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Page i
COMPANION HANDBOOK
Page ii
Notice
Medicine is an ever-changing science. As new research
and clinical experience broaden our knowledge,
changes in treatment and drug therapy are required.
The editors and the publisher of this work have
checked with sources believed to be reliable in their
efforts to provide information that is complete and
generally in accord with the standards accepted at the
time of publication. However, in view of the
possibility of human error or changes in medical
sciences, neither the editors, nor the publisher, nor any
other party who has been involved in the preparation or
publication of this work warrants that the information
contained herein is in every respect accurate or
complete. Readers are encouraged to confirm the
information contained herein with other sources. For
example, and in particular, readers are advised to
check the product information sheet included in the
package of each drug they plan to administer to be
certain that the information contained in this book is
accurate and that changes have not been made in the
recommended dose or in the contraindications for
administration. This recommendation is of particular
importance in connection with new or infrequently
used drugs.
Page iii
COMPANION HANDBOOK
Page iv
Contents
Preface
About the authors
Laboratory reference values
Normal values: diagnostic guidelines
Abbreviations
A ABC of general practice
A diagnostic perspective
Abdominal pain
Abdominal pain in children
Infantile ‘colic’ (period of infant distress)
Intussusception
Drugs
Mesenteric adenitis
Recurrent abdominal pain
Specific causes of acute abdominal pain
Abdominal aortic aneurysm (AAA)
Mesenteric artery occlusion
Acute retention of urine
Acute appendicitis
Small bowel obstruction
Large bowel obstruction
Perforated peptic ulcer
Peritonitis
Ureteric colic
Biliary pain
Acute pancreatitis
Chronic pancreatitis
Acute diverticulitis
Lower abdominal pain in women
Ectopic pregnancy
Ruptured ovarian (Graafian) follicle (Mittelschmerz)
Ruptured ovarian cyst
Acute torsion of ovarian cyst
Pelvic adhesions
Acne
Some topical treatment regimens
Oral antibiotics
Other therapies
Acute allergic reactions
Anaphylaxis and anaphylactic reactions
Angioedema and acute urticaria
Acute coronary syndromes (ACS)
Addison disease (adrenal insufficiency)
Adolescent health
Depression, parasuicide and suicide
Alcohol problems
Alopecia areata (patchy hair loss) Page vi
Androgenetic alopecia (male pattern baldness)
Amnesia (loss of memory)
Transient global amnesia
Anaemia
Classification of anaemia
Microcytic anaemia—MCV ≤ 80 fL
Iron-deficiency anaemia
Thalassaemia
Macrocytic anaemia—MCV > 100 fL
Vitamin B12 deficiency (pernicious anaemia)
Folic acid deficiency
Angina pectoris
Anorectal disorders
Anorectal pain
Anal fissure
Proctalgia fugax
Perianal haematoma
Strangulated haemorrhoids
Perianal abscess
Anorectal lumps
Skin tags
Perianal warts
Internal haemorrhoids
Rectal prolapse
Anal (faecal) incontinence
Anorectal bleeding
Anticoagulants
Anxiety disorders
Generalised anxiety disorder
Panic disorder
Phobic disorders
Obsessive–compulsive disorder
Acute stress disorder
Post-traumatic stress disorder
Aphthous ulcers (canker sores)
Arm and hand pain
Pulled elbow
Tennis elbow
Olecranon bursitis
Trigger finger/thumb
Game keepers thumb (skiers thumb)
Raynaud phenomenon and disorder
Chilblains
Carpal tunnel syndrome
Arthritis
Osteoarthritis
Rheumatoid arthritis
Connective tissue disorders
Crystal arthritis
The spondyloarthropathies Page vii
Viral arthritis
Lyme disease and lyme like disease
The vasculitides
Asthma
Pharmacological agents to treat asthma
Maintenance plan for persistent asthma—adult (example)
Asthma action plan (example)
The acute asthma attack
Asthma in children
B Back pain
Low back pain (LBP)
Vertebral dysfunction with non-radicular pain (non-specific LBP
)
Chronic LBP (pain > 3 mths)
Vertebral dysfunction with radiculopathy (sciatica)
Lumbar spondylosis
Spondylolisthesis
The spondyloarthritides
Thoracic back pain
Scheuermann disorder
Idiopathic adolescent scoliosis
Kyphosis
Dysfunction of the thoracic spine
Bad news (breaking bad news)—guidelines
Bereavement and coping with loss
Balanitis (balanoposthitis)
Bed sores (pressure injury)
Belching (aerophagia)
Bell (facial nerve) palsy
Benzodiazepine problems
Benzodiazepine withdrawal syndrome
Bites and stings
Bite wounds
Snake bites
Spider bites
Human bites and clenched fist injuries
Dog bites (non-rabid)
Cat bites
Bed bug bites
Sandfly (biting midges) bites
Mollusc bite (blue-ringed octopus, cone shell)
Stings
Bee stings
Centipede and scorpion bites/stings
Box jellyfish or sea wasp (Chironex fleckeri)
Irukandji (carukia barnesi) syndrome
‘Blue bottle’ and other stinging jellyfish
Stinging fish
Other bites and stings
Black named disorders Page viii
Bladder cancer
Bladder dysfunction (in women during night)
Blepharitis
Body odour
Boils (recurrent)
Breast lumps
Carcinoma of the breast
Fibrocystic disease
Breast cyst
Lactation cysts (galactoceles)
Fibroadenoma
Fat necrosis
Mammary duct ectasia
Phyllodes tumour
Breast pain (mastalgia)
Cyclical mastalgia
Non-cyclical mastalgia
Costochondritis (Tietze syndrome)
Mastitis
Inflammatory breast cancer (mastitis carcinomatosa)
Breast abscess
Breath-holding attacks
Bronchiolitis
Bronchitis
Acute bronchitis
Chronic bronchitis
Bruising and bleeding
Purpura
Vascular disorders
Platelet disorders
Coagulation disorders
Bruxism (teeth grinding)
Burning feet syndrome
Burns
Burns to hands
Buruli (aka Bairnsdale) ulcer: Mycobacterium ulcerans
C Calf pain
Cancer
Diagnostic triads/tetrads for specific cancers
Metastatic tumours
Cannabis (marijuana)
Cardiopulmonary resuscitation (CPR)
‘Cellulite’
Cellulitis
Central nervous system infections (incl. meningitis, enceph
alitis, abcess)
Bacterial meningitis
Viral meningitis
Encephalitis
Brain abscess Page ix
Spinal subdural or epidural abscess
Prion transmitted diseases
Poliomyelitis
Cervical cancer screening
Performing a cervical screening test
Chest pain
Site, radiation and features of chest pain syndromes
Acute coronary syndromes (ACS)
Key features
Aortic dissection
Pulmonary embolism
Acute pericarditis
Spontaneous pneumothorax
Psychogenic pain
Chilblains
Children: normal developmental milestones
Children: developmental disorders
Growth and puberty problems
Short stature
Tall stature
Growing pains (benign nocturnal limb pain)
Delayed puberty
Precocious puberty
Premature thelarche
Premature adrenarche
Pubertal breast hyperplasia
Intellectual disability
Cerebral palsy
Down syndrome
Fragile X syndrome (FXS)
Prader–Willi syndrome
Fetal alcohol syndrome (FAS)
Williams syndrome
Specific learning disabilities (SLDs)
Dyslexia
Autism spectrum disorders
Child abuse
Childhood: common infectious diseases
Skin eruptions
Measles
Rubella
Scarlet fever
Viral exanthema (fourth syndrome)
Erythema infectiosum (fifth syndrome)
Roseola infantum (exanthema subitum or sixth syndrome)
Chickenpox (varicella)
Hand, foot and mouth (HFM) disease
Kawasaki disease
Others Page x
Mumps (epidemic parotitis)
Pertussis (whooping cough)
Children: special observations
The child as a barometer of the family
Failure to thrive (FTT)
Children’s behaviour disorders
Attention deficit hyperactivity disorder
Breath-holding attacks
Conduct disorders
Crying and fussing in infants
Habit cough
Head banging or rocking
Oppositional defiant disorder
Parasomnias (night terrors, sleep talking and walking)
Poor eating
Sleep disorders
Stealing
Stuttering and stammering
Temper tantrums
Tics (habit spasm)
Tourette disorder
Children: surgical problems
Plagiocephaly (flat head syndrome)
Ear, nose, face and oral cavity
Prominent bat/shell ears
Facial deformity
External angular dermoid
Cleft lip and cleft palate
Nasal disorders
Tongue tie
Pre-auricular sinus
Branchial sinus/cyst/fistula
Eyes
Strabismus (squint)
Blocked nasolacrimal duct
Neck lumps
Sternomastoid tumour/fibrosis
Thyroglossal cyst
Lymphatic malformation/cystic hygroma
Cervical lymphadenopathy
MAIS (Mycobactyerium AIS) lymphadenitis
Congenital heart disorders
Ventricular septal defect
Atrial septal defect
Patent ductus arteriosus
Coarctation of aorta
Hernias and genital disorders
Hernias
Hydroceles
Hypospadias Page xi
Foreskin and circumcision
Children: neonatal leg and foot abnormalities
Developmental dysplasia of hip
Club foot (congenital talipes equinovarus)
Flat feet (pes plano valgus)
Curly toes
Children: special senses
Visual problems
Amblyopia
Strabismus (squint)
Hearing problems
Optimal times for surgery/intervention in early children’s
disorders
Children’s emergencies
Meningitis or encephalitis
Acute epiglottitis
Acute heart failure
Poisoning
Swallowed foreign objects
Inhaled foreign bodies with choking
Management of other emergencies
Collapse in children
Pulse oximetry and oxygen saturation
Children’s skin and hair disorders
Neonatal period and early infancy
Toxic erythema of newborn
Transient neonatal pustular dermatosis
Naevus flammeus (salmon patch)
Capillary malformation (port wine stain)
Infantile haemangioma (strawberry naevus)
Sebaceous hyperplasia
Naevus sebaceous
Congenital naevi
Benign juvenile melanoma
Milia
Miliaria (‘sweat rash’)
Sucking blisters
Umbilical granuloma
Breast hyperplasia
Frey’s syndrome
Common childhood skin problems
Hair disorders
Loose anagen (growing hair) syndrome
Traction alopecia
Trichotillomania (hair pulling)
Localised alopecia areata
Tinea capitis
Chloasma
Chronic obstructive pulmonary disease
Cold sores
Common cold (acute coryza) Page xii
Communication and consulting skills (or how to prevent lit
igation)
Concussion
Conjunctivitis
Bacterial conjunctivitis
Viral conjunctivitis
Primary herpes simplex infection
Allergic conjunctivitis
Chlamydia trachomatis conjunctivitis (trachoma)
Constipation
Idiopathic (functional) constipation
Colorectal cancer (CRC)
Contact dermatitis
Contraception
Cough
Key features
Cough in children
Bronchial carcinoma
Bronchiectasis
Tuberculosis
Symptomatic treatment of cough
Counselling skills
Cognitive behaviour therapy (CBT)
Court appearance
‘Cracked’ skin
Cracked and dry lips
Cracked hands and fingers
Cracked heels
Cramps (nocturnal cramps in legs)
Cranial nerves
Croup
Crying baby
D Dandruff
Persistent dandruff
Deafness and hearing loss
Deafness in children
Otosclerosis
Noise-induced hearing loss
Presbyacusis
Wax impaction
Depression
Notes about antidepressants
Dermatitis/eczema
Atopic dermatitis (eczema)
Other types of atopic dermatitis
Nummular (discoid) eczema
Pityriasis alba
Lichen simplex chronicus
Dyshydrotic dermatitis (pompholyx)
Asteatotic dermatitis (‘winter itch’) Page xiii
Dermatitis of hands
Diabetes mellitus
Type 1 diabetes mellitus
Type 2 diabetes mellitus
Hypoglycaemia
Diabetic ketoacidosis
Diarrhoea
Specific conditions
Pseudomembranous colitis (antibiotic-associated diarrhoea)
Ischaemic colitis in the elderly
Diarrhoea in children
Acute gastroenteritis
Toddlers diarrhoea (‘cradle crap’)
Chronic diarrhoea in children
Acute gastroenteritis in adults
Traveller’s diarrhoea
Inflammatory bowel disease
Difficult, demanding and angry patients
Diplopia
Cranial nerves in general (with function)
Disturbed patients
Dementia (chronic organic brain syndrome)
The acutely disturbed patient
Delirium (acute organic brain syndrome)
The acute psychotic patient
Bipolar disorder
Diverticular disease
Dizziness/vertigo
Vertigo
Giddiness
Syncopal episodes
Disequilibrium
Specific causes of dizziness
Drugs
Cervical spine dysfunction
Acute vestibulopathy (vestibular failure)
Benign paroxysmal positional vertigo
Ménière syndrome
Vestibular migraine (migrainous vertigo)
Recurrent vestibulopathy
Dizzy turns in elderly women
Dizzy turns in girls in late teens
Domestic (intimate partner) violence
Drugs—illicit substance abuse
Dry eyes
Dry hair
Dry mouth
Dry skin
Dyslipidaemia Page xiv
Dysmenorrhoea (primary)
Dyspareunia
Dyspepsia (indigestion)
Dyspepsia in children
Gastro-oesophageal reflux
Dyspepsia in adults
Gastro-oesophageal reflux disease (GORD)
Functional (non-ulcer) dyspepsia
Peptic ulcer disease
NSAIDs and peptic ulcers
Dysphagia
Dyspnoea
Key investigations for dyspnoea
Pulmonary function tests
Interstitial lung diseases
Sarcoidosis
Idiopathic pulmonary fibrosis
Hypersensitive pneumonitic (extrinsic allergic alveolitis)
Occupational pulmonary disease
Acute respiratory distress syndrome (ARDS)
Severe acute respiratory syndrome (SARS)
Dystonia
Dysuria and frequency
E Ear pain
Key features
Otitis media in children
Otitis media in adults
Otitis externa
Furunculosis
Perichondritis
Infected earlobe
Otic barotrauma
Ectropion
Elderly patients
‘Rules of 7’ for assessment of the non-coping elderly patient
The mini-mental state examination
Falls in the elderly
Electrolyte/metabolic disorders
Emergency management of key medical conditions
Encopresis (faecal incontinence in children)
Endocarditis
Endocrine—overview of conditions
Triads/tetrads for syndromes related to pituitary hormones
Thyroid
Adrenal
Pituitary
Other endocrine related
Endometriosis
Entropion
Enuresis (bed-wetting) Page xv
Nocturnal enuresis
Epilepsy
Tonic-clonic seizures
Absence seizure
Complex partial seizures
Simple partial seizures
Status epilepticus
Epistaxis: treatment techniques
Erectile dysfunction
Erysipelas
Eye: dry
Eye pain and redness
Red eye in children
Neonatal conjunctivitis (ophthalmia neonatorum)
Trachoma
Blocked nasolacrimal duct
Orbital cellulitis
Red eye in adults
Conjunctivitis
Episcleritis and scleritis
Uveitis (iritis)
Acute glaucoma
Herpes zoster ophthalmicus
Flash burns
Eyelid and lacrimal disorders
Stye
Chalazion (meibomian cyst)
Blepharitis
Dacryocystitis
Dacroadenitis
Eyelashes: ingrowing (trichiasis)
Eyelid ‘twitching’ or ‘jumping’
Eyes: flash burns
F Facial pain
Cervical spinal dysfunction
Dental disorders
Alveolar osteitis (dry tooth socket)
Pain from paranasal sinuses
Temporomandibular joint (TMJ) dysfunction
Trigeminal neuralgia
Glossopharyngeal neuralgia
Facial migraine (lower half headache)
Chronic paroxysmal hemicrania
Herpes zoster and postherpetic neuralgia
Atypical facial pain
Fatty liver
Fever and chills
Fever of less than 3 days duration
Fever present for 4–14 days
Fever in children Page xvi
Febrile convulsions
Fever of undetermined origin (FUO)
Fibroids (leiomyoma)
Fibromyalgia syndrome
Flatus: excessive
Floaters and flashers of eyes
Folliculitis
Foot odour (smelly and sweaty feet)
Foot pain (podalgia)
Vascular causes
Complex regional pain syndrome 1
Osteoid osteoma
Osteochondritis/aseptic necrosis
Skin disorders
Arthritic conditions
Foot strain
Plantar fasciitis
Metatarsalgia
Stress fractures
Morton neuroma
Foot ache
Callus, corn and wart
Turf toe
Ingrowing toenails
Paronychia
Freckles and lentigines (sun spots)
Frostbite
G Gambling
Ganglion
Gastroenteritis
Gastroparesis (gastropathy) in adults
Genetic disorders
Familial cancer
Genital herpes
Genital warts
Geographical tongue (erythema migrans)
Gingivitis
Glandular fever
Epstein–Barr mononucleosis (EBM)
Globus hystericus
Gout (monosodium urate crystal disease)
Granuloma annularae
Growing pains
Grover disease
Guillain–Barre syndrome
H Haematemesis and melaena
Haematuria
Haemochromatosis (primary hereditary)
Haemorrhoids Page xvii
Hair disorders
Androgenic alopecia
Alopecia areata, alopecia totalis and alopecia universalis
Scarring alopecia
Telogen effluvium
Anagen effluvium
Trichotillomania (hair pulling)
Hair disorders in children
Hirsuties
Hypertrichosis
Dry hair
Oily hair
Halitosis
Hangover
Hay fever (seasonal allergic rhinitis)
Head banging or rocking in toddlers
Headache
Tension-type headache
Migraine
Transformed migraine
Cluster headache
Cervical dysfunction/spondylosis–cervicogenic headache
Combination headache
Temporal arteritis
Frontal sinusitis
Subarachnoid haemorrhage (SAH)
Hypertension headache
Benign intracranial hypertension (pseudotumour cerebri)
Head injury and unconsciousness
Extradural haematoma
Subdural (epidural) haematoma
Heartburn (dyspepsia)
Heart failure
Diastolic heart failure
Acute severe heart failure
Heel pain
Achilles tendon bursitis
Plantar fasciitis
Achilles tendonopathy/peritendonitis
Partial rupture of Achilles tendon
Complete rupture of Achilles tendon
Hepatitis
Hepatitis A
Hepatitis B (HBV)
Hepatitis C (HCV)
Herpes simplex
Herpes labialis (classical cold sores)
Genital herpes
Eczema herpeticum Page xviii
Herpetic whitlow
Herpes simplex keratitis
Herpes zoster (shingles)
Postherpetic neuralgia
Hiccoughs (hiccups)
Hip pain
Key features: hip and buttock pain
Hip pain in children
Developmental dysplasia of the hip (DDH)
Perthes disease
Transient synovitis
Slipped capital femoral epiphysis
Septic arthritis
Hip and buttock pain in the elderly
Osteoarthritis of the hip
Greater trochanteric pain syndrome
Hirsutism
Hives (papular urticaria)
Hoarseness
Human immunodeficiency virus infection
Hypertension
Hyperventilation
Hypoglycaemia
I Immunisation
Impetigo
Incontinence of urine
Infantile colic
Infertility/subfertility
Referral
Influenza
Ingrowing toenails
Injectable contraceptives
Insect stings
Insomnia
Intertrigo
Groin rash
Candida intertrigo
Erythrasma
Irritable bowel syndrome (IBS)
J Jaundice
Key history
Infective viral hepatitis
Cholestatic jaundice (bile outflow obstruction)
Jaundice in the infant
Jet lag
Jitters
Jock itch
K Kawasaki disease (mucocutaneous lymph node syndrome)
Keloid or hypertrophic scar
Keratoacanthoma Page xix
A.D. 1823.
Public debts,
Epithets,
Foul and filthy, good and great,
Glorious wars,
British tars,
Beat and bruise
Parlez-vous,
Frenzy, frown,
Commons, Crown,
Ass and pannier,
Rule Britannia!—
How I love a loud debate!”
Then the Church shakes her rattle, and sends forth to battle
The terror of Papist and sinner,
Who loves to be seen as the modern Mæcenas,
And asks all the poets to dinner.
Indian Stories,
Damn the Tories,
None but he can rule the State,
Wise magicians,
Politicians,
Foreign lands,
Kings and wands,
Fiends and fairies,
Dromedaries,
Laugh at Boodle’s,
Cock-a-doodles—
How I love a loud debate!”
Then up gets a youth with a visage of truth,
An omen of good to our islands,
Who promises health and abundance of wealth
To our Oatlands, and Wheatlands, and Ryelands.
And the honourable gentleman, after making the grand tour in a hand
canter, touching cursorily upon Rome, Constantinople, Amsterdam,
Philadelphia, and the Red Sea; with two quotations, two or three hundred
similes, and two or three hundred thousand metaphors, proceeds to the tune
of
[14]“We, Mr. President, have indeed awful examples to direct us or deter.
Have we not seen the arms of the mighty overpowered, and the counsels of
the wise confounded? Have not the swords of licentious conquest, and the
fasces of perverted law, covered Europe with blood, and tears, and
mourning? Have not priests and princes and nobles been driven in beggary
and exile to implore the protection of rival thrones and hostile altars?
Where is the sacred magnificence of Rome? Where the wealth and
independence of Holland? Where the proud titles of the German Cæsars?
Where the mighty dynasty of Bourbon? But is there yet one nation which
has retained unimpaired its moral and political strength? One nation, whose
shores have ever been accessible to a suppliant, and never to an enemy?
One nation which, while the banners of her foes have been carried in
triumph to half the capitals of the world, has seen them only suspended over
her shrines as trophies? One nation, which, while so many cities have been
a prey to hostile fires, has never seen her streets lighted up but with the
blaze of victorious illumination? History and posterity will reply, ‘That
country was England.’ Let them not talk to us of their philosophy and their
philanthropy, their reason and their rights! We know too well the oratory of
their Smithfield meetings, and the orgies of their midnight clubs! We have
seen the weapons which arm, and the spirit which nerves them. We have
heard the hyæna howl, till the raving which excited dismay provokes
nothing but disgust. Amid the railings of disappointed ambition, and the
curses of factious hate; amid the machinations of the foully wicked, and the
sophistries of the would-be wise, we will cling to our fathers’ banner—we
will rally round our native rock. Mr. President, that banner is the Charta of
our rights—that Rock is the British Constitution!”
“Bravo!” “Can’t say I quite caught the line of argument.” “Argument!
Fiddlestick! Quite gone out except for opponencies; and then for the
language, and the feeling, and the style, and all that sort of thing—oh!
nobody can deny that it was all
Oratoric,
Metaphoric,
Similes of wondrous length;
Illustration,
Conflagration,
Ancient Romans,
House of Commons,
Clever Uriel
And Ithuriel,
Good old king,
Everything!—
How I love a loud debate!”
With his sayings and saws, his hems and his haws,
Another comes up to the scratch;
While Deacon and Law unite in a yaw! [Yawning.
And the President looks at his watch.
Admirable,
Bang the table,
‘Sir, although its getting late,’
Opposition,
Repetition,
Endless speeches,
Leather breeches,
Taxes, hops,
Turnip-tops,
Leather ’em, lather ’em,
Omnium-gatherum—
How I love a loud debate!”
Quite divine
Peregrine,
Never shall we see his mate;
Fun and flams,
Epigrams,
Leering, lying,
Versifying,
Nodding, noting,
Quibbling, quoting,
‘Thief!’ and ‘Bore!’
‘Lie!’ no more—
How I love a loud debate!”
Then up gets the glory of us and our story,
Who does all by logic and rule,
Who can tell the true diff’rence ’twixt twopence and threepence,
And prove Adam Smith quite a fool.
“Do you take trifle?” said Lady Olivia to my poor friend Halloran.
“No, Ma’am, I am reading philosophy,” said Halloran; waking from a fit
of abstraction, with about as much consciousness and perception as exists in
a petrified oyster, or an alderman dying of a surfeit. Halloran is a fool.
A trifle is the one good thing, the sole and surpassing enjoyment. He
only is happy who can fix his thoughts, and his hopes, and his feelings, and
his affections, upon those fickle and fading pleasures, which are tenderly
cherished and easily forgotten, alike acute in their excitement and brief in
their regret. Trifles constitute my summum bonum. Sages may crush them
with the heavy train of argument and syllogism; schoolboys may assail
them with the light artillery of essay and of theme; Members of Parliament
may loathe, doctors of divinity may contemn—bag wigs and big wigs, blue
devils and blue stockings, sophistry and sermons, reasonings and wrinkles,
Solon, Thales, Newton’s “Principia,” Mr. Walker’s “Eidouranion,” the
King’s Bench, the bench of Bishops—all these are serious antagonists; very
serious! But I care not; I defy them; I dote upon trifles; my name is Vyvyan
Joyeuse, and my motto is “Vive la Bagatelle!”
There are many persons who, while they have a tolerable taste for the
frivolous, yet profess remorse and penitence for their indulgence of it; and
continually court and embrace new day-dreams, while they shrink from the
retrospect of those which have already faded. Peace be to their everlasting
laments and their ever-broken resolutions! Your true trifler, meaning your
humble servant, is a being of a very different order. The luxury which I
renew in the recollection of the past is equal to that which I feel in the
enjoyment of the present, or create in the anticipation of the future. I love to
count and recount every treasure I have flung away, every bubble I have
broken; I love to dream again the dreams of my boyhood, and to see the
visions of departed pleasures flitting, like Ossian’s ghosts, around me, “with
stars dim twinkling through their forms.” I look back with delight to a youth
which has been idled away, to tastes which have been perverted, to talents
which have been misemployed; and while in imagination I wander back
through the haunts of my old idlesse, for all the learning of a Greek
professor, for all the morality of Sir John Sewell, I would not lose one
single point of that which has been ridiculous and grotesque, nor one single
tint of that which has been beautiful and beloved.
Moralists and misanthropists, maidens with starched morals and matrons
with starched frills, ancient adorers of Bohea and scandal, venerable
votaries of whispering and of whist, learned professors of the
compassionate sneer and the innocent innuendo, eternal pillars of gravity
and good order, of stupidity and decorum—come not near me with your
spare and spectacled features, your candid and considerate criticism. In you
I have no hope, in me you have no interest. I am to speak of stories you will
not believe, of beings you cannot love; of foibles for which you have no
compassion, of feelings in which you have no share.
Fortunate and unfortunate couples, belles in silks and beaux in
sentimentals, ye who have wept and sighed, ye who have been wept for and
sighed for, victims of vapours and coiners of vows, makers and marrers of
intrigue, readers and writers of songs—come to me with your attention and
your salts, your sympathy and your cambric; your griefs, your raptures,
your anxieties, all have been mine; I know your blushing and your paleness,
your self-deceiving and your self-tormenting.