When the Case is very doubtful and perplexing, it were best to confine
ourselves to the three last-mentioned Remedies, which have often been
successful in severe Degrees of this Disease; and which can occasion no
ill Consequence.
Sec. 292. When this Malady invades old People, though they partly recover,
they never recover perfectly, entirely, from it: and if due Precaution
is not taken, they are very liable to fall into a Dropsy of the Breast
after it.
Sec. 293. The spurious or false Pleurisy is a Distemper that does not
affect the Lungs, but only the Teguments, the Skin, and the Muscles
which cover the Ribs. It is the Effect of a rheumatic Humour thrown upon
these Parts, in which, as it produces very sharp Pains resembling that
which is called a _Stitch_, it has from this Circumstance, been termed a
Pleurisy.
It is generally supposed by the meer Multitude, and even by some of a
different Rank, that a false Pleurisy is more dangerous than a genuine,
a true one; but this is a Mistake. It is often ushered in by a
Shivering, and almost ever attended with a little Fever, a small Cough,
and a slight Difficulty of breathing; which, as well as the Cough, is
occasioned from the Circumstance of a Patient's (who feels Pain in
Respiration, or Breathing) checking Breathing as much as he can; this
accumulates a little too much Blood in the Lungs; but yet he has no
Anguish, nor the other Symptoms of acute true Pleurisies. In some
Patients this Pain is extended, almost over the whole Breast, and to the
Nape of the Neck. The sick Person cannot repose himself on the Side
affected.
This Disorder is not more dangerous than a Rheumatism, except in two
Cases; 1, When the Pain is so very severe, that the Patient strongly
endeavours not to breathe at all, which brings on a great Infarction or
Stoppage in the Lungs. 2, When this Humour, like any other rheumatic
one, is transferred to some internal Part.
Sec. 294. It must be treated exactly like a Rheumatism. See Sec. 168 and 169.
After bleeding once or more, a Blister applied to the affected Part is
often attended with a very good Effect: This being indeed the Kind
of [73] Pleurisy, in which it particularly agrees.
[73] The Seneka Rattle-Snake root, already recommended in true
Pleurisies, will, with the greatest Probability, be found not less
effectual in these false ones, in which the Inflammation of the
Blood is less. The Method of giving it may be seen P. 118,
N. ([26].) By Dr. _Tissot's_ having never mentioned this valuable
Simple throughout his Work, it may be presumed, that when he wrote
it, this Remedy had not been admitted into the Apothecaries Shops
in _Swisserland_. _K._
Sec. 295. This Malady sometimes gives Way to the first Bleeding; often
terminating on the third, fourth or fifth Day, by a very plentiful
Sweat, and rarely lasting beyond the seventh. Sometimes it attacks a
Person very suddenly, after a Stoppage of Perspiration; and then, if at
once before the Fever commences, and has had Time to inflame the Blood,
the Patient takes some _Faltrank_, it effects a speedy Cure by restoring
Perspiration. They are such Cases as these, or that mentioned Sec. 96,
which have given this Composition the Reputation it has obtained in this
Disease: a Reputation nevertheless, which has every Year proved tragical
in its Consequences to many Peasants, who being deceived by some
misleading Resemblances in this Distemper, have rashly and ignorantly
made Use of it in true inflammatory Pleurisies.
__Chapter XXI.__
_Of the Cholic and its different Kinds._
__Sect.__ 296.
The Appellation of a Cholic is commonly given to all Pains of the Belly
indiscriminately; but I apply it in this Place only to such as attack
the Stomach, or the Intestines, the Guts.
Cholics may and do result from very many Causes; and the greater Number
of Cholics are chronical or tedious Complaints, being more common among
the inactive Inhabitants of Cities, and Workmen in sedentary Trades,
than among Country People. Hence I shall treat here only of the small
Variety of Cholics, which happen the most usually in Villages. I have
already proved that the fatal Events of some Distempers were occasioned
by endeavouring to force the Patients into Sweats; and the same unhappy
Consequences have attended Cholics, from accustoming the Subjects of
this Disease to Drams, and hot inflaming spirituous Liquors, with an
Intention to expel the Wind.
_Of the inflammatory Cholic._
Sec. 297. The most violent and dangerous kind of Cholic is that, which
arises from an Inflammation of the Stomach, or of the Intestines. It
begins most commonly without any Shivering, by a vehement Pain in the
Belly, which gradually becomes still more so. The Pulse grows quick and
hard; a burning Pain is felt through the whole Region of the Belly;
sometimes there is a watery _Diarrhoea_, or Purging; at other Times the
Belly is rather costive, which is attended with Vomiting, a very
embarrassing and dangerous Symptom: the Countenance becomes highly
flushed; the Belly tense and hard; neither can it be touched scarcely
without a cruel Augmentation of the Patient's Pain, who is also
afflicted with extreme Restlessness; his Thirst is very great, being
unquenchable by Drink; the Pain often extends to the Loins, where it
proves very sharp, and severe; little Urine is made, and that very red,
and with a kind of burning Heat. The tormented Patient has not a
Moment's Rest, and now and then raves a little. If the Disease is not
removed or moderated, before the Pains rise to their utmost Height and
Violence, the Patient begins at length to complain less; the Pulse
becomes less strong and less hard than before, but quicker: his Face
first abates of its Flush and Redness, and soon after looks pale; the
Parts under the Eyes become livid; the Patient sinks into a low stupid
Kind of _Delirium_, or Raving; his Strength entirely deserts him; the
Face, Hands, Feet, and the whole Body, the Belly only excepted, become
cold: the Surface of the Belly appears bluish; extreme Weakness follows,
and the Patient dies. There frequently occurs, just a Moment before he
expires, an abundant Discharge of excessively foetid Matter by Stool;
and during this Evacuation he dies with his Intestines quite gangrened,
or mortified.
When the Distemper assaults the Stomach, the Symptoms are the very same,
but the Pain is felt higher up, at the Pit of the Stomach. Almost every
thing that is swallowed is cast up again; the Anguish of the tortured
Patient is terrible, and the Raving comes on very speedily. This Disease
proves mortal in a few Hours.
Sec. 298. The only Method of succeeding in the Cure of it is as follows:
1, Take a very large Quantity of Blood from the Arm; this almost
immediately diminishes the Violence of the Pains, and allays the
Vomiting: besides its contributing to the greater Success of the other
Remedies. It is often necessary to repeat this Bleeding within the Space
of two Hours.
2, Whether the Patient has a Looseness, or has not, a Glyster of a
Decoction of Mallows, or of Barley Water and Oil, should be given every
two Hours.
3, The Patient should drink very plentifully of Almond Milk No. 4; or a
Ptisan of Mallow Flowers, or of Barley, all which should be warm.
4, Flanels dipt in hot, or very warm Water should be continually applied
over the Belly, shifting them every Hour, or rather oftner; for in this
Case they very quickly grow dry.
5, If the Disease, notwithstanding all this, continues very obstinate
and violent, the Patient should be put into a warm Water Bath, the
extraordinary Success of which I have observed.
When the Distemper is over, that is to say, when the Pains have
terminated, and the Fever has ceased, so that the Patient recovers a
little Strength, and gets a little Sleep, it will be proper to give him
a Purge, but a very gentle one. Two Ounces of Manna, and a Quarter of an
Ounce of Sedlitz [74] Salt dissolved in a Glass of clear Whey is
generally sufficient, at this Period, to purge the most robust and hardy
Bodies. Manna alone may suffice for more delicate Constitutions: as all
acrid sharp Purges would be highly dangerous, with Regard to the great
Sensibility and tender Condition of the Stomach, and of the Intestines
after this Disease.
[74] Glauber or Epsom Salt may be substituted, where the other is not to
be readily procured. _K._
Sec. 299. It is sometimes the Effect of a general Inflammation of the
Blood; and is produced, like other inflammatory Diseases, by
extraordinary Labour, very great Heat, heating Meats or Drinks, _&c._ It
is often the Consequence of other Cholics which have been injudiciously
treated, and which otherwise would not have degenerated into
inflammatory ones; as I have many Times seen these Cholics introduced
after the Use of heating Medicines; one Instance of which may be seen Sec.
164.
Sec. 300. Ten Days after I had recovered a Woman out of a severe Cholic,
the Pains returned violently in the Night. She, supposing them to arise
only from Wind, hoped to appease them by drinking a deal of distilled
Walnut Water; which, far from producing any such Effect, rendered them
more outrageous. They soon were heightened to a surprising Degree, which
might reasonably be expected. Being sent for very early in the Morning,
I found her Pulse hard, quick, short; her Belly was tense and hard; she
complained greatly of her Loins: her Urine was almost entirely stopt.
She past but a few Drops, which felt as it were scalding hot, and these
with excessive Pain. She went very frequently to the Close-stool, with
scarcely any Effect; her Anguish, Heat, Thirst, and the Dryness of her
Tongue were even terrifying: and her wretched State, the Effect of the
strong hot Liquor she had taken, made me very apprehensive for her. One
Bleeding, to the Quantity of fourteen Ounces, somewhat abated all the
Pains; she took several Glysters, and drank off a few Pots of _Orgeat_
in a few Hours. By these Means the Disease was a little mitigated; by
continuing the same Drink and the Glysters the Looseness abated; the
Pain of the Loins went off, and she passed a considerable Quantity of
Urine, which proved turbid, and then let fall a Sediment, and the
Patient recovered. Nevertheless I verily believe, if the Bleeding had
been delayed two Hours longer, this spirituous Walnut Water would have
been the Death of her. During the Progress of this violent Disease, no
Food is to be allowed; and we should never be too inattentive to such
Degrees of Pain, as sometimes remain after their Severity is over; lest
a _Scirrhus_, an inward hard Tumour, should be generated, which may
occasion the most inveterate and tedious Maladies.
Sec. 301. An Inflammation of the Intestines, and one of the Stomach, may
also terminate in an Abscess, like an Inflammation of any other Part;
and it may be apprehended that one is forming, when, though the Violence
of the Pains abates, there still remains a slow, obtuse, heavy Pain,
with general Inquietude, little Appetite, frequent Shiverings; the
Patient at the same Time not recovering any Strength. In such Cases the
Patient should be allowed no other Drinks, but what are already directed
in this Chapter, and some Soops made of Pulse, or other farinaceous
Food.
The Breaking of the Abscess may sometimes be discovered by a slight
Swoon or fainting Fit; attended with a perceivable Cessation of a Weight
or Heaviness in the Part, where it was lately felt: and when the _Pus_,
or ripe Matter, is effused into the Gut, the Patient sometimes has
Reachings to vomit, a _Vertigo_, or Swimming in the Head, and the Matter
appears in the next Stools. In this Case there remains an Ulcer within
the Gut, which, if either neglected, or improperly treated, may pave the
Way to a slow wasting Fever, and even to Death. Yet this I have cured by
making the Patient live solely upon skimmed Milk, diluted with one third
Part Water, and by giving every other Day a Glyster, consisting of equal
Parts of Milk and Water, with the Addition of a little Honey.
When the Abscess breaks on the Outside of the Gut, and discharges its
Contents into the Cavity of the Belly, it becomes a very miserable Case,
and demands such further Assistance as cannot be particularized here.
_Of the bilious Cholic._
Sec. 302. The bilious Cholic discovers itself by very acute Pains, but is
seldom accompanied with a Fever; at least not until it has lasted a Day
or two. And even if there should be some Degree of a Fever, yet the
Pulse, though quick, is neither strong nor hard: the Belly is neither
tense or stretched as it were, nor burning hot, as in the former Cholic:
the Urine comes away with more Ease, and is less high-coloured:
Nevertheless the inward Heat and Thirst are considerable; the Mouth is
bitter; the Vomiting or Purging, when either of them attend it,
discharge a yellowish Humour or Excrement; and the Patient's Head is
often vertiginous or dizzy.
Sec. 303. The Method of curing this is,
1, By injecting Glysters of Whey and Honey; or, if Whey is not readily
procurable, by repeating the Glyster, No. 5.
2, By making the Sick drink considerably of the same Whey, or of a
Ptisan made of the Root of Dog's-Grass (the common Grass) and a little
Juice of Lemon, for want of which, a little Vinegar and Honey may be
substituted instead of it. [75]
[75] Pullet, or rather Chicken Water, but very weak, may often do
instead of Ptisan, or serve for a little Variety of Drink to some
Patients. _E. L._--K.
3, By giving every Hour one Cup of the Medicine No. 32; or where this is
not to be had, half a Drachm of Cream of Tartar at the same short
Intervals.
4, Fomentations of warm Water and Half-baths are also very proper.
5, If the Pains are sharp and violent, in a robust strong Person, and
the Pulse is strong and tense, Bleeding should be used to prevent an
Inflammation.
6, No other Nourishment should be given, except some maigre Soops, made
from Vegetables, and particularly of Sorrel.
7, After plentiful Dilution with the proper Drink, if no Fever
supervenes; if the Pains still continue, and the Patient discharges but
little by Stool, he should take a moderate Purge. That directed No. 47
is a very proper one.
Sec. 304. This bilious Cholic is habitual to many Persons; and may be
prevented or greatly mitigated by an habitual Use of the Powder No. 24;
by submitting to a moderate Retrenchment in the Article of Flesh-meat;
and by avoiding heating and greasy Food, and the Use of Milk.
_Of Cholics from Indigestions, and of Indigestion._
Sec. 305. Under this Appellation I comprehend all those Cholics, which are
either owing to any overloading Quantity of Food taken at once; or to a
Mass or Accumulation of Aliments formed by Degrees in such Stomachs, as
digest but very imperfectly; or which result from noxious Mixtures of
Aliment in the Stomach, such as that of Milk and Acids; or from Food
either not wholesome in its self, or degenerated into an unwholesome
Condition.
This kind of Cholic may be known from any of these Causes having
preceded it; by its Pains, which are accompanied with great
Restlessness, and come on by Degrees, being less fixed than in the
Cholics before treated of. These Cholics are also without any Fever,
Heat or Thirst, but accompanied with a Giddiness of the Head, and
Efforts to vomit, and rather with a pale, than a high-coloured Visage.
Sec. 306. These Disorders, from these last Causes, are scarcely ever
dangerous in themselves; but may be made such by injudicious Management,
and doing more than is necessary or proper: as the only Thing to be done
is to promote the Discharges by warm Drinks. There are a considerable
Variety of them, which seem equally good, such as warm Water, or even
cold Water with a Toast, with the Addition either of a little Sugar, or
a little Salt: a light Infusion of Chamomile, or of Elder-flowers,
common Tea, or Baum, it imports little which, provided the Patient drink
plentifully of them: in Consequence of which the offending Matter is
discharged, either by vomiting, or a considerable purging; and the
speedier and more in Quantity these Discharges are, the sooner the
Patient is relieved.
If the Belly is remarkably full and costive, Glysters of warm Water and
Salt should be injected.
The Expulsion of the obstructing Matter is also facilitated, by rubbing
the Belly heartily with hot Cloths.
Sometimes the Humours, or other retained Contents of the Belly, are more
pernicious from their Quality, than their Quantity; and then the Malady
may be dissipated without the former Discharges, by the irritating sharp
Humour being diluted, or even drowned, as it were, in the Abundance of
small watery Drinks. When the Pains invade first in the Stomach, they
become less sharp, and the Patient feels less Inquietude, as soon as the
Cause of the Pain has descended out of the Stomach into the Intestines,
whose Sensations are something less acute than, or somewhat different
from, those of the Stomach.
It is often found that after these plentiful Discharges, and when the
Pains are over, there remains a very disagreeable Taste in the Mouth,
resembling the Savour of rotten Eggs. This may be removed by giving some
Doses of the Powder No. 24, and drinking largely of good Water:
It is an essential Point in these Cases, to take no Food before a
perfect Recovery.
Sec. 307. Some have been absurd enough in them, to fly at once to some
heating Cordial Confection, to Venice Treacle, Aniseed Water, Geneva, or
red Wine to stop these Evacuations; but there cannot be a more fatal
Practice: since these Evacuations are the only Thing which can cure the
Complaint, and to stop them is to deprive the Person, who was in Danger
of drowning, of the Plank which might save him. Nay should this
Endeavour of stopping them unhappily succeed, the Patient is either
thrown into a putrid Fever, or some chronical tedious Malady; unless
Nature, much wiser than such a miserable Assistant, should prevail over
the Obstacles opposed to her Recovery, and restore the obstructed
Evacuations by her own Oeconomy, in the Space of a few Days.
Sec. 308. Sometimes an Indigestion happens, with very little Pain or
Cholic, but with violent Reachings to vomit, inexpressible Anguish,
Faintings, and cold Sweats: and not seldom also the Malady begins, only
with a very sudden and unexpected Fainting: the Patient immediately
loses all his Senses, his Face is pale and wan: he has some Hickups
rather than Reachings to vomit, which joined to the Smallness of his
Pulse, to the Easiness of his respiring, or breathing, and to the
Circumstance of his being attacked immediately, or very soon, after a
Meal, makes this Disorder distinguishable from a real Apoplexy.
Nevertheless, when it rises to this Height, with these terrible
Symptoms, it sometimes kills in a few Hours. The first thing to be done
is to throw up a sharp Glyster, in which Salt and Soap are to be
dissolved; next to get down as much Salt and Water as he can swallow;
and if that is ineffectual, the Powder No. 34 is to be dissolved in
three Cups of Water; one half of which is to be given directly; and, if
it does not operate in a Quarter of an Hour, the other half. Generally
speaking the Patient's Sense begins to return, as soon as he begins to
vomit.
_Of the flatulent or windy Cholic._
Sec. 309. Every Particular which constitutes our Food, whether solid or
liquid, contains much Air, but some of them more than others. If they do
not digest soon enough, or but badly, which occasions a sensible Escape
of such Air; if they are such as contain an extraordinary Quantity of
Air; or if the Guts being straitened or compressed any where in the
Course of their Extent, prevent that Air from being equally diffused
(which must occasion a greater Proportion of it in some Places) then the
Stomach and the Guts are distended by this Wind; and this Distention
occasions these Pains, which are called flatulent, or windy.
This Sort of Cholic rarely appears alone and simple; but is often
complicated with, or added, as it were, to the other Sorts, of which it
is a Consequence; and is more especially joined with the Cholic from
Indigestions, whose Symptoms it multiplies and heightens. It may be
known, like that, by the Causes which have preceded it, by its not being
accompanied either with Fever, Heat, or Thirst; the Belly's being large
and full, though without Hardness, being unequal in its Largeness, which
prevails more in one Part of it than in another, forming something like
Pockets of Wind, sometimes in one Part, sometimes in another; and by the
Patient's feeling some Ease merely from the rubbing of his Belly, as it
moves the Wind about; which escaping either upwards or downwards affords
him still a greater Relief.
Sec. 310. When it is combined with any different Species of the Cholic, it
requires no distinct Treatment from that Species; and it is removed or
dissipated by the Medicines which cure the principal Disease.
Sometimes however it does happen to exist alone, and then it depends on
the Windiness of the solid and liquid Food of the Person affected with
it, such as the _Must_ or new Wine, Beer, especially very new Beer,
certain Fruits and Garden-stuff. It may be cured by a Glyster; by
chaffing the Belly with hot Cloths; by the Use of Drink moderately
spiced; and especially by Camomile Tea, to which a little cordial
Confection, or even Venice Treacle, may be added. When the Pains are
almost entirely vanished, and there is no Fever, nor any unhealthy
Degree of Heat; and if the Patient is sensible of a Weakness at Stomach,
he may take a little aromatic, or spiced Wine, or even a small cordial
stomachic Dram. It should be observed, that these are not to be allowed
in any other Kind of Cholic.
Sec. 311. When any Person is frequently subject to cholic-like Pains, it is
a Proof that the digestive Faculty is impaired; the restoring of which
should be carefully attended to; without which the Health of the Patient
must suffer considerably, and he must be very likely to contract many
tedious and troublesome Disorders.
_Of Cholics from Cold._
Sec. 312. When any Person has been very cold, and especially in his Feet,
it is not uncommon for him to be attacked, within a few Hours after it,
with violent Cholic Pains, in which heating and spirituous Medicines are
very pernicious: but which are easily cured by rubbing the Legs well
with hot Cloths; and keeping them afterwards for a considerable Time in
warm Water; advising them at the same Time to drink freely of a light
Infusion of Chamomile or Elder-flowers.
The Cure will be effected the sooner, if the Patient is put to Bed and
sweats a little, especially in the Legs and Feet.
A Woman who had put her Legs into a pretty cool Spring, after travelling
in the Height of Summer, was very quickly after attacked with a most
violent Cholic. She took different hot Medicines; she became still
worse; she was purged, but the Distemper was still further aggravated. I
was called in on the third Day, a few Hours before her Decease.
In such Cases, if the Pain be excessive, it may be necessary to
bleed; [76] to give a Glyster of warm Water; to keep the Legs several
Hours over the Steam of hot Water, and afterwards in the Water; to drink
plentifully of an Infusion of the Flowers of the Lime-tree, with a
little Milk; and if the Distemper is not subdued by these Means,
Blisters should be applied to the Legs, which I have known to be highly
efficacious.
[76] Bleeding should not be determined on too hastily in this Sort of
Cholic, but rather be omitted, or deferred at least, till there be
an evident Tendency to an Inflammation. _E. L._
The Propriety or Impropriety of Bleeding in a Cholic from this
Cause should be determined, I think, from the State of the Person
it happens to: So that Bleeding a strong Person with a firm Fibre,
and a hard Pulse, may be very prudent and precautionary: But if it
be a weakly lax Subject with a soft and low Pulse, there may be
Room either for omitting, or for suspending it. _K._
Sec. 313. It appears, through the Course of this Chapter, that it is
necessary to be extremely on our Guard, against permitting the Use of
heating and spirituous Medicines in Cholics, as they may not only
aggravate, but even render them mortal. In short they should never be
given, and when it is difficult to discover the real Cause of the
Cholic, I advise Country People to confine themselves to the three
following Remedies, which cannot be hurtful in any Sort of Cholic, and
may remove as many as are not of a violent Nature. First then, let
Glysters be frequently repeated. 2, Let the Patient drink warm Water
plentifully, or Elder Tea. 3, Let the Belly be often fomented in pretty
warm Water, which is the most preferable Fomentation of any.
Sec. 314 I have said nothing here of the Use of any Oils in this Disease,
as they agree but in very few Species of Cholics, and not at all in
those of which I have been treating. For this Reason I advise a total
Disuse of them, since they may be of bad Consequence in many Respects.
Sec. 315. Chronical Diseases not coming within the Plan of this Work, I
purposely forbear treating of any Kind of those tedious Cholics, which
afflict some People for many Years: but I think it my Duty to admonish
such, that their Torments being very generally occasioned by
Obstructions in the _Viscera_, or different Bowels of the Belly, or by
some other Fault, and more particularly in those Organs, which are
intended to prepare the Bile, they should, 1, avoid with the greatest
Care, the Use of sharp, hot, violent Medicines, Vomits, strong Purges,
Elixirs, _&c._ 2, They should be thoroughly on their Guard against all
those, who promise them a very speedy Cure, by the Assistance of some
specific Remedy; and ought to look upon them as Mountebanks, into whose
Hands it is highly dangerous to trust themselves. 3, They should be
persuaded, or rather convinced, that they can entertain no reasonable
Hope of being cured, without an exact Conformity to a proper and
judicious Regimen, and a long Perseverance in a Course of mild and safe
Remedies. 4, They should continually reflect with themselves, that there
is little Difficulty in doing them great Mischief; and that their
Complaints are of that Sort, which require the greatest Knowledge and
Prudence in those Persons, to whom the Treatment and Cure of them are
confided.
__Chapter XXII.__
_Of the Iliac Passion, and of the Cholera-morbus._
__Sect.__ 316.
These violent Diseases are fatal to many Country People, while their
Neighbours are frequently so ignorant of the Cause of their Death, that
Superstition has ascribed it to Poison, or to Witchcraft.
Sec. 317. The first of these, the _Miserere_, or Iliac Passion, is one of
the most excruciating Distempers. If any Part of the Intestines, the
Cavity of the Guts is closed up, whatever may have occasioned it, the
Course or Descent of the Food they contain is necessarily stopped; in
which Case it frequently happens, that that continual Motion observed in
the Guts of a living Animal dissected, and which was intended to
detrude, or force their Contents downwards, is propagated in a directly
contrary Manner, from the Guts towards the Mouth.
This Disease sometimes begins after a Constipation, or Costiveness, of
some Days; at other Times without that Costiveness having been preceded
by Pains in any Part of the Belly, especially around the Navel; but
which Pains, gradually increasing after their Commencement, at length
become extremely violent, and throw the Patient into excessive Anguish.
In some of these Cases a hard Tumour may be felt, which surrounds the
Belly like a Cord. The Flatulences within become very audible, some of
them are discharged upwards; in a little Time after, Vomitings come on,
which increase till the Patient has thrown up all he had taken in, with
a still further Augmentation of the excessive Pain. With the first of
his Vomitings he only brings up the last Food he had taken, with his
Drink and some yellowish Humour: but what comes up afterwards proves
stinking; and when the Disease is greatly heightened, they have what is
called the Smell of Excrement or Dung; but which rather resembles that
of a putrid dead Body. It happens too sometimes, that if the Sick have
taken Glysters composed of Materials of a strong Smell, the same Smell
is discernible in the Matter they vomit up. I confess however I never
saw either real Excrements, or the Substance of their Glysters, brought
up, much less the Suppositories that were introduced into the Fundament:
and were it credible that Instances of this Kind had occurred, they must
be allowed very difficult to account for. Throughout this whole Term of
the Disease, the Patient has not a single Discharge by Stool; the Belly
is greatly distended; the Urine not seldom suppressed, and at other
Times thick and foetid. The Pulse, which at first was pretty hard,
becomes quick and small; the Strength entirely vanishes; a Raving comes
on; a Hiccup almost constantly supervenes, and sometimes general
Convulsions; the Extremities grow cold, the Pulse scarcely perceivable;
the Pain and the Vomiting cease, and the Patient dies very quickly
after.
Sec. 318. As this Disease is highly dangerous, the Moment it is strongly
apprehended, it is necessary to oppose it by proper Means and Remedies:
the smallest Error may be of fatal Consequence, and hot inflaming
Liquids have been known to kill the Patient in a few Hours. I was called
in the second Day of the Disease to a young Person, who had taken a good
deal of Venice Treacle: Nothing could afford her any Relief, and she
died early on the third Day.
This Disease should be treated precisely in the same Manner as an
inflammatory Cholic; the principal Difference being, that in the former
there are no Stools, but continual Vomitings.
1, First of all then the Patient should be plentifully bled, if the
Physician has been called in early enough, and before the Sick has lost
his Strength.
2, He should receive opening Glysters made of a Decoction of Barley
Water, with five or six Ounces of Oil in each.
3, We should endeavour to allay the violent Efforts to vomit, by giving
every two Hours a Spoonful of the Mixture No. 48.
4, The Sick should drink plentifully, in very small Quantities, very
often repeated, of an appeasing, diluting, refreshing Drink, which tends
at the same Time to promote both Stools and Urine. Nothing is preferable
to the Whey No. 49, if it can be had immediately: if not, give simple
clear Whey sweetened with Honey, and the Drinks prescribed Sec. 298, Art.
3.
5, The Patient is to be put into a warm Bath, and kept as long as he can
bear it, repeating it as often daily too, as his Strength will permit.
6, After Bleeding, warm Bathing, repeated Glysters and Fomentations, if
each and all of these have availed nothing; the Fume or Smoak of Tobacco
may be introduced in the Manner of a Glyster, of which I shall speak
further, in the Chapter on Persons drowned.
I cured a Person of this Disease, by conveying him into a Bath,
immediately after bleeding him, and giving him a Purge on his going into
the Bath.
Sec. 319. If the Pain abates before the Patient has quite lost his
Strength; if the Pulse improves at the same Time; if the Vomitings are
less in Number, and in the Quantity of the Matter brought up; if that
Matter seems in a less putrid offensive State; if he feels some
Commotion and Rumbling in his Bowels; if he has some little Discharge by
Stool; and if at the same Time he feels himself a little stronger than
before, his Cure may reasonably be expected; but if he is otherwise
circumstanced he will soon depart. It frequently happens, a single Hour
before Death, that the Pain seems to vanish, and a surprising Quantity
of extremely foetid Matter is discharged by Stool: the Patient is
suddenly seized with a great Weakness and Sinking, falls into a cold
Sweat, and immediately expires.
Sec. 320. This is the Disease which the common People attribute to, and
term, the _Twisting of the Guts_; and in which they make the Patients
swallow Bullets, or large Quantities of Quick-silver. This twisting,
tangling, or Knoting of the Guts is an utter, an impossible Chimera; for
how can they admit of such a Circumstance, as one of their Extremities,
their Ends, is connected to the Stomach, and the other irremoveably
fastened to the Skin of the Fork or Cleft of the Buttocks? In Fact this
Disease results from a Variety of Causes, which have been discovered on
a Dissection of those who have died of it. It were to be wished indeed
this prudent Custom, so extremely conducive to enrich, and to perfect,
the Art of Physick, were to prevail more generally; and which we ought
rather to consider as a Duty to comply with, than a Difficulty to submit
to; as it is our Duty to contribute to the Perfection of a Science, on
which the Happiness of Mankind so considerably depends. I shall not
enter into a Detail of these Causes; but whatever they are, the Practice
of swallowing Bullets in the Disease is always pernicious, and the like
Use of Mercury must be often so. Each of these pretended Remedies may
aggravate the Disease, and contribute an insurmountable Obstacle to the
Cure--Of that Iliac Passion, which is sometimes a Consequence of
Ruptures, I shall treat in another Place.
_Of the Cholera-morbus._
Sec. 321. This Disease is a sudden, abundant, and painful Evacuation by
vomiting and by Stool.
It begins with much Flatulence, or Wind, with Swelling and slight Pains
in the Belly, accompanied with great Dejection; and followed with large
Evacuations either by Stool or by Vomit at first, but whenever either of
them has begun, the other quickly follows. The Matter evacuated is
either yellowish, green, brown, whitish, or black; the Pains in the
Belly violent; the Pulse, almost constantly feverish, is sometimes
strong at first, but soon sinks into Weakness, in Consequence of the
prodigious Discharge. Some Patients purge a hundred Times in the Compass
of a few Hours: they may even be seen to fall away; and if the Disease
exists in a violent Degree, they are scarcely to be known within three
or four Hours from the Commencement of these Discharges. After a great
Number of them they are afflicted with Spasms, or Cramps, in their Legs,
Thighs, and Arms, which torment them as much as the Pains in the Belly.
When the Disease rages too highly to be asswaged, Hiccups, Convulsions
and a Coldness of the Extremities approach; there is a scarcely
intermitting Succession of fainting, or swooning Fits, the Patient dying
either in one of them, or in Convulsions.
Sec. 322. This Disease, which constantly depends on a Bile raised to the
highest Acrimony, commonly prevails towards the End of July and in
August: especially if the Heats have been very violent, and there have
been little or no Summer Fruits, which greatly conduce to attempt: and
allay the putrescent Acrimony of the Bile.
Sec. 323. Nevertheless, however violent this Distemper may be, it is less
dangerous, and also less tormenting than the former, many Persons
recovering from it.
1, Our first Endeavour should be to dilute, or even to drown this acrid
Bile, by Draughts, by Deluges, of the most mitigating Drinks; the
irritation being so very great, that every Thing having the least
Sharpness is injurious. Wherefore the patient should continually take
in, by Drink, and by Way of Glyster, either Barley-Water, Almond-Milk,
or pure Water, with one eighth Part Milk, which has succeeded very well
in my Practice. Or he may use a very light Decoction, or Ptisan, as it
were, of Bread, which is made by gently boiling a Pound of toasted
Bread, in three or four Pots of Water for half an Hour. In _Swisserland_
we prefer Oat bread. We also successfully use pounded Rye, making a
light Ptisan of it.
A very light thin Soup made of a Pullet, a Chicken, or of one Pound of
lean Veal, in three Pots of Water, is very proper too in this Disease.
Whey is also employed to good Purpose; and in those Places, where it can
easily be had, Butter-milk is the best Drink of any. But, whichever of
these Drinks shall be thought preferable, it is a necessary Point to
drink very plentifully of it; and the Glysters should be given every two
Hours.
2, If the Patient is of a robust Constitution, and sanguine Complexion,
with a strong Pulse at the Time of the Attack, and the Pains are very
severe, a first, and in some Cases, a second Bleeding, very early in the
Invasion, asswages the Violence of the Malady, and allows more Leisure
for the Assistance of other Remedies. I have seen the Vomiting cease
almost entirely, after the first Bleeding.
The Rage of this Disease abates a little after a Duration of five or six
Hours: we must not however, during this Remission or Abatement, forbear
to throw in proper Remedies; since it returns soon after with great
Force, which Return however indicates no Alteration of the Method
already entered upon.
3, In general the warm Bath refreshes the Patient while he continues in
it; but the Pains frequently return soon after he is taken out, which,
however, is no Reason for omitting it, since it has frequently been
found to give a more durable Relief. The Patient should continue in it a
considerable Time, and, during that Time, he should take six or seven
Glasses of the Potion No. 32, which has been very efficacious in this
Disease. By these Means the Vomiting has been stopt; and the Patient,
upon going out of the Bath, has had several large Stools, which very
considerably diminished the Violence of the Disease.
4, If the Patient's Attendants are terrified by these great Evacuations,
and determine to check them (however prematurely) by Venice Treacle,
Mint Water, Syrup of white Poppies, called Diacodium, by Opium or
Mithridate, it either happens, that the Disease and all its Symptoms are
heightened, to which I have been a Witness; or, if the Evacuations
should actually be stopt, the Patient, in Consequence of it, is thrown
into a more dangerous Condition. I have been obliged to give a Purge, in
order to renew the Discharges, to a Man, who had been thrown into a
violent Fever, attended with a raging _Delirium_, by a Medicine composed
of Venice Treacle, Mithridate and Oil. Such Medicines ought not to be
employed, until the Smallness of the Pulse, great Weakness, violent and
almost continual Cramps, and even the Insufficience of the Patient's
Efforts to vomit, make us apprehensive of his sinking irrecoverably. In
such Circumstances indeed he should take, every Quarter or half Quarter
of an Hour, a Spoonful of the Mixture No. 50, still continuing the
diluting Drinks. After the first Hour, they should only be given every
Hour, and that only to the Extent of eight Doses. But I desire to insist
upon it here, that this Medicine should not be given too early in this
Distemper.
Sec. 324. If the Patient is likely to recover, the Pains and the
Evacuations gradually abate; the Thirst is less; the Pulse continues
very quick, but it becomes regular. There have been Instances of their
Propensity to a heavy kind of Drowsiness at this Time; for perfect
refreshing Sleep advances but slowly after this Disease. It will still
be proper to persevere in the Medicines already directed, though
somewhat less frequently. And now we may begin to allow the Patient a
few Soups from farinaceous mealy Substances; and as soon as the
Evacuations accompanying this Disease are evidently ceased, and the
Pains are vanished; though an acute Sensibility and great Weakness
continues, beside such Soups, he may be allowed some new-laid Eggs, very
lightly boiled, or even raw, for some Days. After this he must be
referred to the Regimen so frequently recommended to Persons in a State
of Recovery: when the concurring Use of the Powder No. 24, taken twice a
Day, will greatly assist to hasten and to establish his Health.
__Chapter XXIII.__
_Of a Diarrhoea, or Looseness._
__Sect.__ 325.
Every one knows what is meant by a Looseness or Purging, which the
Populace frequently call a Flux, and sometimes a Cholic.
There are certain very chronical, or tedious and obstinate ones, which
arise from some essential Fault in the Constitution. Of such, as foreign
to my Plan, I shall say nothing.
Those which come on suddenly, without any preceding Disorder, except
sometimes a slight Qualm or short Loathing, and a Pain in the Loins and
Knees; which are not attended with smart Pains nor a Fever (and
frequently without any Pain, or any other Complaint) are oftener of
Service than prejudicial. They carry off a Heap of Matter that may have
been long amassed and corrupted in the Body; which, if not discharged,
might have produced some Distemper; and, far from weakening the Body,
such Purgings as these render it more strong, light and active.
Sec. 326. Such therefore ought by no Means to be stopped, nor even speedily
checked: they generally cease of themselves, as soon as all the noxious
Matter is discharged; and as they require no Medicine, it is only
necessary to retrench considerably from the ordinary Quantity of
Nourishment; to abstain from Flesh, Eggs and Wine or other strong Drink;
to live only on some Soups, on Pulse, or on a little Fruit, whether raw
or baked, and to drink rather less than usual. A simple Ptisan with a
little Syrup of _Capillaire_, or Maiden-hair, is sufficient in these
Purgings, which require no Venice Treacle, Confection, nor any Drug
whatever.
Sec. 327. But should it continue more than five or six Days, and manifestly
weaken the Patient; if the Pain attending it grows a little severe; and
especially if the Irritation, the urging to Stool, proves more frequent,
it becomes seasonable to check, or to stop, it. For this Purpose the
Patient is to be put into a Regimen; and if the Looseness has been
accompanied with a great Loathing, with Risings or Wamblings at Stomach,
with a foul furred Tongue, and a bad Taste in the Mouth, he must take
the Powder No. 35. But if these Symptoms do not appear, give him that of
No. 51: and during the three following Hours, let him take, every half
Hour, a Cup of weak light Broth, without any Fat on it.
If the Purging, after being restrained by this Medicine, should return
within a few Days, it would strongly infer, there was still some tough
viscid Matter within, that required Evacuation. To effect this he should
take the Medicines No. 21, 25 or 27; and afterwards take fasting, for
two successive Mornings, half the Powder, No. 51.
On the Evening of that Day when the Patient took No. 35, or No. 51, or
any other Purge, he may take a small Dose of Venice Treacle.
Sec. 328. A Purging is often neglected for a long Time, without observing
the least Regimen, from which Neglect they degenerate into tedious and
as it were habitual, perpetual ones, and entirely weaken the Patient. In
such Cases, the Medicine No. 35 should be given first; then, every other
Day for four Times successively, he should take No. 51: during all which
Time he should live on nothing but Panada (See Sec. 57) or on Rice boiled
in weak Chicken-broth. A strengthing stomachic Plaister has sometimes
been successfully applied, which may be often moistened in a Decoction
of Herbs boiled in Wine. Cold and Moisture should be carefully avoided
in these Cases, which frequently occasion immediate Relapses, even after
the Looseness had ceased for many Days.
__Chapter XXIV.__
_Of the Dysentery, or Bloody-flux._
__Sect.__ 329.
The Dysentery is a Flux or Looseness of the Belly, attended with great
Restlessness and Anguish, with severe Gripings, and frequent
Propensities to go to Stool. There is generally a little Blood in the
Stools, though this is not a constant Symptom, and is not essential to
the Existence of a Dysentery; notwithstanding it may not be much less
dangerous, for the Absence of this Symptom.
Sec. 330. The Dysentery is often epidemical; beginning sometimes at the End
of July, though oftner in August, and going off when the Frosts set in.
The great preceding Heats render the Blood and the Bile acrid or sharp;
and though, during the Continuance of the Heat, Perspiration is kept up
(See Introduct. P. 28) yet as soon as the Heat abates, especially in the
Mornings and Evenings, that Discharge is diminished; and by how much the
more Viscidity or Thickness the Humours have acquired, in Consequence of
the violent Heats, the Discharge of the sharp Humour by Perspiration
being now checked, it is thrown upon the Bowels which it irritates,
producing Pains in, and Evacuations from them.
This Kind of Dysentery may happen at all Times, and in all Countries;
but if other Causes, capable of producing a Putridity of the Humours, be
complicated with it; such as the crouding up a great Number of People
into very little Room, and very close Quarters, as in Hospitals, Camps,
or Prisons, this introduces a malignant Principle into the Humours,
which, co-operating with the simpler Cause of the Dysentery, renders it
the more difficult and dangerous.
Sec. 331. This Disease begins with a general Coldness rather than a
Shivering, which lasts some Hours; the Patient's Strength soon abates,
and he feels sharp Pains in his Belly, which sometimes continue for
several Hours, before the Flux begins. He is affected with _Vertigos_,
or Swimmings in the Head, with Reachings to vomit, and grows pale; his
Pulse at the same Time being very little, if at all, feverish, but
commonly small, and at length the Purging begins. The first Stools are
often thin, and yellowish; but in a little Time they are mixt with a
viscid ropy Matter, which is often tinged with Blood. Their Colour and
Consistence are various too, being either brown, greenish or black,
thinner or thicker, and foetid: The Pains increase before each of the
Discharges, which grow very frequent, to the Number of eight, ten,
twelve or fifteen in an Hour: then the Fundament becomes considerably
irritated, and the _Tenesmus_ (which is a great Urgency to go to Stool,
though without any Effect) is joined to the Dysentery or Flux, and often
brings on a Protrusion or falling down of the Fundament, the Patient
being now most severely afflicted. Worms are sometimes voided, and
glairy hairy Humours, resembling Pieces or Peelings of Guts, and
sometimes Clots of Blood.
If the Distemper rises to a violent Height, the Guts become inflamed,
which terminates either in Suppuration or in Mortification; the
miserable Patient discharges _Pus_, or black and foetid watery Stools:
the Hiccup supervenes; he grows delirious; his Pulse sinks; and he falls
into cold Sweats and Faintings which terminate in Death.
A kind of Phrenzy, or raging _Delirium_, sometimes comes on before the
Minute of Expiration. I have seen a very unusual Symptom accompany this
Disease in two Persons, which was an Impossibility of swallowing, for
three Days before Death.
But in general this Distemper is not so extremely violent; the
Discharges are less frequent, being from twenty-five to forty within a
Day and Night. Their Contents are less various and uncommon, and mixed
with very little Blood; the Patient retains more Strength; the Number of
Stools gradually decrease; the Blood disappears; the Consistence of the
Discharges improves; Sleep and Appetite return, and the Sick recovers.
Many of the Sick have not the least Degree of Fever, nor of Thirst,
which perhaps is less common in this Disease, than in a simple Purging
or Looseness.
Their Urine sometimes is but in a small Quantity; and many Patients have
ineffectual Endeavours to pass it, to their no small Affliction and
Restlessness.
Sec. 332. The most efficacious Remedy for this Disease is a Vomit. That of
No. 34, (when there is no present Circumstance that forbids the giving a
Vomit) if taken immediately on the first Invasion of it, often removes
it at once; and always shortens its Duration. That of No. 35 is not less
effectual; it has been considered for a long Time, even as a certain
Specific, which it is not, though a very useful Medicine. If the Stools
prove less frequent after the Operation of either of them, it is a good
Sign; if they are no Ways diminished, we may apprehend the Disease is
like to be tedious and obstinate.
The Patient is to be ordered to a Regimen, abstaining from all
Flesh-meat with the strictest Attention, until the perfect Cure of the
Disease. The Ptisan No. 3 is the best Drink for him.
The Day after the Vomit, he must take the Powder No. 51 divided into two
Doses: the next Day he should take no other Medicine but his Ptisan; on
the fourth the Rhubarb must be repeated; after which the Violence of the
Disease commonly abates: His Diet during the Disease is nevertheless to
be continued exactly for some Days; after which he may be allowed to
enter upon that of Persons in a State of Recovery.
Sec. 333. The Dysentery sometimes commences with an inflammatory Fever; a
feverish, hard, full Pulse, with a violent Pain in the Head and Loins,
and a stiff distended Belly. In such a Case the Patient must be bled
once; and daily receive three or even four of the Glysters No. 6,
drinking plentifully of the Drink No. 3.
When all Dread of an Inflammation is entirely over, the Patient is to be
treated in the Manner just related; though often there is no Necessity
for the Vomit: and if the inflammatory Symptoms have run high, his first
Purge should be that of No. 11, and the Use of the Rhubarb may be
postponed, till about the manifest Conclusion of the Disease.
I have cured many Dysenteries, by ordering the Sick no other Remedy, but
a Cup of warm Water every Quarter of an Hour; and it were better to rely
only on this simple Remedy, which must be of some Utility, than to
employ those, of whose Effects Country People are ignorant, and which
are often productive of very dangerous ones.
Sec. 334. It sometimes happens that the Dysentery is combined with a putrid
Fever, which makes it necessary, after the Vomit, to give the Purges No.
23 or 47, and several Doses of No. 24, before the Rhubarb is given. No.
32 is excellent in this combined Case.
There was in _Swisserland_ in the Autumn of 1755, after a very numerous
Prevalence of epidemical putrid Fevers had ceased, a Multitude of
Dysenteries, which had no small Affinity with, or Relation to, such
Fevers. I treated them first, with the Prescription No. 34, giving
afterwards No. 32; and I directed the Rhubarb only to very few, and that
towards the Conclusion of the Disease. By much the greater Number of
them were cured at the End of four or five Days. A small Proportion of
them, to whom I could not give the Vomit, or whose Cases were more
complicated, remained languid a considerable Time, though without
Fatality or Danger.
Sec. 335. When the Dysentery is blended with Symptoms of Malignity (See Sec.
245) after premising the Prescription No. 35, those of No. 38 and 39 may
be called in successfully.
Sec. 336. When the Disease has already been of many Days standing, without
the Patient's having taken any Medicines, or only such as were injurious
to him, he must be treated as if the Distemper had but just commenced;
unless some Symptoms, foreign to the Nature of the Dysentery, had
supervened upon it.
Sec. 337. Relapses sometimes occur in Dysenteries, some few Days after the
Patients appeared well; much the greater Number of which are occasioned
either by some Error in Diet, by cold Air, or by being considerably
over-heated. They are to be prevented by avoiding these Causes of them;
and may be removed by putting the Patient on his Regimen, and giving him
one Dose of the Prescription No. 51. Should it return even without any
such discoverable Causes, and if it manifests itself to be the same
Distemper renewed, it must be treated as such.
Sec. 338. This Disease is sometimes combined too with an intermitting
Fever; in which Case the Dysentery must be removed first, and the
intermittent afterwards. Nevertheless if the Access, the Fits of the
Fever have been very strong, the Bark must be given as directed Sec. 259.
Sec. 339. One pernicious Prejudice, which still generally prevails is, that
Fruits are noxious in a Dysentery, that they even give it, and aggravate
it; and this perhaps is an extremely ill-grounded one. In truth bad
Fruits, and such as have not ripened well, in unseasonable Years, may
really occasion Cholics, a Looseness (though oftner a Costiveness) and
Disorders of the Nerves, and of the Skin; but never can occasion an
epidemical Dysentery or Flux. Ripe Fruits, of whatever Species, and
especially Summer Fruits, are the real Preservatives from this Disease.
The greatest Mischief they can effect, must result from their thinning
and washing down the Humours, especially the thick glutinous Bile, if
they are in such a State; good ripe Fruits being the true Dissolvents of
such; by which indeed they may bring on a Purging, but such a one, as is
rather a Guard against a Dysentery.
We had a great, an extraordinary Abundance of Fruit in 1759 and 1760,
but scarcely any Dysenteries. It has been even observed to be more rare,
and less dangerous than formerly; and if the Fact is certain, it cannot
be attributed to any thing more probably, than to the very numerous
Plantations of Trees, which have rendered Fruit very plenty, cheap and
common. Whenever I have observed Dysenteries to prevail, I made it a
Rule to eat less Flesh, and Plenty of Fruit; I have never had the
slightest Attack of one; and several Physicians use the same Caution
with the same Success.
I have seen eleven Patients in a Dysentery in one House, of whom nine
were very tractable; they eat Fruit and recovered. The Grandmother and
one Child, whom she loved more than the rest, were carried off. She
managed the Child after her own Fashion, with burnt Wine, Oil, and some
Spices, but no Fruit. She conducted herself in the very same Manner, and
both died.
In a Country Seat near _Berne_, in the Year 1751, when these Fluxes made
great Havock, and People were severely warned against the Use of Fruits,
out of eleven Persons in the Family, ten eat plentifully of Prunes, and
not one of them was seized with it: The poor Coachman alone rigidly
observed that Abstinence from Fruit injoined by this Prejudice, and took
a terrible Dysentery.
This same Distemper had nearly destroyed a Swiss Regiment in Garrison in
the South of _France_; the Captains purchased the whole Crop of several
Acres of Vineyard; there they carried the sick Soldiers, and gathered
the Grapes for such as could not bear being carried into the Vineyard;
those who were well eating nothing else: after this not one more died,
nor were any more even attacked with the Dysentery.
A Clergyman was seized with a Dysentery, which was not in the least
mitigated by any Medicines he had taken. By meer Chance he saw some red
Currans; he longed for them, and eat three Pounds of them between seven
and nine o'Clock in the Morning; that very Day he became better, and was
entirely well on the next.
I could greatly enlarge the Number of such Instances; but these may
suffice to convince the most incredulous, whom I thought it might be of
some Importance to convince. Far from forbidding good Fruit, when
Dysenteries rage, the Patients should be encouraged to eat them freely;
and the Directors of the Police, instead of prohibiting them, ought to
see the Markets well provided with them. It is a Fact of which Persons,
who have carefully informed themselves, do not in the least doubt.
Experience demonstrates it, and it is founded in Reason, as good Fruit
counter-operates all the Causes of Dysenteries. [77]
[77] The Experience of all Countries and Times so strongly confirms
these important Truths, that they cannot be too often repeated, too
generally published, whenever and wherever this Disease rages. The
Succession of cold Showers to violent Heats; too moist a
Constitution of the Air; an Excess of animal Food; Uncleanliness
and Contagion, are the frequent Causes of epidemical Fluxes. _E.
L._
I have retained the preceding Note, abridged from this Gentleman,
as it contains the Suffrage of another experienced Physician,
against that Prejudice of ripe Fruits occasioning Fluxes, which is
too popular among ourselves, and probably more so in the Country
than in _London_. I have been also very credibly assured, that the
Son of a learned Physician was perfectly cured of a very obstinate
Purging, of a Year's Continuance (in Spite of all the usual
officinal Remedies) by his devouring large Quantities of ripe
Mulberries, for which he ardently longed, and drinking very freely
of their expressed Juice. The Fact occurred after his Father's
Decease, and was affirmed to me by a Gentleman intimately
acquainted with them both. _K._
Sec. 340. It is important and even necessary, that each Subject of this
Disease should have a Close-stool or Convenience apart to himself, as
the Matter discharged is extremely infectious: and if they make Use of
Bed-pans, they should be carried immediately out of the Chamber, the Air
of which should be continually renewed, burning Vinegar frequently in
it.
It is also very necessary to change the Patient's Linen frequently;
without all which Precautions the Distemper becomes more violent, and
attacks others who live in the same House. Hence it is greatly to be
wished the People in general were convinced of these Truths.
It was _Boerhaave's_ Opinion, that all the Water which was drank, while
Dysenteries were epidemical, should be _stummed_, as we term it, or
sulphurized. [78]
[78] Our learned Author, or his medical Editor at _Lyons_, observes
here, 'that in the Edition of this Treatise at _Paris_, there was
an essential Mistake, by making _Boerhaave_ recommend the Addition
of Brandy, _Eau de vie_, instead of stumming or sulphurizing it,'
for which this Note, and the Text too use the Verb _branter_, which
Word we do not find in any Dictionary. We are told however, it
means to impregnate the Casks in which the Water is reserved, with
the Vapour of Sulphur, and then stopping them; in the same Manner
that Vessels are in some Countries, for the keeping of Wine. He
observes the Purpose of this is to oppose Corruption by the acid
Steams of the Sulphur. _K._
Sec. 341. It has happened, by some unaccountable Fatality, that there is no
Disease, for which a greater Number of Remedies are advised, than for
the Dysentery. There is scarcely any Person but what boasts of his own
Prescription, in Preference to all the rest, and who does not boldly
engage to cure, and that within a few Hours, a tedious severe Disease,
of which he has formed no just Notion, with some Medicine or
Composition, of whose Operation he is totally ignorant: while the poor
Sufferer, restless and impatient, swallows every Body's Recommendation,
and gets poisoned either through Fear, downright Disgust or Weariness,
or through entire Complaisance. Of these many boasted Compositions, some
are only indifferent, but others pernicious. I shall not pretend to
detail all I know myself, but after repeatedly affirming, that the only
true Method of Cure is that I have advised here, the Purpose of which is
evacuating the offending Matter; I also affirm that all those Methods,
which have a different Scope or Drift, are pernicious; but shall
particularly observe, that the Method most generally followed, which is
that of stopping the Stools by Astringents, or by Opiates, is the worst
of all, and even so mortal a one, as to destroy a Multitude of People
annually, and which throws others into incurable Diseases. By preventing
the Discharge of these Stools, and inclosing the Wolf in the Fold, it
either follows, 1, that this [79] retained Matter irritates and inflames
the Bowels from which Inflammation excruciating Pains arise, an acute
inflammatory Cholic, and finally a Mortification and Death; or a
_Schirrhus_, which degenerates into a _Cancer_, (of which I have seen a
dreadful Instance) or else an Abscess, Suppuration and Ulcer. Or 2, this
arrested Humour is repelled elsewhere, producing a _Scirrhus_ in the
Liver, or Asthmas, Apoplexy, Epilepsy, or Falling Sickness; horrible
rheumatic Pains, or incurable Disorders of the Eyes, or of the
Teguments, the Skin and Surface.
[79] A first or second Dose of Glauber Salt has been known to succeed in
the epidemical Summer Fluxes of the hotter Climates, when repeated
Doses of Rhubarb and Opiates had failed. Such Instances seems a
collateral Confirmation of Dr. _Tissot's_ rational and successful
Use of cooling opening Fruits in them. _K._
Such are the Consequences of all the astringent Medicines, and of those
which are given to procure Sleep in this Disease, as Venice Treacle,
Mithridate and Diascordium, when given too early in Dysenteries.
I have been consulted on Account of a terrible Rheumatism, which ensued
immediately after taking a Mixture of Venice Treacle and Plantain, on
the second Day of a Dysentery.
As those who advise such Medicines, are certainly unaware of their
Consequences, I hope this Account of them will be sufficient, to prevent
their Repetition.
Sec. 342. Neither are Purges without their Abuse and Danger; they determine
the Course of all the Humours more violently to the tender afflicted
Parts; the Body becomes exhausted; the Digestions fail; the Bowels are
weakened, and sometimes even lightly ulcerated, whence incurable
_Diarrhoeas_ or Purgings ensue, and prove fatal after many Years
Affliction.
Sec. 343. If the Evacuations prove excessive, and the Distemper tedious,
the Patient is likely to fall into a Dropsy; but if this is immediately
opposed, it may be removed by a regular and drying Diet, by
Strengthners, by Friction and proper Exercise.
__Chapter XXV.__
_Of the Itch._
__Sect.__ 344.
The Itch is an infectious Disorder contracted by touching infected
Persons or Cloaths, but not imbibed from the Air: So that by carefully
avoiding the _Medium_, or Means of Contagion, the Disorder may be
certainly escaped.
Though any Part of the Body may be infested with the Itch, it commonly
shews itself on the Hands, and chiefly between the Fingers. At first one
or two little Pimples or Pustules appear, filled with a kind of clear
Water, and excite a very disagreeable Itching. If these Pustules are
broke by scratching them, the Water oozing from them infects the
neighbouring Parts. At the Beginning of this Infection it can scarcely
be distinguished, if a Person is not well apprized of its Nature; but in
the Progress of it, the little Pustules increase both in Number and
Size; and when they are opened by scratching, a loathsome kind of Scab
is formed, and the Malady extends over the whole Surface. Where they
continue long, they produce small Ulcers, and are at that Time highly
contagious.
Sec. 345. Bad Diet, particularly the Use of Salt Meat, bad unripe Fruit,
and Uncleanliness occasion this Disease; though it is oftnest taken by
Contagion. Some very good Physicians suppose it is never contracted
otherwise; but I must take Leave to dissent, as I have certainly seen it
exist without Contagion.
When it happens to a Person, who cannot suspect he has received it by
Contact, his Cure should commence with a total Abstinence from all Salt,
sour, fat and spicy Food. He should drink a Ptisan of wild and bitter
Succory, or that of No. 26, five or six Glasses of which may be daily
taken; at the End of four or five Days, he may be purged with No. 21, or
with an Ounce of _Sedlitz_ [or _Epsom_] Salt. His Abstinence, his
Regimen is to be continued; the Purge to be repeated after six or seven
Days; and then all the Parts affected, and those very near them, are to
be rubbed in the Morning fasting, with a fourth Part of the Ointment No.
52. The three following Days the same Friction is to be repeated, after
which the same Quantity of Ointment is to be procured, and used in the
same Proportion; but only every other Day. It happens but seldom that
this Method fails to remove this disagreeable Malady; sometimes however
it will return, in which Case, the Patient must be purged again, and
then recur to the Ointment, whose good Effects I have experienced, and
continually do.
If the Disease has been very lately contracted, and most certainly by
Contact, the Ointment may be fearlessly employed, as soon as it is
discovered, without taking any Purge before it. But if, on the contrary,
the Disease has been long neglected, and has rose to a high Degree, it
will be necessary to restrain the Patient a long Time to the Regimen I
have directed; he must be repeatedly purged, and then drink plentifully
of the Ptisan No. 26, before the Ointment is rubbed in. When the Malady
is thus circumstanced, I have always begun with the Ointment No. 28,
half a Quarter of which is to be used every Morning. I have also
frequently omitted the Use of that No. 52, having always found the
former as certain, but a little slower in its Effects.
Sec. 346. While these Medicines are employed, the Patient must avoid all
Cold and Wet, especially if he makes Use of No. 28, [80] in which there
is Quick-silver; which, if such Precautions were neglected, might bring
on a Swelling of the Throat and Gums, and even rise to a Salivation. Yet
this Ointment has one Advantage in its having no Smell, and being
susceptible of an agreeable one; while it is very difficult to disguise
the disagreeable Odour of the other.
The Linen of a Person in this Disease ought to be often changed; but his
upper Cloaths must not be changed: because these having been infected,
might, when worn again, communicate the Itch to the Wearer again, after
he had been cured.
Shirts, Breeches and Stockings may be fumigated with Sulphur, before
they are put on; and this Fumigation should be made in the open Air.
[80] I have seen a pretty singular Consequence from the Abuse of
mercurial Unction for the Itch; whether it happened from the
Strength or Quantity of the Ointment, or from taking Cold after
applying it, as this Subject, a healthy Youth of about sixteen,
probably did, by riding three or four Miles through the Rain. But
without any other previous Complaint, he awoke quite blind one
Morning, wondering, as he said, when it would be Day. His Eyes were
very clear, and free from Inflammation, but the Pupil was wholly
immoveable, as in a _Gutta serena_. I effected the Cure by some
moderate Purges repeated a few Times; by disposing him to sweat by
lying pretty much in Bed (it being towards Winter) and by promoting
his Perspiration, chiefly with Sulphur: after which the shaved
Scalp was embrocated with a warm nervous Mixture, in which Balsam
of _Peru_ was a considerable Ingredient. In something less than
three Weeks he could discern a glowing Fire, or the bright Flame of
a Candle. As his Sight increased, he discerned other Objects, which
appeared for some Days inverted to him, with their Colours
confused; but Red was most distinguishable. He discovered the Aces
sooner than other Cards; and in about six or seven Weeks recovered
his full Sight in all its natural Strength, which he now enjoys.
_K._
Sec. 347. If this Disorder becomes very inveterate and tedious, it exhausts
the Patient, in Consequence of its not suffering him to sleep at Nights,
as well as by his restless Irritation; and sometimes even brings on a
Fever, so that he falls away in Flesh, and his Strength abates.
In such a Case he must take, 1, a gentle Purge.
2, Make Use frequently of warm Baths.
3, He must be put on the Regimen of Persons in a State of Recovery.
4, He must take Morning and Evening, fifteen Days successively, the
Powder No. 53, with the Ptisan No. 26.
This Malady is often very obstinate, and then the Medicines must be
varied according to the Circumstances, the Detail of which I avoid here.
Sec. 348. After giving repeated Purges in such obstinate Cases, mineral
Waters abounding with Sulphur, such as [81] those of _Yverdun_, &c.
often effect a Cure; and simple cold Bathings in Rivers or Lakes have
sometimes succeeded in very inveterate Cases of this Disorder.
[81] Sea water, and those of _Dulwich_, _Harrigate_, _Shadwell_, &c.
will be full as effectual. _K._
Nothing conduces more to the long Continuance of this Malady, than the
Abuse of hot Waters, such as infusions of Tea, &c.
Sec. 349. I shall conclude this Chapter, with a repeated Injunction not to
be too free or rash in the Use of the Ointment No. 52, and other outward
Remedies for extinguishing the Itch. There is hardly any Complaint, but
what has been found to be the Consequence of too sudden a Removal of
this Disorder by outward Applications, before due Evacuations have been
made, and a moderate Abatement of the Sharpness of the Humours has been
effected.
__Chapter XXVI.__
_The Treatment of Diseases peculiar to Women._
__Sect.__ 350.
Besides all the preceding Diseases, to which Women are liable in common
with Men, their Sex also exposes them to others peculiar to it, and
which depend upon four principal Sources; which are their monthly
Discharges, their Pregnancy, their Labours in Child-birth, and the
Consequences of their Labours. It is not my present Design to treat
professedly on each of the Diseases arising from these Causes, which
would require a larger Volume than I have proposed; but I shall confine
myself to certain general Directions on these four Heads.
Sec. 351. Nature, who intended Women for the Increase, and the Nourishment
of the human Race at the Breast, has subjected them to a periodical
Efflux, or Discharge, of Blood: which Circumstance constitutes the
Source, from whence the Infant is afterwards to receive his Nutrition
and Growth.
This Discharge generally commences, with us, between the Age of sixteen
and eighteen. Young Maidens, before the Appearance of this Discharge,
are frequently, and many for a long Time, in a State of Weakness,
attended with various Complaints, which is termed the _Chlorosis_, or
Green Sickness, and Obstructions: and when their Appearance is extremely
slow and backward, it occasions very grievous, and sometimes even mortal
Diseases. Nevertheless it is too usual, though very improper, to ascribe
all the Evils, to which they are subject at this Term of Life, solely to
this Cause; while they really often result from a different Cause, of
which the Obstructions themselves are sometimes only the Effect; and
this is the natural, and, in some Degree, even necessary Feebleness of
the Sex. The Fibres of Women which are intended to be relaxed, and to
give Way, when they are unavoidably extended by the Growth of the Child,
and its inclosing Membranes (which frequently arise to a very
considerable Size) should necessarily be less stiff and rigid, less
strong, and more lax and yielding than the Fibres of Men. Hence the
Circulation of their Blood is more slow and languid than in Males; their
Blood is less compact and dense, and more watery; their Fluids are more
liable to stagnate in their different Bowels, and to form Infarctions
and Obstructions.
Sec. 352. The Disorders to which such a Constitution subjects them might,
in some Measure, be prevented, by assisting that Languor or Feebleness
of their natural Movements, by such an Increase of their Force, as
Exercise might contribute to: But this Assistance, which in some Manner
is more necessary for Females than Males, they are partly deprived of,
by the general Education and Habitude of the Sex; as they are usually
employed in managing Household Business, and such light sedentary Work,
as afford them less Exercise and Motion, than the more active
Occupations of Men. They stir about but little, whence their natural
Tendency to Weakness increases from Habit, and thence becomes morbid and
sickly. Their Blood circulates imperfectly; its Qualities become
impaired; the Humours tend to a pretty general Stagnation; and none of
the vital Functions are completely discharged.
From such Causes and Circumstances they begin to sink into a State of
Weakness, sometimes while they are very young, and many Years before
this periodical Discharge could be expected. This State of Languor
disposes them to be inactive; a little Exercise soon fatigues them,
whence they take none at all. It might prove a Remedy, and even effect a
Cure, at the Beginning of their Complaint; but as it is a Remedy, that
is painful and disagreeable to them, they reject it, and thus increase
their Disorders.
Their Appetite declines with the other vital Functions, and gradually
becomes still less; the usual salutary Kinds of Food never exciting it;
instead of which they indulge themselves in whimsical Cravings, and
often of the oddest and most improper Substances for Nutrition, which
entirely impair the Stomach with its digestive Functions, and
consequently Health itself.
But sometimes after the Duration of this State for a few Years, the
ordinary Time of their monthly Evacuations approaches, which however
make not the least Appearance, for two Reasons. The first is, that their
Health is too much impaired to accomplish this new Function, at a Time
when all the others are so languid: and the second is, that under such
Circumstances, the Evacuations themselves are unnecessary; since their
final Purpose is to discharge (when the Sex are not pregnant) that
superfluous Blood, which they were intended to produce, and whose
Retention would be unhealthy, when not applied to the Growth of the
Foetus, or Nourishment of the Child: and this Superfluity of Blood does
not exist in Women, who have been long in a very low and languishing
State.
Sec. 353. Their Disorder however continues to increase, as every one daily
must, which does not terminate. This Increase of it is attributed to the
Suppression or Non-appearance of their monthly Efflux, which is often
erroneous; since the Disorder is not always owing to that Suppression,
which is often the Effect of their Distemperature. This is so true, that
even when the Efflux happens, if their Weakness still continues, the
Patients are far from being the better for it, but the reverse. Neither
is it unusual to see young Lads, who have received from Nature, and from
their Parents, a sort of feminine Constitution, Education and Habitude,
infested with much the same Symptoms, as obstructed young Women.
Country Girls, who are generally more accustomed to such hardy Work and
Exercise as Country Men, are less subject to these Complaints, than
Women who live in Cities.
Sec. 354. Let People then be careful not to deceive themselves on this
important Account; since all the Complaints of young Maidens are not
owing to the Want of their Customs. Nevertheless it is certain there are
some of them, who are really afflicted from this Cause. For Instance,
when a strong young Virgin in full Health, who is nearly arrived to her
full Growth, and who manifestly abounds with Blood, does not obtain this
Discharge at the usual Time of Life, then indeed this superfluous Blood
is the Fountain of very many Disorders, and greatly more violent ones
than those, which result from the contrary Causes already mentioned.
If the lazy inactive City Girls are more subject to the Obstructions,
which either arise from the Weakness and Languor I have formerly taken
Notice of, or which accompany it; Country Girls are more subject to
Complaints from this latter Cause (too great a Retention of superfluous
Blood) than Women who live in Cities: and it is this last Cause that
excites those singular Disorders, which appear so supernatural to the
common People, that they ascribe them to Sorcery.
Sec. 355. And even after these periodical Discharges have appeared, it is
known that they have often been suppressed, without the least unhealthy
Consequence resulting from that Suppression. They are often suppressed,
in the Circumstances mentioned Sec. 351, by a Continuance of the Disease,
which was first an Obstacle or Retardment to their Appearance; and in
other Cases, they have been suppressed by other Causes, such as Cold,
Moisture, violent Fear, any very strong Passion; by too chilly a Course
of Diet, with Indigestion; or too hot and irritating Diet; by Drinks
cooled with Ice, by Exercise too long continued, and by unusual
Watching. The Symptoms, occasioned by such Suppressions, are sometimes
more violent than those, which preceded the first Appearance of the
Discharge.
Sec. 356. The great Facility with which this Evacuation may be suppressed,
diminished, or disordered, by the Causes already assigned; the terrible
Evils which are the Consequences of such Interruptions and
Irregularities of them, seem to me very cogent Reasons to engage the Sex
to use all possible Care, in every Respect, to preserve the Regularity
of them; by avoiding, during their Approach and Continuance, every Cause
that may prevent or lessen them. Would they be thoroughly persuaded, not
solely by my Advice, but by that of their Mothers, their Relations,
their Friends, and by their own Experience, of what great Importance it
is to be very attentive to themselves, at those critical Times, I think
there is not one Woman, who from the first, to the very last Appearance
of them, would not conduct herself with the most scrupulous Regularity.
Their Demeanour, in these Circumstances, very fundamentally interests
their own Health, as well as that of their Children; and consequently
their own Happiness, as well as that of their Husbands and Families.
The younger and more delicate they are, Caution becomes the more
necessary for them. I am very sensible a strong Country Girl is too
negligent in regulating herself at those critical Seasons, and sometimes
without any ill Consequence; but at another Time she may suffer severely
for it: and I could produce a long List of many, who, by their
Imprudence on such Occasions, have thrown themselves into the most
terrible Condition.
Besides the Caution with which Females should avoid these general
Causes, just mentioned in the preceding Section, every Person ought to
remember what has most particularly disagreed with her during that Term,
and for ever constantly to reject it.
Sec. 357. There are many Women whose Customs visit them without the
slightest Impeachment of their Health: others are sensibly disordered on
every Return of them; and to others again they are very tormenting, by
the violent Cholics, of a longer or a shorter Duration, which precede or
accompany them. I have known some of these violent Attacks last but some
Minutes, and others which continued a few Hours. Nay some indeed have
persisted for many Days, attended with Vomiting, Fainting, with
Convulsions from excessive Pain, with Vomiting of Blood, Bleedings from
the Nose, _&c._ which, in short, have brought them to the very Jaws of
Death. So very dangerous a Situation requires the closest Attention;
though, as it results from several and frequently very opposite Causes,
it is impossible within the present Plan, to direct the Treatment that
may be proper for each Individual. Some Women have the Unhappiness to be
subject to these Symptoms every Month, from the first Appearance, to the
final Termination, of these Discharges; except proper Remedies and
Regimen, and sometimes a happy Child-birth, remove them. Others complain
but now and then, every second, third, or fourth Month; and there are
some again, who having suffered very severely during the first Months,
or Years, after their first Eruptions, suffer no more afterwards. A
fourth Number, after having had their Customs for a long Time, without
the least Complaint, find themselves afflicted with cruel Pains, at
every Return of them; if by Imprudence, or some inevitable Fatality,
they have incurred any Cause, that has suppressed, diminished, or
delayed them. This Consideration ought to suggest a proper Caution even
to such, as generally undergo these Discharges, without Pain or
Complaint: since all may be assured, that though they suffer no sensible
Disorder at that Time, they are nevertheless more delicate, more
impressible by extraneous Substances, more easily affected by the
Passions of the Mind, and have also weaker Stomachs at these particular
Periods.
Sec. 358. These Discharges may also be sometimes too profuse in Quantity,
in which Case the Patients become obnoxious to very grievous Maladies;
into the Discussion of which however I shall not enter here, as they are
much less frequent than those, arising from a Suppression of them.
Besides which, in such Cases, Recourse may be had to the Directions I
shall give hereafter, when I treat of that Loss of Blood, which may be
expedient, during the Course of Gravidation or Pregnancy. See Sec. 365.
Sec. 359. Finally, even when they are the most regular, after their
Continuance for a pretty certain Number of Years (rarely exceeding
thirty-five) they go off of their own Accord, and necessarily, between
the Age of forty-five and fifty; sometimes even sooner, but seldom
continuing longer: and this _Crisis_ of their ceasing is generally a
very troublesome, and often a very dangerous, one for the Sex.
Sec. 360. The Evils mentioned Sec. 352 may be prevented, by avoiding the
Causes producing them; and, 1, by obliging young Maidens to use
considerable Exercise; especially as soon as there is the least Reason
to suspect the Approach of this Disorder, the _Chlorosis_, or Green
Sickness.
2, By watching them carefully, that they eat nothing unwholesome or
improper; as there are scarcely any natural Substances, even among such
as are most improper for them, and the most distasteful, which have not
sometimes been the Objects of their sickly, their unaccountable
Cravings. Fat Aliments, Pastry, farinaceous or mealy, and sour and
watery Foods are pernicious to them. Herb-Teas, which are frequently
directed as a Medicine for them, are sufficient to throw them into the
Disorder, by increasing that Relaxation of their Fibres, which is a
principal Cause of it. If they must drink any such Infusions, as
medicated Drinks, let them be taken cold: but the best Drink for them is
Water, in which red hot Iron has been extinguished.
3, They must avoid hot sharp Medicines, and such as are solely intended
to force down their Terms, which are frequently attended with very
pernicious Consequences, and never do any good: and they are still the
more hurtful, as the Patient is the younger.
4, If the Malady increases, it will be necessary to give them some
Remedies; but these should not be Purges, nor consist of Diluters, and
Decoctions of Herbs, of Salts, and a Heap of other useless and noxious
Ingredients; but they should take Filings of Iron, which is the most
certain Remedy in such Cases. These Filings Should be of true simple
Iron, and not from Steel; and Care should be taken that it be not rusty,
in which State it has very little Effect.
At the Beginning of this Distemper, and to young Girls, it is sufficient
to give twenty Grains daily, enjoining due Exercise and a suitable Diet.
When it prevails in a severer Degree, and the Patient is not so young, a
Quarter of an Ounce may be safely ventured on: Certain Bitters or
Aromatics may be advantageously joined to the Filings, which are
numbered in the Appendix, 54, 55, 56, and constitute the most effectual
Remedies in this Distemper, to be taken in the Form of Powder, of vinous
Infusion, or of Electary. [82] When there is a just Indication to bring
down the Discharge, the vinous Infusion No. 55 must be given, and
generally succeeds: but I must again repeat it (as it should carefully
be considered) that the Stoppage or Obstruction of this Discharge is
frequently the Effect, not the Cause, of this Disease; and that there
should be no Attempt to force it down, which in such a Case, may
sometimes prove more hurtful than beneficial; since it would naturally
return of its own Accord, on the Recovery, and with the Strength, of the
Patient: as their Return should follow that of perfect Health, and
neither can precede Health, nor introduce it. There are some Cases
particularly, in which it would be highly dangerous to use hot and
active Medicines, such Cases for Instance, as are attended with some
Degree of Fever, a frequent Coughing, a Haemorrhage, or Bleeding, with
great Leanness and considerable Thirst: all which Complaints should be
removed, before any hot Medicines are given to force this Evacuation,
which many very ignorantly imagine cures all other female Disorders; an
Error, that has prematurely occasioned the Loss of many Womens' Lives.
[82] The _French_ Word here, _Opiat_, is sometimes used by them for a
compound Medicine of the Consistence of an Electary; and cannot be
supposed, in this Place, to mean any Preparation, into which
_Opium_ enters. _K._
Sec. 361. While the Patient is under a Course of these Medicines, she
should not take any of those I have forbidden in the preceding Sections;
and the Efficacy of these should also be furthered with proper Exercise.
That in a Carriage is very healthy; Dancing is so too, provided it be
not extended to an Excess. In Case of a Relapse in these Disorders, the
Patient is to be treated, as if it were an original Attack.
Sec. 362. The other Sort of Obstructions described Sec. 354 requires a very
different Treatment. Bleeding, which is hurtful in the former Sort, and
the Use, or rather Abuse, of which has thrown several young Women into
irrecoverable Weaknesses, has often removed this latter Species, as it
were, in a Moment. Bathing of the Feet, the Powders No. 20, and Whey
have frequently succeeded: but at other Times it is necessary to
accommodate the Remedies and the Method to each particular Case, and to
judge of it from its own peculiar Circumstances and Appearances.
Sec. 363. When these Evacuations naturally cease through Age (See Sec. 359) if
they stop suddenly and all at once, and had formerly flowed very
largely, Bleeding must, 1, necessarily be directed, and repeated every
six, every four, or even every three Months.
2, The usual Quantity of Food should be somewhat diminished, especially
of Flesh, of Eggs and of strong Drink.
3, Exercise should be increased.
4, The Patient should frequently take, in a Morning fasting, the Powder
No. 24, which is very beneficial in such Cases; as it moderately
increases the natural Excretions by Stool, Urine and Perspiration; and
thence lessens that Quantity of Blood, which would otherwise
superabound.
Nevertheless, should this total Cessation of the monthly Discharge be
preceded by, or attended with, any extraordinary Loss of Blood, which is
frequently the Case, Bleeding is not so necessary; but the Regimen and
Powder just directed are very much so; to which the Purge No. 23 should
now and then be joined, at moderate Intervals. The Use of astringent
Medicines at this critical Time might dispose the Patient to a Cancer of
the Womb.
Many Women die about this Age, as it is but too easy a Matter to injure
them then; a Circumstance that should make them very cautious and
prudent in the Medicines they recur to. On the other Hand it also
frequently happens, that their Constitutions alter for the better, after
this critical Time of Life; their Fibres grow stronger; they find
themselves sensibly more hearty and hardy; many former slight
Infirmities disappear, and they enjoy a healthy and happy old Age. I
have known several who threw away their Spectacles at the Age of
fifty-two, or fifty-three, which they had used five or six Years before.
The Regimen I have just directed, the Powder No. 24, and the Potion No.
32, agree very well in almost all inveterate Discharges (I speak of the
female Peasantry) at whatever Time of Life.
_Of Disorders attending Gravidation, or the Term of going with Child._
Sec. 364. Gravidation is generally a less ailing or unhealthy State in the
Country, than in very populous Towns. Nevertheless Country Women are
subject, as well as Citizens, to Pains of the Stomach, to vomiting in a
Morning, to Head-ach and Tooth-ach; but these Complaints very commonly
yield to Bleeding, which is almost the only Remedy necessary [83] for
pregnant Women.
[83] Too great a Fulness of Blood is undoubtedly the Cause of all these
Complaints; but as there are different Methods of opposing this
Cause, the gentlest should always be preferred; nor should the
Constitution become habituated to such Remedies, as might either
impair the Strength of the Mother, or of her Fruit. Some Expedients
therefore should be thought of, that may compensate for the Want of
Bleeding, by enjoining proper Exercise in a clear Air, with a less
nourishing, and a less juicy Diet. _E. L._
This Note might have its Use sometimes, in the Cases of such
delicate and hysterical, yet pregnant Women, as are apt to suffer
from Bleeding, or any other Evacuation, though no ways immoderate.
But it should have been considered, that Dr. _Tissot_ was
professedly writing here to hearty active Country Wives, who are
very rarely thus constituted; and whom he might be unwilling to
confuse with such multiplied Distinctions and Directions, as would
very seldom be necessary, and might sometimes prevent them from
doing what was so. Besides which, this Editor might have seen, our
Author has hinted at such Cases very soon after. _K._
Sec. 365. Sometimes after carrying too heavy Burthens; after too much or
too violent Work; after receiving excessive Jolts, or having had a Fall,
they are subject to violent Pains of the Loins, which extend down to
their Thighs, and terminate quite at the Bottom of the Belly; and which
commonly import, that they are in Danger of an Abortion, or Miscarrying.
To prevent this Consequence, which is always dangerous, they should, 1,
immediately go to Bed; and if they have not a Mattrass, they should lie
upon a Bed stuffed with Straw, a Feather-bed being very improper in such
Cases. They should repose, or keep themselves quite still in this
Situation for several Days, not stirring, and speaking as little as
possible.
2, They should directly lose eight or nine Ounces of Blood from the Arm.
3, They should not eat Flesh, Flesh-broth, nor Eggs; but live solely on
Soups made of farinaceous or mealy Substances.
4, They should take every two Hours half a Paper of the Powder No. 20;
and should drink nothing but the Ptisan No. 2.
Some sanguine robust Women are very liable to miscarry at a certain
Time, or Stage, of their Pregnancy. This may be obviated by their
bleeding some Days before that Time approaches, and by their observing
the Regimen I have advised. But this Method would avail very little for
delicate Citizens, who miscarry from a very different Cause; and whose
Abortions are to be prevented by a very different Treatment.
_Of Delivery, or Child-birth._
Sec. 366. It has been observed that a greater Proportion of Women die in
the Country in, or very speedily after, their Delivery, and that from
the Scarcity of good Assistance, and the great Plenty of what is bad;
and that a greater Proportion of those in Cities die after their Labours
are effected, by a Continuance of their former bad Health.
The Necessity there is for better instructed, better qualified Midwives,
through a great Part of _Swisserland_, is but too manifest an
Unhappiness, which is attended with the most fatal Consequences, and
which merits the utmost Attention of the Government.
The Errors which are incurred, during actual Labour, are numberless, and
too often indeed are also irremediable. It would require a whole Book,
expressly for that Purpose (and in some Countries there are such) to
give all the Directions that are necessary, to prevent so many
Fatalities: and it would be as necessary to form a sufficient Number of
well-qualified Midwives to comprehend, and to observe them; which
exceeds the Plan of the Work I have proposed. I shall only mark out one
of the Causes, and the most injurious one on this Occasion: This is the
Custom of giving hot irritating Things, whenever the Labour is very
painful, or is slow; such as Castor, or its Tincture, Saffron, Sage,
Rue, Savin, Oil of Amber, Wine, Venice Treacle, Wine burnt with Spices,
Coffee, Brandy, Aniseed-Water, Walnut-Water, Fennel-Water, and other
Drams or strong Liquors. All these Things are so many Poisons in this
Respect, which, very far from promoting the Woman's Delivery, render it
more difficult by inflaming the Womb (which cannot then so well contract
itself) and the Parts, through which the Birth is to pass, in
Consequence of which they swell, become more straitened, and cannot
yield or be dilated. Sometimes these stimulating hot Medicines also
bring on Haemorrhages, which prove mortal in a few Hours.
Sec. 367. A considerable Number, both of Mothers and Infants, might be
preserved by the directly opposite Method. As soon as a Woman who was in
very good Health, just before the Approach of her Labour, being robust
and well made, finds her Travail come on, and that it is painful and
difficult; far from encouraging those premature Efforts, which are
always destructive; and from furthering them by the pernicious Medicines
I have just enumerated, the Patient should be bled in the Arm, which
will prevent the Swelling and Inflammation; asswage the Pains; relax the
Parts, and dispose every thing to a favourable Issue.
During actual Labour no other Nourishment should be allowed, except a
little Panada every three Hours, and as much Toast and Water, as the
Woman chuses.
Every fourth Hour a Glyster should be given, consisting of a Decoction
of Mallows and a little Oil. In the Intervals between these Glysters she
should be set over a kind of Stove, or in a pierced easy Chair,
containing a Vessel in which there is some hot Water: the Passage should
be gently rubbed with a little Butter; and Stapes wrung out of a
Fomentation of simple hot Water, which is the most efficacious of any,
should be applied over the Belly.
The Midwives, by taking this Method, are not only certain of doing no
Mischief, but they also allow Nature an Opportunity of doing Good: as a
great many Labours, which seem difficult at time, terminate happily; and
this safe and unprecipitate Manner of proceeding at least affords Time
to call in further Assistance. Besides, the Consequences of such
Deliveries are healthy and happy; when by pursuing the heating
oppressing Practice, even though the Delivery be effected, both Mother
and Infant have been so cruelly, though undesignedly, tormented, that
both of them frequently perish.
Sec. 368. I acknowledge these Means are insufficient, when the Child is
unhappily situated in the Womb; or when there is an embarrassing
Conformation in the Mother: though at least they prevent the Case from
proving worse, and leave Time for calling in Men-Midwives, or other
female ones, who may be better qualified.
I beg leave again to remind the Midwives, that they should be very
cautious of urging their Women to make any forced Efforts to forward the
Birth, which are extremely injurious to them, and which may render a
Delivery very dangerous and embarrassing, that might otherwise have been
happily effected: and I insist the more freely on the Danger attending
these unreasonable Efforts, and on the very great Importance of
Patience, as the other very pernicious Practice is become next to
universal amongst us.
The Weakness, in which the labouring Woman appears, makes the
By-standers fearful that she will not have Strength enough to be
delivered; which they think abundantly justifies them in giving her
Cordials; but this Way of Reasoning is very weak and chimerical. Their
Strength, on such Occasions, is not so very speedily dissipated: the
small light Pains sink them, but in Proportion as the Pains become
stronger, their Strength arises; being never deficient, when there is no
extraordinary and uncommon Symptom; and we may reasonably be assured,
that in a healthy, well formed Woman, meer Weakness never prevents a
Delivery.
_Of the Consequences of Labour, or Childbirth._
Sec. 369. The most usual Consequences of Childbirth in the Country are, 1,
An excessive Haemorrhage. 2, An Inflammation of the Womb. 3, A sudden
Suppression of the _Lochia_, or usual Discharges after Delivery. And, 4,
the Fever and other Accidents, resulting from the Milk.
Excessive Bleedings or Floodings, should be treated according to the
Manner directed Sec. 365: and if they are very excessive, Folds of Linen,
which have been wrung out of a Mixture of equal Parts of Water and
Vinegar, should be applied to the Belly, the Loins, and the Thighs:
these should be changed for fresh moist ones, as they dry; and should be
omitted, as soon as the Bleeding abates.
Sec. 370. The Inflammation of the Womb is discoverable by Pains in all the
lower Parts of the Belly; by a Tension or Tightness of the whole; by a
sensible Increase of Pain upon touching it; a kind of red Stain or Spot,
that mounts to the Middle of the Belly, as high as the Navel; which
Spot, as the Disease increases, turns black, and then is always a mortal
Symptom; by a very extraordinary Degree of Weakness; an astonishing
Change of Countenance; a light _Delirium_ or Raving; a continual Fever
with a weak and hard Pulse; sometimes incessant Vomitings; a frequent
Hiccup; a moderate Discharge of a reddish, stinking, sharp Water;
frequent Urgings to go to Stool; a burning kind of Heat of Urine; and
sometimes an entire Suppression of it.
Sec. 371. This most dangerous and frequently mortal Disease should be
treated like inflammatory ones. After Bleeding, frequent Glysters of
warm Water must by no Means be omitted; some should also be injected
into the Womb, and applied continually over the Belly. The Patient may
also drink continually, either of simple Barley-Water, with a Quarter of
an Ounce of Nitre in every Pot of it, or of Almond Milk No. 4.
Sec. 372. The total Suppression of the _Lochia_, the Discharges after
Labour, which proves a Cause of the most violent Disorders, should be
treated exactly in the same Manner: but if unhappily hot Medicines have
been given, in order to force them down, the Case will very generally
prove a most hopeless one.
Sec. 373. If the Milk-fever run very high, the Barley Ptisan directed Sec.
371, and Glysters, with a very light Diet, consisting only of Panada, or
made of some other farinaceous Substances, and very thin, very generally
remove it.
Sec. 374. Delicate infirm Women, who have not all the requisite and
necessary Attendance they want; and such as from Indigence are obliged
to work too soon, are exposed to many Accidents, which frequently arise
from a Want of due Perspiration, and an insufficient Discharge of the
_Lochia_; and hence, the Separation of the Milk in their Breasts being
disturbed, there are milky Congestions, or Knots as it were, which are
always very painful and troublesome, and especially when they are formed
more inwardly. They often happen on the Thighs, in which Case the Ptisan
No. 58 is to be drank, and the Pultices No. 59 must be applied. These
two Remedies gradually dissipate and remove the Tumour, if that may be
effected without Suppuration. But if that proves impossible, and _Pus_,
or Matter, is actually formed, a Surgeon must open the Abscess, and
treat it like any other.
Sec. 375. Should the Milk coagulate, or curdle as it were, in the Breast,
it is of the utmost Importance immediately to attenuate or dissolve that
Thickness, which would otherwise degenerate into a Hardness and prove a
_Scirrhus_; and from a _Scirrhus_ in Process of Time a Cancer, that most
tormenting and cruel Distemper.
This horrible Evil however may be prevented by an Application to these
small Tumours, as soon as ever they appear, For this Purpose nothing is
more effectual than the Prescriptions No. 57 and 60; but under such
menacing Circumstances, it is always prudent to take the best Advice, as
early as possible.
From the Moment these hard Tumours become excessively and obstinately
so, and yet without any Pain, we should abstain from every Application,
all are injurious; and greasy, sharp, resinous and spirituous ones
speedily change the _Scirrhus_ into a Cancer. Whenever it becomes
manifestly such, all Applications are also equally pernicious, except
that of No. 60. Cancers have long been thought and found incurable; but
within a few Years past some have been cured by the Remedy No. 57; which
nevertheless is not infallible, though it should always be tried. [84]
[84] The Use of Hemlock, which has been tried at _Lyons_, by all who
have had cancerous Patients, having been given in very large Doses,
has been attended with no Effect there, that merited the serious
Attention of Practitioners. Many were careful to obtain the Extract
from _Vienna_, and even to procure it from Dr. _Storck_ himself.
But now it appears to have had so little Success, as to become
entirely neglected. _E. L._
Having exactly translated in this Place, and in the Table of
Remedies, our learned Author's considerable Recommendation of the
Extract of Hemlock in Cancers, we think it but fair, on the other
Hand, to publish this Note of his Editor's against it; that the
real Efficacy or Inefficacy of this Medicine may at length be
ascertained, on the most extensive Evidence and Experience. As far
as my own Opportunities and Reflections, and the Experience of many
others, have instructed me on this Subject, it appears clear to
myself, that though the Consequences of it have not been constantly
unsuccessful with us, yet its Successes have come very short of its
Failures. Nevertheless, as in all such Cancers, every other
internal Medicine almost universally fails, we think with Dr.
_Tissot_ it should always be tried (from the meer Possibility of
its succeeding in some particular Habit and Circumstances) at least
till longer Experience shall finally determine against it. _K._
Sec. 376. The Nipples of Women, who give Milk, are often fretted or
excoriated, which proves very severely painful to them. One of the best
Applications is the most simple Ointment, being a Mixture of Oil and Wax
melted together; or the Ointment No. 66. Should the Complaint prove very
obstinate, the Nurse ought to be purged, which generally removes it.
__Chapter XXVII.__
_Medical Directions concerning Children._
__Sect.__ 377.
The Diseases of Children, and every Thing relating to their Health, are
Objects which generally seem to have been too much neglected by
Physicians; and have been too long confided to the Conduct of the most
improper Persons for such a Charge. At the same Time it must be admitted
their Health is of no little Importance; their Preservation is as
necessary as the Continuance of the human Race; and the Application of
the Practice of Physick to their Disorders is susceptible of nearer
Approaches to Perfection, than is generally conceived. It seems to have
even some Advantage over that Practice which regards grown Persons; and
it consists in this, that the Diseases of Children are more simple, and
less frequently complicated than those of Adults.
It may be said indeed, they cannot make themselves so well understood,
and meer Infants certainly not at all. This is true in Fact to a certain
Degree, but not rigidly true; for though they do not speak our Language,
they have one which we should contrive to understand. Nay every
Distemper may be said, in some Sense, to have a Language of its own,
which an attentive Physician will learn. He should therefore use his
utmost Care to understand that of Infants, and avail himself of it, to
increase the Means of rendering them healthy and vigorous, and to cure
them of the different Distempers to which they are liable. I do not
propose actually to compleat this Task myself, in all that Extent it may
justly demand; but I shall set forth the principal Causes of their
Distempers, and the general Method of treating them. By this Means I
shall at least preserve them from some of the Mischiefs which are too
frequently done them; and the lessening such Evils as Ignorance, or
erroneous Practice, occasions, is one of the most important Purposes of
the present Work.
Sec. 378. Nearly all the Children who die before they are one Year, and
even two Years, old, die _with_ Convulsions: People say they died _of_
them, which is partly true, as it is in Effect, the Convulsions that
have destroyed them. But then these very Convulsions are the
Consequences, the Effects, of other Diseases, which require the utmost
Attention of those, who are entrusted with the Care and Health of the
little Innocents: as an effectual Opposition to these Diseases, these
morbid Causes, is the only Means of removing the Convulsions. The four
principal known Causes are, the _Meconium_; the Excrements contained in
the Body of the Infant, at the Birth; _Acidities_, or sharp and sour
Humours; the Cutting of the Teeth, and Worms. I shall treat briefly of
each.
_Of the Meconium._
Sec.379. The Stomach and Guts of the Infant, at its Entrance into the
World, are filled with a black Sort of Matter, of a middling
Consistence, and very viscid or glutinous, which is called the
_Meconium_. It is necessary this Matter should be discharged before the
Infant sucks, since it would otherwise corrupt the Milk, and, becoming
extremely sharp itself, there would result from their Mixture a double
Source of Evils, to the Destruction of the Infant.
The Evacuation of this Excrement is procured, 1, By giving them no Milk
at all for the first twenty-four Hours of their Lives. 2, By making them
drink during that Time some Water, to which a little Sugar or Honey must
be added, which will dilute this _Meconium_, and promote the Discharge
of it by Stool, and sometimes by vomiting.
To be the more certain of expelling all this Matter, they should take
one Ounce of Compound Syrup [85] of Succory, which should be diluted
with a little Water, drinking up this Quantity within the Space of four
or five Hours. This Practice is a very beneficial one, and it is to be
wished it were to become general. This Syrup is greatly preferable to
all others, given in such Cases, and especially to Oil of Almonds.
[85] This Method (says the Editor and Annotator of _Lyons_) is useful,
whenever the Mother does not suckle her Child. Art is then obliged
to prove a Kind of Substitute to Nature, though always a very
imperfect one. But when a Mother, attentive to her own true
Interest, as well as her Infant's, and, listening to the Voice of
Nature and her Duty, suckles it herself, these Remedies [he adds]
seem hurtful, or at least, useless. The Mother should give her
Child the Breast as soon as she can. The first Milk, the
_Colostrum_, or _Strippings_, as it is called in Quadrupeds, which
is very serous or watery, will be serviceable as a Purgative; it
will forward the Expulsion of the _Meconium_, prove gradually
nourishing, and is better than Biscuits, or Panada, which (he
thinks) are dangerous in the first Days after the Birth. _E. L._
This Syrup of Succory being scarcely ever prepared with us, though
sufficiently proper for the Use assigned it here, I have retained
the preceding Note, as the Author of it directs these _Strippings_,
for the same Purpose, with an Air of certain Experience; and as
this Effect of them seems no Ways repugnant to the physical Wisdom
and Oeconomy of Nature, on such important Points. Should it in fact
be their very general Operation, it cannot be unknown to any Male
or Female Practitioner in Midwifery, and may save poor People a
little Expence, which was one Object of our humane Author's Plan.
The Oil Of _Ricinus_, corruptly called _Castor_ Oil (being
expressed from the Berries of the _Palma Christi_) is particularly
recommended by some late medical Writers from _Jamaica_, _&c._ for
this Purpose of expelling the _Meconium_, to the Quantity of a
small Spoonful. These Gentlemen also consider it as the most
proper, and almost specific Opener, in the dry Belly-ach of that
torrid Climate, which tormenting Disease has the closest Affinity
to the _Miserere_, or Iliac Passion, of any I have seen. The
Annotator's Objection to our Author's very _thin light_ Panada,
seems to be of little Weight. _K._
Should the great Weakness of the Child seem to call for some
Nourishment, there would be no Inconvenience in allowing a little
Biscuit well boiled in Water, which is pretty commonly done, or a little
very thin light Panada.
_Of Acidities, or sharp Humours._
Sec. 380. Notwithstanding the Bodies of Children have been properly emptied
speedily after their Birth, yet the Milk very often turns sour in their
Stomachs, producing Vomitings, violent Cholics, Convulsions, a
Looseness, and even terminating in Death. There are but two Purposes to
be pursued in such Cases, which are to carry off the sour or sharp
Humours, and to prevent the Generation of more. The first of these
Intentions is best effected by the Syrup of Succory [86] just mentioned.
[86] Or, for Want of it, the solutive Syrup of Roses. _K._
The Generation of further Acidities is prevented, by giving three Doses
daily, if the Symptoms are violent, and but two, or even one only, if
they are very moderate, of the Powder No. 61, drinking after it Bawm
Tea, or a Tea of Lime-tree Leaves.
Sec. 381. It has been a Custom to load Children with Oil of Almonds, [87]
as soon as ever they are infested with Gripes: but it is a pernicious
Custom, and attended with very dangerous Consequences. It it very true
that this Oil sometimes immediately allays the Gripes, by involving, or
sheathing up, as it were, the acid Humours, and somewhat blunting the
Sensibility of the Nerves. But it proves only a palliative Remedy, or
asswaging for a Time, which, far from removing, increases the Cause,
since it becomes sharp and rancid itself; whence the Disorder speedily
returns, and the more Oil the Infant takes, it is griped the more. I
have cured some Children of such Disorders, without any other Remedy,
except abstaining from Oil, which weakens their Stomachs, whence their
Milk is less perfectly, and more slowly digested, and becomes more
easily soured. Besides this Weakness of the Stomach, which thus
commences at that very early Age, has sometimes an unhealthy Influence
on the Constitution of the Child, throughout the Remainder of his Life.
[87] The _Magnesia_ is an excellent Substitute in Children, for these
Oils Dr. _Tissot_ so justly condemns here. _K._
A free and open Belly is beneficial to Children; now it is certain that
the Oil very often binds them, in Consequence of its diminishing the
Force and Action of the Bowels. There is scarcely any Person, who cannot
observe this Inconvenience attending it; notwithstanding they all
continue to advise and to give it, to obtain a very different Purpose:
But such is the Power of Prejudice in this Case, and in so many others;
People are so strongly pre-possessed with a Notion, that such a Medicine
must produce such an Effect; that its never having produced it avails
nothing with them, their Prejudice still prevails; they ascribe its Want
of Efficacy to the Smallness of the Doses; these are doubled then, and
notwithstanding its bad Effects are augmented, their obstinate Blindness
continues.