Item of the Day: Parkinson’s Medical Admonitions (1803)

Full Title:

Medical Admonitions to Families, Respecting the Preservation of Health, and the Treatment of the Sick.  Also, a Table of Symptoms, Serving to Point out the Degree of Danger, and, to Distinguish one Disease from Another.  With Observations on the Improper Indulgence of Children, &c.  By James Parkinson, M.D.  Hoxton.  First American, from the Fourth English Edition.  Portsmouth, New-Hampshire: Printed for Charles Peirce, by N. S. & W. Peirce.  1803.

Gout.

The paroxysms of this tormenting disease are most commonly preceded, by a general uneasiness; the feet and legs are afflicted with numbness and coldness, and frequently also with the sense of prickling; the veins on the surface are also said to become unusually turgid, and the muscles of the leg to be affected with the cramp.  But the circumstances which have been observed, most particularly to precede the attacks of this disease, are the changes which, for some little time before, take place in the stomach; this organ generally suffers a considerable derangement of its functions; the appetite being much impaired, and the stomach and bowels distended with wind, the consequence of digestion not being properly carried on; the appetite becoming, however more eager before the attack. 

According to the observations of the attentive Sydenham, the paroxysm generally begins about two o’clock in the morning.  The patient, having gone to bed free from pain, is waked about the time with pain possessing commonly some part of the foot.  Soon after this, comes on a coldness and shivering, which terminates in fever.  The pain increasing, sometimes resembles that which might by expected to be produced by the stretching and tearing of the ligaments, or the gnawing of a dog; at others, the parts seem to suffer the effects of a tight stricture, or considerable pressure, being so feelingly alive, as not only, not to bear the weight of bed-clothes, but not even the heavy tread of any one across the room.  In this miserable state the patient continues, tossing about the bed, in vain trying the effect of variety of posture to lessen his sufferings.  At about the same hour of the following morning, the patient, in general, experiences a sudden mitigation of the pain, which he commonly attributes to the last position in which the limb was placed.  Soon after this, a moderate sweat coming on, he falls asleep, and, upon waking, finds that the pain is considerably diminished; but that the part which suffers is affected with a red shining swelling.  The pain sometimes continues two or three days, increasing at night, and becoming more mild towards morning. 

If, after the disease has thus completed its course in one foot, it disappears entirely, the patient regains use of the foot, and experiences a most grateful change–strength and alacrity having taken the places of debility and languor.  But it often happens, that after the violence of the first attack has subsided, a second will be experienced in the other foot.  In more inveterate cases, both feet, sometimes, are affected at the same time; an repeated paroxysms sometimes extend the sufferings of the patient for six weeks or two months, or even longer.     

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Item of the Day: Observations on the Construction of Hospitals (1793)

Full Title: Observations on the construction of Hospitals, by Mr. Le Roy, Member of the Royal Academy of Sciences — (Extracted from an Essay on the Subject, which, with several elegant plans, was transmitted by the author to the Society, but could not be inserted entire, as it contained many remarks of a local nature, respecting Paris —only.

 Found In: Transactions of the American Philosophical Society, held at Philadelphia, for promoting Useful Knowledge. Vol. III> Philadelphia: Printed and sold by Robert Aitken & Son, No. 22, Market Street, M.DCC.XCIII. [1793]

 [pp. 348-350]

THE construction of Hospitals is in general objectionable, either because many of the wards do not admit of perfect ventilation, or because the air passes from one patient over another, by which means contagious diseases are often spread.

To avoid these inconveniences, a large Hospital should consist of distinct and separate buildings, each forming one ward, erected upon arches or columns, at a considerable height from the ground, and ranged at a distance from each other, like the tents of an encampment.

The cieling [sic] or roof of each ward should be formed into a number of spherical arches according to  its size, the crown of each arch being in the middle of the breadth of the ward, and opening into a funnel like a common chimney, which should be supplied with a vane, (resembling that we call a cow) so that it may always open to leeward.

In each floor, midway as to breadth, should be a row of holes at suitable distances from each other, to admit air from below, so constructed that the quantitiy of it may be regulated at pleasure.

In consequence of this structure there must be a constant change of air, for that which is in the lower part of the ward, being warmed by the patients and nurses, and the necessary fires, will ascend, and in consequence of the spherical construction of the roof, will be directed to the openings in it, and flow through them, while the holes in the floor will afford a constant supply of fresh air, which will move rapidly as it enters the from so low.

A number of arches with openings is preferable to a single arch in the center, because the air is passing from the extremeities of the room to the center flows, from one patient over another–and a plan or flat cieling [sic], even with apertures, is improper, because the upper air at a distance from the apertures cannot move to them.

The rooms may be warmed by placing grates or stoves over these holes in the floor, and no bad effect can be produced by t he fire as the air and vapours will ascend from it and go off by the holes in the cieling — If it be necessary to quicken the circulation of air, either on account of the sluggishness of the atmosphere, or of the contagious nature of any diseases in the ward, small fires may be fixed ingrates or stoves near the openings in the cieling, to increase the motion of the air.

To prevent the spreading of contagion, as well as to keep the sick from beholding the sufferings of each other, a screenof suitable height should be placed between each bed.

For contagious disorders and surgical cases, there should be a number of wards, at a distance from the Hospital, and to leeward of it with respect to prevailing winds. . . .

Item of the Day: The Works of John Fothergill (1784)

Full Title: The Works of John Fothergill, M.D.  . . . with some Account of his Life by John Coakley Lettsom. London: Printed for Charles Dilly, in the Puultry, M.DCC.LXXXIV. [1784] 

 

OF THE MANAGEMENT PROPER

AT THE

CESSATION OF THE MENSES

 

To the Medical Society in London.

Gentlemen,

THERE is a period in the life of Females to which, for the most part, they are taught to look with some degree of anxiety; as a period on which depends their enjoying a good or bad state of health during the residue of their lives.

The various and absurd opinions relative to the ceasing of the mentrual discharge, and its consequences, propagated through successive ages, have tended to embitter the hours of many a sensible women. Nor have these mistaken notions been confined to them only; they have occupied the minds of such who ought to have been better informed: some practitioners, in other respects able and judicious, if they have not favoured these erroneous and terrifying notions, seem not to have endeavoured to correct them, with the diligence and humanity which an object like this requires.

The design of this essay is to contribute my mite towards so necessary a purpose; to assist in removing these groundless apprehensions, and to substitute a reasonable confidence, that, with very little aid, Nature is sufficient to provide for her own security on this occasion.

You must forget for a moment that I am submitting these remarks to the judgment of a Society, every member of which, perhaps, is as capable of this work, and some much better than myself. I am writing to many sensible young men in the profession of physic, who, though they may have applied themselves to the general study and practice of our profession with diligence and success, may not yet, perhaps, know where to look for such information on this subject as may be sufficient to satisfy themselves and their patients, what managment is proper when the Menses are about to cease.

To propose a regimen that shall suit all the different cases that may occur, would require a volume. To give some general direction is all I intend, without entering into a minute description of the commencement, progress, and termination of the Menses. I must suppose every thing of this kind is already known, and that the single question is, What conduct, what management is necessary to be observed, when the Menses are about to cease, by the patient who consults her physician on the occasion? We are now sensible that the menstrual discharge is not, what it was too long and too generally believed be by many of the sex, an evacuation of peccant matter and morbid humour, sometimes acrimonious and malignant, whose retention, from its noxious qualities, never fails to be extremely injurious to the constitution. What opinion the ancients entertained concerning it, I need not repeat to you: that its malignancy was such as to affect even inanimate bodies. But these fables are wholly disbelieved, except by some of those who ought to be undeceived in a matter that so much concerns them.

It is now well known, and the sex cannot be too generally apprized of it, that the menstrual discharge possesses no such injurious or malignant properties; that it is solely a redundancy of that pure vital blood, which animates the whole frame of a healthy person; and that its retention is by no means attended, in general, with effects that are not as easily removed as any disorder to which they are subject.

That some acrimonious morbid humours may be discharged together with the Menses, when any such exist, is not improbable. So it happens likewise to men subject to piles, or other preternatural excretions.

Women who have unhappily imbibed that prejedice, are naturally alarmed at the consequences they apprehend must ensue from such a change in their constitution; and the more strongly they are preposessed with a belief, that by this channel has been regularly discharged whatever had a tendency to produce diseases, the more they are terrified with apprehensions of some of the worst complaints: and, indeed, it is not seldom that, by such anxiety, they bring on disorders that are not easily removed, attributing them to the cause we are speaking of, whilst they principally originate from anxiety.

 For the most part, the menstrual discharge, as has been mentioned, proceeds from a redundancy of good and healthy blood; this redundancy is formed for the most necessary purposes; continues whilst this necessity subsists; and ceases when, according to the constitution of the female frame, it is no longer required.

The powers communicated to the human system, generally expressed by the term Nature, are such as spontaneously bring about this cessation. The provision for the Mesnes ceases, and extra quantity of blood is not generated, and the vessels provided for its regular discharge by degrees collapse; and in general all this proceeds without any the least interruption to the health of the subject in which this alteration happens. Here it might not be improper to mention at what time this alteration first begins, and the general period of its cessation. These circumstances, however, may be found elsewhere so amply treated of, as to render it as unnecessary as it is foreign to my present design.

There are great numbers of women in whom the menstrual discharge ceases, without their perceiving any alteration in their usual health. There are some who, from being invalids during a part of the season which is appropriated to menstruation, find themselves by degrees recovering health and vigour, to which they have been strangers during that period, when this discharge leaves them entirely. Very tender, delicate, relaxed habits, subject to copious discharges, are often much benefited by the cessation. All, however, are not so fortunate. Some alterations frequently supervene, that render assistance necessary. . . .