« НазадПродовжити »
awakened by a very acute pain, most com- that enlightened physician, Dr. Rush, to be monly in the first joint of the great toe: applied to the legs and wrists : burning sometimes, however, it attacks other parts with moxa may be advised, or a cabbageof the foot. The pain resembles that of a leaf applied to the part affected will often dislocated bone, and is attended with the afford considerable relief; bootlets made sensation as if all but cold water was poured of oiled silk, are an useful application to upon the part. There is at the same time gouty joints: when the violence of the more or less of a cold shivering, which abates symptoms is abated, opiates may be given as the pain increases in violence, and is with advantage, when the pain only returns succeeded by a hot fit. The pain, from the during the night, and prevents sleep. When commencement, gradually becomes more the constitution is broken down by repeated violent: it is sometimes so acute, as to be attacks of the disease, evacuations must be compared to a dog gnawing the part, and employed with cautiou, and it will in genethat and the fever continue in the same ral be more advisable and safe to allow state, accompanied with great restlessness, some animal food, and wine or diluted till next midnight, when they gradually re. spirits : the parts affected should at the mit, and after a continuance of twenty-four same time be wrapped in flannel, fleecy hours from the cortimencement of the pa. hosiery, or new-combed wool, and a gentle roxysm, they commonly cease entirely: the diaphoresis should be excited. When a patient falls asleep, during which a gentle swelling and stiffness remain in the joints, perspiration generally comes on, and on after the paroxysm has ceased, they will be waking he finds the part affected somewhat removed by the diligent use of the fleshred and swelled. For some days the pain brush, gentle exercise of the parts, and the and fever return in the evening, but with a Buxton or Bath waters, taken at the founless degree of violence, and a remission tain head; and where the gout has left a takes place towards morning; and after number of dyspeptic symptoms, the latter these symptoms have continued for about may be drank with considerable advantage. ten or fourteen days, gradually becoming Purging immediately after a paroxysm will less severe, they generally cease altogether. be very apt to induce a relapse. In the inCostiveness, an impaired appetite, chilliness tervals we must endeavour to prevent a reof the body towards evening, are also to turn of the paroxysms, or to render them be reckoned among the symptoms of this less violent : 1. By temperance, which disease.
should be regulated according to the age, The indications of cure are, in the pa. habits of life, and constitution of the paroxysms, to moderate their violence and tient. It is very probable that a diet, conshorten their duration as much as can be sisting of milk, vegetables, and water, would done with safety; and in the intervals to prevent the recurrence of the disease; but prevent the return of the paroxysms, or to in general fish, eggs, the white meats, and render them less frequent and more mode. weak broths, inay be taken in small quanrate. The violence of the paroxysm will tities once a day, and a little salted meat be moderated by blood-letting, which must may be eaten occasionally, and weak wine be repeated according to the state of the and water, or small beer, may be taken at pulse and degree of excitement, where the meals. As there is a disposition in the gout constitution is not worn down by repeated to return in the spring and autumin, a greater attacks; leeches should be applied to the in- degree of abstinence in eating and drinking flamed parts, and gentle cathartics should will be necessary at those seasons than at be administered: these parts should also any other period : and if any of the premo. be exposed to cool or cold air, and diluting nitory symptoms are then present, and the liquids should be taken freely: the anti- vigonr of the system remains unimpaired, phlogistic
regimen must be strictly adhered the disease may be often prevented from to: abstinence from wine, spirits, ferment- occurring by the loss of a few ounces of ed liquors, and stimulating food, should be blood, or perhaps by an emetic or a gentle carefully enjoined, unless the system is very cathartic, and afterwards bathing the feet much debilitated; in which case a more in warm water: a full dose of the tincture of nourishing diet, and a small quantity of wine opium might probably be of service. In the or of diluted spirits may be allowed: after decline of life, or when the constitution is the excitement has been subdued by pro. much debilitated, this abstemious mode of per evacuations, blisters may be employed living must be commenced with cantion, with advantage; they are recommended by as it might be the means of inducing more violent and dangerons fits of the gout. treatment as typhus. Chicken pox, and 2. By moderate labonr and gentle exercise, nettle-rash, have a near approach to synoas riding on horseback ; but more particu- cha, and so far possess the same indicalarly walking. 3. By avoiding cold, espe- tions; but they are generally slighit diseases, cially when it is combined with moisture. and of not more than three days' duration.
The feet should be kept constantly warm The rest, for the most part, are of a mixed and dry by means of socks and cork-soled breed, and have hence a closer resemshoes, and the patient shonld wear flannel blance to synochus: they commence with next to the skin. 4. By the prevention of inflammatory affections ; but have soon a costiveness, by means of gentle laxatives, as strong tendency to run into the putrid aloetics combined with soap and rhubarb, type. We shall select an example or two or oil of castor. 5. By tonics, as the bark, from the diseases of this order, either most qnassia, and chalybeates. 6. By the exhi- important or most frequent. bition of alkalies in various forms, as the Variola. Small.pox. This is of two va. fixed alkali, both mild and caustic, lime rieties, the distinct and the confluent. The water, soap, and the absorbent earths; and, general nature, symptoms and treatment of lastly, by studiously avoiding the exciting the former, are so well known, that it is causes. In the retrocedent species, strong unnecessary to repeat them. In the con. stimulants, both external and internal, fluent kiud, our chief attention must be dishould be instantly employed with an unhe- rected to support the strength of the sys. sitating band; and in the atonic species the tem, and to obviate the tendency to great diet should be peculiarly generous, and depression of strength and putrefaction of compounded of spices and other aromatics. the Auids, which will be effected by the ex.
hibition of cordials, wine, bark, mineral ORDER III. Exanthemata. ERUPTIVE acids, and a nourishing diet, and by all the FEVERS.
means recommended in the treatment of Thiese consist of the following genera : typhus, except the application of cold wa1. Erysipelas, or St. Anthony's fire. 2. Pes. ter after the appearance of the eruption ; tis ; plague. 3. Variola; small pox. 4. Va. the bowels should be kept regular by the ricella ; chicken-pox. 5. Rubeola ; mea. mildest cathartics, or by laxative clysters ; sles. 6. Miliaria; miliary fever. 7. Scar- some anthors, however, recommend a more latina; scarlet fever. 8. Urticaria; nettle. liberal use of them, unless a diarrhiva has rash. 9. Pemphigus ; bladdery fever. 10. supervened, even when the disease assumes Aphthæ; thrush. The whole of this order the type of typhus. When the disease is atis defined by Cullen to consist of diseases tended with violent symptoms, blisters affecting persons only once in their life, should be applied in succession, on differ. commencing with fever, and succeeded by ent parts of the body, without regard to the phlogoses, generally small in size, consider parts being covered with pustules ; if there able in number, and dispersed over the be obstinate vomiting, the saline dranghts skin. The definition, however, will not should be given in a state of effervescence; hold good in several of its clanses, and espe. or camphor, combined with opium, may be cially in its first; for, perhiaps, there is not employed with advantage; the extract of a single disease in the list, but wbat has oc- cascarilla, administered in some aromatic casionally recurred, and many of them re- liquid, is often of use in allaying the vomitpeatedly. It is to be remarked, through ing; and if we do not succeed by those the whole of these, that, whatever danger means, it will be proper to apply a blister may accompany them, depends rather upon to the region of the stomach: should the the degree of fever, and the nature of the epileptic fits continue violent, it will be ne. fever that introduces them, than upon the cessary to administer opiates, both by the extent or nature of the eruptions tem- mouth and by clysters, which act, not only selves : and hence, with very few excep. by their antispasmodic power, but also by tions, the general plan laid down for the perspiration, and mustard cataplasms should treatment of the different gevera, in the or- be applied to the feet, at the same time der . Febris, is the plan which ought to be gentle cathartics will be necessary, as the followed in the order before ns. Thus the recurrence of the fits frequently proceeds fever accompanying plagne is evidently ty. from the irritation of retained feres, espephns, which, in effect, when accompanied 'cially in children: when a retrocession of by eruptions of any kind, is evidently a ty. the ernptioù happens, wine, opium, volatile phoid eruptive fever, and requires the same alkali, musk, and camphor, with the warm
bath, are the remedies most generally em- antimony; the cough will be alleviated, and ployed; blisters and mustard cataplasms expectoration promoted by a solution of should also be applied to the lower extre. spermaceti, guñ arabic, or of the pulvis tramities: if the swelling of the face subsides gacanthæ compositus, or the decoctum horsuddenly, and is not succeeded by the dei compositum may be employed in consiswelling of the hands, blisters are recom- derable quantities; inhaling the vapour of mended to be applied to the wrists and hot water, the application of oil round the fore-arms; anointing great part of the body chest, and the pediluvium, or warm bath, with mercurial ointment, or applying a large will be found useful auxiliaries: should the mercurial plaster to the scrobiculus cordis cough and dyspnæa prove urgent, attended under the same circumstances, is often at- with pyrexia, or should they remain after tended with good effects ; if the salivation the desquamation, blood letting, either gesuddenly cease, without any swelling of the neral or local, should be employed: we hands, blisters should be applied to the must, however, be cautious in reducing the wrists, and small doses of ipecacuanha strength of the patient; small blisters should be administered: should there be a should be applied in succession about the suppression of urine, the patient should be thorax; the apartment in which the patient exposed to a current of cool air; if this continues should be kept cool ; le must does not succeed, and he is not in a very not be exposed to cold air so freely as in debilitated state, and the heat of the body the small-pox, as much disorder may be is steadily above the natural degree, it will produced in the system, if, from such expobe proper to dash cold water upon the legs; sure, retrocession of the eruption should and perhaps to extend the affusion over the take place; the degree of temperature whole surface.
should therefore in a great measure be reRubeola. Measles. This disease will be gulated by the patient's feelings: when the distinguished from the other exanthemata, excitement is subdued by evacuations, and by the dry, hard cough, hoarseness, sneez. the congh remains the only troublesome ing, watering of the eyes, coryza, dyspnæa, symptom, opiates may then be given with and great drowsiness, or coma.
great advantage; and at this period of the tarrh, the greater violence of the febrile disease, a change of air will be of the most symptoms, the greater affection of the eyes, essential service. As a morbid tendency and many of the symptoms accompanying remains for some time after this complaint, the eruptive fever of measles, particulurly it will be not only advisable, but indispen. the coma, will afford a ready diagnosis be sably necessary, to administer gentle ca. tween the two discases.
thartics at proper intervals. If symptoms The remedies indicated in the cure of of pneumonia should snpervene after the this disease are such as will obviate, or re- desquamation, blood-letting, both general move the morbid excitement; blood-letting and local, if the strength of the patient will will therefore be requisite in proportion to admit of it, blisters and the other remedies, the violence of the fever, cough, and dysp- which are mentioned when treating of that nea, if the nature of the prevailing epide inflammation, must be diligently employed : mic does not contra-indicate ; but as the when a diarrhæa remains troublesome, after danger, at the commencement of the com- the desquamation has taken place, it must plaint, is for the most part inconsiderable, not be checked too bastily by the employthat powerful remedy may, unless the ex. ment of astringents and opiates, on account. citement is very great, and threatens im- of the tendency to inflammatory complaints mediate danger, or much subsequent debi- which remains after the measles: the caslity, generally be reserved till after the pe- carilla, or columba may, however, be em. riod of desquamation, which is often suc- ployed in small doses, before we have receeded by a more dangerous train of symp- course to more powerful astringents; bloodtoms than any that have preceded; gentle letting will generally remove both the diar cathartics are indispensably requisite in all rhæa and cough; it will, therefore, be ad. cases, snch as phosphate of soda, Epsom visable to endeavour to check the diarrhea salts, infusion of senna, &c.; analogy is, by that evacuation, rather tban employ however, greatly in favour of calomel; te- astringents in the first instance. The pupid mucilaginous diluents shonld be freely trid measles appeared in London in 1672, allowed; it will be adviseable to excite a. 1763, and 1768, and have appeared occa. gentle diaphoresis by means of the saline sionally since: in this variety all the symp. draughts, with small doses of tartarised toms are more violent, accompanied with
greater depression of strength ; the reme- sexy, with a flow of blood without external dies must be of the same kind, but more ac violence; the blood, upon venesection, ex, tively and instantaneously employed. hibiting the same appearance as in phleg.
Scarlatina. The general nature and treat- masia. The genera are : 1. Epistaxis ; ment of this disease will be found in Ty- bleeding from the nose. 2. Hæmoptysis ; phus, and Cynanche Maligna.
spitting of blood. S. Hæmorrhois ; piles. Erysipelas. St. Anthony's Fire. This 4. Menorrhagia ; immoderate menstruation. will be readily distinguished from the scar. These, for the most part, and when the pro" latina cynanchica, by the absence of the fusions are not merely symptomatic or cria pain, redness, tumour, and sloughs in the tical, are a natural class of diseases; and, fauces and tonsils, and by the other con- excepting in one or two instances, are to comitant symptoms. The danger will be be attacked by a general plan of a similar in proportion to the violence of the symp. kind and tendency. They are preceded, toms denoting a tendency to an affection of for a longer or shorter time, by a sense of the brain; the parts which were red be- fulness and tension in the parts whence the coming suddenly pale, and a considerable blood is about to issue : if those parts be degree of coma or delirium, particularly at visible, there is redness, tumour, a sense of the commencement of the disease, with an heat or itching, and of pain and weight ; inincrease rather than diminution of it, after ternally, in the neighbourhood, there is a the appearance of the eruption, are symp. similar sense, weight, fulness, tension, leat, toms of the utmost danger. When the dis, and pain; and when these symptoms have ease terminates in a favourable manner, subsisted for some time, a cold fit comes there is sometimes a gentle diaphoresis ; on, attended with weariness of the limbs, more frequently, however, the disease goes pains of the back and bead, costiveness, off withont any evident crisis.
and other febrile symptoms, succeeded by In the removal of this disease, if there be a hot fit, in the course of which the blood a considerable degree of excitement, at- most commonly flows in a greater or less tended with much coma or delirium, and a quantity, and after an uncertain time it strong, full, and hard pulse, blood-letting ceases spontaneously; during the hot stage, will be necessary, and it should be repeat the pulse is frequent and full, and in many ed according to the urgency of the symp- cases hard, but as the blood flows, the pulse toms, strength of the patient, and state of becomes softer and less frequent, and the the pulse ; an emetic should be given at the blood, when drawn from a vein, appears as commencement of the fever, unless the in the cases of the phlegmasiæ. After an head is affected, in which case it is at least hæmorrhage has once occurred, it frequently a doubtful remedy; cooling purgatives are observes periodical returns. particularly useful ; mild diaphoretics, as. The remote causes are, a plethoric and sisted by the plentiful use of mucilaginous sanguine temperament; the suppression acidulated diluents, will be proper ; the an- or diminution of accustomed evacuations ; tipblogistic regimen must be strictly ad. changeable weather, as spring and autumn; bered to, and the patient should be placed considerable and sudden diminution in the in as erect a posture as he can bear with.' weight of the atmosphere; external heat; out inconvenience ; if the delirium, but violent exercise of particular parts of the more particularly the coma, be urgent, blis- body; whatever increases the force of the ters should be applied to the shaved head, circulation, as violent exercise, violent efor between the shoulders ; cupping should forts, anger, and other violent active pasbe advised, and mustard cataplasms should sions ; postures of the body increasing de. be put upon the soles of the feet. The terminations to, or ligatures occasioning acerysipelatous eruption sometimes shews it- cumulations in particular parts of the body; self in typhus, and increases the fever, in a determination to certain vessels rendered which case we must have immediate re- habitnal from the frequent repetition of hæcourse to bark, wine, cordials, the sul morrhage ; mal-conformation of particular phuric acid, and the other remedies for parts; and lastly, cold externally applied, that disease. When the eruption returns as changing the distribution of the blood, periodically, issues, and a low diet will fres and determining it in greater quantities inquently prevent it.
to the internal parts; or, perhaps, by its ORDER IV. Hemorrhagia ; or Sangurexciting some degree of synocha. "The NEOUS FLUXES.
proximate cause is supposed to be conges.
tion in particular parts of the sanguiferous These are thus ordinarily defined; py: system, occasioning distention of these vessels, and violent re-action, the consequence the continuance of the hæmorrhage, or by of which is a rupture of them.
proper remedies, opiates may be given with Treatment. When an hemorrhage has advantage, and should subsultus tendinum, taken place, and threatens to go to excess, or convulsions supervene, they are parwe must endeavour to moderate or check ticularly serviceable, combined with the the flow of blood, and prevent its return; camphor, castor, and musk. The retum the first indication will be answered by a of the hemorrhage is to be prevented strict adherence to the antiphlogistic regi- by our counteracting or preventing a plemen, therefore the removal of every cause thoric state of the system, by an absteof irritation is always necessary, the patient mious diet, or by taking food of a less numust be kept quiet and still, heat must be tritious quality, by exercise, gestation will particularly guarded against, he shonld be be generally more safe than walking, by freely exposed to the cold air, and should gentle cathartics, by cold bathing, bitters, be allowed cold or iced water, or iced le- and aromatics, which tend to prevent plemonade to drink; every exertion of mind or thora, by increasing the tone of the vessels, body is to be avoided; a vegetable diet will and by studionsly avoiding the remote be most proper, unless the strength of the causes; tonics, which much increase the patient is greatly exhausted, in which case, force of the circulation, although indicatmild broths, and the mildest kind of animal ed, ar doubtful remedies, in particular, food may be allowed; gentle carthartics, or bark and chalybeates; astringents are in laxative clysters, will be necessary to pre- general more efficacious, particularly the vent any accumulation of the fæces, and sulphuric acid, alum, &c. if the plethoric blood-letting will be requisite, if there is a state, notwithstanding our endeavours, considerable degree of excitement; dry- should become considerable, and a return cupping is frequently useful, and blisters of the hæmorrhage is threatened, blood-let. may be employed with advantage : vomit- ting, both general and local, and blisters, ing is a powerful remedy in diminishing will be proper when the vis a tergo is great, the action of the heart and arteries; the but when the habit is debilitated, it will be digitalis, however, in our opinion, is a pre- more advisable to employ only local blood. ferable remedy; refrigerents should be or- letting and blisters; it will be proper to redered, as the sulphuric acid, nitre, cream mark, that blood-letting should always preof tartar, and the vegetable acids; the first cede the employment of blisters. of which is, however, the most efficacious These directions will suffice for the treat. medicine. Internal and external astrin- ment of hæmorrhagies in general. Upon gents must also be employed; of the for- menorrhagia we shall enter more fully in mer class are the vitriolic acid, alum, and the article MIDWIFERY, and shall only in the the sugar of lead, which is by far the most present place offer a few words on phthisis. powerful remedy, and may occasionally be Phthisis; or Pulmonary Consumption : exhibited with advantage in small doses, but upon the Cullenian system is made a spe. the long.continued use of this remedy is cies of hæmoptysis. The impropriety of often attended with dangerous conse. thus naming a disease from a single, and quences, and it shonld be given in combi• that only an occasional, symptom, must be nation with the opium pill, or some tena. obvious to every one. But our only duty cious extract, in order to obviate its perni- at present is to describe the disease. This cious effects on the stomach and bowels. then is generally preceded by more or less The external astringents in most general of the following symptoms : a slight de. use, are, cold applied suddenly, cold water gree of fever, increased by the least exerin which salt has been recently dissolved, cise; a dry burning heat of the palms of or powdered ice, or solutions of sugar of the hands, particularly towards evening, lead, alum, or white vitriol, &c.; pressure and of the soles of the feet towards mornis a powerful means of checking hemor- ing; moisture of the eyes after sleep; irreThage, when it can be applied to the part; gular flushings; hoarseness ; a dry, troublewhen the hemorrhage is very profuse, it is some, and sonorous cough, occasioning improper to employ any means to prevent slight pain or stitches, most commonly in syncope, unless it partakes very much of the sides ; some degree of hardness of the the passive state, in which case it must be pulse ; lacinating or fixed pains in the prevented by every possible means; the thorax ; head-ach; frequent fainting fits ; cinchona, with chalybeates, are indicated some degree of dyspnea, increased on under the same circumstances. When the using exercise ; an expectoration of a small pblogistic diathesis is taken off, eiller by quantity of thio, frothy matter ; impaired