THIS disease prevails chiefly in cold northern countries especially in low damp situations, near large marshes, or great quantities of stagnating water. Sedentary people, of a dull melancholy disposition, are most subject to it. It proves often fatal to sailors on long voyages, particularly in ships that are not properly ventilated, have many people on board, or where cleanliness is neglected.
IT is not necessary to mention the different species into which this disease has been divided, as they differ from one another chiefly in degree. What is called the land scurvy, however, is seldom attended with those highly putrid symptoms which appear in patients who have been long at sea, and which, we presume, are rather owing to confined air, want of exercise, and the unwholesome food eat by sailors on long voyages, than to any specific difference in the disease.
CAUSES. - The scurvy is occasioned by cold moist air; by the long use of saIted or smoke-dried provisions, or any kind of food that is hard of digestion, and affords little nourishment. It may also proceed from the suppression of customary evacuations: as the menses, the haemorrhoidal flux, &c. It is sometimes owing to a hereditary taint, in which case a very small cause will excite the latent disorder. Grief, fear, and other depressing passions, have great tendency both to excite and aggravate this disease. The same observation holds with regard to neglect of cleanliness; bad clothing; the want of proper exercise; confined air; unwholesome food; or any disease which greatly weakens the body, or vitiates the humours.
SYMPTOMS. - This disease may be known by unusual weariness, heaviness, and difficulty of breathing, especially after motion; rottenness of the gums, which are apt to bleed on the slightest touch; a stinking breath; frequent bleeding at the nose; crackling of the joints; difficulty of walking; sometimes a swelling and sometimes a falling away of the legs, on which there are livid, yellow, or violet coloured spots; the face is generally of a pale or leaden colour. As the disease advances, other symptoms come on as rottenness of the teeth, haemorrhages, or discharges of blood from different parts of the body, foul obstinate ulcers, pains in various parts, especially about the breast, dry scaly eruptions all over the body, &c. At last a wasting or hectic fever comes on, and the miserable patient is often carried off by a dysentery, a diarrhoea, a dropsy, the palsy, fainting fits, or a mortification of some of the bowels.
CURE. - We know no way of curing this disease but by pursuing a plan, directly opposite to that which brings it on. It proceeds from a vitiated state of the humours, occasioned by errors in diet, air, or exercise; and this cannot be removed but by a proper attention to these important articles.
IF the patient has been obliged to breathe a cold, damp, or confined air, he should be removed, as soon as possible, to a dry, open, and moderately warm one. If there is reason to believe that the disease proceeds from a sedentary life, or depressing passions, as grief, fear, &c. the patient must take daily as much exercise in the open air as he can bear, and his mind should be diverted by cheerful company and other amusements. Nothing has a greater tendency either to prevent, or to remove this disease, than constant cheerfulness and good humour. But this, alas! is seldom the lot of persons afflicted with the scurvy; they are generally surly, peevish, and morose. When the scurvy has been brought on by a long use of salted provisions, the proper medicine is a diet consisting chiefly of fresh vegetables; as oranges, apples, lemons, limes, tamarinds, water-cresses, scurvy-grass, brook-lime, &c. The use of these, with milk, pot-herbs, new bread, and fresh beer or cyder, will seldom fail to remove a scurvy of this kind, if taken before it be too far advanced; but to have this effect, they must be persisted in for a considerable time. When fresh vegetables cannot be obtained, pickled or preserved ones may be used; and where these are wanting, recourse must be had to the chymical acids. All the patient's food and drink should in this case be sharpened with cream of tartar, elixir of vitriol, vinegar, or the spirit of sea-salt.
THESE things however will more certainly prevent than cure the scurvy; for which reason sea-faring people, especially on long voyages, ought to lay in plenty of them. Cabbages, onions, gooseberries, and many other vegetables, may be kept a long time by pickling, preserving, &c. and when these fail, the chymical acids, recommended above, which will keep for any length of time, may be used. We have reason to believe, if ships were well ventilated, had good store of fruits, greens, cyder, &c. laid in, and if proper regard were paid to cleanliness and warmth, the sailors would be the most healthy people in the world, and would seldom suffer either from the scurvy or putrid fevers, which are so fatal to that useful set of men; but it is too much the temper of such people to despise all precaution; they will not think of any calamity till it overtakes them, when it is too late to ward off the blow.
IT must indeed be owned, that many of them have it not in their power to make the provision we are speaking of; but in this case it is the duty of their employers to make it for them; and no man ought to engage in a long voyage without having these articles secured.
I HAVE often seen very extraordinary effects in the land-scurvy from a milk diet. This preparation of Nature is a mixture of animal and vegetable properties, which of all others is the most fit for restoring a decayed constitution, and removing that particular acrimony of the humours, which seems to constitute the very essence of the scurvy, and many other diseases. But people despise this wholesome and nourishing food, because it is cheap, and devour with greediness, flesh, and fermented liquors, while milk is only deemed fit for their hogs.
THE most proper drink in the scurvy is whey or butter-milk. When these cannot be had, sound cyder, perry, or spruce-beer, may be used. Wort has likewise been found to be a proper drink in the scurvy, and may be used at sea, as malt will keep during the longest voyage. A decoction of the tops of the spruce fir is likewise proper. It may be drank in the quantity of an English pint twice a-day. Tar-water may be used for the same purpose, or decoctions of any of the mild mucilaginous vegetables; as sarsaparilla, marsh-mallow roots, &c. Infusions of the bitter plants, as ground-ivy, the lesser centaury, marsh-trefoil, &c. are likewise beneficial. I have seen the peasants in some parts of Britain express the juice of the last-mentioned plant, and drink it with good effect in those foul scorbutic eruptions with which they are often troubled in the spring season.
HARROWGATE water is certainly an excellent medicine in the land-scurvy. I have often seen patients who had been reduced to most deplorable condition by this disease, greatly relieved by drinking the sulphur-water, and bathing in it. The chalybeate-water may also be used with advantage, especiaIly with a view to brace the stomach after drinking the sulphur-water, which, though it sharpens the appetite, never fails to weaken the powers of digestion.
A SLIGHT degree of scurvy may be carried off by frequently sucking a little of the juice of a bitter orange, or a lemon. When the disease affects the gums only, this practice, if continued for some time, will generally carry it off. We would however recommend the bitter-orange as greatly preferable to lemon; it seems to be as good a medicine, and is not near so hurtful to the stomach. Perhaps our own sorrel may be little inferior to either of them.
ALL kinds of sallad are good in the scurvy, and ought to be eat very plentifully, as spinage, lettuce, parsley, celery, endive, radish, dandelion, &c. It is amazing to see how soon fresh vegetables in the spring cure the brute animals of any scab or foulness which is upon their skins. It is reasonable to suppose that their effects would be as great upon the human species, were they used in proper quantity for a sufficient length of time.
I HAVE sometimes seen good effects in scorbutic complaints of very long standing, from the use of a decoction of the roots of water-dock. It is usually made by boiling a pound of the fresh root in six English pints of water, till about one-third of it be consumed. The dose is from half a pint to a whole pint of the decoction every day. But in all the cases where I have seen it prove beneficial, it was made much stronger, and drank in larger quantities. The safest way, however, is for the patient to begin with small doses, and increase them both in strength and quantity as he finds his stomach will bear it. It must be used for a considerable time. I have known some who had used it for several years, before they were sensible of any benefit, but who, nevertheless, were cured by it at length.
THE LEPROSY, which was so common in this country long ago, seems to have been near a-kin to the scurvy. Perhaps its appearing so seldom now, may be owing to the inhabitants of Britain eating more vegetable food than formerly, living more upon tea, and other diluting diet, using less salted meat, being more cleanly, better lodged and clothed, &c. - For the cure of this disease we would recommend the same course of diet and medicine as in the scurvy.
THIS disease chiefly affects the glands, especially those of the neck. Children and young persons of a sedentary life are very subject to it. It is one of those diseases which may be removed by proper regimen, but seldom yields to medicine. The inhabitants of cold, damp, marshy countries are most liable to the scrophula.
CAUSES. - This disease may proceed from a hereditary taint, from a scrophulous nurse, &c. Children who have the misfortune to be born of sickly parents whose constitutions have been greatly injured by the pox, or other chronic diseases, are apt to be affected with the scrophula. It may likewise proceed from such diseases as weaken the habit or vitiate the humours, as the small-pox, measles, &c. External injuries, as blows, bruises, and the like, sometimes produce scrophulous ulcers; but we have reason to believe, when this happens, that there has been a predisposition in the habit to this disease. In short, whatever tends to vitiate the humours or relax the solids, paves the way to the scrophula; as the want of proper exercise, too much heat or cold, confined air, unwholesome food, bad water, the long use of poor, weak, watery aliments, the neglect of cleanliness, &c. Nothing tends more to induce this disease in children than allowing them to continue long wet. The scrophula, as well as the rickets, is found to prevail in large manufacturing towns, where people live gross, and lead sedentary lives.
SYMPTOMS. - At first small knots appear under the chin or behind the ears, which gradually increase In number and size, till they form one large hard tumour. This often continues for a long time without breaking, and when it does break, it only discharges a thin sanies or watery humour. Other parts of the body are likewise liable to its attack, as the arm-pits, groins, feet, hands, eyes, breasts, &c. Nor are the internal parts exempt from it. It often affects the lungs, liver, or spleen; and I have frequently seen the glands of the mysentery greatly enlarged by it.
THOSE obstinate ulcers which break out upon the feet and hands with swelling, and little or no redness, are of the scrophulous kind. They seIdom discharge good matter, and are exceedingly difficult to cure. The white swellings of the joints seem likewise to be of this kind. They are with difficulty brought to a suppuration, and when opened they only discharge a thin ichor. There is not a more general symptom of the scrophula than a swelling of the upper lip and nose.
REGIMEN. - As this disease proceeds, in a great measure, from relaxation, the diet ought to be generous and nourishing, but at the same time light and of easy digestion; as well fermented bread, made of sound grain, the flesh and broth of young animals, with now and then a glass of generous wine, or good ale. The air ought to be open, dry, and not too cold, and the patient should take as much exercise as he can bear. This is of the utmost importance. Children who have enough of exercise are seldom troubled with the scrophula.
MEDICINE - The vulgar are remarkably credulous with regard to the cure of the scrophula, many of them believing in the virtue of the royal touch, that of the seventh son, &c. The truth is, we know but little either of the nature or cure of this dlsease, and where reason or medicines fail, superstition always comes in their place. Hence it is, that in diseases which are the most difficult to understand, we generally hear of the greatest number of miraculous cures being performed. Here, however, the deception is easily accounted for. The scrophula, at a certain period of life, often cures of itself; and, if the patient happens to be touched about this time, the cure is imputed to the touch, and not to Nature, who is really the physician. In the same way the insignificant nostrums of quacks and old women often gain applause when they deserve none.
THERE is nothing more pernicious than the custom of plying children in the scrophula with strong purgative medicines. People imagine it proceeds from humours which must be purged off, without considering that these purgatives increase the debility, and aggravate the disease. It has indeed been found, that keeping the body gently open, for some time, especially with sea-water, has a good effect; but this should only be given in gross habits, and in such quantity as to procure one, or at most two stools every day.
BATHING in the salt water has likewise a very good effect, especially in the warm season. I have often known a course of bathing in salt water, and drinking it in such quantities as to keep the body gently open, cure a scrophula, after many other medicines had been tried in vain. When salt water cannot be obtained, the patient may be bathed in fresh water, and his body kept open by small quantities of salt and water, or some other mild purgative.
NEXT to cold bathing, and drinking the salt-water, we would recommend the Peruvian bark. The cold bath may be used in summer, and the bark in winter. To an adult half a drachm of the bark in powder may be given, in a glass of red wine, four or five times a-day. Children, and such as cannot take it in substance, may use the decoction made in the following manner:
BOIL an ounce of Peruvian bark and a drachm of Winter's bark, both grossly powdered, in an English quart of water to a pint: towards the end half an ounce of sliced liquorice-root, and a handful of raisins may be added, which will both render the decoction less disagreeable, and make it take up more of the bark. The liquor must be strained, and two, three, or four table-spoonfuls, according to the age of the patient. given three times a-day.
THE Moffat and Harrowgate waters, especially the latter, are likewise very proper medicines in the scrophula. They ought not however to be drank in large quantities, but should be taken so as to keep the body gently open, and must be used for a considerable time.
THE hemlock may sometimes be used with advantage in the scrophula. Some lay it down as a general rule, that the sea-water is most proper before there are any suppuration or symptoms of tabes; the Peruvian bark, when there are running sores, and a degree of hectic fever; and the hemlock in old inveterate cases, approaching to the scirrhous or cancerous state. Either the extract or the fresh juice of this plant may be used. The dose must be small at first, and increased gradually as far as the stomach is able to bear it.
EXTERNAL applications are of little use. Before the tumour breaks, nothing ought to be applied to it, unless a piece of flannel, or something to keep it warm. After it breaks, the sore may be dressed with some digestive ointment. What I have always found to answer best, was the yellow basilicon mixed with about a sixth or eighth part of its weight of red precipitate of mercury. The sore may be dressed with this twice a-day; and if it be very fungous, and does not digest well, a larger proportion of the precipitate may be added.
MEDICINES which mitigate this disease, though they do not cure it, are not to be despised If the patient can be kept alive by any means till he arrives at the age of puberty, he has a great chance to get well; but if he does not recover at this time, in all probability he never will.
THERE is no malady which parents are so apt to communicate to their offspring as the scrophula, for which reason people ought to beware of marrying into families affected with this disease.
FOR the means of preventing the scrophula, we must refer the reader to the observations on nursing, at the beginning of the book.
THOUGH this disease is commonIy communicated by infection, yet it seldom prevails where due regard is paid to cleanliness, fresh air, and wholesome diet. It generally appears in form of small watery pustules, first about the wrists, or between the fingers; afterwards it affects the arms, legs, thighs, &c. These pustules are attended with an intolerable itching, especially when the patient is warm a-bed, or sits by the fire. Sometimes indeed the skin is covered with large blotches or scabs, and at other times with a white scurf, or scaly eruption. This last is called the dry itch, and is the most difficult to cure.
THE itch is seldom a dangerous disease, unless when it is rendered so by neglect, or improper treatment. If it be suffered to continue too long, it may vitiate the whole mass of humours; and, if it be suddenly drove in, without proper evacuations, it may occasion fevers, inflammations of the viscera, or other internal disorders.
THE best medicine yet known for the itch is sulphur, which ought to be used both externally and internally. The parts most affected may be rubbed with an ointment made of the flowers of sulphur, two ounces; crude sal ammoniac finely powdered two drachms; hog's lard, or butter, four ounces. If a scruple or half a drachm of the essence of lemon be added, It will entirely take away the disageeeable smell. About the bulk of a nutmeg of this may be rubbed upon the extremities, at bed-time, twice or thrice a-week. It is seldom necessary to rub the whole body, but when it is, it ought to be done all at once, but by turns, as it is dangerous to stop too many pores at the same tlme.
BEFORE the patient begins to use the ointment, he ought, if he be of a full habit, to bleed or take a purge or two. It will likewise be proper, during the use of it, to take every night and morning as much of the flower of brimstone and cream of tartar, in a little treacle or new milk, as will keep the body gently open. He should beware of catching cold, should wear more clothes than usual, and take every thing warm. The same clothes, the linen excepted, ought to be worn all the time of using the ointment and such clothes as have been worn while the patient was under the disease, are not to be used again, unless they have been fumigated with brimstone, and thoroughly cleaned, otherwise they will communicate the infection anew. Sir John Pringle observes that, though this disease may seem trifling, there is no one in the army that is more troublesome to cure, as the infection often lurks in clothes, &c. and breaks out a second, or even a third time. The same inconveniency occurs in private families, unless particular regard is paid to the changing or cleaning of their clothes, which last is by no means an easy operation.
I NEVER knew brimstone, when used as directed above, fail to cure the itch; and I have reason to believe, that, if duly persisted in, it never will fail; but if it be only used once or twice, and cleanliness neglected, it is no wonder if the disorder returns. The quantity of ointment mentioned above will generally be sufficient for the cure of one person; but, if any symptoms of the disease should appear again, the medicine may be repeated. It is both more safe and efficacious when persisted in for a considerable time, than when a large quantity is applied at once. As most people dislike the smell of sulphur, they may use, in its place, the powder of white hellebore root made up into an ointment, in the same manner, which will seldom fail to cure the itch.
PEOPLE ought to be extremely cautious lest they take other eruptions for the itch; as the stoppage of these may be attended with fatal consequences. Many of the eruptive disorders to which children are liable, have a near resemblance to this disease; and I have often known infants killed by being rubbed with greasy ointments that made these eruptions strike suddenly in, which Nature had thrown out to preserve the patient's life, or prevent some other malady.
MUCH mischief is likewise done by the use of mercury in this disease. Some persons are so fool hardy as to wash the parts affected with a strong solution or the corrosive sublimate. Others use the mercurial ointment, without taking the least care either to avoid cold, keep the body open, or observe a proper regimen. The consequences of such conduct may be easily guessed. I have known even the mercurial girdles produce tragical effects, and would advise every person, as he values his health, to beware how he uses them. Mercury ought never to be used as a medicine without the greatest care. Ignorant people look upon these girdles as a kind of charm, without considering that the mercury enters the body.
IT is not to be told what mischief is done by using mercurial ointment for curing the itch and killing vermin; yet it is unnecessary for either: The former may be always more certainly cured by sulphur, and the latter will never be found where due regard is paid to cleanliness.
THOSE who would avoid this detestable disease ought to beware of infected persons, to use wholesome food, and to study universal cleanliness. The itch is now by cleanliness banished from every genteel family in Britain. It still however prevails among the poorer sort of peasants in Scotland, and among the manufacturers in England. These are not only sufficient to keep the seeds of the disease alive, but to spread the infection among others. It were to be wished that some effectual method could be devised for extirpating it altogether. Several country clergymen have told me, that by getting such as were infected cured, and strongly recommending an attention to cleanliness, they have banished the itch entirely out of their parishes. Why might not others do the same?