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break out, fooner or later, all over the body; fometimes red, fometimes whitish, and again both forts intermixed; at one time smaller, at another larger and more elevated, and of a bad fmell. Sobbing and anxiety about the heart are very frequent fymptoms, which are often followed by a delirium and convulfions. The difeafe runs into a confiderable length: and if it happens to end too foon, without a fufficiently perfect crifis, it often brings on a bad habit of body. The red pimples are not fo dangerous as the whitish; and the more lively their colour, they are the fafer. Hence it appears that this fever is more owing to a defect in the humours, and the animal fpirits in particular, than to any bad quality of the air; and that it requires different methods of cure according to its different circumstances.

But of what kind foever the puftules are, blood is to be drawn in the beginning, if the patient has ftrength to bear it; unless he be actually in a sweat, in which cafe blood-letting is either to be omitted, or at least to be put off for a day or two, or fome other convenient time. Now, red puftules bear bleeding much better than the whitish: and though in both forts blifters are ferviceable, yet they are more neceffary in the latter; and they are to be applied to the neck, head, and all the limbs, at proper diftances of time. After all, I would advise the physician always to bear in mind, that the more fparingly blood has been drawn, the more happily the difeafe generally terminates: for when the ftrength has been exhausted by evacuations toward the latter end, the eruption finks in, and the patient dies.

Nature's endeavours to expel the morbific matter through

through the skin, are to be affifted by moderately cordial medicines. Of this tribe the moft proper are the bezoardic powder, the compound powder of contrayerva, and the cordial confection; adding nitre, in cafe of an inflammation: and this falt may be very advantageously joined to cordial medicines in almost all malignant fevers, at least in the beginning. Toward the decline, warm bathing is fometimes ferviceable, in order to bring forth the remains of the puftules.

long in the ufe of unlefs the length of

But if, either at the height, or on the decline of the fever, the only appearance of an eruption is a vast number of pellucid veficles, fo fmall as hardly to be feen; it is not fafe to perfift too internal medicines of this tribe; the diftemper has fo far weakened the patient, as to render even more powerful cordials neceffary. For fuch little roughnesses of the skin are not able to bring on a good crifis, but, on the contrary, generally denote a difficult and tedious illness: wherefore, without difcontinuing the blifters, the caufe of the disease is to be carried off by other ways, especially through the intestinal canal by gentle purges of rhubarb, or manna and Glauber's falt.

It is to be observed, that this disease is not always terminated by any one fort of crisis. It has fometimes one fort, fometimes another and in fome cafes feveral forts together; as I have already faid frequently happens in other malignant fevers. Thus at the fame time that there are other difcharges of the morbific matter, a thrufh fometimes breaks out, and fpreads all over the mouth and throat. This commonly begins with a hiccup and if it be whitish and VOL. III.

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very

very moift, and occafion a plentiful fpitting, it is fa far from portending any great danger, that it is a fign of the distemper ending happily: but if it be of the black kind, and dry, and the fpittle tough and little in quantity, it is of fatal omen, as it indicates the mouth and throat choked up with flimy phlegm, In thefe cafes it is proper to use gargles made of barley-water and fyrup of mulberries, or fome fuch other fyrup, or the pectoral decoction: for repellents of all kinds are to be carefully avoided,

It may poffibly feem ftrange to fome, that Sydenham prescribed the bark in this fever, and the aphthe attending it, and fays, he always found it to anfwer his expectations *. But this was not a rafh practice in that fagacious phyfician: for this fever often intermits, when the aphthæ do not appear; but it more frequently ends upon their going off. In both cafes this excellent antidote is of very great fervice. And in juftice to the memory of that great man, who had accustomed himself, after the example of Hippocrates, to obferve the return of epidemical difeafes, and found that they varied in the fame feafons of the year according to the diversity of the weather: I must observe, that he was the first among us who defcribed this fever; which, he says, took its rife here in the month of February 1.684, after the long fevere froft of the preceding winter. Hence it is probable, that it arofe from the acrimony of the humours induced by the constriction of the fibres of the skin from cold, and the confequent dimipution of perfpiration.

See his Schedula monitoria.

SEC

SECTION V.

The petechial fever.

THE petechiae, from which this fever has its name,

are broad, red fpots, like the bites of fleas, not rifing above the furface of the skin. When they are livid or black, they are of very dangerous prognoftic: because they are really fo many little gangrenes; and therefore the more numerous they are, the more their confequence is to be dreaded.

The common practice of giving hot medicines in the beginning of this diftemper, in order to raise fweats, is quite wrong. It is much the fafer way, to check the gangrenous difpofition of the humours by the beźoardic powder, or rather the compound powder of contrayerva, with nitre, as is above mentioned; or to affift nature with the cordial confection diffolved in fimple alexeterial water and alfo to acidulate the patient's drink with dulcified spirit of nitre; to repair his ftrength with Rhenish wine; and in fine, a very proper drink will be barley-water with juice of lemons. And all thefe liquors are to be drank plentifully. It will likewife be of use fometimes, to administer some dofes of the calx of antimony and bezoardic powder mixed, in order to provoke fweat : but the calx fhould not be too much washed. Yet it is necessary to admonish, that it is not an uncommon case, especially towards the latter end of the dif cafe, that the patient's weak low ftate requires warmer cordials; fuch as Virginia fnake-root, contrayervaroot, the root of wild valerian, faffron, and the like. And infufions of these in water will be far more convenient than their powders; efpecially if D 2 they

create nauseating, is rendered more agreeable to the stomach, and better adapted to the disease.

Upon the fame principles Mindererus's spirit * is. likewife of excellent ufe in all putrid fevers.

In fine, I have more than once experienced the good effects of mufk, especially when convulfions come on and thus I order it :

Take of mufk, the cordial confection, and cinna bar of antimony, each ten grains; mix, and with a little syrup make a bolus, to be repeated at proper intervals.

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Hofe fevers which are accompanied with an înflammation of any particular parts, require a treatment fuitable to those parts. I inftance in

A Pleurify.

IN which, after drawing as much blood as is ne ceffary, draughts with fresh-drawn linfeed-oil are of great fervice for eafing the cough; nitre for allaying the heat; for diffolving the fizy blood, obftructing the small canals, wild goat's blood, and volatile falts; and lastly, a blister laid on the part affected, in order to draw forth the peccant humour. The advantage of this external remedy I first learned from Sir Theodore Mayerne's practice † ; and I have for many years paft ufed it with good fuccefs. In *Of the Edinburgh difpenfatory. + De morbis internis fyntagma primum, cap. v. de pleuritide.

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