is, whether it have been the ge- neral opinion of practical authors, that eme- tics, cathartics, diuretics, bleeding (by leeches, cupping-glasses, or the lancet), sudorifics, blis- ters, issues, sternutatories, or salivation, have in similar cases been found to be beneficial,

2dly. A\^hether it be a distemper, for which any specific, or certain remed}^ has been found out. Many such in all ages, and in every country, have been for a little while in fashion ;

E 3 ver^

6 COMMENTARIES ON THE

very few of which have justified the promises of their patrons, and answered the wishes of physicians and patients; so that there is no where more reason to be upon our guard, and to remember the old caution, voc(p£ Kod [>i,6fjivu(r uTTigm. However, the honour of this title may be justly claimed b^' the Peruvian bark for the cures of agues ; quicksilver for Venereal disorders; sulphur for the itch; and perhaps opium for some spasms; and Bath waters for the injury done to the stomach by drinking.

Besides the few remedies here uientioned, it may be doubted whether ten others have upon any good authority l>een reputed specifics, ox certain remedies for particular diseases, the re- putation of wliich has afterwards been suffici- ently confirmed by experience. Borax has been celebrated as such for aphthas ; the Portland powder for the gout: squills and the fetid gum- resins for the asthma; soap-ley for the gravel and stone ; hemlock for cancers; electrification for blindness: antimony for continual fevers; sugar of lead for haemorrhages; and some few others for other distempers.

Though, among the pretended specifics,

some have very little virtue, and others may

be inconstant in their operations ; yet, if a

physician 1)6 satisfied that they are safe, there

9 may

HISTORY AND CURE Or DISEASES. 7

may be many occasions when he may with propriety employ them.

3dly. Vomiting, purging, pain, and other troublesome symptoms, are in many cases so urgent, as to make some present reUef indis- pensably requisite; for the procuring of which, opium is very commonly the most ef- fectual means,

4thly. In long and obstinate diseases, in which no particular remedy is found to have succeeded, it is often advisable to have re- course to the general means of strongly af* fecting and of making considerable changes in the state of the body; in hopes, by this shock, of dislodging the cause of the disease. For this end, mercury, antimony, hendock, and electrification, are sometimes employed.

Lastly, where there is no room for any thing else, there it is the duty of a physician to exert himself as much as possible in sup- porting the powers of life, by strengthening the appetite and digestion, and by providing that the stools, and sleep, and every other article of health, shall approach as nearly as may be to its natural state.

There may be such a state of a distemper, in which the whole attention of the physician must be given up to the supporting and en-

:b 4 liveuilig

8 COMMENTARIES ON THE

livening the vital powers ; but there can be no stage of any disease which does not require some attention to this important point. As this is a precept, in the due observance of which the welfare of every patient is deeply interested, it will be worth whilt to say some- thiv. J. ^ore upon this subject.

To ivo^fxuv 'ipu%i} Archceus spiritus ani^ males N atura—

These and various other terms have been employed to denote the principle of hfe, or that unknown energy, which makes the diffe- rence between an animated body, and an iur animated mass of matter.

In the physiology and pathology of the hur man body, tliere has been perhaps both too much and too little use made of that vital principle which constitutes the animal. Some have pretended to a knowledge of it much beyond what we have hitherto attained, and have employed it in the ministry of the animal ceconomy, and in explaining the causes and cures of diseases, guided much more by their own fancies and speculations, than by the au- thority of facts and experience; while others, in accounting for the same appearances, have overlooked the lavvs and powers peculiar to animal life, and have endeavoured to solve

all

HISTORY AND CURE OF DISEASES. 9

all difficulties by the common mechanical powers, and by the general properties of dead matter.

Whatever animation be, experience has un- doubtedly acquainted us with several means both of deadening, and of invigorating its ope- rations. Of the first sort is in an eminent degree the fox-glove, and all the narcotic poi- sons: to the second belong wine and spirituous liquors, all sirengtheners of the stomach, aro- matics, an 1 every thing capable of irri tating the senses. But vinous liquors in a certain quan- tity oppress, and some of the narcotics in a small dose exhilarate the powers of life.

Many of the narcotics being applied in a small wound, to any part of the surface of the body, will have their full effect in damping or destroying the vital energy; but most of them, and almost all of the opposite class, exert their powers only when taken down into the sto- mach; the control and dominion of which part over the princi])le of animation through- out the whole body are such, that universal refreshment and invigoration, orfaintness and death itself, will be the instantaneous effects of its being touched by certain friendly or in- jurious substances.

In all distempers it is one part of the phy- sicians

10 COMMENTARIES ON THE

sician's duty to remove or relieve, as far as can safely be done, the present inconveniences: but the mischief principally to be dreaded in every illness is its tendency to destroy life; and against this the patient is most solicitously to be guarded. Now of the means before men- tioned by which the vires vitae can be sup- ported and strengthened, great irritations of the senses can only afford a momentary relief in sudden languors and faintings. Wine and aromatics will indeed make a more lasting; impression on the stomach, and in many lan- guid illnesses may beadmmistered with great advantage; but they must be used with cau- tion, as the vinous liquors may intoxicate, and both of them in many distempers may excite too great a degree of heat. Dr. !Morton*s practice in the last century lias been much censured, for his method of cure by an immo- derate use of aromatics, for the purpose, as he says, of exciting and expanding the spiritus animales. A freer use niay safely be made of the mild astringents and bitters, and there are perhaps few disorders in which they would not make very useful associates of other me- dicines. Camomile llovrers in powder are sufficiently grateful to the stomach; but light infusions of the barks, and woods, and roots,

are

HISTORY AND CURE OF DISEASES. 11

are preferable to their powders. Of this verj numerous class of simples a great variety of medicines may be made; but none perhaps better than an infusion made by one ounce of the Peruvian bark and one dram of the root of gentian, put into a point of boiling water. I hardly know that distemper in which two ounces of this infusion might not be taken twice a day with safety, and, I believe, with advantage.

The Peruvian bark has been more objected to than any other of these medicines in cases of considerable inflammation, or where a free ex- pectoration is of importance; for it is supposed to have, beyond any other stomach medicine, such a strong bracing quality, as to tigliten the fibres still more which were already too mu(;h upon the streatch in an inflammation, and its astringency has been judged to be the likely means of checking or putting a stop to ex- pectoration. All this appeared much more plausible when taught in the schools of l)hy- sic, than probable when I attended to fact and experience. The unquestionable safety and acknowledged use of the bark in the worst stage of an inflammation, when it is tending to a mortification, affords a sutlicient answer to the first of these objections; and I have several

times

12 COMMENTARIES ON THE

times seen it given plentifully in the confluent small -pox, without lessening in any degree the expectoration. An asthma, which ssemed to be near its last stage, became very little trou- blesome for several years, during which the patient took two scruples of the bark every morning and night. If great care be taken not to give it in such a manner as to load or oppress the stomach, every reasonable objection would, in my judgment, be removed, to the giving of it in any distemper whatever. For the purpose now under consideration, its efficacy is the same with any other bitters; but some prefer- ence may perhaps be due to this simple on ac- countof its friendly pov.ers to the human body, manifested in its being a specific remedy for in- termittents: butifanyonecannotquiethisown or his patient's appreliensions of some lurking mischief in the Peruvian bark, any other mild bitter* may be used for the same purpose of enabling nature to struggle successfully with the malady, b}^ invigorating the principle of animation in the stomach. Too much atten-

* Such as a tew grains of camomile flowers powdered in a neutral saline draught; or an aromatic confection draught may be made up with a weak infusion of quassia wood, or columbo root; or, if it be made up with any dir>tilled water, twenty drops of the tinctui e of gentian, or of columbo root, inay be added to each draught.

tion

HISTORY AND CURE OF DISEASES. 13

tion can never be paid to this very important article of a just method of treating a patient; every distemper requires it, and in many it is all that a physician can do.

It is a most alarming stage of any illness, when the stomach has so entirely lost its pow- ers, that the person is averse from taking every thing that is offered; as if nature were con- scious that the vital powers were too nearly extinguished to )3e recoverable by any means, and therefore all were rejected: this death of the stomach never fails to be soon succeeded by an universal loss of life.

IIAP. 3.

Abdomen.

Tii R abdomen has been observed to swell from various other causes besides the more common ones of a dropsy either in the belly or ovaries, of pregnancy, or scirrhi of some of the viscera, or flatulence. The hard swelled bellies of children continue too long to be owing to flatulence, and they yield too soon to purging medicines to be occasioned by scirrhi. Upon the total ceasing of the menstrua, or iipon a temporary obstruction of them, the ab- domen

14 COMMENTARIES ON THE

domen will often be swelled, and continue so for some months. Women not uncommonly com- plain of such tumours after miscarriages, or afterbeinQ:brouG,littobed. Manvoftheseswell- ings are probably owing to some secret power of the nerves, which they frequently exert when disturbed by several poisons. They have in some persons been known to continue for two or three years; and, after a violent head- ach, the whole body has swelled, and subsided within an hour. Very large swellings, conti- nuing for two or three days, have been known to attend the attacks of the essera, or nettle- rash. Ithasoflenhappencd to the same person to have a tumour of the abdomen disappear upon the suddengushingof about a pint of wa- ter from the uterus. In oneperson, wdioseabdo- menhad been swelled for two or three years, a sudden swelling would often rise up in other parts, as on the thighs, back, and thorax, quite up to the neck. A tumour half as big as a child's head would suddenly rise up in the same patient's neck ; and though the swelling of the belly never totally disappeared, yet it would souietimes in a morning be hardly per- ceivable, and in an instant the whole abdomen would become so distended that the skin

seemed

HISTORY AND CURE OF DISEASES. 15

seemed ready to break. She often felt some- thing move from the stomach to the Umbs, which were immediately convulsed.

There often occur pains in the abdomen, si- milar to those which are frequently felt in the thorax, in which the viscera seem not at all concerned, but which are rather of a rheumatic nature, and will continue for a very long time. The remedies are the volatile liniment, v/ith, or without, the addition of laudanum; empl. cymini; a perpetual blister; an oily draught, witli as much volatile salt as can easily be borne; opium; andall therheumaticmedicines.

Chap. 4. Abortus.

One woman miscarried five-and-thirty times. Though the third month be most usually the time of miscarrying, yet there are some women who constantly miscarry about thefifth or sixth month; and in these the milk running oat of their breasts is a sign of the approach- ing miscarriage. A woman who was with child of twins miscarried of one at the end of three months, but went on with the other, who was born at the proper time, and lived to maturity. Abortions are the eflects of acci- dents,

16 COMMENTARIES ON THE

deats, of mal-confonnation, and of ill health : if frequently repeated, they are also the causes of ill health, and occasion the fluor albus, and the whole train of evils belonging to what is called the hysteric passion, and likewise those which are enumerated under the article of a broken constitution''^. One woman, after fre- quent abortions, took for a long time three drams of bark in a day while she was breed- ing, and went her time, and brought forth the strongest of all her children.

Chap. 5.

Ahus.

A VERY oreat difference is observable in different constitutions in regard to the eva- cuation by stool. One man never went but once in a month: another had twelve stools every day for thirty years, and afterwards se- ven in a day for seven years, and in the mean time did not fall away, but rather grcAV fat.

The fipces sometimes lie in the rectum for many months, and are collected into a large hard mass, which cannot be voided without the help of a surgeon. The signs of this are, pains in the belly; a <:onstant desire to go to stool,

* Chap. 94.

even

HISTORY AND CURE OF DISEASES. 17

even just after an evacuation ; none but liquid faeces are ever voided ; and the disorder is at- tended with a difficulty of making water.

The inner coat of the rectum is sometimes 90 relaxed as to come out after every stool, and in ridins;, and will not go up again with out the assistance of the hand : an astringent fomentation may be applied with some ad- vantage after every stool.

With the tape-worm, and Avith the ascaridesj there is a most troublesome and almost intole- rable itching of the fundament towards night.

Great pains are not uncommonly felt in the anus, which are sometimes relieved, but oftener exasperated, by stool, and are not un frequently worse in bed than in the day-time, and even than in walking or riding ; and in this state they will last several years. A small blister kept open upon the thigh for two or three months has cured this disorder. These pains sometimes proceed from an inflamma-* tion, and are aooravated to an almost into- lerable degree by sitting, standing, coughing, sneezing, or making \vater. Where the inflam- mation has suppurated, the healing of the al'> scess will in some constitutions be succeeded by broken health, or by a fatal pulmonary consumption ; whether it be because the dis- order at first was not merely local, or because

C the

18 COMMENTARIES ON THE

the habit of body became diseased by the too long continuance of the ulcer before it was properly opened and healed. In order to pre- vent these mischievous consequences, it is often advisable to open an issue as soon as the abscess begins to heal *.

Chap. 6.

Aneurysma. Aneurv^smatic tumors of the neck will often continue for many years, attended with some degree of difficulty in breathing, and at last end in sudden death. Many tumors of the neck, apparently of this sort, from having a strong pulsation in them, have after several years spontaneously decreased, till at last they have almost disappeared.

Chap. 7. Angina, and Scarlet Fever, The scarlet fever begins with the common symptoms of other fevers. On the first or se- cond day an unusual redness appears on the skin, and there isashght pain of the throat. At the same time in some patients there are swell-

See chap. 40, on the Fistula Ani*

ings

HISTORY AND CURE OF DISEASES. 19

ings under each ear, or in other glands, which are not always dispersed without coming to suppuration. In others, the arms, and particu- larly the fingers, have swelled; which swellings have happened indifFerentlj, both where the disease hath proved gentle, and where it hath been fatal. On the third or fourth day the soreness of the throat goes off; about the sixth day the redness of the skin begins to retreat; and, if all things go on well, the distemper abates very fast after the seventh day.

In some of these fevers the whole skin is coloured, in others only the breast and arms; and it is not uncommon to see the redness only on the back of the wrist. This scarlet colour is either equally diffused over the whole skin, without any spots or small pimples, or is deeper coloured in some places, and lighter in others ; or it is attended with little swellings, like the stinging of nettles; or else v.'ith very small eruptions, like the measles. After the redness has disappeared, the whole skin is often re- newed, the old one either peeling off in large pieces, or becoming rough and branny, and so falling off. The redness of tlie skin affords no certain mark of the degree and event of th^j disorder : I have seen it become much more florid without any relief to the patient, and grow pale without any ill consequence: the c 2 warmth

£0 COMMENTARIES ON THE

warmth of the bed is so far from being always the certain means of making the eruption more florid and vigorous, that I remarked it in one patient to have been constantly faint and hin- guid while she was in bed, and to liave a far livelier hue as long as she was up.

The eruption is often attended with a vcr}^ troublesome itching. It sometimes resembles the measles so exactly as not to be easily dis- tinguished from the measley efflorescence ; though this be a matter of great importance, because the method of cure in these two dis- tempers is extremely different. The redness of the scarlet fever is more equally diffused than in the measles, and is not in distinct spots with the natural colour of tb.e skin interposed; yet, in some ihw cases, I have seen it so. Then in the measles the eruption rises more above the skin, and occasions a manifest rouohness to the touch, which is hardly observable in the scarlet fever, except a very little roughness sometimes in the arms. In the scarlet fever there is no cough, the e3^es do not water, and the eye-lids are not read and swoln; all which rarely fail to attend the measles. The time likewise of the eruption is different; for it ap- pears in the scarlet fever both in the fece and urms on the first or second day; but in the measles it begins only on the third day of die

fever

HISTORY AND CURE OF DISEASES. 21

fever to be visible about the chin, and does not come to the arms and hands till the fourth Or fifth day.

Beside the restlessness and languor, which are very great in the scarlet fever, several who have it in a oreat degjree are troubled with a sharp humour in their throats and nostrils, which makes them deaf, and hoarse, and even dumb, and takes away their senses of tasting and smelling. The inside of the nostrils and all the upper lip has beisn so corroded with this humour, as to leave these parts sore and scabbed for a Ions; time alter the ceasins; of the fever.

This distemper is not often fatal; and is sometimes so very slight as to last hardly a da3% and woukl be utterly unnoticed, if, to- getlier with other very gentle symptoms, there were not somebluslior redness perceivable in the skin, and if at the same time others of the family were not ill of this fever in a more violent manner, so as to leave no room to doubt about its nature.

There is no other distemper in which a delirium is of so little importance as in this ; in other fevers it seldom comes on till they have arrived at a dangerous height; but it sometimes accompanies a scarlet fever on the very first day; and many of these patients never fail to

c 3 be

22 COMMENTARIES ON THE

be light-headed every night, though, except this, there be not any unfavourable symptom from the beginning to the end of their illness.

The small-pox is not more infectious than this malady among children and very young persons of both sexes. After their twentieth year, men are very little liable to catch it, though I have seen one man in it who was four-and-thirt^s but I have not unfrequently known not only the middle-aged, but even elderly women ill of this distemper: however, the older they are, the more secure they are found to be from its contagion.

This fever has begun to show itself on the fifth day afterthe infection was, most probably, taken by those who, being perfectly well be- fore, have been brought to the house where some children were ill of it; and perhaps the space of time intervening between the infec- tion and sickening may here, as well as in the small-pox, be generally nearly the same.

Where the scarlet fever proves fatal, a coma will sometimes show itself about the fifth or sixth day, or a shortness of breath with spitr ting of blood, in those whose lungs appeared before to be sound. Some few are attacked with such violence as to die within the first three days«

After

HISTORY AND CURE OP DISEASES. 23

After the fever is much abated, and all dan- ger is past, the glands under the ears will sometimes swell with considerable pain, and even come to suppuration, and in some the testicles have swelled: the limbs will also be afflicted with rheumatic pains.

In the fever which has just been described, there is always some degree of redness in the skin, and the throat is not without an uneasy sensation. Where it happens that the throat is full of little ulcers attended with considerable pain, there the disease, though the skin be ever so red, is not denominated from this colour, but from the soreness of the throat, and ob- tains the name of the molignaiit soi^e throat ; and many suppose that the two disorders differ in nature as well as in name : of this let Ihe reader judge, when he has considered the histories of both.

§ 2. The MaUgna7it Sore Throat.

It is matter of doubt whether, in some in- stances of the malignant sore