Part 8

Sec. 43. 6. His Bed should be made daily while he sits up; and the Sheets of the Bed, as well as the Patient's Linen, should be changed every two Days, if it can be done with Safety. An unhappy Prejudice has established a contrary, and a really dangerous, Practice. The People about the Patient dread the very Thought of his rising out of Bed; they let him continue there in nasty Linen loaden with putrid Steams and Humours; which contribute, not only to keep up the Distemper, but even to heighten it into some Degree of Malignity. I do again repeat it here, that nothing conduces more to continue the Fever and Raving, than confining the Sick constantly to Bed, and witholding him from changing his foul Linen: by relieving him from both of which Circumstances I have, without the Assistance of any other Remedy, put a Stop to a continual Delirium of twelve Days uninterrupted Duration. It is usually said, the Patient is too weak, but this is a very weak Reason. He must be in very nearly a dying Condition, not to be able to bear these small Commotions, which, in the very Moment when he permits them, increase his Strength, and immediately after abate his Complaints. One Advantage the Sick gain by sitting up a little out of Bed, is the increased Quantity of their Urine, with greater Facility in passing it. Some have been observed to make none at all, if they did not rise out of Bed.

A very considerable Number of acute Diseases have been radically, effectually, cured by this Method, which mitigates them all. Where it is not used, as an Assistance at least, Medicines are very often of no Advantage. It were to be wished the Patient and his Friends were made to understand, that Distempers were not to be expelled at once with rough and precipitate Usage; that they must have their certain Career or Course; and that the Use of the violent Methods and Medicines they chuse to employ, might indeed abridge the Course of them, by killing the Patient; yet never otherwise shortened the Disease; but, on the contrary, rendered it more perplexing, tedious and obstinate; and often entailed such unhappy Consequences on the Sufferer, as left him feeble and languid for the rest of his Life.

Sec. 44. But it is not sufficient to treat, and, as it were, to conduct the Distemper properly. The Term of Recovery from a Disease requires considerable Vigilance and Attention, as it is always a State of Feebleness, and, thence, of Depression and Faintness. The same Kind of Prejudice which destroys the Sick, by compelling them to eat, during the Violence of the Disease, is extended also into the Stage of Convalescence, or Recovery; and either renders it troublesome and tedious; or produces fatal Relapses, and often chronical Distempers. In Proportion to the Abatement, and in the Decline, of the Fever, the Quantity of Nourishment may be gradually increased: but as long as there are any Remains of it, their Qualities should be those I have already recommended. Whenever the Fever is compleatly terminated, some different Foods may be entered upon; so that the Patient may venture upon a little white Meat, provided it be tender; some Fish; a little Flesh-Soup, a few Eggs at times, with Wine property diluted. It must be observed at the same Time, that those very proper Aliments which restore the Strength, when taken moderately, delay the perfect Cure, if they exceed in Quantity, tho' but a little; because the Action of the Stomach being extremely weakened by the Disease and the Remedies, is capable only, as yet, of a small Degree of Digestion; and if the Quantity of its Extents exceed its Powers, they do not digest, but become putrid. Frequent Returns of the Fever supervene; a continual Faintishness; Head-achs; a heavy Drowsiness without a Power of Sleeping comfortably; flying Pains and Heats in the Arms and Legs; Inquietude; Peevishness; Propensity to Vomit; Looseness; Obstructions, and sometimes a slow Fever, with a Collection of Humours, that comes to Suppuration.

All these bad Consequences are prevented, by the recovering Sick contenting themselves, for some Time, with a very moderate Share of proper Food. We are not nourished in Proportion to the Quantity we swallow, but to that we digest. A Person on the mending Hand, who eats moderately, digests it and grows strong from it. He who swallows abundantly does not digest it, and instead of being nourished and strengthened, he withers insensibly away.

The most allowable of these are Whitings, Flounders, Plaice, Dabbs, or Gudgeons; especially such of the last as are taken out of clear current Streams with gravelly Bottoms. Salmon, Eels, Carp, all the Skate kind, Haddock, and the like, should not be permitted, before the Sick return to their usual Diet when in Health. K.

Sec. 45. We may reduce, within the few following Rules, all that is most especially to be observed, in Order to procure a compleat, a perfect Termination of acute Diseases; and to prevent their leaving behind them any Impediments to Health.

1. Let these who are recovering, as well as those who are actually sick, take very little Nourishment at a time, and take it often.

2. Let them take but one sort of Food at each Meal, and not change their Food too often.

3. Let them chew whatever solid Victuals they eat, very carefully.

4. Let them diminish their Quantity of Drink. The best for them in general is Water, with a fourth or third Part of white Wine. Too great a Quantity of Liquids at this time prevents the Stomach from recovering its Tone and Strength; impairs Digestion; keeps up Weakness; increases the Tendency to a Swelling of the Legs; sometimes even occasions a slow Fever; and throws back the Person recovering into a languid State.

We have known many who had an Aversion to Water, and with whom, on that very Account, it might probably agree less, find Water very grateful, in which a thoroughly baked and hot, not burnt, Slice of Bread had been infused, untill it attained the Colour of fine clear Small-beer, or light Amber coloured Beer, and we never saw any Inconvenience result from it. Doubtless pure, untoasted elemental Water may be preferable for those who like, and have been accustomed to it. K.

5. Let them go abroad as often as they are able, whether on Foot, in a Carriage, or on Horseback. This last Exercise is the healthiest of all, and three fourths of the labouring People in this Country, who have it in their Power to procure it without Expense, are in the wrong to neglect it. They, who would practice it, should mount before their principal Meal, which should be about Noon, and never ride after it. Exercise taken before a Meal strengthens the Organs of Digestion, which is promoted by it. If the Exercise is taken soon after the Meal, it impairs it.

6. As People in this State are seldom quite as well towards Night, in the Evening they should take very little Food. Their Sleep will be the less disturbed for this, and repair them the more, and sooner.

7. They should not remain in Bed above seven, or eight Hours.

8. The Swelling of the Legs and Ancles, which happens to most Persons at this time, is not dangerous, and generally disappears of itself; if they live soberly and regularly, and take moderate Exercise.

9. It is not necessary, in this State, that they should go constantly every Day to Stool; though they should not be without one above two or three. If their Costiveness exceeds this Term, they should receive a Glyster the third Day, and even sooner, if they are heated by it, if they feel puffed up, are restless, and have any Pains in the Head.

10. Should they, after some time, still continue very weak; if their Stomach is disordered; if they have, from time to time, a little irregular Fever, they should take three Doses daily of the Prescription No. 14. which fortifies the Digestions, recovers the strength, and drives away the Fever.

11. They must by no means return to their Labour too soon. This erroneous Habit daily prevents many Peasants from ever getting perfectly well, and recovering their former Strength. From not having been able to confine themselves to Repose and Indolence for some Days, they never become as hearty hardy Workmen as they had been: and this premature hasty Labour makes them lose in the Consequence, every following Week of their Lives, more time than they ever gained, by their over-early resuming of their Labour. I see every Day weakly Labourers, Vineroons, and other Workmen, who date the Commencement of their Weakness from that of some acute Disease, which, for want of proper Management through the Term of their Recovery, was never perfectly cured. A Repose of seven or eight Days, more than they allowed themselves, would have prevented all these Infirmities; notwithstanding it is very difficult to make them sensible of this. The Bulk, the Body of the People, in this and in many other Cases, look no further than the present Day; and never extend their Views to the following one. They are for making no Sacrifice to Futurity; which nevertheless must be done, to render it favourable to us.

_Chapter IV._

Of an Inflammation of the Breast.

_Sect._ 46.

The Inflammation of the Breast, or Peripneumony, or a Fluxion upon the Breast, is an Inflammation of the Lungs, and most commonly of one only, and consequently on one Side. The Signs by which it is evident, are a Shivering, of more or less Duration, during which the Person affected is sometimes very restless and in great Anguish, an essential and inseparable symptom; and which has helped me more than once to distinguish this Disease certainly, at the very Instant of its Invasion. Besides this, a considerable Degree of Heat succeeds the Shivering, which Heat, for a few ensuing Hours, is often blended as it were, with some Returns of Chilliness. The Pulse is quick, pretty strong, moderately full, hard and regular, when the Distemper is not very violent; but small, soft and irregular, when it is very dangerous. There is also a Sensation of Pain, but rather light and tolerable, in one Side of the Breast; sometimes a kind of straitning or Pressure on the Heart; at other times Pains through the whole Body, especially along the Reins; and some Degree of Oppression, at least very often; for sometimes it is but very inconsiderable. The Patient finds a Necessity of lying almost continually upon his Back, being able to lie but very rarely upon either of his Sides. Sometimes his Cough is dry, and then attended with the most Pain; at other times it is accompanied with a Spitting or Hawking up, blended with more or less Blood, and sometimes with pure sheer Blood. There is also some Pain, or at least a Sensation of Weight and Heaviness in the Head: and frequently a Propensity to rave. The Face is almost continually flushed and red: though sometimes there is a Degree of Paleness and an Air of Astonishment, at the Beginning of the Disease, which portend no little Danger. The Lips, the Tongue, the Palate, the Skin are all dry; the Breath hot; the Urine little and high coloured in the first Stage: but more plentiful, less flaming, and letting fall much Sediment afterwards. There is a frequent Thirst, and sometimes an Inclination to vomit; which imposing on the ignorant Assistants, have often inclined them to give the Patient a Vomit, which is mortal, especially at this Juncture. The Heat becomes universal. The Symptoms are heightened almost every Night, during which the Cough is more exasperated, and the Spitting or Expectoration in less Quantity. The best Expectoration is of a middling Consistence, neither too thin, nor too hard and tough, like those which are brought up at the Termination of a Cold; but rather more yellow, and mixed with a little Blood, which gradually becomes still less, and commonly disappears entirely, before the seventh Day. Sometimes the Inflammation ascends along the Wind-pipe, and in some Measure suffocates the Patient, paining him considerably in Swallowing, which makes him think he has a sore Throat.

Sec. 47. Whenever the Disease is very violent at first, or increases to be such, the Patient cannot draw his Breath, but when he sits up. The Pulse becomes very small and very quick; the Countenance livid, the Tongue black; the Eyes stare wildly; and he suffers inexpressible Anguish, attended with incessant Restlessness and Agitation in his Bed. One of his Arms is sometimes affected with a sort of Palsy; he raves without Intermission; can neither thoroughly wake nor sleep. The Skin of his Breast and of his Neck is covered (especially in close sultry Weather, and when the Distemper is extremely violent) with livid Spots, more or less remarkable, which should be called petechial ones, but are improperly termed the pourpre, or purple. The natural Strength becomes exhausted; the Difficulty of breathing increases every Moment; he sinks into a Lethargy, and soon dies a terrible Death in Country Places, by the very Effects of the inflaming Medicines they employ on such Occasions. It has been known in Fact, that the Use of them has raised the Distemper to such a Height, that the very Heart has been rent open, which the Dissection of the Body has demonstrated.

Sec. 48. If the Disease rushes on at once, with a sudden and violent Attack; if the Horror, the Cold and Shivering last many Hours, and are followed with a nearly scorching Degree of Heat; if the Brain is affected from the very Onset; if the Patient has a small Purging, attended with a Tenesinus, or straining to Stool, often termed a Needy; if he abhors the Bed; if he either sweat excessively, or if his Skin be extremely dry; if his natural Manner and Look are considerably changed; and if he spits up with much Difficulty, the Disease is extremely dangerous.

Sec. 49. He must directly, from the first Seizure in this State, be put upon a Regimen, and his Drink must never be given cold. It should either be the Barley Water No. 2, the Almond Emulsion No. 4, or that of No. 7. The Juices of the Plants, which enter into the last of these Drinks, are excellent Remedies in this Case; as they powerfully attenuate, or melt down, the viscid thick Blood, which causes the Inflammation.

The Advantage of Bleeding:

As long as the Fever keeps up extremely violent; while the Patient does not expectorate sufficiently; continues raving; has a violent Head-ach, or raises up pure Blood, the Glyster No. 5 must be given thrice, or at least twice, in twenty four Hours. However the principal Remedy is Bleeding. As soon as ever the preceding cold Assault is over, twelve Ounces of Blood must be taken away at once; and, if the Patient be young and strong, fourteen or even sixteen. This plentiful Bleeding gives him more Ease, than if twenty four Ounces had been drawn, at three different Times.

Sec. 50. When the Disease is circumstanced as described (Sec. 46) that first Bleeding makes the Patient easy for some Hours; but the Complaint returns; and to obviate its Violence, as much as possible, we must, except things promise extremely well, repeat the Bleeding four Hours after the first, taking again twelve Ounces of Blood, which pretty often proves sufficient. But if, about the Expiration of eight or ten Hours, it appears to kindle up again, it must be repeated a third, or even a fourth Time. Yet, with the Assistance of other proper Remedies, I have seldom been obliged to bleed a fourth Time, and have sometimes found the two first Bleedings sufficient.