Practical rules of diet in the various constitutions and diseases of human bodies: By John Arbuthnot, ...

CHAP. III.

Of Acute Diseases.

Fevers, with their various Symptoms.

RIGOR, Coldness. A right Regi|men during the Rigor or cold Fit in the beginning of a Fever, is of great Importance, and Mistakes of dangerous Consequence: A long continued Rigor is a Sign of a strong Disease, and is in it self an. Approach towards Death; during the Rigor, the Circulation is less quick, and the Blood actually stag|nates in the Extremities, and pres|sing upon the Heart creates great Anxieties, and may produce Con|cretions about the Heart, and in other Parts of the Body; therefore a Rigor increaseth an Inflammation. Those who die of Quartan Fevers, die in the cold Fit; and indeed there

is no Mischief but what may pro|ceed from a Rigor of long Dura|tion.

In such Rigors, all warm Cordials and stimulating Substances are im|proper, for the first acting with force upon the right Ventricle of the Heart, may drive the Blood with too much Force through the Lungs; and stimulating Substances, by con|stringing the Vessels, often increase the Symptom.

In such a Rigor, nothing is more proper than Water, which dilutes and relaxes at the same time, and will sooner terminate the cold Fit, and throw the Patient into a Sweat, than the warmest Cordial; if a very small Quantity of Rhenish Wine be mix'd with the Water, it will be still more effectual: In this Case strong Fric|tions of the Extremities relieve.

Anxieties. In Anxieties which at|tend Fevers, when the cold Fit is over, a warmer Regimen may be

allow'd; and because Anxieties often happen by Spasms from Wind, Spices are useful.

In those Anxieties, Soapy Sub|stances which dissolve the Blood, are indicated; ripe Fruits; some of the lactescent Plants, as Lettuce, Endive, &c. and especially Honey, have this Quality.

Thirst. In Thirst attending Fevers, Liquors should not be drank quite cold; for cold Liquors, by constring|ing the Glands of the Palate and Throat, do not quench Thirst so well as Liquors moderately warm: In this Case subacid Liquors should be drank plentifully; all Salts increase Thirst, except Nitre, and dulcify'd Spi|rit of Nitre mix'd with Water, is very proper in this Case; so are Barley|Water and Emulsions, except in great Weakness and Flatulencies of the Sto|mach, in which Case Water mix'd with a small Quantity of Rhenish Wine, is best of all.

Sickness, Vomiting. This is one of the most troublesome Symptoms at|tending a Fever, because it renders the Patient incapable of taking any thing.

This Symptom is often prevented by giving a Vomit; or cur'd by pro|moting the Vomiting for a while by tepid Water.

During the Symptom, acid Li|quors, and ev'n such as are austere and astringent, are indicated, because such strengthen the Fibres of the Stomach; and indeed Nature directs Patients to such a Diet, for they co|vet subacid Liquors, and abhor fat and oily things.

Diluting, and sometimes relaxing the Belly, and carrying the bilious Salts downwards, often cures this Symptom.

Attention is to be given to the Appetites of Patients, in this and many other Cases, who have some|times coveted odd things which

have reliev'd them, as Salt, Vine|gar, &c.

Vomiting, from a bilious Cause, is cur'd by subacid Liquors; Vomit|ing, from some putrid Cause, by Salts of all Kinds; in such a Case, Water-Gruel with Cream of Tartar, Rhenish Wine and Water, Jelly of Currants, Marmalade of Quinces, Sorrel boil'd in Broths well skimm'd from Fat, are beneficial.

If the Vomiting comes from a phlegmatick Cause, Spices, and bit|ter things will relieve. The Counter|poison must be adapted to the Cause; for Example, in Poison from Subli|mated Corrosive, and Arsenick.

In the First, alkaline Substances; in the Second, oily Substances are proper; in both, diluent.

It is easy to judge of the Cause by the Substances which the Patient throws up.

Whether Vomit may be safely or properly given, must be judg'd by the Circumstances; if there be any Symptoms of an Inflammation of the Stomach, a Vomit is ex|tremely dangerous.

Wind and Spasms are occasion'd by the feverish Heat expanding the ae|rial Particles in the Fluids.

Whatever is anodyne and quiets Convulsions, and what abates the Heat, relieves this Symptom.

Weakness, or the Impotence of ex|ercising animal Motion which attends Fevers, proceeds from too great Ful|ness in the beginning, and too great Inanition in the latter end of the Disease; for whatever stops or re|tards the Circulation in the smallest Vessels, especially those of the Brain (which either of these Causes will do) produceth this Symptom. Those two Causes demand different Me|thods, in the first emptying and dilu|ting;

in the latter, a more plentiful Nourishment, the use of Wine dilu|ted with Water, and Spices in small Quantities, Jellies, Broths, the alka|lescent Quality of which may be cor|rected with some acid, unless there be Signs of Acidity, and in that Case the Diet ought to be contrary to the Cause of the Symptom; Viper-Broth is both anti-acid and nourishing.

In Debility, from great Loss of Blood, Wine, and all Aliment that is easily assimulated, or turn'd into Blood, is proper; Blood is required to make Blood; a small Quantity of Blood brings the Patient into danger of a Dropsy.

Frictions of the extreme Parts re|lieve Weaknesses, as they promote the Flux of the Juices and Spirits in the Joints and Limbs.

Fat People are most subject to this Symptom of Weakness in Fevers, because the Fat, melted by the fever|ish Heat, obstructs the small Canals,

and consequently produceth this Symptom. This is evident by the great Loss of Fat such People sustain in Fevers. In the latter end of Fe|vers, such are weak by the Laxity of the Fibres, and the Emptiness of the smaller Vessels; such therefore must be treated with particular Care, viz, after due Evacuations, diluting strongly both by Drink and Clysters, avoiding all things oily, and using Sugar, Honey, and ripe Fruits.

Cordials made of spirituous Li|quors are not the best Remedies for this Debility, tho' they increase the Force of the Heart, and are necessa|ry sometimes to keep up the vital Functions, they rather coagulate the Fluid; they add Strength to the Mill, but congeal the Stream. Whatever makes the Circulation more free through the small Vessels, is a Cor|dial.

Heat; the Degree of which may be known by the Thermoscope, the

Sensation of the Patient, the Intense|ness of the red Colour of the Urine, the Sizeness of the Blood, the Dissi|pation of the fluid Parts, which renders it thicker; the Hardness, Strength, and Frequency of the Pulse, which makes the Friction the stronger, to which the Heat is pro|portional, the bad Disposition of the Humour, and the dry Temperament of the Body.

Feverish Heat is moderated by Blood-letting, by muscular Rest, by moderate Ligatures which compress the Veins only, and often removed from Joint to Joint, by a mechanical Rea|son, retard the Circulation; of such sort is dry Cupping, bathing the lower Parts, watery Liquors for Drink, not cold, but tepid; subacid, as Jel|ly of Currants dissolved in tepid wa|tery Liquors; Decoctions of mealy Substances acidulated, Substances a|nodyne, Substances which dissolve Concretions, as Sugar, Honey, and

the simple Oxymel, often used by Hippocrates, plentiful diluting, and restoring as much Water to the Blood as is dissipated by the Heat; all de|mulcent and relaxing Substances, cooling the Air in the Room, open|ing the Curtains, and removing too thick Bed-clothes; all stimulating and slyptick Substances to be avoided, be|cause they increase the Force of the solid Parts.

Delirium. Too great Alacrity and Promptness in Answering, especially in Persons naturally of another Tem|per, is a Sign of an approaching De|lirium: In a feverish Delirium there is a small Inflammation of the Brain; therefore any thing which increaseth the Circulation in the lower Parts, and diminisheth the Pressure on the Brain, is beneficial, as immerging the Feet in warm Water; nothing relieves the Head more than the Piles, therefore Suppositories of Ho|ney, Aloes, and Rock-Salt, ought

to be try'd, relaxing by emollient and watery Substances, both in Drink and Clysters, especially Bar|ley-Cream and Barley-Gruel.

Coma Sleepiness. A Coma will proceed either from a Pressure upon the Originals of the Nerves, by too great Repletion; or from a Penury of Spirits by too great Ina|nition.

Old Men are subject to Comas by the Tenacity of the Fluids circula|ting in the Brain, which being re|solved by the Fever, obstruct the small Canals of the Brain: In young People it commonly proceeds from Fulness, and is best cur'd by letting Blood, and relaxing the Belly. The Sign of such a Fulness is, a red Countenance, and Eyes inflamed; if it proceeds from a glutinous Oil, it ought to be attempted to be resolv'd by Water, nitrous Salts, Soaps, and subacid Liquors.

People recovering from Comas, must take at first soft Nourishment, and in small Quantities.

Watchfulness. This Symptom, which is sometimes call'd a Coma Vigil, often precedes too great Sleepi|ness, and is perhaps the most ill-bo|ding Symptom of a Fever.

The Expedients in such a Case are extreme Care to keep the Pa|tient from Noise, and what makes any strong Impression upon his Senses, some of those Helps us'd in a Deli|rium, because this is an Approach to|wards it; a moist softening Diet; all Preparations of Barley, Emulsions of Poppy Seeds, and Almonds, Ali|ment of some lactescent Plants, espe|cially Lettuces, Decoctions of Scor|zonera Roots, Almond Cream, and what is call'd Winter Flummery, us'd as Aliment; Tea, made of Cowslip Flowers, relaxing gently the Belly.

Boerhaave proposes some mecha|nical Expedients which may perhaps have a good Effect, as a soft Noise of Water distilling by Drops into a Bason, and the Patient trying to reckon them.

The Air perfum'd with the Smell of soporiferous Plants, as Poppies, Mandrakes, Nightshade, Bean Flow|ers.

Application of Cloths dipp'd in Vinegar to the Temples.

Opiats must never be given but after great Evacuations.

Convulsions. It is of the utmost Importance to know the Cause and the Seat of this Disease, which is of|ten obscure.

In Infants they commonly pro|ceed from Acidity in the Stomach, and are cured by terrestrial Absor|bents; in such indeed Convulsions attending Fevers are not quite so dangerous.

Convulsions arising from some Acrimony in the Stomach, or from something vellicating a Nerve in its Extremity, and not in its Original where it ariseth from the Brain, are not very dangerous.

Convulsions which arise from great Evacuations, as great Haemorrages attending Fevers, are dangerous.

Convulsions arising from Inflam|mations of the Membranes of the Brain are commonly fatal: The Symptoms attending them are a great Heat, a hard Pulse, and a De|lirium: The Remedies, and even those from Diet, are to be us'd ac|cording to the Seat of the Disease.

If from the Stomach, such Ali|ments as are contrary to the par|ticular Acrimony, Acid Alkaline, or Oily, residing there, as in the Case of Vomiting.

If from something impacted in the Brain, warm volatile and spicy Substances will increase the Disease;

in that Case, Substances which re|lax and dilute are proper, especially such as open the Belly; which, See in the First Chapter; and in general, the Regimen prescrib'd in a Coma, or Delirium.

Violent Sweats proceed from a Laxity of the Vessels, and too vehe|ment a Circulation of the Blood.

Profuse Sweats deprive the Blood of its most fluid Parts, thicken, and often cause Obstructions; it is not good Practice to push Sweating too much in Fevers, except in such as are pestilential.

In profuse Sweats, Care at least should be taken, by diluting, to re|store the Liquid which the Blood loseth, and to use the Methods ad|vised in too great Heat, by taking away some of the Coverings of the Bed, and admitting of cool Air, and using a Diet moderately astrin|gent; Wine, Spices, and spirituous Liquors, in this Case, have often a

good Effect; spirituous Liquors thick|en the Fluids; Sage is a good Re|medy in the Case of profuse Sweats.

A Diarrhoea Looseness proves often a dangerous and fatal Symptom in Fe|vers, it weakens, excoriates and inflames the Bowels, occasions Bloody-Fluxes, thickens the circulating Juices, and exhausts the Strength of the Patient; notwithstanding, a critical Diarrhoea is not to be stopt, for fear of in|curring these Dangers.

Attention is to be given to the Cause of Acidity; it is to be cur'd by Anti-acids; but, as in Fevers, the Cause is more frequently alkaline and bilious, Acid or four things resolve, and it happens that oily Substances by blasting the Acrimony will do good in Diarrhoeas. Oily Substances of themselves do not irritate or pro|voke Diarrhoeas, they only lubricate or make the Bowels slippery. Diar|hoeas arising from Quantities of Fruit are often cur'd by Emulsions.

Vomiting, by evacuating the irri|tating Cause, often cures such Diar|rhoeas.

Anodyne Substances are proper, and generally speaking, solid and dry Aliment, rather than liquid.

Inflammatory Eruptions. In all these of any kind whatsoever, as Small-Pox, Meazles, Scarlet Fever, Purples, the Intention in Diet ought to be, to avoid strong Sudo|rificks, which push out too great a Quantity of the Matter upon the Skin; to use cooling and temperate Diluents, which keep the Matter flu|id and moveable, so that it may be secern'd from the Blood; to keep warm during the Eruption; and that then Diet be cool; for which Reason the moderate Use of Acids, as Juice of Limon, is indicated.

A due Attention to the few Rules above-mention'd, in the several Symp|toms, will prove very successful in the Cure of most Fevers. I shall

only add a few more according to the various Kinds of Fevers and In|flammatory Distempers.

An Ephemera, or a Fever of one Day, is cur'd by Abstinence, Rest, and Diluting; and the same Method will prove effectual if the Fever lasts se|veral Days, and is not putrid, or attend|ed with a greater Inflammation and Acrimony, and Obstruction of the Vessels in some Parts of the Body, amongst which is what is commonly call'd, a Causus, or burning Fever.

The Causes of such a Fever are various; Errors in the Non-Naturals, Air, Meat and Drink, Rest and Mo|tion. Such a Fever will be rais'd by Vehement Exercise or Labour, Heat of the Sun, by long Thirst, by the immoderate Use of fermented and spirituous Liquors; and hot things, as Spices; and by great Lassitude en|dured any way, especially in hot Weather.

Its Symptoms are a burning Heat in the Skin, a Sensation of extreme Heat inwardly; sometimes Coldness in the extreme Parts; Dryness of the Skin, Mouth, and Nostrils; a Dryness and Roughness of the Tongue; laborious and short breath|ing; great Thirst; Loathing, Sick|ness of the Stomach, and Vomiting; Anxiety, Restlesness, Weariness; some|times a Cough and Hoarseness; Watch|fulness and Delirium, and Exacerba|tion every other Day.

Such a Fever is often resolv'd by a bleeding at the Nose, which ought not to be stop'd unless it endangers Life. It is likewise often in the cri|tical Day resolv'd by Sweating, Vo|miting, Looseness, and Spitting of thick Phlegm. The fatal Signs are commonly bloody Urine, Difficulty of Swallowing, watery Sweats about the Head and Face, without Relief; Coldness of the Extremities, Trem|bling, too great a Looseness; and

sometimes an Inflammation of the Lungs.

The Regimen, in such a Fever, is keeping the Air of the Room pure and cool, untainted with Fire, Smoke, or the Breaths of many People; they ought to have no more Bed-clothes than barely protects them from Cold; their Curtains ought to be kept open so as to renew the Air; and their Posture in lying, as erect as they can bear; the Sick, in this Condition, covet all these things, and their Con|traries offend them.

Their Drink ought to be cool, mild, subacid, tepid, given in moderate Quantities, and often, as Water with Juice of Limon or Tama|rinds.

Their Aliment ought to be light, of farinaceous Vegetables, as Water-Gruel, Preparations of Barley, with some Juice of Limon; Rice boil'd in Whey, and strain'd. Roasted Apples in the Progress of the Disease; a lit|tle

toasted Bread with Rhenish Wine and Water, Jelly of Currants; Broths and Jellies made of animal Substances are rather too alkalescent, at least they ought to be qualify'd with Juices of Limon, or some acid.

Sometimes such alimentary Sub|stances as gently stimulate the Belly, are useful, as some ripe Fruits, Straw|berries, Currants, Mulberries.

The Symptoms increase by the Use of hot things given either as Ali|ment or Medicine.

Intermitting Fevers.

They are (at least in this Country) very obstinate, often return in spite of all Remedies, and by long Con|tinuance they degenerate into Hepa|tical Fevers, and many chronical Dis|tempers, as Jaundice, Dropsy, Schir|rus's, and Scurvies; therefore in this Disease a right Method, both of Me|dicines and Diet, is of great Impor|tance.

There is a great Variety in these Diseases, as to the Intervals of Times between the Paroxysms; Ter|tians sometimes redouble their Paro|xysms, so as to appear like Quotidians. I think it may be taken as a general Rule, That the greater Distance of Time there is between the Paroxysms, the Fever is less dangerous, but more obstinate.

There is a different Regimen to be us'd during the Continuance and Absence of the Paroxysm; and in the Paroxysm itself, during the Rigor or cold Fit, the Heat and the Sweat.

During the Rigor, the Regimen prescrib'd in the foregoing Part of this Chapter, in the Article of Fever|ish Rigors, is proper in all Fevers, and Care is to be taken by all pro|per Methods to shorten that Period as much as possible, and by tepid Di|luents to bring on the Sweat soon, but not to push it beyond its due Measure, because an intermitting Fe|ver

relaxeth and weakens the Body extremely.

Between the Paroxysms, too great Abstinence is hurtful as much as too great Repletion; as intermitting Fe|vers are often of long Continuance, extreme Abstinence is impractica|ble, and would reduce the Pa|tient to a Condition not to be able to sustain the Shock of the next At|tack.

Between the Paroxysms, such Sub|stances as temper, correct, and sub|due the bilious Alkali, as acid Sub|stances, nitrous Salts, small thin Wines with Water, Chicken Broth with Juice of Limons; Wine with Bitters infused, are proper; Cichory and Dandelion are useful, because the ex|press'd Juices of them cure intermit|ting Fevers in warm Countries; the Physicians of these Countries likewise use astringent Vegetables, See Chap. I. N^o 1.

Exercise, to as great a degree as the Patient can bear, is extremely beneficial between the Paroxysms.

But the chief Remedy of all is to endeavour to prevent the cold Fit, by getting to Bed, by Frictions, and some sudorifick and warm Liquor; for by putting off the cold Fit some Agues have been cur'd.

Letting of Blood seldom does good, and often a great deal of Hurt in intermitting Fevers; but the Con|dition of the Patient is to be consi|der'd in this Case.

Intermitting Fevers have been ob|served to free from some Chronical Distempers, as the Gout and Con|vulsions, but they often induce great ones themselves.

INFLAMMATORY DISEASES.

A Phrensy, or Inflammation of the Brain.

This Disease, of all others, re|quires the speediest Applications, profuse Haemorrages from the Nose commonly resolve it, and copious Bleeding, by opening the temporal Arteries, are the most effectual Re|medies: But to stick to my Subject, which is the Diet.

Substances which cool, and at the same time relax the Belly, are highly beneficial, as Tamarinds boil'd in Water, which taken plentifully may at last bring a Looseness which is a great Relief to the Head.

Soliciting the Blood to other Parts of the Body; therefore tepid Bathings of the lower Parts, and procuring the Piles, relaxing Fomentations apply'd to the Veins, which carry the Blood from the Head, relieve in this Di|sease.

Cool Air, and Sitting up, if possible; for the warm Air of the Bed exagitates the Blood.

The Aliment ought to be slender, of farinaceous Substances, as Water-Gruel acidulated, or subacid ripe Fruits, with their Jellies; the Drink small, diluting, and cooling, Barley-Water, Small-Beer, or the Decoction of Tamarinds above-mentioned. All such gentle Anodynes as are to be found amongst the Alimentary Kind, are safe. See the Articles of Deli|rium and Watchfulness in this Chap|ter.

Quincy.

The Tumour of the Throat, which occasions the Difficulty of Swallowing and Breathing, attending this Dis|temper, may be of various sorts: Sometimes it proceeds from a Serosi|ty obstructing the Glands, which may be watery, aedematose, schirrous,

according to the several degrees of the Viscosity of the Humour; some|time inflammatory, which Inflamma|tion will sometimes end in a Suppu|ration, or Gangrene.

The Difficulties of Breathing and Swallowing, which happen without any Tumour outward or inward, af|ter long Diseases, proceed commonly from a Resolution or paralytical Dis|position of the Parts, and is the im|mediate Forerunner of Death.

The Regimen in those Quincies which proceed merely from the Ob|struction of the Glands, must be to use such warm Liquors as gently re|lax, soften, and moisten those Glands, such as carry off the redundant Se|rum by Stool, Sweat, and Urine; or by stimulating, open the Emuncto|ries of these Glands to secern the Humour* 1.1.

In a more watery Tumour, the Diet may be more warm than in the inflammatory, and the moderate use of Wine often relieves the Patient.

The Difficulty of Swallowing and Breathing, occasion'd by Schirrosities of the Glands, is not to be cur'd any otherwise than by Extirpation.

Those who are subject to Inflam|mations of the Throat, ought to live temperately to prevent a Plethora; or to break such a Fulness speedily by proper Evacuations, to beware of cold Air, too astringent or stimula|ting Aliment or Medicine, and vio|lent Exercise, which, by increasing the projectile Motion of the Blood, heat; but especially the swallowing of cold Liquors when they are hot.

In these Inflammations a slight Di|arrhoea relieves; therefore Aliments which promote it are useful, as Ta|marinds infus'd in Whey. Decoc|tions and Emulsions of farinaceous

Vegetables moderately acidulated, and such as abound with a cooling ni|trous Salt, are proper; it is com|monly thought that Punpenella, Saxi|fraga, or Burnet, is a Specifick in this Case: Every body knows the Be|nefit of Mulberries, taken all man|ner of ways. All Acids, as Sorrel, Juice of Limon, &c. abate Inflam|mations.

The Mouth and Throat must be kept moist, and the Nose clear, that the Air may have a free Passage through it; for Air drawn by the Mouth, dries.

When the Deglutition is totally abolish'd, the Patient may be nou|rish'd by Clysters, which I have known to have been done for a whole Week, after which the Tumour suppurated.

When the Inflammation ends in a Gangrene, the Case generally proves mortal, except it be only in the Tonsils, Uvula, and Palate, and go no

further, which Parts may be separated, and the Patient live.

Inflammation of the Lungs.

Such may happen either in the bronchial or pulmonary Vessels, and may soon be communicated from one to the other; when the Inflam|mation affects both the Lobes and the whole Body of the Lungs, the Case is desperate, because the Circulation must be stopt, and no Blood can flow back into the Heart. Besides the general Causes of Inflammations, those which affect the Lungs particu|larly, are a bad Conformation of the Lungs and Thorax commonly atten|ded with an Asthma, Air too hot, cold and moist, abounding perhaps with caustick, astringent, and coa|gulating Particles; the Lungs, pro|perly speaking, are an outward Part of the Body, expos'd to the Air, which, by its immediate Contact may easily

coagulate the Blood which flows a|long the Surfaces of the Air-Bladders, and I believe the Qualities of the Air are the general Cause of the In|flammation of the Lungs which hap|pen in the Winter time.

As the Lungs are the chief Organ of Sanguification, crude and viscous Chyle, viscous Aliment, Spices, but especially spirituous Liquors, may oc|casion this Inflammation; too great an Exercise of the Lungs, so as to occasion a short and laborious Breath|ing, or keeping them too long upon the Stretch by Vociferation, or loud Singing, may produce the same Ef|fect: There are coagulating Poisons which affect the Lungs very suddenly; extreme violent Passions, by affecting the Motion of the Heart, may do the same; it is a common thing to see People in sudden Transports of Anger breathe short. Inflammations are sometimes translated from other Parts to the Lungs; a Pleurisy easily

passeth into Peripneumony. The a|voiding those Causes is the best Rule of Diet to prevent the Disease; be|sides, speedy and plentiful letting of Blood before it has quite taken place.

This Disease is often cur'd by the critical Resolution, Concoction, and Evacuation of the morbifick Matter, which is either attenuated so as to be return'd into the Channels, and to go on in the common. Thread of Circulation, or expectorated by Coughing, which may be easily known by the Abatement of Symp|toms, viz. the Fever, Difficulty of Breathing, Thirst, Anxiety, Restles|ness, and the Patient's falling into gentle breathing Sweats. One of the best Resolvents is the Blood of the wild Goat.

Copious Bleeding is the most ef|fectual Remedy in the beginning of the Disease; but when the Expecto|ration goes on successfully, not so

proper, because it sometimes suppres|seth it, and in that Case Sudorificks thicken the Matter that is expectora|ted. The Motions of Nature ought to be followed. This by the way.

From the Symptoms in this Stage of the Disease, and the use of the Lungs, it is evident the Aliment ought to be more slender and thin than in any other inflammatory Di|sease whatsoever, common Whey be|ing sufficient to preserve the Strength of the Patient; watery Liquors, and even the Steam of warm Water ta|ken in by the Breath, attenuates the impacted Matter. Relaxing Ali|ment, of which Barley and all its Preparations are the best.

In this State, Diureticks, which have not much Acrimony in them, are proper, for Fluxes of Urine re|lieve the Lungs; for this Intention, an Infusion of Fenel Roots in warm Water, with Milk, is good, both as Nourishment and Drinks.

If Nature relieves by a Diarrhoea, without sinking the Strength of the Patient, it is not to be stopt, but promoted gently by emollient Cly|sters.

Decoction of Cichory, Lettuce, as being anodyne and resolvent, are proper.

If the Patient is not reliev'd nor dies in eight Days, the Inflammation ends in a Suppuration and an Abscess in the Lungs, and sometimes in some other Part of the Body; the Symptoms of which are, an obstinate dry Cough, increas'd by Motion and taking of Food; theeasiest Posture in Lying be|ing upon the affected Side; a continual Lent-Fever, with Rigors invading with uncertain Periods; Exacerbations af|ter Motion and Repast, Thirst, Night-Sweats, a frothy Urine, Paleness, Leanness, Weakness.

In such a Case one must forbear letting of Blood. The Diet must be mild, soft, incrassating, and more

plentiful; tepid Vapours admitted into the Lungs, of Decoctions of proper Ingredients; and when by the Symptoms and Time the Impost|hume may be judg'd to be ripe, the Vapour of Vinegar it self, and any thing which creates a Cough, as Oxymel, or Vinegar and Honey, Exercise and Concussion are proper, the sooner it is broke, the less Dan|ger to the Lungs.

Tho' such a State is extremely dan|gerous, it is not quite desperate; the Aliment ought to be Milk; the Drink, Milk, and Barley-Water, and such alimentary Substances as are ex|pectorating and cleansing, with gen|tle Anodynes, that the Patient may have some Rest. See Chap I.

The principal Intention in every State of Inflammation of the Lungs is to promote Expectoration, and to restore it when it is lost.

If the Inflammation ends in a Gangrene, the Case is desperate; if in a Schirrus, incurable.

There is a spurious sort of a Pe|ripneumony, not inflammatory; when the Vessels are obstructed with a vis|cous Pituite that mixeth with the Blood, and invades in cold Weather, it is dangerous, and often suffocates; it is incident to weak and old Peo|ple. In this, some of the Methods used in the Inflammatory are pro|per, but not so copious Bleeding, Clysters frequently injected; Ali|ment more generous, Broths, and Jellies with Juice of Limon, Hydro|mel, or Honey and Water; for Drink, soft Oils, and Aliments which abound with a soft, not volatile Oil, are beneficial.

A Peripneumony is the last fatal Symptom of every Disease, for no Body dies without a Stagnation of the Blood in the Lungs; as long as

it circulates through the Lungs, it will circulate through the rest of the Body. The total Extinction of Breath is caus'd by the Stagnation of Blood in the Lungs.

Pleurisy.

There is none of the Membranes which invest the Inside of the Breast, but may be the Seat of this Disease, the Mediastine as well as the Pleura.

The Causes of this Disease, be|sides those common to all Inflamma|tions, are often a particular Disposi|tion to inflammatory Distempers, a Straitness of the Arteries of the Pleu|ra, a Callosity of that Membrane, an Adhesion of the Lungs, the sud|den Admission of cold Air by too thin clothing, too hot a Regimen, and especially the copious use of spi|rituous Liquors, cold Liquors drank when the Body is very hot, a Trans|lation

of some inflammatory Matter from some other Part, but most of all cold Air from a Northerly or North-easterly Wind; from which Causes proper Cautions may be ta|ken in the Regimen by way of Pre|vention.

This Disease is sometimes dry, without any Spitting, and sometimes attended with Expectoration from the Lungs, and that is taken off by a Coction and Resolution of the feverish Matter, or terminates in Suppurations, or a Gangrene.

The Regimen ought to be much the same as in a Peripneumony, a cool, relaxing, slender, diluting Diet, and avoiding all things which in|crease Heat, even too hot Air.

The Symptoms of Suppuration are the same as in Inflammations of the Lungs; when the Matter is made, the Side must be opened to let it out.

When the Disease is obstinate a|gainst all Remedies, a sudden Abate|ment of the Pain, a quick weak Pulse, sometimes intermitting, short Breath and cold Sweats are Symp|toms of a Gangrene, and approach|ing Death.

Paraphrenitis, or Inflammation of the Diaphragm.

The Symptoms of this Disease (which is often mistaken) are a vio|lent Fever, a most exquisite Pain in|creas'd upon Inspiration; by which it is distinguish'd from a Pleurisy, in which the greatest Pain is in Expi|ration.

This Pain is increas'd by Sickness, Vomiting, Repletion of the Sto|mach, or any Compression of the Muscles of the Abdomen, by render|ing the Faeces or Urine. The Breath|ing is extremely quick, suffocating,

and seems to be perform'd only by the Motion of the Breast: It is like|wise attended with a Delirium, Fury, and an involuntary Laughter, the Convulsion emulating this Mo|tion.

This Disease terminates as Pleuri|sies and Peripneumonies, but is ge|nerally fatal if it suppurates the Pus, is evacuated into the lower Belly, where it produceth Putrefaction, and a most miserable and painful Death.

The Regimen, if any can be suc|cessful, ought to be the some as in Pleurisies.

Inflammation of the Liver.

The hepatical Artery, and the Vena Porta, carry the Blood into the Liver; the first being very small, and the Mo|tion of the Blood in the last being slow, is the reason that Inflammations in the Liver are not so frequent as in

some other Parts of the Body; but when they obtain, extremely dange|rous, unless they take up but a small Part of the Liver, and such happen more frequently than is commonly imagined.

Some of the best Cautions in Diet may be taken from the Causes and Symptoms of this Disease.

Which, besides the general Causes of Inflammations, are extreme Fat|ness. Fat dissolv'd by Heat and In|flammations obstructs the Vessels of the Liver very suddenly. Cattle fat|ted by good Pasturage, after violent Motion, sometimes die suddenly; in such the Liver is found to be in|flamed and corrupted. An atrabila|rian adust Temper of the Blood and Gall, an acrimonious or purulent Matter, stagnating in some other Or|gan, is more easily deposited upon the Liver than any other Part, especially if attended with the use of hot and spicy Aliments, spirituous

Liquors, great Heat, and a Fever▪ Erosions, by the Acrimony of the Gall, or Obstructions by Viscosity; any Callosity, Schirrus, or Stone in the Liver; Thirst, long endur'd, be|ing suddenly chill'd by cold Air, cold Water, or drinking cold Liquors after great Heat; Vomits given injudi|ciously, when the Liver is already unsound, which if they do not re|move the Obstruction, exagitate the Liver too much; inveterate hypo|condriacal Distempers. All these Causes may produce Inflammations of the Liver.

In such a Case, the Liver being swell'd compresseth the Stomach, Dia|phragm, and the neighbouring vis|cera of the lower Belly, stops the Circulation of the Juices, the Gene|ration and Excretion of the Gall, and all Digestion; produceth an In|finity of bad Symptoms, the Jaun|dice, with all the Diseases depending upon it; for the Liver receives the

refluent Blood almost from all the Parts of the Abdomen, and is the chief Instrument of all the Dige|stions which are made there. A Fe|ver, an Inflammation and pungent Pain on the Region of the Liver and Diaphragm, a Tension of the Hypochondres, Yellowness of the Skin and Eyes, and a Saffron-colour'd Urine, are Signs of an inflammato|ry Disposition of the Liver.

This Disease ends as other Inflam|mations, being cur'd either by Reso|lution, Concoction, and Excretion of the morbid Matter, terminates in an Abscess, Schirrus, or Gangrene.

During the first State, a warm Re|gimen and Saffron, which is reckon'd a Specifick, is improper.

Cooling resolving Liquors taken inwardly, as Whey, with Sorrel boil'd in it; outward Fomentations, and frequent Injection of Clysters, Bath|ing and Frictions, relax, and render the Matter fluid; Honey, with a lit|tle

Rhenish Wine, or Vinegar; the Juices and Jellies of some ripe Gar|den Fruits; and those of some lactes|cent papescent Plants, as Endive, Dandelion, Lettuce, are resolvent.

Violent Purging hurts, gently re|laxing the Belly relieves, Diluents with nitrous Salts are beneficial, or Tamarinds boil'd in warm Water or Whey; bloody Stools, not in an ex|treme degree, or streak'd with Blood, ought not to be stop'd, because they help to resolve the Distemper, and Haemorrages by the Nose often do the same.

The feverish Matter is often car|ried off by Urine, and therefore Di|ureticks not highly stimulating, are proper.

Sweating ought not to be promo|ted by warm Cordials, but encourag'd by warm diluting Liquors.

It is a deplorable Case when the Inflammation terminates in a Suppu|ration, unless the Abscess points out|wardly,

so as it may be opened; for if the Pus be evacuated into the Ab|domen, it produceth dismal Symp|toms, Putrefaction, or an incura|ble hepatical Dysentery, or Bloody-Flux.

The Pus, from an Ulcer of the Lungs, growing thin and ichorose corrodes the Vessels (for the Liver of all the Viscera, is the most friable, and easily crumbled or dissolv'd) it is often carried into the Blood, and rejected by Vomiting, with a cada|verous Smell, attended with great Thirst; if it is carried downward, it occasions a purulent colliquative Di|arrhoea; acid Substances relieve most in this Case.

This Disease may happen to pro|duce a Cancer, or Schirrus; one can|not say that the last is absolutely in|curable, because it has been known by Experience that Grass and fresh Pasture has cur'd it in Cattle; and perhaps the express'd Juices of Grass,

and some opening Plants, may do the same thing in Mankind, as of the lactescent Plants above-mention'd.

The Diet prescrib'd here is neces|sary in a Jaundice, and all Diseases of the Liver; and Abstinence from such Substances as induce Putrefaction, especially salted Fish and Flesh, and above all, strong Liquors.

Inflammation of the Stomach.

The Symptoms of this Disease are a vehement, burning, fix'd, pungent Pain in the Stomach, attended with a Fever; a great Exacerbation of this Pain the Moment after swallow|ing any thing, succeeded with Vo|miting; a painful Hickup, and great Anxiety. The Causes of these Symp|toms are those common to all In|flammations, a natural Weakness, and perhaps Erosion of the Coats of the Stomach, and acrid Substances taken as Aliment and Medicines.

If this Disease is not speedily cur'd, it proves fatal.

It terminates in a Cure by a Reso|lution of the morbifick Matter, a Suppuration, Schirrus, Cancer, but most commonly in a Gangrene.

Of all Diseases this demands most a total Abstinence from every thing that has Acrimony in it, even the nitrous cooling Salts, which are be|neficial in other Inflammations, ir|ritate too much; Vomits, all Cor|dials of volatile or spicy Substances; spirituous Liquors are no better than Poison, and Milk generally curdles; Aliments must be given frequently, and by Spoonfuls at a time, for any Distension increaseth the Inflamma|tion; a thin Gruel of Barley, Oat|meal, Whey, with very little Sugar, or Honey, or Chicken-Broth, are proper Aliments; Whey, emollient Decoctions, Barley-Water, Emulsions, are proper Drinks; and it has been found by Experience, that chalybeat

Waters have been agreeable to the Stomach even in this inflammatory State. If there happens an Impost|hume, Honey, and even Honey of Roses, taken inwardly, is a good Cleanser, and Decoctions of Com|frey Roots, healing; speedy and plentiful Bleeding, Fomentations, and Clysters, have the same good Effect as in other inflammatory Distem|pers.

The same Regimen is necessary in a Schirrus, or Cancer of the Sto|mach; though nothing will be quite effectual.

The same Regimen is to be ob|served in the Inflammation of the Spleen, Caul, Pancreas.

Inflammation of the Guts.

The Intestines or Guts, most fre|quently the small ones, may be in|flam'd by any acrid or poisonous Substance taken inwardly; from any

purulent Matter translated upon them from some other Part of the Body; from Bile, extremely acrimonious, by a violent Tension; from a Convulsion filling them with Wind.

The Symptoms are a total Stop|page of the Passage; a vehement fix'd burning Pain, irritated by things ta|ken inwardly, when any thing touch|eth the affected Part, it excites Vo|miting, sharp griping Pains, with Wind in other Parts of the Bowels; the Consequences of such an Inflam|mation are an Ileus, what is com|monly called the Twisting of the Guts, but is really either a Circum|volution or Insertion of one part of the Gut within the other. All these Symptoms are attended with a Fe|ver.

It is of the utmost Importance to know what the Causes of Colicks are; for as they are various, the Re|medies in one Case are quite oppo|site and destructive in the other; for

the spicy warm carminative things which are given in a Colick, from a phlegmatick or cold Cause, are Poi|son in an inflammatory one; they may be distinguish'd by the Fever, high Pulse, Thirst, and flame-co|lour'd Urine attending the Inflam|mation, as to the Heat, tho' it is great likewise by the Violence of the Pain, the Extremities grow cold; be|sides, there is a sudden Prostration of the Strength or Weakness attending this Colick, more than any other.

This Disease admits of a speedy Remedy, or none, for it ends in an Ileus, and Mortification of the Bow|els very soon.

Besides a copious Bleeding, there is hardly any other Method but fo|menting and relaxing the Bowels by emollient tepid Liquids, both taken by the Mouth and by Clysters, in|jected hourly; yet it has been known by Experience, that Acids have re|lieved in very desperate Cases, as

Juice of Limons taken by the Mouth, and Vinegar and warm Water given in Clysters, have sav'd the Patient, because of the incessant Vomiting; Opiats to quiet the Convulsions are sometimes necessary.

Warm Fomentations even of warm Animals to the Belly, are extremely beneficial.

If the Inflammation happens to be in the lower Guts, it is not so dangerous; and even when it suppu|rates, it admits of a Cure, then it can be reach'd by proper Medicines in the Form of Clysters; in the lat|ter end of such a Case Chalybeat Wa|ters are beneficial.

If the Patient survives three Days, the Acuteness of the Pain abates, and a Chilliness or Gruing affects the Body, it betokens a Suppuration, and in a few Days the Matter flows either into the Cavity of the Abdo|men, producing all the Symptoms which happen in the Imposthumation

of the Liver, or into the Cavity of the Intestines, and causing a puru|lent Bloody-Flux, and often a Con|sumption, Sinus's, Fistulas.

Whey and Chalybeat Waters are often beneficial in such a Case, as Drinks.

The Aliment ought to be of such things as generate little or no Excre|ments, as Broths of Flesh-Meat, with Scorzonera, Parsley, or Fennel boil'd in them; Goats Whey is likewise ex|cellent; fat and oily Substances ge|nerally hurt.

The Continuance of the Fever, clammy Sweats, Paleness, an ichorose Diarrhoea, foetid, black, or like the Washings of Flesh, a small intermit|ting Pulse, and at last a total Cessa|tion of Pain, are Signs of a Gan|grene and approaching Death.

If none of the foremention'd things happen, if the Fever abates, and the Patient complains of a Weight, dull Pain, Stoppage of the Excrements,

a Schirrus is forming, which increas|eth daily, and may terminate in a Cancer, which Purging, and indeed all Medicines irritate; the Patient in such a Case may protract a miserable Life with an exact thin Diet of Whey, Broths, and such things as produce no Foeces, or by alimentary Clysters.

A Thrush.

By this Name are call'd small, round, superficial, Ulcerations, which appear first in the Mouth, but as they proceed from the Obstruction of the Emissaries of the Saliva, by the Lentor and Viscosity of the Hu|mour, they may affect every Part of the alimentary Duct, except the thick Guts; they often succeed Fevers, es|pecially those that inflame the Inte|stines, or are attended with a Loose|ness; and they are just the same in the inward Parts as Scabs in the Skin, and fall off from the Inside of the

Bowels like a Crust: The nearer they approach to a white Colour, the less dangerous.

The viscous Matter is to be push'd out, therefore Bleeding in the begin|ning is not proper, nor Sudorificks, because they thicken; but Sweating is beneficial, when the Matter is quite push'd out; tepid, diluent and small Liquors are good in the first State, and Bathing, if the Patient can bear it, with Gargarisms, Clysters; after|wards the Food ought to be nourish|ing, detergent, Panadas with Bread and Water, Bread and Milk, Ho|ney mix'd with the Aliment, when they fall, Aliment demulcent, soft, anodyne, and the moderate use of Rhenish Wine; when they are separated, lenitive, purging Sub|stances.

Inflammations of the Kidneys.

The Kidneys are subject to Inflam|mations as much as other Parts of the Body.

A pungent Pain in the Region of the Kidneys, a Stupor, or dull Pain in the Thigh, Colick, Wind, Vomiting, a Fever, Urine some|times totally suppress'd, in small Quantity, high colour'd; and which is worse, sometimes quite pale, with|out any Sediment, are Symptoms of an Inflammation of the Kidneys; as to the Sensation of outward Heat, the Extremity of Pain often creates a Coldness in the Extremities, but such a Sensation is very consistent with an inflammatory Distemper.

Whatever obstructs the Blood in the Extremities of the Arteries of the Kidneys, will produce this Disease; a Wound, Abscess, Bruise, Swelling, Lying much on the Back, too vio|lent

Motion, especially walking in hot Weather; whatever obstructs the Passage of the Urine, as a viscous Matter, Gravel or Stone; every thing which drives the Blood into the Uri|nary Canals, Heat, hard Riding, too great Fulness of Blood, but especially sharp and forcing Diureticks: Last|ly, Spasms and involuntary Contrac|tions of the Vessels of the Kidneys.

Coffee-colour'd Urine is not a dan|gerous Symptom; it proceeds indeed from a Mixture of a small Quantity of Blood with the Urine, but often prognosticates a Resolution of the obstructing Matter, and the Expul|sion of Gravel or a Stone after great Pain; pale Urine is a Symptom of a more lasting and dangerous Di|sease.

After plentiful Bleeding, and a careful avoiding of all stimulating Diureticks, which in this State of the Disease will increase it, the Expul|sion of the obstructing Cause must

be promoted by emollient and soft Liquors drank plentifully, by Cly|sters of the same frequently injected, by Bathing and outward Fomenta|tions, by opiat and anodyne Sub|stances, which stupify and relax the Fibres; those Liquors must be swal|low'd down notwithstanding the con|tinual Vomiting; for Vomiting is the Instrument of Nature to promote the Expulsion of the Stone Gravel, or other obstructing Cause.

Whey, and in a great feverish Heat, Butter-Milk, Emulsions of Barley and Poppy Seeds, Honey in Whey and Water, are proper Liquors for this Intention.

When the Gravel, Stone, or other obstructing Cause is separated from the Kidney, soft express'd Oils, and oily Substances relax the Passages; if the Pain proceeds only from Gravel, or a Stone, oily Substances may be join'd safely with stimulating Sub|stances, as with Juice of Limon, Ju|niper-Water,

and some diuretick Syr|rup; this by the way, for it is out of my present Subject.

Violent Motion, as jolting in a Coach, may be us'd in this Case.

The Pain protracted beyond seven Days, a Pulsation, Chillness, often and irregularly returning, a Heaviness and Stupor in the Part, are Signs of making of Matter, which when made will appear in the Urine.

In which Case soft and balsamick Substances are beneficial, for if the Matter stays long, the Case is incu|rable.

It happens sometimes to end in a Fistula, with which the Patient may live many Years in no great Uneasi|finess. Butter-Milk, not very sour, has been reckon'd a great Secret in Ulcers of the Kidneys, and Chalybeat Waters have been beneficial to some; Spruce Beer is a good Balsamick in such a Case: I should advise soft Malt Liquors rather than Wine.

Inflammations of the Kidneys sometimes end in a Schirrus, or great Stone in the Kidneys.

A sudden Remission of the Pain, with cold Sweats, weak and inter|mitting Pulse, Hickup; no Urine, or in small Quantity, black and foe|tid, are Signs of a Mortification and approaching Death.

The Regimen of such as are sub|ject to nephritick Symptoms may be in some measure taken from what is above-mentioned.

Such ought to be extremely care|ful of the choice of their Liquors; sharp Wines which abound with Tartar, are hurtful; Malt Liquors, not hard, nor stale, are certainly bet|ter to make use of; some of the softest Diureticks mentioned Chap. I. N^o 15. to avoid acrimonious Sub|stances in their Aliment, use mode|rate Exercise, and not to lie hot, soft, nor much upon the Back.

Apoplexy.

This Disease is a sudden Abolition of all the Senses, external and inter|nal, and of all voluntary Motion, by the Stoppage of the Flux or Reflux of the Animal Spirits through the Nerves destin'd for those Motions, commonly attended with a strong Pulse, laborious Breathing, a deep Sleep with Snorting.

There is no difference between a Person asleep, and in an Apoplexy, but that the one can be awak'd, and the other cannot.

The Causes of this Disease are a particular Confirmation of the Body, as a short Neck; for there be some who have fewer Vertebrae in their Necks than others; long-necked Peo|ple are subject to Consumptions, and short-neck'd to Apoplexies, tho' this Rule is not generally true; a gross, ple|thorick, fat, phlegmatick Constitu|tion;

whatever hinders the Motion of the Blood through the Arteries of the Brain, as polypose Concretions, especially about the Heart, attended, commonly with an unequal Pulse, a Vertigo, and sometimes a momenta|ry Loss of the Eye-sight; an inflam|matory and coreaceous Thickness of the Blood, preceded by a Fever, at|tended with the Head-ach, Redness of the Face and Eyes; Old Age, at|tended with a glutinous, cold, ca|tarrhous, leucophlegmatick Constitu|tion; in such, the Forerunners of an Apoplexy are Dulness, Inactivity, Drowsiness, Sleepiness, Slowness of Speech and giving Answers, Verti|goes, Tremblings, Oppressions in Sleep, Night-Mares; Weakness, Wa|teryness, and Turgidity of the Eyes; pituitous Vomiting, laborious Breath|ing upon the smallest Motion; what|ever compresseth the Vessels of the Brain so as to stop the Flux of the animal Spirits and Blood; a great

Fulness of Blood with its Velocity, increas'd by Heat, violent Motion, a high Diet, spirituous Liquors, Tu|mours of any kind; within the Skull a partial and imperfect Circulation of the Blood towards the lower Parts. The Effusion and Pressure of any Serosity or Blood upon the Ven|tricles of the Brain (which is the most common and immediate Cause of Apoplexies) violent Passions and Affections of the Mind. The im|mediate Forerunners of an Apo|plexy are commonly a Vertigo, Staggering, Loss of Memory, Stu|por, Sleepiness, a Noise in the Ears, and a more deep and laborious Breathing; those last Symptoms com|monly precede an Apoplexy, but they are likewise common to it with other nervous and hysterical Distem|pers.

Attention to the foremention'd Symptoms affords the best Cautions and Rules of Diet by way of Pre|vention;

for when it has taken place Hippocrates's Prognostick is generally true, That it is very hard to resolve a small Apoplexy, and quite impos|sible to resolve a great one, the gen|tlest Kind of this Disease is often ta|ken off by Sweating.

The Applications in the Fit are of the Medicinal Kind, it being too acute a Disease to admit of any Helps from Diet, but that may be of great use for Prevention; a thin, slender, cool, regular Diet, opposite to the particular Symptoms above-men|tion'd; frequent and copious Bleed|ing; keeping the Belly always open; stimulating Substances, which have been thought beneficial, in this Case very often hurt, by forcing the Blood too much up to the Head; Vomit|ing may prove extremely pernicious, but the Regimen is to be varied ac|cording to the Cause of the Disease, which may be collected from the Constitution of the Patient in these

Apoplexies, which depend upon a sanguineous Cause: The Regimen prescrib'd in sanguineous Constitu|tions is proper; fat and phlegma|tick People, who are very subject to this Disease, ought to attend to the Rules prescribed in their Case; and as there are Apoplexies from invete|rate Gouts, the Regimen of such must be different from both, the Intention being to translate the mor|bifick Matter upon the Extremities of the Body.

Those who have a Disposition to this Disease ought never to go to Bed with a full Stomach, nor to lie with their Head low.

An Apoplexy is resolv'd by a Fe|ver, and when not fatal terminates in a Palsy.

There is a Disease of the same Kind, but not so frequent, call'd a Catalepsis, wherein the Patient is suddenly seiz'd without Sense or Mo|tion, and remains in the same Po|sture

in which the Disease seizeth him, the Muscles remaining in the same Tension: Violent Fevers in strong atrabilarious dry Constitutions has produc'd this Distemper; the Diet after the Fit is off ought to be moistening and relaxing. A Lethar|gy is a lighter sort of Apoplexy, and demands the same Cure and Diet as an Apoplexy from a phleg|matick Case, such being the Consti|tution of the Lethargick.

Notes

• * 1.1

  See Chap. I.