Heels, Ears, Nose and Lips, those of Children especially, and mostly in
Winter; when these Extremities are exposed to the sudden Changes from
hot to cold, and from cold to hot Weather. They begin with an Inflation
or kind of Swelling, which, at first, occasions but little Heat, Pain or
Itching. Sometimes they do not exceed this first State, and go off
spontaneously without any Application: But at other Times (which may be
termed the second Degree of the Disorder, whether it happens from their
being neglected, or improperly treated) their Heat, Redness, Itching and
Pain increase considerably; so that the Patient is often deprived of the
free Use of his Fingers by the Pain, Swelling and Numbness: in which
Case the Malady is still aggravated, if effectual Means are not used.
Whenever the Inflammation mounts to a still higher Degree, small
Vesications or Blisters are formed, which are not long without bursting;
when they leave a slight Excoriation, or Rawness, as it were, which
speedily ulcerates, and frequently proves a very deep and obstinate
Ulcer, discharging a sharp and ill-conditioned Matter.
The last and most virulent Degree of Chilblains, which is not infrequent
in the very coldest Countries, though very rare in the temperate ones,
is, when the Inflammation degenerates into a Gangrene.
Sec. 463. These Tumours are owing to a Fulness and Obstruction of the
Vessels of the Skin, which occurs from this Circumstance, that the
Veins, which are more superficial than the Arteries, being
proportionably more affected and straitened by the Cold, do not carry
off all the Blood communicated to them by the Arteries; and perhaps also
the Particles or Atoms of Cold, which are admitted through the Pores of
the Skin, may act upon our Fluids, as it does upon Water, and occasion a
Congelation of them, or a considerable Approach towards it.
If these Complaints are chiefly felt, which in Fact is the Case, rather
on the extreme Parts than on others, it arises from two Causes, the
principal one being, that the Circulation's being weaker at the
Extremities than elsewhere, the Effect of those Causes, that may impair
it, must be more considerably felt there. The second Reason is, because
these Parts are more exposed to the Impressions from without than the
others.
They occur most frequently to Children, from their Weakness and the
greater Tenderness and Sensibility of their Organs, which necessarily
increases the Effect of external Impressions. It is the frequent and
strong Alteration from Heat to Cold, that seems to contribute the most
powerfully to the Production of Chilblains; and this Effect of it is
most considerable, when the Heat of the Air is at the same Time blended
with Moisture; whence the extreme and superficial Parts pass suddenly as
it were, out of a hot, into a cold, Bath. A Man sixty Years of Age, who
never before was troubled with Kibes, having worn, for some Hours on a
Journey, a Pair of furred Gloves, in which his Hands sweated, felt them
very tender, and found them swelled up with Blood: as the common Effect
of the warm Bath is to soften and relax, and to draw Blood abundantly to
the bathed Parts, whence it renders them more sensible.
This Man, I say, thus circumstanced, was at that Age first attacked with
Chilblains, which proved extremely troublesome; and he was every
succeeding Winter as certainly infested with them, within Half an Hour
after he left off his Gloves, and was exposed to a very cold Air.
It is for this Reason, that several Persons are never infested with
Chilblains, but when they use themselves to Muffs, which are scarcely
known in hot Countries; nor are they very common among the more northern
ones, in which the extraordinary Changes from Cold to Heat are very rare
and unusual.
Some People are subject to this troublesome Complaint in the Fall; while
others have it only in the Spring. The Child of a labouring Peasant, who
has a hard Skin, and one inured to all the Impressions of the Seasons
and of the Elements, is, and indeed necessarily must be, less liable to
Kibes, than the Child of a rich Citizen, whose Skin is often cherished,
at the Expence of his Constitution. But even among Children of the same
Rank in Life and Circumstances, who seem pretty much of the same
Complexion, and live much in the same Manner; whence they might of
Course be supposed equally liable to the same Impressions, and to the
like Effects of them, there is, nevertheless, a very great Difference
with Respect to their constitutional Propensity to contract Chilblains.
Some are very cruelly tormented with them, from the setting in of
Autumn, to the very End of the Spring: others have either none at all,
or have them but very slightly, and for a very short Time. This
Difference undoubtedly arises from the different Quality of their
Humours, and the Texture of their whole Surface, but particularly from
that of the Skin of their Hands; though we readily confess it is by no
Means easy to determine, with Certainty and Precision, in what this
Difference essentially consists.
Children of a sanguine Complexion and delicate Skin are pretty generally
subject to this Disorder, which is often regarded much too slightly,
though it is really severe enough to engage our Attention more; since,
even abstracted from the sharp Pains which smart these unhappy Children
for several Months; it sometimes gives them a Fever, hinders them from
sleeping, and yet confines them to their Bed, which is very prejudicial
to their Constitutions. It also breaks in upon the Order of their
different Duties and Employments; it interrupts their innocent salutary
Pleasures; and sometimes, when they are obliged to earn their daily
Bread by doing some Work or other, it sinks them down to Misery. I knew
a young Man, who from being rendered incapable by Chilblains, of serving
out his Apprenticeship to a Watch-maker, is become a lazy Beggar.
Chilblains which attack the Nose, often leave a Mark that alters the
Physiognomy, the Aspect of the Patient, for the Remainder of his Life:
and the Hands of such as have suffered from very obstinate ones, are
commonly ever sensible of their Consequences.
Sec. 464. With Respect, therefore, to these afflicting Tumours and
Ulcerations, we should, in the first Place, do our utmost to prevent
them; and next exert our best Endeavours to cure such as we could not
prevent.
Sec. 465. Since they manifestly depend on the Sensibility of the Skin, the
Nature of the Humours, and the Changes of the Weather from Heat to Cold,
in Order to prevent them, in the first Place, the Skin must be rendered
firmer or less tender. 2, That vicious Quality of the Temperament, which
contributes to their Existence, must be corrected; and, 3, the Persons
so liable must guard themselves as well as possible, against these
Changes of the Weather.
Now the Skin of the Hands, as well as that of the whole Body, may be
strengthened by that Habit of washing or bathing in cold Water, which I
have described at large, Sec. 384; and in Fact I have never seen Children,
who had been early accustomed and inured to this Habit, as much
afflicted with Chilblains as others. But still a more particular Regard
should be had to fortify the Skin of the Hands, which are more obnoxious
to this Disorder than the Feet, by making Children dip them in cold
Water, and keep them for some Moments together in it every Morning, and
every Evening too before Supper, from the very Beginning of the Fall. It
will give the Children no Sort of Pain, during that Season, to contract
this Habit; and when it is once contracted, it will give them no Trouble
to continue it throughout the Winter, even when the Water is ready to
freeze every where. They may also be habituated to plunge their Feet
into cold Water twice or thrice a Week: and this Method, which might be
less adapted for grown Persons, who had not been accustomed to it, must
be without Objection with Respect to such Children, as have been
accustomed to it; to whom all its Consequences must be useful and
salutary.
At the same Time Care must be taken not to defeat or lessen the Effect
of the cold bathing, by suffering the Bather or Washer, to grow too warm
between two Baths or Dippings; which is also avoiding the too speedy
Successions of Heat and Cold. For this Purpose, 1, the Children must be
taught never to warm their Hands before the Fire at such Times, and
still less before the Stoves, which very probably are one of the
principal Causes of Chilblains, that are less usual in Countries which
use no such Stoves, and among those Individuals who make the least Use
of them, where they are. Above all, the Use of _Cavettes_ (that is, of
Seats or little Stairs, as it were, contrived between the Stove and the
Wall) is prejudicial to Children, and even to grown People, upon several
Accounts. 2, They should never accustom themselves to wear Muffs. 3, It
would be also proper they should never use Gloves, unless some
particular Circumstances require it; and I recommend this Abstinence
from Gloves, especially to young Boys: but if any should be allowed
them, let the Gloves be thin and smooth.
Sec. 466. When Chilblains seem to be nourished by some Fault in the
Temperament or Humours, the Consideration of a Physician becomes
necessary, to direct a proper Method of removing or altering it. I have
seen Children from the Age of three, to that of twelve or thirteen
Years, in whom their Chilblains, raw and flead, as it were, for eight
Months of the Year, seemed to be a particular Kind of Issue, by which
Nature freed herself of an inconvenient Superfluity of Humours, when the
Perspiration was diminished by the Abatement of the violent Heats. In
such Cases I have been obliged to carry them through a pretty long
Course of Regimen and Remedies; which, however, being necessarily
various from a Variety of Circumstances, cannot be detailed here. The
milder Preparations of Antimony are often necessary in such Cases; and
some Purges conduce in particular ones to allay and to abridge the
Disorder.
Sec. 467. The first Degree of this Complaint goes off, as I have already
said, without the Aid of Medicine; or should it prove somewhat more
obstinate, it may easily be dissipated by some of the following
Remedies. But when they rise to the second Degree, they must be treated
like other Complaints from Congelation, or Frost-biting (of which they
are the first Degree) with cold Water, Ice-water and Snow.
No other Method or Medicine is nearly as efficacious as very cold Water,
so as to be ready to freeze, in which the Hands are to be dipt and
retained for some Minutes together, and several Times daily. In short it
is the only Remedy which ought to be applied, when the Hands are the
Parts affected; when the Patient has the Courage to bear this Degree of
Cold; and when he is under no Circumstance which may render it
prejudicial. It is the only Application I have used for myself, after
having been attacked with Chilblains for some Years past, from having
accustomed myself to too warm a Muff.
There ensues a slight Degree of Pain for some Moments after plunging the
Hand into Water, but it diminishes gradually. On taking the Hand out,
the Fingers are numbed with the Cold, but they presently grow warm
again; and within a Quarter of an Hour, it is entirely over.
The Hands, on being taken out of the Water, are to be well dried, and
put into Skin Gloves; after bathing three or four Times, their Swelling
subsides, so that the Skin wrinkles: but by continuing the cold Bathing,
it grows tight and smooth again; the Cure is compleated after using it
three or four Days; and, in general, the Disorder never returns again
the same Winter.
The most troublesome raging Itching is certainly assuaged by plunging
the Hands into cold Water.
The Effect of Snow is, perhaps, still more speedy: the Hands are to be
gently and often rubbed with it for a considerable Time; they grow hot,
and are of a very high Red for some Moments, but entire Ease very
quickly succeeds.
Nevertheless, a very small Number of Persons, who must have extremely
delicate and sensible Skins, do not experience the Efficacy of this
Application. It seems too active for them; it affects the Skin much like
a common blistering Plaister; and by bringing on a large flow of Humours
there, it increases, instead of lessening the Complaint.
Sec. 468. When this last Reason indeed, or some other Circumstance exists;
such as the Child's Want of Courage, or its Affliction; the monthly
Discharges in a Woman; a violent Cough; habitual Colics; and some other
Maladies, which have been observed to be renewed or aggravated by the
Influence of Cold at the Extremities, do really forbid this very cold
Application, some others must be substituted.
One of the best is to wear Day and Night, without ever putting it off, a
Glove made of some smooth Skin, such as that of a Dog; which seldom
fails to extinguish the Disorder in some Days time.
When the Feet are affected with Chilblains, Socks of the same Skin
should be worn; and the Patient keep close to his Bed for some Days.
Sec. 469. When the Disorder is violent, the Use of cold Water prohibited,
and the Gloves just recommended have but a slow Effect, the diseased
Parts should be gently fomented or moistened several times a Day, with
some Decoction, rather more than warm; which at the same time should be
dissolving and emollient. Such is that celebrated Decoction of the
Scrapings, the Peel of Radishes, whose Efficacy is still further
increased, by adding one sixth Part of Vinegar to the Decoction.
Another Decoction, of whose great Efficacy I have been a Witness, but
which dies the Hands yellow for a few Days, is the Prescription No. 71.
Many others may be made, of nearly the same Virtues, with all the
vulnerary Herbs, and even with the _Faltranc_.
Urine, which some boast of in these Cases, from their having used it
with Success; and the Mixture of Urine and Lime-water have the like
Virtues with the former Decoctions. [100]
[100] Chilblains may also be advantageously washed with Water and Flower
of Mustard, which will concur, in a certain and easy Manner, both
to cleanse and to cure them. _E. L._
As soon as the Hands affected are taken out of these Decoctions, they
must be defended from the Air by Gloves.
Sec. 470. Vapours or Steams are often more efficacious than Decoctions;
whence instead of dipping the Hands into these already mentioned, we may
expose them to their Vapours, with still more Success. That of hot
Vinegar is one of the most powerful Remedies; those of [101] _Asphalt_,
or of Turpentine have frequently succeeded too. It may be needless to
add that the affected Parts must be defended from the Air, as well after
the Steams as the Decoctions; since it is from this Cause of keeping off
the Air, that the Cerecloths are of Service; and hence also the
Application of Suet has sometimes answered.
[101] This is or should be, the same with the _Bitumen Judaicum_,
formerly kept in the Shops; but which is never directed, except in
that strange Medley the _Venice_ Treacle, according to the old
Prescription. The best is found in _Egypt_, and on the _Red Sea_:
but a different Sort, from _Germany_, _France_, and _Swisserland_,
is now generally substituted here. _K._
When the Distemper is subdued by the Use of Bathings or Steams, which
make the Skin supple and soft, then it should be strengthened by washing
the Parts with a little camphorated Brandy, diluted with an equal
Quantity of Water.
Sec. 471. When the Nose is affected with a Chilblain, the Steam of Vinegar,
and an artificial Nose, or Covering for it, made of Dog-skin, are the
most effectual Applications. The same Treatment is equally proper for
the Ears and the Chin, when infested with them. Frequently washing these
Parts in cold Water is a good Preservative from their being attacked.
Sec. 472. Whenever the Inflammation rises very high, and brings on some
Degree of a Fever, the Patient's usual Quantity of strong Drink and of
Flesh-meat must be lessened; his Body should be kept open by a few
Glysters; he should take every Evening a Dose of Nitre as prescribed,
No. 20; and if the Fever proved strong, he should lose some Blood too.
As many as are troubled with obstinate Chilblains, should always be
denied the Use of strong Liquor and Flesh.
Sec. 473. When this Distemper prevails in its third Degree, and the Parts
are ulcerated; besides keeping the Patients strictly to the Regimen of
Persons in a Way of Recovery, and giving them a Purge of Manna, the
swelled Parts should be exposed to the Steams of Vinegar; the
Ulcerations should be covered with a Diapalma Plaister; and the whole
Part should be enveloped in a smooth soft Skin, or in thin Cerecloths.
Sec. 474. The fourth Degree of this Disease, in which the Parts become
gangrenous, must be prevented by the Method and Medicines which remove
an Inflammation; but if unhappily a Gangrene has already appeared, the
Assistance of a Surgeon proves indispensably necessary.
_Of Ruptures._
Sec. 475. _Hernias_ or Ruptures, which Country-People term _being bursten_,
are a Disorder which sometimes occurs at the very Birth; though more
frequently they are the Effects of violent crying, of a strong forcing
Cough, or of repeated Efforts to vomit, in the first Months of Infancy.
They may happen afterwards indiscriminately at every Age, either as
Consequences of particular Maladies, or Accidents, or from Peoples'
violent Exertions of their Strength. They happen much oftner to Men than
Women; and the most common Sort, indeed the only one of which I propose
to treat, and that but briefly, is that which consists in the Descent of
a Part of the Guts, or of the Cawl, into the Bag or Cod-piece.
It is not difficult to distinguish this Rupture. When it occurs in
little Children, it is almost ever cured by making them constantly wear
a Bandage which should be made only of Fustian, with a little Pillow or
Pincushion, stuffed with Linen Rags, Hair or Bran. There should be at
least two of these Bandages, to change them alternately; nor should it
ever be applied, but when the Child is laid down on its Back, and after
being well assured that the Gut or Cawl, which had fallen down, has been
safely returned into the Cavity of the Belly; since without this
Precaution it might occasion the worst Consequences.
The good Effect of the Bandage may be still further promoted, by
applying upon the Skin, and within the Plait or Fold of the Groin (under
which Place the Rings, or Passage out of the Belly into the Bag lie)
some pretty astringent or strengthening Plaister, such as that commonly
used for Fractures, or that I have already mentioned, Sec. 144. Here we may
observe by the Way, that ruptured Children should never be set on a
Horse, nor be carried by any Person on Horseback, before the Rupture is
perfectly cured.
Sec. 476. In a more advanced Age, a Bandage only of Fustian is not
sufficient; one must be procured with a Plate of Steel, even so as to
constrain and incommode the Wearer a little at first: nevertheless it
soon becomes habitual, and is then no longer inconvenient to them.
Sec. 477. Ruptures sometimes attain a monstrous Size; and a great Part of
the Guts fall down in to the _Scrotum_ or Bag, without any Symptom of an
actual Disease. This Circumstance, nevertheless, is accompanied with
very great Inconvenience, which disables Persons affected with it to
work; and whenever the Malady is so considerable, and of a long Standing
too, there are commonly some Obstacles that prevent a compleat Return of
the Guts into the Belly. In this State indeed, the Application of the
Bandage or Truss is impracticable, and the miserable Patients are
condemned to carry their grievous Burthen for the Remainder of their
Lives; which may however, be palliated a little by the Use of a
Suspensory and Bag, adapted to the Size of the Rupture. This Dread of
its increasing Magnitude is a strong Motive for checking the Progress of
it, when it first appears. But there is another still stronger, which
is, that Ruptures expose the Patient to a Symptom frequently mortal.
This occurs when that Part of the Intestines fallen into the _Scrotum_
inflames; when still increasing in its Bulk, and being extremely
compressed, acute Pains come on: for now from the Increase of the
Rupture's Extent, the Passage which gave Way to its Descent, cannot
admit of its Return or Ascent; the Blood-vessels themselves being
oppressed, the Inflammation increases every Moment; the Communication
between the Stomach and the Fundament is often entirely cut off; so that
nothing passes through, but incessant Vomitings come on [this being the
Kind of _Miserere_, or Iliac Passion I have mentioned, Sec. 320] which are
succeeded by the Hickup, Raving, Swooning, cold Sweats, and Death.
Sec. 478. This Symptom supervenes in Ruptures, when the Excrements become
hard in that Part of the Guts fallen into the _Scrotum_; when the
Patient is overheated with Wine, Drams, an inflammatory Diet, _&c._ or
when he has received a Stroke on the ailing Part, or had a Fall.
Sec. 479. The best Means and Remedies are, 1, as soon as ever this Symptom
or Accident is manifest, to bleed the Patient very plentifully, as he
lies down in his Bed and upon his Back, with his Head a little raised,
and his Legs somewhat bent, so that his Knees may be erect. This is the
Attitude or Posture they should always preserve as much as possible.
When the Malady is not too far advanced, the first Bleeding often makes
a compleat Cure; and the Guts return up as soon as it is over. At other
Times this Bleeding is less successful, and leaves a Necessity for its
Repetition.
2, A Glyster must be thrown up consisting of a strong Decoction of the
large white Beet Leaves, with a small Spoonful or Pinch of common Salt,
and a Bit of fresh Butter of the Size of an Egg.
3, Folds of Linen dipt in Ice-water must be applied all over the Tumour,
and constantly renewed every Quarter of an Hour. This Remedy, when
immediately applied, has produced the most happy Effects; but if the
Symptom has endured violently more than ten or twelve Hours, it is often
too late to apply it; and then it is better to make Use of Flanels dipt
in a warm Decoction of Mallow and Elder Flowers, shifting them
frequently. It has been known however, that Ice-water, or Ice itself has
succeeded as late as the third Day. [102]
[102] Pieces of Ice applied between two Pieces of Linen, directly upon
the Rupture, as soon as possible after its first Appearance, is one
of those extraordinary Remedies, which we should never hesitate to
make immediate Use of. We may be certain by this Application, if
the Rupture is simple, and not complicated from some aggravating
Cause, to remove speedily, and with very little Pain, a Disorder,
that might be attended with the most dreadful Consequences. But the
Continuance of this Application must be proportioned to the
Strength of the Person ruptured, which may be sufficiently
estimated by the Pulse. _E. L._
4, When these Endeavours are insufficient, Glysters of Tobacco Smoke
must be tried, which has often redressed and returned Ruptures, when
every Thing else had failed.
5, And lastly, if all these Attempts are fruitless, the Operation must
be resolved on, without losing a Moment's Time; as this local Disease
proves sometimes mortal in the Space of two Days; but for this Operation
an excellent Surgeon is indispensably necessary. The happy Consequence
with which I have ordered it, in a most desperate Case since the first
Edition of this Work, on the sixth Day after a Labour, has convinced me,
still more than any former Observation I had made, that the Trial of it
ought never to be omitted, when other Attempts have been unavailing. It
cannot even hasten the Patient's Death, which must be inevitable without
it, but it rather renders that more gentle, where it might fail to
prevent it. When it is performed as Mr. _Levade_ effected it, in the
Case I have just referred to, the Pain attending it is very tolerable
and soon over.
I shall not attempt to describe the Operation, as I could not explain
myself sufficiently to instruct an ignorant Surgeon in it; and an
excellent and experienced one must be sufficiently apprized of all I
could say concerning it.
A certain Woman in this Place, but now dead, had the great and impudent
Temerity to attempt this Operation, and killed her Patients after the
most excruciating Torments, and an Extirpation, or cutting away of the
Testicle; which Quacks and ignorant Surgeons always do, but which a good
Surgeon never does in this Operation. This is often the Custom too (in
Country Places) of those Caitiffs, who perform this Operation without
the least Necessity; and mercilessly emasculate a Multitude of Infants;
whom Nature, if left to her own Conduct, or assisted only by a simple
Bandage, would have perfectly cured; instead of which, they absolutely
kill a great many, and deprive those of their Virility, who survive
their Robbery and Violence. It were religiously to be wished such
Caitiffs were to be duly, that is, severely punished; and it cannot be
too much inculcated into the People, that this Operation (termed the
_Bubonocele_) in the Manner it is performed by the best Surgeons, is not
necessary; except in the Symptoms and Circumstances I have mentioned,
and that the cutting off the Testicle never is so.
_Of Phlegmons or Boils._
Sec. 480. Every Person knows what Boils are at Sight, which are
considerably painful when large, highly inflamed, or so situated as to
incommode the Motions, or different Positions of the Body. Whenever
their Inflammation is very considerable; when there are a great many of
them at once, and they prevent the Patients from sleeping, it becomes
necessary to enter them into a cooling Regimen; to throw up some opening
Glysters; and to make them drink plentifully of the Ptisan, No. 2.
Sometimes it is also necessary to bleed the Patient.
Should the Inflammation be very high indeed, a Pultice of Bread and
Milk, or of Sorrel a little boiled and bruised, must be applied to it.
But if the Inflammation is only moderate, a Mucilage Plaister, or one of
the simple Diachylon, may be sufficient. Diachylon with the Gums is more
active and efficacious; but it so greatly augments the Pain of some
Persons afflicted with Boils, that they cannot bear it.
Boils, which often return, signify some Fault in the Temperament, and
frequently one so considerable, that might dispose a Physician to be so
far apprehensive of its Consequences, as to enquire into the Cause, and
to attempt the Extinction of it. But the Detail of this is no Part nor
Purpose of the present Work.
Sec. 481. The Phlegmon, or Boil, commonly terminates in Suppuration, but a
Suppuration of a singular Kind. It breaks open at first on its Top, or
the most pointed Part, when some Drops of a _Pus_ like that of an
Abscess comes out, after which the Germ, or what is called the Core of
it may be discerned. This is a purulent Matter or Substance, but so
thick and tenacious, that it appears like a solid Body; which may be
drawn out entirely in the Shape of a small Cylinder, like the Pith of
Elder, to the Length of some Lines of an Inch; sometimes to the Length
of a full Inch, and even more. The Emission of this Core is commonly
followed by the Discharge of a certain Quantity, according to the Size
of the Tumour, of liquid Matter, spread throughout the Bottom of it. As
soon as ever this Discharge is made, the Pain goes entirely off; and the
Swelling disappears at the End of a few Days, by continuing to apply the
simple Diachylon, or the Ointment No. 66.
_Of Fellons or Whitlows._
Sec. 482. The Danger of these small Tumours is much greater than is
generally supposed. It is an Inflammation at the Extremity or End of a
Finger, which is often the Effect of a small Quantity of Humour
extravasated, or stagnant, in that Part; whether this has happened in
Consequence of a Bruise, a Sting, or a Bite. At other times it is
evident that it has resulted from no external Cause, but is the Effect
of some inward one.
It is distinguished into many Kinds, according to the Place in which the
Inflammation begins; but the essential Nature of the Malady is always
the same, and requires the same Sort of Remedies. Hence such as are
neither Physicians nor Surgeons, may spare themselves the Trouble of
enquiring into the Divisions of this Distemper; which, though they vary
the Danger of it, and diversify the Manner of the Surgeons Operation,
yet have no Relation to the general Treatment of it; the Power and
Activity of which must be regulated by the Violence of the Symptoms.
Sec. 483. This Disorder begins with a slow heavy Pain, attended by a slight
Pulsation, without Swelling, without Redness, and without Heat; but in a
little Time the Pain, Heat, and Pulsation or Throbbing becomes
intolerable. The Part grows very large and red; the adjoining Fingers
and the whole Hand swelling up. In some Cases a Kind of red and inflated
Fuse or Streak may be observed, which, beginning at the affected Part,
is continued almost to the Elbow; neither is it unusual for the Patients
to complain of a very sharp Pain under the Shoulder; and sometimes the
whole Arm is excessively inflamed and swelled. The Sick have not a Wink
of Sleep, the Fever and other Symptoms quickly increasing. If the
Distemper rises to a violent Degree indeed, a _Delirium_ and Convulsions
supervene.
This Inflammation of the Finger determines, either in Suppuration, or in
a Gangrene. When the last of these occurs, the Patient is in very great
Danger, if he is not very speedily relieved; and it has proved necessary
more than once to cut off the Arm, for the Preservation of his Life.
When Suppuration is effected, if the Matter lies very deep and sharp, or
if the Assistance of a Surgeon has arrived too late, the Bone of the
last _Phalanx_, or Row of Bones of the Finger, is generally carious and
lost. But how gentle soever the Complaint has been, the Nail is very
generally separated and falls off.
Sec. 484. The internal Treatment in Whitlows, is the same with that in
other inflammatory Distempers. The Patient must enter upon a Regimen
more or less strict, in Proportion to the Degree of the Fever; and if
this runs very high, and the Inflammation be very considerable, there
may be a Necessity for several Bleedings.
The external Treatment consists in allaying the Inflammation; in
softening the Skin; and in procuring a Discharge of the Matter, as soon
as it is formed. For this Purpose,
1, The Finger affected is to be plunged, as soon as the Disorder is
manifest, in Water a little more than warm: the Steam of boiling Water
may also by admitted into it; and by doing these Things almost
constantly for the first Day, a total Dissipation of the Malady has
often been obtained. But unhappily it has been generally supposed, that
such slight Attacks could have but very slight Consequences, whence they
have been neglected until the Disorder has greatly advanced; in which
State Suppuration becomes absolutely necessary.
2, This Suppuration therefore may be forwarded, by continually involving
the Finger, as it were, in a Decoction of Mallow Flowers boiled in Milk,
or with a Cataplasm of Bread and Milk. This may be rendered still more
active and ripening, by adding a few white Lilly Roots, or a little
Honey. But this last must not be applied before the Inflammation is
somewhat abated, and Suppuration begins; before which Term, all sharp
Applications are very dangerous. At this Time, Yeast or Leaven may be
advantagiously used, which powerfully promotes Suppuration. The Sorrel
Pultice, mentioned Sec. 480, is also a very efficacious one.
Sec. 485. A speedy Discharge of the ripe Matter is of considerable
Importance, but this particularly requires the Attention of the Surgeon;
as it is not proper to wait till the Tumour breaks and discharges of
itself; and this the rather, as from the Skin's proving sometimes
extremely hard, the Matter might be inwardly effused between the
Muscles, and upon their Membranes, before it could penetrate through the
Skin. For this Reason, as soon as Matter is suspected to be formed, a
Surgeon should be called in, to determine exactly on the Time, when an
Opening should be made; which had better be performed a little too soon
than too late; and a little too deep, than not deep enough.
When the Orifice has been made, and the Discharge is effected, it is to
be dressed up with the Plaister No. 66, spread upon Linen, or with the
Cerecloth; and these Dressings are to be repeated daily.
Sec. 486. When the Whitlow is caused by a Humour extravasated very near the
Nail, an expert Surgeon speedily checks its Progress, and cures it
effectually by an Incision which lets out the Humour. Yet,
notwithstanding this Operation is in no wise difficult, all Surgeons are
not qualified to perform it, and but too many have no Idea at all of it.
Sec. 487. Fungous, or, as it is commonly called, proud Flesh sometimes
appears during the incarning or healing of the Incision. Such may be
kept down with sprinkling a little _Minium_ (red Lead) or burnt Alum
over it.
Sec. 488. If a _Caries_, a Rottenness of the Bone, should be a Consequence,
there is a Necessity for a Surgeon's Attendance, as much as if there was
a Gangrene; for which Reason, I shall add nothing with Respect to either
of these Symptoms; only observing, there are three very essential
Remedies against the last; _viz._ the Bark, No. 14, a Drachm of which
must be taken every two Hours; Scarifications throughout the whole
gangrened Part; and Fomentations with a Decoction of the Bark, and the
Addition of Spirit of Sulphur. This Medicine is certainly no cheap one;
but a Decoction of other bitter Plants, with the Addition of Spirit of
Salt, may sometimes do instead of it. And here I take leave to insist
again upon it, that in most Cases of gangrened Limbs, it is judicious
not to proceed to an Amputation of the mortified Part, till the Gangrene
stops, which may be known by a very perceivable Circle, (and easily
distinguished by the most ignorant Persons) that marks the Bounds of the
Gangrene, and separates the living from the mortified Parts.
_Of Thorns, Splinters, or other pointed Substances piercing into the
Skin, or Flesh._
Sec. 489. It is very common for the Hands, Feet or Legs, to be pierced by
the forcible Intrusion of small pointed Substances, such as Thorns or
Prickles, whether of Roses, Thistles or Chestnuts, or little Splinters
of Wood, Bone, _&c._
If such Substances are immediately and entirely extracted, the Accident
is generally attended with no bad Consequences; though more certainly to
obviate any such, Compresses of Linen dipt in warm Water may be applied
to the Part, or it may be kept a little while in a warm Bath. But if any
such pointed penetrating Body cannot be directly extracted, or if a Part
of it be left within, it causes an Inflammation, which, in its Progress,
soon produces the same Symptoms as a Whitlow: or if it happens in the
Leg, it inflames and forms a considerable Abscess there.
Sec. 490. To prevent such Consequences, if the penetrating Substance is
still near the Surface, and an expert Surgeon is at Hand, he must
immediately make a small Incision, and thence extract it. But if the
Inflammation were already formed, this would be useless, and even
dangerous.
When the Incision, therefore, is improper; there should be applied to
the affected Part, (after conveying the Steam of some hot Water into it)
either some very emollient Pultices of the Crumb of Bread, Milk and Oil,
or some very emollient unctuous Matter alone, the Fat of a [103] Hare
being generally employed in such Cases, and being indeed very effectual
to relax and supple the Skin; and, by thus diminishing its Resistance,
to afford the offensive penetrating Body an Opportunity of springing
forth. Nothing however, but the grossest Prejudice, could make any one
imagine, that this Fat attracted the Splinter, Thorn, or any other
intruded Substance by any sympathetic Virtue; no other Sympathy in
Nature being clearly demonstrated, except that very common one between
wrong Heads, and absurd extravagant Opinions.
[103] These Creatures perhaps are fatter in _Swisserland_, than we often
see them here. _K._
It is absolutely necessary that the injured Part should be kept in the
easiest Posture, and as immoveable as possible.
If Suppuration has not been prevented by an immediate Extraction of the
offending Substance, the Abscess should be opened as soon as ever Matter
is formed. I have known very troublesome Events from its being too long
delayed.
Sec. 491. Sometimes the Thorn, after having very painfully penetrated
through the Teguments, the Skin, enters directly into the Fat; upon
which the Pain ceases, and the Patient begins to conclude no sharp
prickling Substance had ever been introduced into the Part; and of
Course supposes none can remain there. Nevertheless some Days after, or,
in other Instances, some Weeks, fresh Pains are excited, to which an
Inflammation and Abscess succeed, which are to be treated as usual, with
Emollients, and seasonably opened.
A Patient has been reduced to lose his Hand, in Consequence of a sharp
Thorn's piercing into his Finger; from its having been neglected at
first, and improperly treated afterwards.
_Of Warts._
Sec. 492. Warts are sometimes the Effects of a particular Fault in the
Blood, which feeds and extrudes a surprizing Quantity of them. This
happens to some Children, from four to ten Years old, and especially to
those who feed most plentifully on Milk or Milk-meats. They may be
removed by a moderate Change of their Diet, and the Pills prescribed No.
18.
But they are more frequently an accidental Disorder of the Skin, arising
from some external Cause.
In this last Case, if they are very troublesome in Consequence of their
great Size, their Situation or their long Standing, they may be
destroyed, 1, by tying them closely with a Silk Thread, or with a strong
flaxen one waxed. 2, By cutting them off with a sharp Scissars or a
Bistory, and applying a Plaister of Diachylon, with the Gums, over the
cut Wart, which brings on a small Suppuration that may destroy or
dissolve the Root of the Wart: and, 3, By drying, or, as it were,
withering them up by some moderately corroding Application, such as that
of the milky Juice of [104] Purslain, of Fig-leaves, of _Chelidonium_
(Swallow-wort) or of Spurge. But besides these corroding vegetable Milks
being procurable only in Summer, People who have very delicate thin
Skins should not make Use of them, as they may occasion a considerable
and painful Swelling. Strong Vinegar, charged with as much common Salt
as it will dissolve, is a very proper Application to them. A Plaister
may also be composed from Sal Ammoniac and some Galbanum, which being
kneaded up well together and applied, seldom fails of destroying them.
[104] Our Garden Purslain, though a very juicy Herb, cannot strictly be
termed milky. In the hotter Climates where it is wild, and grows
very rankly, they sometimes boil the Leaves and Stalks (besides
eating them as a cooling Salad) and find the whole an insipid
mucilaginous Pot-herb. But Dr. _Tissot_ observes to me, that its
Juice will inflame the Skin; and that some Writers on Diet, who
disapprove it internally, affirm they have known it productive of
bad Effects. Yet none such have ever happened to myself, nor to
many others, who have frequently eaten of it. Its Seeds have
sometimes been directed in cooling Emulsions. The Wart Spurge is a
very milky and common Herb, which flowers in Summer here. _K._
The most powerful Corrosives should never be used, without the Direction
of a Surgeon; and even then it is full as prudent not to meddle with
them, any more than with actual Cauteries. I have lately seen some very
tedious and troublesome Disorders and Ulcerations of the Kidnies, ensue
the Application of a corrosive Water, by the Advice of a Quack. Cutting
them away is a more certain, a less painful, and a less dangerous Way of
removing them.
Wens, if of a pretty considerable Size, and Duration, are incurable by
any other Remedy, except Amputation.
_Of Corns._
Sec. 493. The very general or only Causes of Corns, are Shoes either too
hard and stiff, or too small.
The whole Cure consists in softening the Corns by repeated Washings and
Soakings of the Feet in pretty hot Water; then in cutting them, when
softened, with a Penknife or Scissars, without wounding the sound Parts
(which are the more sensible, in Proportion as they are more extended
than usual) and next in applying a Leaf of House-leek, of Ground-ivy, or
of Purslain dipt in Vinegar, upon the Part. Instead of these Leaves, if
any Person will give himself the little Trouble of dressing them every
Day, he may apply a Plaister of simple Diachylon, or of Gum Ammoniacum
softened in Vinegar.
The Increase or Return of Corns can only be prevented, by avoiding the
Causes that produce them.
__Chapter XXXI.__
_Of some Cases which require immediate Assistance; such as
Swoonings; Haemorrhages, or involuntary Loss of Blood; Convulsion
Fitts, and Suffocations; the sudden Effects of great Fear; of
Disorders caused by noxious Vapours; of Poisons, and of acute
Pains._
_Of Swoonings._
__Sect.__ 494.
There are many Degrees of Swooning, or fainting away: the slightest is
that in which the Patient constantly perceives and understands, yet
without the Power of speaking. This is called a Fainting, which happens
very often to vapourish Persons, and without any remarkable Alteration
of the Pulse.
If the Patient entirely loses Sensation, or Feeling, and Understanding,
with a very considerable Sinking of the Pulse, this is called a
_Syncope_, and is the second Degree of Swooning.
But if this _Syncope_ is so violent, that the Pulse seems totally
extinguished; without any discernible Breathing; with a manifest
Coldness of the whole Body; and a wanly livid Countenance, it
constitutes a third and last Degree, which is the true Image of Death,
that in Effect sometimes attends it, and it is called an _Asphixy_,
which may signify a total Resolution.
Swoonings result from many different Causes, of which I shall only
enumerate the principal; and these are, 1, Too large a Quantity of
Blood. 2, A Defect or insufficient Proportion of it, and a general
Weakness. 3, A Load at and violent Disorders of the Stomach. 4, Nervous
Maladies. 5, The Passions; and, 6, some Kinds of Diseases.
_Of Swoonings occasioned by Excess of Blood._
Sec. 495. An excessive Quantity of Blood is frequently a Cause of Swooning;
and it may be inferred that it is owing to this Cause, when it attacks
sanguine, hearty and robust Persons; and more especially when it attacks
them, after being combined with any additional or supervening Cause,
that suddenly increased the Motion of the Blood; such as heating Meats
or Drinks, Wine, spirituous Liquors: smaller Drinks, if taken very hot
and plentifully, such as Coffee, Indian Tea, Bawm Tea and the like; a
long Exposure to the hot Sun, or being detained in a very hot Place;
much and violent Exercise; an over intense and assiduous Study or
Application, or some excessive Passion.
In such Cases, first of all the Patient should be made to smell to, or
even to snuff up, some Vinegar; and his Forehead, his Temples and his
Wrists should be bathed with it; adding an equal Quantity of warm Water,
if at Hand. Bathing them with distilled or spirituous Liquids would be
prejudicial in this Kind of Swooning.
2, The Patient should be made, if possible, to swallow two or three
Spoonfuls of Vinegar, with four or five Times as much Water.
3, The Patient's Garters should be tied very tightly above his Knees; as
by this Means a greater Quantity of Blood is retained in the Legs,
whence the Heart may be less overladen with it.
4, If the Fainting proves obstinate, that is, if it continues longer
than a Quarter of an Hour, or degenerates into a _Syncope_, an Abolition
of Feeling and Understanding, he must be bled in the Arm, which quickly
revives him.
5, After the Bleeding, the Injection of a Glyster will be highly proper;
and then the Patient should be kept still and calm, only letting him
drink, every half Hour, some Cups of Elder Flower Tea, with the Addition
of a little Sugar and Vinegar.
When Swoonings which result from this Cause occur frequently in the same
Person, he should, in Order to escape them, pursue the Directions I
shall hereafter mention, Sec. 544, when treating of Persons who superabound
with Blood.
The very same Cause, or Causes, which occasion these Swoonings, also
frequently produce violent Palpitations, under the same Circumstances;
the Palpitation often preceding or following the _Deliquium_, or
Swooning.
_Of Swoonings occasioned by Weakness._
Sec. 496. If too great a Quantity of Blood, which may be considered as some
Excess of Health, is sometimes the Cause of Swooning, this last is
oftener the Effect of a very contrary Cause, that is, of a Want of
Blood, or an Exhaustion of too much.
This Sort of Swooning happens after great Haemorrhages, or Discharges of
Blood; after sudden or excessive Evacuations, such as one of some Hours
Continuance in a _Cholera Morbus_ (Sec. 321) or such as are more slow, but
of longer Duration, as for Instance, after an inveterate _Diarrhoea_, or
Purging; excessive Sweats; a Flood of Urine; such Excesses as tend to
exhaust Nature; obstinate Wakefulness; a long Inappetency, which, by
depriving the Body of its necessary Sustenance, is attended with the
same Consequence as profuse Evacuations.
These different Causes of Swooning should be opposed by the Means and
Remedies adapted to each of them. A Detail of all these would be
improper here; but the Assistances that are necessary at the Time of
Swooning, are nearly the same for all Cases of this Class; excepting for
that attending a great Loss of Blood, of which I shall treat hereafter:
first of all, the Patients should be laid down on a Bed, and being
covered, should have their Legs and Thighs, their Arms, and their whole
Bodies rubbed pretty strongly with hot Flanels; and no Ligature should
remain on any Part of them.
2, They should have very spirituous Things to smell or snuff up, such as
the Carmelite Water, Hungary Water, the [105] _English_ Salt, Spirit of
Sal Ammoniac, strong smelling Herbs, such as Rue, Sage, Rosemary, Mint,
Wormwood, and the like.
[105] Dr. _Tissot_ informs me, that in _Swisserland_, they call a
volatile Salt of Vipers, or the volatile Salt of raw Silk, _Sel.
d'Angleterre_, of which one _Goddard_ made a Secret, and which he
brought into Vogue the latter End of the last Century. But he
justly observes at the same Time, that on the present Occasion
every other volatile Alkali will equally answer the Purpose; and
indeed the Smell of some of them, as the Spirit of Sal Ammoniac
with Quicklime, _Eau de Luce_, _&c._ seem more penetrating. _K._
3, These should be conveyed into their Mouths; and they should be
forced, if possible, to swallow some Drops of Carmelite Water, or of
Brandy, or of some other potable Liquor, mixed with a little Water;
while some hot Wine mixed with Sugar and Cinnamon, which makes one of
the best Cordials, is getting ready.
4, A Compress of Flanel, or of some other woollen Stuff, dipt in hot
Wine, in which some aromatic Herb has been steeped, must be applied to
the Pit of the Stomach.
5, If the Swooning seems likely to continue, the Patient must be put
into a well heated Bed, which has before been perfumed with burning
Sugar and Cinnamon; the Frictions of the whole Body with hot Flanels
being still continued.
6, As soon as the Patient can swallow, he should take some Soup or
Broth, with the Yolk of an Egg; or a little Bread or Biscuit; soaked in
the hot spiced Wine.
7, Lastly, during the whole Time that all other Precautions are taken to
oppose the Cause of the Swooning, Care must be had for some Days to
prevent any _Deliquium_ or Fainting, by giving them often, and but
little at a time, some light yet strengthening Nourishment, such as
Panada made with Soup instead of Water, new laid Eggs very lightly
poached, light roast Meats with sweet Sauce, Chocolate, Soups of the
most nourishing Meats, Jellies, Milk, _&c._
Sec. 497. Those Swoonings, which are the Effect of Bleeding, or of the
violent Operation of some Purge, are to be ranged in this Class.
Such as happen after artificial Bleeding, are generally very moderate,
commonly terminating as soon as the Patient is laid upon the Bed: and
Persons subject to this Kind, should be bled lying down, in Order to
prevent it. But should the Fainting continue longer than usual, some
Vinegar smelt to, and a little swallowed with some Water, is a very good
Remedy.
The Treatment of such Faintings or Swoonings, as are the Consequences of
too violent Vomits or Purges, may be seen hereafter Sec. 552.
_Of Faintings occasioned by a Load, or Uneasiness, at Stomach._
Sec. 498. It has been already observed, Sec. 308, that Indigestions were
sometimes attended with Swoonings, and indeed such vehement ones, as
required speedy and very active Succour too, such as that of a Vomit.
The Indigestion is sometimes less the Effect of the Quantity, than of
the Quality, or the Corruption of the Food, contained in the Stomach.
Thus we see there are some Persons, who are disordered by eating Eggs,
Fish, Craw Fish, or any fat Meat; being thrown by them into
inexpressible Anguish attended with Swooning too. It may be supposed to
depend on this Cause, when these very Aliments have been lately eaten;
and when it evidently neither depends on the other Causes I have
mentioned; nor on such as I shall soon proceed to enumerate.
We should in Cases of this Sort, excite and revive the Patients as in
the former, by making them receive some very strong Smell, of whatever
Kind is at hand; but the most essential Point is to make them swallow
down a large Quantity of light warm Fluid; which may serve to drown, as
it were, the indigested Matter; which may soften its Acrimony; and
either effect the Discharge of it by vomiting, or force it down into the
Chanel of the Intestines.
A light Infusion of Chamomile Flowers, of Tea, of Sage, of Elder
Flowers, or of _Carduus Benedictus_, operate with much the same
Efficacy; though the Chamomile and Carduus promote the Operation of
vomiting rather more powerfully; which warm Water alone will sometimes
sufficiently do.
The Swooning ceases, or at least, considerably abates in these Cases, as
soon as ever the Vomiting commences. It frequently happens too, that,
during the Swooning, Nature herself brings on certain _Nausea_, a
Wambling and sickish Commotion of the Stomach, that revives or rouses
the Patient for a Moment; but yet not being sufficient to excite an
actual Vomiting, lets him soon sink down again into this temporary
Dissolution, which often continues a pretty considerable Time; leaving
behind it a Sickness at Stomach, Vertigos, and a Depression and Anxiety,
which do not occur in the former Species of this Malady.
Whenever these Swoonings from this Cause are entirely terminated, the
Patient must be kept for some Days to a very light Diet, and take, at
the same Time, every Morning fasting, a Dose of the Powder, No. 38,
which relieves and exonerates the Stomach of whatever noxious Contents
might remain in it; and then restores its natural Strength and
Functions.
Sec. 499. There is another Kind of Swooning, which also results from a
Cause in the Stomach; but which is, nevertheless, very different from
this we have just been treating of; and which requires a very different
Kind of Assistance. It arises from an extraordinary Sensibility of this
important Organ, and from a general Weakness of the Patient.
Those subject to this Malady are valetudinary weakly Persons, who are
disordered from many slight Causes, and whose Stomachs are at once very
feeble and extremely sensible. They have almost continually a little
Uneasiness after a Meal, though they should indulge but a little more
than usual; or if they eat of any Food not quite so easy of Digestion,
they have some Qualm or Commotion after it: Nay, should the Weather only
be unfavourable, and sometimes without any perceivable assignable Cause,
their Uneasiness terminates in a Swoon.
Patients swooning, from these Causes, have a greater Necessity for great
Tranquillity and Repose, than for any other Remedy; and it might be
sufficient to lay them down on the Bed: But as the Bystanders in such
Cases find it difficult to remain inactive Spectators of Persons in a
Swoon, some spirituous Liquid may be held to their Nose, while their
Temples and Wrists are rubbed with it; and at the same Time a little
Wine should be given them. Frictions are also useful in these Cases.
This Species of Swooning is oftener attended with a little Feverishness
than the others.
_Of those Swoonings, which arise from nervous Disorders._
Sec. 500. This Species of Swooning is almost wholely unknown to those
Persons, for whom this Treatise is chiefly intended. Yet as there are
some Citizens who pass a Part of their Lives in the Country; and some
Country People who are unhappily afflicted with the Ailments of the
Inhabitants of large Towns and Cities, it seemed necessary to treat
briefly of them.
By Disorders of the Nerves, I understand in this Place, only that Fault
or Defect in them, which is the Cause of their exciting in the Body,
either irregular Motions, that is, Motions without any external Cause,
at least any perceivable one; and without our Will's consenting to the
Production of them: or such Motions, as are greatly more considerable
than they should be, if they had been proportioned to the Force of the
Impression from without. This is very exactly that State, or Affection
termed the _Vapours_; and by the common People, the _Mother_: And as
there is no Organ unprovided with Nerves; and none, or hardly any
Function, in which the Nerves have not their Influence; it may be easily
comprehended, that the Vapours being a State or Condition, which arises
from the Nerves exerting irregular involuntary Motions, without any
evident Cause, and all the Functions of the Body depending partly on the
Nerves; there is no one Symptom of other Diseases which the Vapours may
not produce or imitate; and that these Symptoms, for the same Reason,
must vary infinitely, according to those Branches of the Nerves which
are disordered. It may also hence be conceived, why the Vapours of one
Person have frequently no Resemblance to those of another: and why the
Vapours of the very same Person, in one Day, are so very different from
those in the next. It is also very conceivable that the Vapours are a
certain, a real Malady; and that Oddity of the Symptoms, which cannot be
accounted for, by People unacquainted with the animal Oeconomy, has been
the Cause of their being considered rather as the Effect of a depraved
Imagination, than as a real Disease. It is very conceiveable, I say,
that this surprizing Oddity of the Symptoms is a necessary Effect of the
Cause of the Vapours; and that no Person can any more prevent his being
invaded by the Vapours, than he can prevent the Attack of a Fever, or of
the Tooth-ach.
Sec. 501. A few plain Instances will furnish out a more compleat Notion of
the Mechanism, or Nature, of Vapours. An Emetic, a vomiting Medicine,
excites the Act, or rather the Passion, the Convulsion of Vomiting,
chiefly by the Irritation it gives to the Nerves of the Stomach; which
Irritation produces a Spasm, a Contraction of this Organ. Now if in
Consequence of this morbid or defective Texture of the Nerves, which
constitutes the Vapours, those of the Stomach are excited to act with
the same Violence, as in Consequence of taking a Vomit, the Patient will
be agitated and worked by violent Efforts to vomit, as much as if he had
really taken one.
If an involuntary unusual Motion in the Nerves, that are distributed
through the Lungs, should constrain and straiten the very little
Vesicles, or Bladders, as it were, which admit the fresh Air at every
Respiration, the Patient will feel a Degree of Suffocation; just as if
that Straitening or Contraction of the Vesicles were occasioned by some
noxious Steam or Vapour.
Should the Nerves which are distributed throughout the whole Skin, by a
Succession of these irregular morbid Motions, contract themselves, as
they may from external Cold, or by some stimulating Application,
Perspiration by the Pores will be prevented or checked; whence the
Humours, which should be evacuated through the Pores of the Skin, will
be thrown upon the Kidnies, and the Patient will make a great Quantity
of thin clear Urine, a Symptom very common to vapourish People; or it
may be diverted to the Glands of the Intestines, the Guts, and terminate
in a watery _Diarrhoea_, or Looseness, which frequently proves a very
obstinate one.
Sec. 502. Neither are Swoonings the least usual Symptoms attending the
Vapours: and we may be certain they spring from this Source, when they
happen to a Person subject to the Vapours; and none of the other Causes
producing them are evident, or have lately preceded them.
Such Swoonings, however, are indeed very rarely dangerous, and scarcely
require any medical Assistance. The Patient should be laid upon a Bed;
the fresh Air should be very freely admitted to him; and he should be
made to smell rather to some disagreeable and fetid, than to any
fragrant, Substance. It is in such Faintings as these that the Smell of
burnt Leather, of Feathers, or of Paper, have often proved of great
Service.
Sec. 503. Patients also frequently faint away, in Consequence of fasting
too long; or from having eat a little too much; from being confined in
too hot a Chamber; from having seen too much Company; from smelling too
over-powering a Scent; from being too costive; from being too forcibly
affected with some Discourse or Sentiments; and, in a Word, from a great
Variety of Causes, which might not make the least Impression on Persons
in perfect Health; but which violently operate upon those vapourish
People, because, as I have said, the Fault of their Nerves consists in
their being too vividly, too acutely affected; the Force of their
Sensation being nowise proportioned to the external Cause of it.
As soon as that particular Cause is distinguished from all the rest,
which has occasioned the present Swooning; it is manifest that this
Swooning is to be remedied by removing that particular Cause of it.
_Of Swoonings occasioned by the Passions._
Sec. 504. There have been some Instances of Persons dying within a Moment,
through excessive Joy. But such Instances are so very rare and sudden,
that Assistance has seldom been sought for on this Occasion. The Case is
otherwise with Respect to those produced from Rage, Vexation, and Dread
or Horror. I shall treat in a separate Article of those resulting from
great Fear; and shall briefly consider here such as ensue from Rage, and
vehement Grief or Disappointment.
Sec. 505. Excessive Rage and violent Affliction are sometimes fatal in the
Twinkling of an Eye; though they oftener terminate in fainting only.
Excessive Grief or Chagrine is especially accompanied with this
Consequence; and it is very common to see Persons thus affected, sink
into successive Faintings for several Hours. It is plainly obvious that
very little Assistance can be given in such Cases: it is proper,
however, they should smell to strong Vinegar; and frequently take a few
Cups of some hot and temperately cordial Drink, such as Bawm Tea, or
Lemonade with a little Orange or Lemon-peel.
The calming asswaging Cordial, that has seemed the most efficacious to
me, is one small Coffee Spoonful of a Mixture of three Parts of the
Mineral Anodyne Liquor of _Hoffman_, [106] and one Part of the
spirituous Tincture of Amber, which should be swallowed in a Spoonful of
Water; taking after it a few Cups of such Drinks as I shall presently
direct.
[106] Our sweet Spirit of Vitriol is a similar, and as effectual a
Medicine. _K._
It is not to be supposed that Swoonings or Faintings, from excessive
Passions, can be cured by Nourishment. The physical State or Condition,
into which vehement Grief throws the Body, is that, of all others, in
which Nourishment would be most injurious to it: and as long as the
Vehemence of the Affliction endures, the Sufferer should take nothing
but some Spoonfuls of Soup or Broth, or a few Morsels of some light Meat
roasted.
Sec. 506. When Wrath or Rage has risen to so high a Pitch, that the human
Machine, the Body, entirely exhausted, as it were, by that violent
Effort, sinks down at once into excessive Relaxation, a Fainting
sometimes succeeds, and even the most perilous Degree of it, a
_Syncope_.
It is sufficient, or rather the most that can be done here, to let the
Patient be perfectly still a while in this State; only making him smell
to some Vinegar. But when he is come to himself, he should drink
plentifully of hot Lemonade, and take one or more of the Glysters No. 5.
Sometimes there remain in these Cases Sicknesses at Stomach, Reachings
to vomit, a Bitterness in the Mouth, and some vertiginous Symptoms which
seem to require a Vomit. But such a Medicine must be very carefully
avoided, since it may be attended with the most fatal Consequence; and
Lemonade with Glysters generally and gradually remove these Swoonings.
If the _Nausea_ and Sickness at Stomach continue, the utmost Medicine we
should allow besides, would be that of No. 23, or a few Doses of No. 24.
_Of symptomatical Swoonings, or such, as happen in the Progress of other
Diseases._
Sec. 507. Swoonings, which supervene in the Course of other Diseases, never
afford a favourable Prognostic; as they denote Weakness, and Weakness is
an Obstacle to Recovery.
In the Beginning of putrid Diseases, they also denote an Oppression at
Stomach, or a Mass of corrupt Humours; and they cease as soon as an
Evacuation supervenes, whether by Vomit or Stool.
When they occur at the Beginning of malignant Fevers, they declare the
high Degree of their Malignancy, and the great Diminution of the
Patient's natural Strength.
In each of these Cases Vinegar, used externally and internally, is the
best Remedy during the Exacerbation or Height of the Paroxysm; and
Plenty of Lemon Juice and Water after it.
Sec. 508. Swoonings which supervene in Diseases, accompanied with great
Evacuations, are cured like those which are owing to Weakness; and
Endeavours should be used to restrain or moderate the Evacuations.
Sec. 509. Those who have any inward Abscess or Imposthume are apt to swoon
frequently. They may sometimes be revived a little by Vinegar, but they
prove too frequently mortal.
Sec. 510. Many Persons have a slighter or a deeper Swooning, at the End of
a violent Fit of an intermitting Fever, or at that of each Exacerbation
of a continual Fever; this constantly shews the Fever has run very high,
the Swooning having been the Consequence of that great Relaxation, which
has succeeded to a very high Tension. A Spoonful or two of light white
Wine, with an equal Quantity of Water, affords all the Succour proper in
such a Case.
Sec. 511. Persons subject to frequent Swoonings, should neglect nothing
that may enable them to remove them when known; since the Consequences
of them are always detrimental, except in some Fevers, in which they
seem to mark the _Crisis_.
Every swooning Fit leaves the Patient in Dejection and Weakness; the
Secretions from the Blood are suspended; the Humours disposed to
Stagnation; Grumosities, or Coagulations, and Obstructions are formed;
and if the Motion of the Blood is totally intercepted, or considerably
checked, _Polypus's_, and these often incurable, are formed in the
Heart, or in the larger Vessels; the Consequences of which are dreadful,
and sometimes give Rise to internal Aneurisms, which always prove
mortal, after long Anxiety and Oppression.
Swoonings which attack old People, without any manifest Cause, always
afford an unfavourable Prognostic.
_Of Haemorrhages, or an involuntary Loss of Blood._
Sec. 512. Haemorrhages of the Nose, supervening in inflammatory Fevers,
commonly prove a favourable _Crisis_; which Bleeding we should carefully
avoid stopping; except it becomes excessive, and seems to threaten the
Patient's Life.
As they scarcely ever happen in very healthy Subjects, but from a
superfluous Abundance of Blood, it is very improper to check them too
soon; lest some internal Stuffings and Obstructions should prove the
Consequence.
A Swooning sometimes ensues after the Loss of only a moderate Quantity
of Blood. This Swooning stops the Haemorrhage, and goes off without any
further Assistance, except the smelling to Vinegar. But in other Cases
there is a Succession of fainting Fits, without the Blood's stopping;
while at the same time slight convulsive Motions and Twitchings ensue,
attended with a Raving, when it becomes really necessary to stop the
Bleeding: and indeed, without waiting till these violent Symptoms
appear, the following Signs will sufficiently direct us, when it is
right to stop the Flux of Blood, or to permit its Continuance--As long
as the Pulse is still pretty full; while the Heat of the Body is equally
extended to the very Extremities; and the Countenance and Lips preserve
their natural Redness, no ill Consequence is to be apprehended from the
Haemorrhage, though it has been very copious, and even somewhat profuse.
But whenever the Pulse begins to faulter and tremble; when the
Countenance and the Lips grow pale, and the Patient complains of a
Sickness at Stomach, it is absolutely necessary to stop the Discharge of
Blood. And considering that the Operation of Remedies does not
immediately follow the Exhibition or Application of them, it is safer to
begin a little too early with them, than to delay them, though ever so
little too long.
Sec. 513. First of all then, tight Bandages, or Ligatures, should be
applied round both Arms, on the Part they are applied over in order to
Bleeding; and round the lower Part of both Thighs, on the gartering
Place; and all these are to be drawn very tight, with an Intention to
detain and accumulate the Blood in the Extremities.
2, In Order to increase this Effect, the Legs are to be plunged in warm
Water up to the Knees; for by relaxing the Blood-vessels of the Legs and
Feet, they are dilated at the same time, and thence receive, and, in
Consequence of the Ligatures above the Knees, retain the more Blood. If
the Water were cold, it would repel the Blood to the Head; if hot, it
would increase the Motion of it; and, by giving a greater Quickness to
the Pulse, would even contribute to increase the Haemorrhage.
As soon however, as the Haemorrhage is stopt, these Ligatures [on the
Thighs] may be relaxed a little, or one of them be entirely removed;
allowing the others to continue on an Hour or two longer without
touching them: but great Precaution should be taken not to slacken them
entirely, nor all at once.
3, Seven or eight Grains of Nitre, and a Spoonful of Vinegar, in half a
Glass of cool Water, should be given the Patient every half Hour.
4, One Drachm of white Vitriol must be dissolved in two common Spoonfuls
of Spring Water; and a Tent of Lint, or Bits of soft fine Linen dipt in
this Solution, are to be introduced into the Nostrils, horizontally at
first, but afterwards to be intruded upwards, and as high as may be, by
the Assistance of a flexible Bit of Wood or Whale-bone. But should this
Application be ineffectual, the Mineral Anodyne Liquor of _Hoffman_ is
certain to succeed: and in the Country, where it often happens that
neither of these Applications are to be had speedily, Brandy, and even
Spirit of Wine, mixt with a third Part Vinegar, have answered entirely
well, of which I have been a Witness.
The Prescription No. 67, which I have already referred to, on the
Article of Wounds, may also be serviceable on this Occasion. It must be
reduced to Powder, and conveyed up the Nostrils as high as may be, on
the Point or Extremity of a Tent of Lint, which may easily be covered
with it. Or a Quill, well charged with the Powder, may be introduced
high into the Nostrils, and its Countents be strongly blown up from its
other Extremity: though after all the former Method is preferable.
5, When the Flux of Blood is totally stopt, the Patient is to be kept as
still and quiet as possible; taking great Care not to extract the Tent
which remains in the Nose; nor to remove the Clots of coagulated Blood
which fill up the Passage. The loosening and removing of these should be
effected very gradually and cautiously; and frequently the Tent does not
spring out spontaneously, till after many Days.
Sec. 514. I have not, hitherto, said any thing of artificial Bleeding in
these Cases, as I think it at best unserviceable; since, though it may
sometimes have stopt the morbid Loss of Blood, it has at other times
increased it. Neither have I mentioned Anodynes here, whose constant
Effect is to determine a larger Quantity of Blood to the Head.
Applications of cold Water to the Nape of the Neck ought to be wholly
disused, having sometimes been attended with the most embarrassing
Consequences.
In all Haemorrhages, all Fluxes of Blood, great Tranquillity, Ligatures,
and the Use of the Drinks No. 2 or 4, are very useful.
Sec. 515. People who are very liable to frequent Haemorrhages, ought to
manage themselves conformably to the Directions contained in the next
Chapter, Sec. 544. They should take very little Supper; avoid all sharp and
spirituous Liquors; Apartments that are over hot, and cover their Heads
but very lightly.
When a Patient has for a long time been subject to Haemorrhages, if they
cease, he should retrench from his usual Quantity of Food; accustom
himself to artificial Bleedings at proper Intervals; and take some
gentle opening Purges, especially that of No. 24, and frequently a
little Nitre in an Evening.
_Of Convulsion Fits._
Sec. 516. Convulsions are, in general, more terrifying than dangerous; they
result from many and various Causes; and on the Removal or Extirpation
of these, their Cure depends.
In the very Fit itself very little is to be done or attempted.
As nothing does shorten the Duration, nor even lessen the Violence, of
an epileptic Fit, so nothing at all should be attempted in it; and the
rather, because Means and Medicines often aggravate the Disease. We
should confine our Endeavours solely to the Security of the Patient, by
preventing him from giving himself any violent Strokes; by getting
something, if possible, between his Teeth, such as a small Roller of
Linen to prevent his Tongue from being hurt, or very dangerously
squeezed and bruised, in a strong Convulsion.
The only Case which requires immediate Assistance in the Fit, is, when
it is so extremely violent, the Neck so swelled, and the Face so very
red, that there is Room to be apprehensive of an Apoplexy, which we
should endeavour to obviate, by drawing eight or ten Ounces of Blood
from the Arm.
As this terrible Disease is common in the Country, it is doing a real
Service to the unfortunate Victims of it, to inform them how very
dangerous it is to give themselves blindly up to take all the Medicines,
which are cried up to them in such Cases. If there be any one Disease,
which requires a more attentive, delicate, and exquisite Kind of
Treatment, it is this very Disease. Some Species of it are wholly
incurable: and such as may be susceptible of a Cure, require the utmost
Care and Consideration of the most enlightned and most experienced
Physicians: while those who pretend to cure all epileptic Patients, with
one invariable Medicine, are either Ignorants, or Impostors, and
sometimes both in one.
Sec. 517. Simple Convulsion Fits, which are not epileptic, are frequently
of a long Continuance, persevering, with very few and short Intervals,
for Days and even for Weeks.
The true genuine Cause should be investigated as strictly as possible,
though nothing should be attempted in the Fit. The Nerves are, during
that Term, in so high a Degree of Tension and Sensibility, that the very
Medicines, supposed to be strongly indicated, often redouble the Storm
they were intended to appease.
Thin watery Liquors, moderately imbued with Aromatics, are the least
hurtful, the most innocent Things that can be given; such as Bawm,
Lime-tree, and Elder Flower Tea. A Ptisan of Liquorice Root only has
sometimes answered better than any other.
_Of suffocating, or strangling Fits._
Sec. 518. These Fits (by whatever other Name they may be called) whenever
they very suddenly attack a Person, whose Breathing was easy and natural
just before, depend almost constantly on a Spasm or Contraction of the
Nerves, in the Vesicles of the Lungs; or upon an Infarction, a Stuffing
of the same Parts, produced by viscid clammy Humours.
That Suffocation which arises from a Spasm is not dangerous, it goes off
of itself, or it may be treated like Swoonings owing to the same Cause.
See Sec. 502.
Sec. 519. That Suffocation, which is the Effect of a sanguineous Fulness
and Obstruction, may be distinguished by its attacking strong, vigorous,
sanguine Persons, who are great Eaters, using much juicy nutritious
Food, and strong Wine and Liquors, and who frequently eat and inflame
themselves; and when the Fit has come on after any inflaming Cause; when
the Pulse is full and strong, and the Countenance red.
Such are cured, 1, by a very plentiful Discharge of Blood from the Arm,
which is to be repeated, if necessary.
2, By the Use of Glysters.
3, By drinking plentifully of the Ptisan No. 1; to each Pot of which, a
Drachm of Nitre is to be added; and,
4, By the Vapour of hot Vinegar, continually received by Respiration or
Breathing. See Sec. 55.
Sec. 520. There is Reason to think that one of these Fits is owing to a
Quantity of tough viscid Humours in the Lungs, when it attacks Persons,
whose Temperament, and whose Manner of living are opposite to those I
have just described; such as valetudinary, weakly, phlegmatic,
pituitous, inactive, and squeamish Persons, who feed badly, or on fat,
viscid, and insipid Diet, and who drink much hot Water, either alone, or
in Tea-like Infusions. And these Signs of Suffocation, resulting from
such Causes, are still more probable, if the Fit came on in rainy
Weather, and during a southerly Wind; and when the Pulse is soft and
small, the Visage pale and hollow.
The most efficacious Treatment we can advise, is, 1, To give every half
Hour half a Cup of the Potion, No. 8, if it can be readily had. 2, To
make the Patient drink very plentifully of the Drink No. 12; and, 3, to
apply two strong Blisters to the fleshy Parts of his Legs.
If he was strong and hearty before the Fit, and the Pulse still
continues vigorous, and feels somewhat full withall, the Loss of seven
or eight Ounces of Blood is sometimes indispensably necessary. A Glyster
has also frequently been attended with extraordinary good Effects.
Those afflicted with this oppressing Malady are commonly relieved, as
soon as they expectorate, and sometimes even by vomiting a little.
The Medicine No. 25, a Dose of which may be taken every two Hours, with
a Cup of the Ptisan No. 12, often succeeds very well.
But if neither this Medicine, nor the Prescription of No. 8 are at Hand,
which may be the Case in Country Places; an Onion of a moderate Size
should be pounded in an Iron or Marble Mortar; upon this, a Glass of
Vinegar is to be poured, and then strongly squeezed out again through a
Piece of Linen. An equal Quantity of Honey is then to be added to it. A
Spoonful of this Mixture, whose remarkable Efficacy I have been a
Witness of, is to be given every half Hour.
_Of the violent Effects of Fear._
Sec. 521. Here I shall insert some Directions to prevent the ill
Consequences of great Fear or Terror, which are very prejudicial at
every Term of Life, but chiefly during Infancy.
The general Effects of Terror, are a great Straitening or Contraction of
all the small Vessels, and a Repulsion of the Blood into the large and
internal ones. Hence follows the Suppression of Perspiration, the
general Seizure or Oppression, the Trembling, the Palpitations and
Anguish, from the Heart and the Lungs being overcharged with Blood; and
sometimes attended with Swoonings, irremediable Disorders of the Heart,
and Death itself. A heavy Drowsiness, Raving, and a Kind of furious or
raging _Delirium_ happen in other Cases, which I have frequently
observed in Children, when the Blood-vessels of the Neck were swelled
and stuffed up; and Convulsions, and even the Epilepsy have come on, all
which have proved the horrible Consequence of a most senseless and
wicked Foolery or Sporting. One half of those Epilepsies which do not
depend on such Causes, as might exist before the Child's Birth, are
owing to this detestable Custom; and it cannot be too much inculcated
into Children, never to frighten one another; a Point which Persons
intrusted with their Education, ought to have the strictest Regard to.
When the Humours that should have passed off by Perspiration, are
repelled to the Intestines, a tedious and very obstinate Looseness is
the frequent Consequence.
Sec. 522. Our Endeavours should be directed, to re-establish the disordered
Circulation; to restore the obstructed Perspiration; and to allay the
Agitation of the Nerves.
The popular Custom in these Cases has been to give the terrified Patient
some cold Water directly; but when the Fright has been considerable,
this is a very pernicious custom, and I have seen some terrible
Consequences from it.
They should, on the contrary, be conveyed into some very quiet
Situation, leaving there but very few Persons, and such only as they are
thoroughly familiar with. They should take a few Cups of pretty warm
Drink, particularly of an Infusion of Lime-tree Flowers and Bawm. Their
Legs should be put into warm Water, and remain there an Hour, if they
will patiently permit it, rubbing them gently now and then, and giving
them every half-quarter of an Hour, a small Cup of the said Drink. When
their Composure and Tranquillity are returned a little, and their Skin
seems to have recovered its wonted and general Warmth, Care should be
taken to dispose them to sleep, and to perspire plentifully. For this
Purpose they may be allowed a few Spoonfuls of Wine, on putting them
into Bed, with one Cup of the former Infusion; or, which is more certain
and effectual, a few Drops of _Sydenham's_ Liquid Laudanum, No. 44; but
should that not be near at Hand, a small Dose of _Venice_ Treacle.
Sec. 523. It sometimes happens that Children do not seem at first extremely
terrified; but the Fright is renewed while they sleep, and with no small
Violence. The Directions I have just given must then be observed, for
some successive Evenings, before they are put to Bed.
Their Fright frequently returns about the latter End of the Night, and
agitates them violently every Day. The same Treatment should be
continued in such Cases; and we should endeavour to dispose them to be
a-sleep at the usual Hour of its Return.
By this very Method, I have dissipated the dismal Consequences of Fear
of Women in Child-bed, which is so commonly, and often speedily, mortal.
If a Suffocation from this Cause is violent, there is sometimes a
Necessity for opening a Vein in the Arm.
These Patients should gradually be inured to an almost continual, but
gentle, Kind of Exercise.
All violent Medicines render those Diseases, which are the Consequences
of great Fear, incurable. A pretty common one is that of an Obstruction
of the Liver, which has been productive of a Jaundice. [107]
[107] I have seen this actually verified by great and disagreeable
Surprize, attended indeed with much Concern, in a Person of
exquisite Sensations. _K._
_Of Accidents or Symptoms produced by the Vapours of Coal, and of Wine._
Sec. 524. Not a single Year passes over here, without the Destruction of
many People by the Vapour of Charcoal, or of small Coal, and by the
Steam or Vapour of Wine.
The Symptoms by Coal occur, when [108] small Coal, and especially
when [109] Charcoal is burnt in a Chamber close shut, which is direct
Poison to a Person shut up in it. The sulphureous Oil, which is set at
Liberty and diffused by the Action of Fire, expands itself through the
Chamber; while those who are in it perceive a Disorder and Confusion in
their Heads; contract Vertigos, Sickness at Stomach, a Weakness, and
very unusual Kind of Numbness; become raving, convulsed and trembling;
and if they fail of Presence of Mind, or of Strength, to get out of the
Chamber, they die within a short Time.
[108] _La Braise._
[109] _Charbon._ Dr. _Tissot_ informs me, their Difference consists in
this, that the Charcoal is prepared from Wood burnt in a close or
stifled Fire; and that the small Coal is made of Wood (and of
smaller Wood) burnt in an open Fire, and extinguished before it is
reduced to the State of a Cinder. He says the latter is smaller,
softer, less durable in the Fire, and the Vapour of it less
dangerous than that of Charcoal.
I have seen a Woman who had vertiginous Commotions in her Head for two
Days, and almost continual Vomitings, from her having been confined less
than six Minutes in a Chamber (and that notwithstanding, both one Window
and one Door were open) in which there was a Chafing-dish with some
burning Coals. Had the Room been quite close, she must have perished by
it.
This Vapour is narcotic or stupefying, and proves mortal in Consequence
of its producing a sleepy or apoplectic Disorder, though blended, at the
same time, with something convulsive; which sufficiently appears from
the Closure of the Mouth, and the strict Contraction or Locking of the
Jaws.
The Condition of the Brain, in the dissected Bodies of Persons thus
destroyed, proves that they die of an Apoplexy: notwithstanding it is
very probable that Suffocation is also partly the Cause of their Deaths;
as the Lungs have been found stuffed up with Blood and livid.
It has also been observed in some other such Bodies, that Patients
killed by the Vapour of burning Coals, have commonly their whole Body
swelled out to one third more than their Magnitude, when living. The
Face, Neck, and Arms are swelled out, as if they had been blown up; and
the whole human Machine appears in such a State, as the dead Body of a
Person would, who had been violently strangled; and who had made all
possible Resistance for a long time, before he was overpowered.
Sec. 525. Such as are sensible of the great Danger they are in, and retreat
seasonably from it, are generally relieved as soon as they get into the
open Air; or if they have any remaining Uneasiness, a little Water and
Vinegar, or Lemonade, drank hot, affords them speedy Relief. But when
they are so far poisoned, as to have lost their Feeling and
Understanding, if there be any Means of reviving them, such Means
consist,
1, In exposing them to a very pure, fresh and open Air.
2, In making them smell to some very penetrating Odour, which is
somewhat stimulating and reviving, such as the volatile Spirit of Sal
Ammoniac, the [110] _English_ Salt; and afterwards to surround them, as
it were, with the Steam of Vinegar.
[110] See Note [105] Page 495.
3, In taking some Blood from their Arm.
4, In putting their Legs into warm or hot Water, and chafing them well.
5, In making them swallow, if practicable, much Lemonade, or Water and
Vinegar, with the Addition of Nitre: and,
6, In throwing up some sharp Glysters.
As it is manifest there is something spasmodic in these Cases, it were
proper to be provided with some antispasmodic Remedies, such as the
Mineral Anodyne Liquid of _Hoffman_. Even Opium has sometimes been
successfully given here, but it should be allowed to Physicians only to
direct it in such Cases.
A Vomit would be hurtful; and the Reachings to vomit arise only from the
Oppression on the Brain.
It is a common but erroneous Opinion, that if the Coal be suffered to
burn for a Minute or so in the open Air, or in a Chimney, it is
sufficient to prevent any Danger from the Vapour of it.
Hence it amounts even to a criminal Degree of Imprudence, to sleep in a
Chamber while Charcoal or small Coal is burning in it; and the Number of
such imprudent Persons, as have never awaked after it, is so
considerable, and so generally known too, that the Continuance of this
unhappy Custom is astonishing.
Sec. 526. The Bakers, who make Use of much small Coal, often keep great
Quantities of it in their Cellars, which frequently abound so much with
the Vapour of it, that it seizes them violently the Moment they enter
into the Cellar. They sink down at once deprived of all Sensation, and
die if they are not drawn out of it soon enough to be assisted,
according to the Directions I have just given.
One certain Means of preventing such fatal Accidents is, upon going into
the Cellar to throw some flaming Paper or Straw into it, and if these
continue to flame out and consume, there is no Reason for dreading the
Vapour: but if they should be extinguished, no Person should venture in.
But after opening the Vent-hole, a Bundle of flaming Straw must be set
at the Door, which serves to attract the external Air strongly. Soon
after the Experiment of the flaming Paper must be repeated, and if it
goes out, more Straw is to be set on Fire before the Cellar Door.
Sec. 527. Small Coal, burnt in an open Fire, is not near so dangerous as
_Charcoal_, properly so called, the Danger of which arises from this,
that in extinguishing it by the usual Methods, all those sulphureous
Particles of it, in which its Danger consists, are concentred.
Nevertheless, small Coal is not entirely deprived of all its noxious
Quality, without some of which it could not strictly be Coal.
The common Method of throwing some Salt on live Coals, before they are
conveyed into a Chamber; or of casting a Piece of Iron among them to
imbibe some Part of their deadly narcotic Sulphur, is not without its
Utility; though by no means sufficient to prevent all Danger from them.
Sec. 528. When the most dangerous Symptoms from this Cause disappear, and
there remains only some Degree of Weakness, of Numbness, and a little
Inappetency, or Loathing at Stomach, nothing is better than Lemonade
with one fourth Part Wine, half a Cup of which should frequently be
taken, with a small Crust of Bread.
Sec. 529. The Vapour which exhales from Wine, and in general from all
fermenting Liquors, such as Beer, Cyder, _&c._ contains something
poisonous, which kills in the like Manner with the Vapour of Coal; and
there is always some Danger in going into a Cellar, where there is much
Wine in the State of Fermentation; if it has been shut up close for
several Hours. There have been many Examples of Persons struck dead on
entering one, and of others who have escaped out of it with Difficulty.
When such unhappy Accidents occur, Men should not be successively
exposed, one after another, to perish, by endeavouring to fetch out the
first who sunk down upon his Entrance; but the Air should immediately be
purified by the Method already directed, or by discharging some Guns
into the Cellar; after which People may venture in with Precaution. And
when the Persons unfortunately affected are brought out, they are to be
treated like those, who were affected with the Coal-Vapour.
I saw a Man, about eight Years since, who was not sensible of the
Application of Spirit of Sal Ammoniac, till about an Hour after he was
struck down, and who was entirely freed at last by a plentiful Bleeding;
though he had been so insensible, that it was several Hours before he
discovered a very great Wound he had, which extended from the Middle of
his Arm to his Armpit, and which was made by a Hook intended to be used,
in Case of a House catching Fire, to assist Persons in escaping from the
Flames.
Sec. 530. When subterraneous Caves that have been very long shut are
opened; or when deep Wells are cleaned, that have not been emptied for
several Years, the Vapours arising from them produce the same Symptoms I
have mentioned, and require the same Assistance. They are to be cleansed
and purified by burning Sulphur and Salt Petre in them, or Gunpowder, as
compounded of both.
Sec. 531. The offensive Stink of Lamps and of Candles, especially when
their Flames are extinguished, operate like other Vapours, though with
less Violence, and less suddenly. Nevertheless there have been Instances
of People killed by the Fumes of Lamps fed with Nut Oil, which had been
extinguished in a close Room. These last Smells or Fumes prove noxious
also, in Consequence of their Greasiness, which being conveyed, together
with the Air, into the Lungs, prevent their Respiration: And hence we
may observe, that Persons of weak delicate Breasts find themselves
quickly oppressed in Chambers or Apartments, illuminated with many
Candles.
The proper Remedies have been already directed, Sec. 525. The Steam of
Vinegar is very serviceable in such Cases.
_Of Poisons._
Sec. 532. There are a great Number of Poisons, whose Manner of acting is
not alike; and whose ill Effects are to be opposed by different
Remedies: But Arsenic, or Ratsbane, and some particular Plants are the
Poisons which are the most frequently productive of Mischief, in Country
Places.
Sec. 533. It is in Consequence of its excessive Acrimony, or violent Heat
and Sharpness, which corrodes or gnaws, that Arsenic destroys by an
excessive Inflammation, with a burning Fire as it were, most torturing
Pains in the Mouth, Throat, Stomach, Guts; with rending and often bloody
Vomitings, and Stools, Convulsions, Faintings, _&c._
The best Remedy of all is pouring down whole Torrents of Milk, or, where
there is not Milk, of warm Water. Nothing but a prodigious Quantity of
such weak Liquids can avail such a miserable Patient. If the Cause of
the Disorder is immediately known, after having very speedily taken down
a large Quantity of warm Water, Vomiting may be excited with Oil, or
with melted Butter, and by tickling the Inside of the Throat with a
Feather. But when the Poison has already inflamed the Stomach and the
Guts, we must not expect to discharge it by vomiting. Whatever is
healing or emollient, Decoctions of mealy Pulse, of Barley, of Oatmeal,
of Marsh-mallows, and Butter and Oil are the most suitable.
As soon as ever the tormenting Pains are felt in the Belly, and the
Intestines seem attacked, Glysters of Milk must be very frequently
thrown up.
If at the very Beginning of the Attack, the Patient has a strong Pulse,
a very large Bleeding may be considerably serviceable by its delaying
the Progress, and diminishing the Degree of Inflammation.
And even though it should happen that a Patient overcomes the first
Violence of this dreadful Accident, it is too common for him to continue
in a languid State for a long Time, and sometimes for all the Remainder
of his Life. The most certain Method of preventing this Misery, is to
live for some Months solely upon Milk, and some very new laid Eggs, just
received from the Hen, and dissolved or blended in the Milk, without
boiling them.
Sec. 534. The Plants which chiefly produce these unhappy Accidents are some
Kinds of Hemlock, whether it be the Leaf or the Root, the Berries of the
_Bella Donna_, or deadly Nightshade, which Children eat by mistake for
Cherries; some Kind of Mushrooms, the Seed of the _Datura_, or the
stinking Thorn-Apple.
All the Poisons of this Class prove mortal rather from a narcotic, or
stupefying, than from an acrid, or very sharp Quality. Vertigos,
Faintings, Reachings to vomit, and actual Vomitings are the first
Symptoms produced by them.
The Patient should immediately swallow down a large Quantity of Water,
moderately seasoned with Salt or with Sugar; and then a Vomiting should
be excited as soon as possible by the Prescription No. 34 or 35: or, if
neither of these is very readily procurable, with Radish-seed pounded,
to the Quantity of a Coffee Spoonful, swallowed in warm Water, soon
after forcing a Feather or a Finger into the Patient's Throat, to
expedite the Vomiting.
After the Operation of the Vomit, he must continue to take a large
Quantity of Water, sweetened with Honey or Sugar, together with a
considerable Quantity of Vinegar, which is the true Specific, or
Antidote, as it were, against those Poisons: the Intestines must also be
emptied by a few Glysters.
Thirty-seven Soldiers having unhappily eaten, instead of Carrots, of the
Roots of the _Oenanthe_; or Water-hemlock, became all extremely sick;
when the Emetic, No. 34, with the Assistance of Glysters, and very
plentiful drinking of warm Water, saved all but one of them, who died
before he could be assisted.
Sec. 535. If a Person has taken too much Opium; or any Medicine into which
it enters, as _Venice_ Treacle, Mithridate, Diascordium, _&c._ whether
by Imprudence, Mistake, Ignorance, or through any bad Design, he must be
bled upon the Spot, and treated as if he had a sanguine Apoplexy, (See Sec.
147) by Reason that Opium in Effect produces such a one. He should snuff
up and inhale the Vapour of Vinegar plentifully, adding it also
liberally to the Water he is to drink.
_Of acute Pains._
Sec. 536. It is not my Intention to treat here of those Pains, that
accompany any evident known Disease, and which should be conducted as
relating to such Diseases; nor of such Pains as infirm valetudinary
Persons are habitually subject to; since Experience has informed such of
the most effectual Relief for them: But when a Person sound and hale,
finds himself suddenly attacked with some excessive Pain, in whatever
Part it occurs, without knowing either the Nature, or the Cause of it,
they may, till proper Advice can be procured,
1, Part with some Blood, which, by abating the Fulness and Tension,
almost constantly asswages the Pains, at least for some Time: and it may
even be repeated, if, without weakening the Patient much, it has
lessened the Violence of the Pain.
2, The Patient should drink abundantly of some very mild temperate
Drink, such as the Ptisan No. 2, the Almond Emulsion No. 4, or warm
Water with a fourth or fifth Part Milk.
3, Several emollient Glysters should be given.
4, The whole Part that is affected, and the adjoining Parts should be
covered with Cataplasms, or soothed with the emollient Fomentation, No.
9.
5, The warm Bath may also be advantagiously used.
6, If notwithstanding all these Assistances, the Pain should still
continue violent, and the Pulse is neither full nor hard, the grown
Patient may take an Ounce of Syrup of Diacodium, or sixteen Drops of
liquid Laudanum; and when neither of these are to be had, [111] an
_English_ Pint of boiling Water must be poured upon three or four
Poppy-heads with their Seeds, but without the Leaves, and this Decoction
is to be drank like Tea.
[111] _Une Quartette._
Sec. 537. Persons very subject to frequent Pains, and especially to violent
Head-achs, should abstain from all strong Drink; such Abstinence being
often the only Means of curing them: And People are very often mistaken
in supposing Wine necessary for as many as seem to have a weak Stomach.
__Chapter XXXII.__
_Of Medicines taken by Way of Precaution, or Prevention._
__Sect.__ 538.
I Have pointed out, in some Parts of this Work, the Means of preventing
the bad Effects of several Causes of Diseases; and of prohibiting the
Return of some habitual Disorders. In the present Chapter I shall adjoin
some Observations, on the Use of the principal Remedies, which are
employed as general Preservatives; pretty regularly too at certain
stated Times, and almost always from meer Custom only, without knowing,
and often with very little Consideration, whether they are right or
wrong.
Nevertheless, the Use, the Habit of taking Medicines, is certainly no
indifferent Matter: it is ridiculous, dangerous, and even criminal to
omit them, when they are necessary, but not less so to take them when
they are not wanted. A good Medicine taken seasonably, when there is
some Disorder, some _Disarrangement_ in the Body, which would in a short
time occasion a Distemper, has often prevented it. But yet the very same
Medicine, if given to a Person in perfect Health, if it does not
directly make him sick, leaves him at the best in a greater Propensity
to the Impressions of Diseases: and there are but too many Examples of
People, who having very unhappily contracted a Habit, a Disposition to
take Physick, have really injured their Health, and impaired their
Constitution, however naturally strong, by an Abuse of those Materials
which Providence has given for the Recovery and Re-establishment of it;
an Abuse which, though it should not injure the Health of the Person,
would occasion those Remedies, when he should be really sick, to be less
efficacious and serviceable to him, from their having been familiar to
his Constitution; and thus he becomes deprived of the Assistance he
would have received from them, if taken only in those Times and
Circumstances, in which they were necessary for him.
_Of Bleeding._
Sec. 539. Bleeding is necessary only in these four Cases. 1, When there is
too great a Quantity of Blood in the Body. 2, When there is any
Inflammation, or an inflammatory Disease. 3, When some Cause supervenes,
or is about to supervene, in the Constitution, which would speedily
produce an Inflammation, or some other dangerous Symptom, if the Vessels
were not relaxed by Bleeding. It is upon this Principle that Patients
are bled after Wounds, and after Bruises; that Bleeding is directed for
a pregnant Woman, if she has a violent Cough; and that Bleeding is
performed, by Way of Precaution, in several other Cases. 4, We also
advise Bleeding sometimes to asswage an excessive Pain, though such Pain
is not owing to Excess of Blood, nor arises from an inflamed Blood; but
in Order to appease and moderate the Pain by Bleeding; and thereby to
obtain Time for destroying the Cause of it by other Remedies. But as
these two last Reasons are in Effect involved or implied in the two
first; it may be very generally concluded, that an Excess of Blood, and
an inflamed State of it, are the only two necessary Motives for
Bleeding.
Sec. 540. An Inflammation of the Blood is known by the Symptoms
accompanying those Diseases, which that Cause produces. Of these I have
already spoken, and I have at the same time regulated the Practice of
Bleeding in such Cases. Here I shall point out those Symptoms and
Circumstances, which manifest an Excess of Blood.
The first, then, is the general Course and Manner of the Patient's
living, while in Health. If he is a great Eater, and indulges in juicy
nutritious Food, and especially on much Flesh-meat; if he drinks rich
and nourishing Wine, or other strong Drink, and at the same time enjoys
a good Digestion; if he takes but little Exercise, sleeps much, and has
not been subject to any very considerable Evacuation, he may well be
supposed to abound in Blood. It is very obvious that all these Causes
rarely occur in Country People; if we except only the Abatement of their
Exercise, during some Weeks in Winter, which indeed may contribute to
their generating more Blood than they commonly do.
The labouring Country-man, for much the greater part of his Time, lives
only on Bread, Water and Vegetables; Materials but very moderately
nourishing, as one Pound of Bread probably does not make, in the same
Body, more Blood than one Ounce of Flesh; though a general Prejudice
seems to have established a contrary Opinion. 2, The total Stopping or
long Interruption of some involuntary Bleeding or Haemorrhage, to which
he had been accustomed. 3, A full and strong Pulse, and Veins visibly
filled with Blood, in a Body that is not lean and thin, and when he is
not heated. 4, A florid lively Ruddiness. 5, A considerable and unusual
Numbness; Sleep more profound, of more Duration, and yet less tranquil
and calm, than at other times; a greater Propensity than ordinary to be
fatigued after moderate Exercise or Work; and a little Oppression and
Heaviness from walking. 6, Palpitations, accompanied sometimes with very
great Dejection, and even with a slight fainting Fit; especially on
being in any hot Place, or after moving about considerably. 7, Vertigos,
or Swimmings of the Head, especially on bowing down and raising it up at
once, and after sleeping. 8, Frequent Pains of the Head, to which the
Person was not formerly subject; and which seem not to arise from any
Defect in the Digestions. 9, An evident Sensation of Heat, pretty
generally diffused over the whole Body. 10, A smarting Sort of Itching
all over, from a very little more Heat than usual. And lastly, frequent
Haemorrhages, and these attended with manifest Relief, and more Vivacity.
People should, notwithstanding, be cautious of supposing an unhealthy
Excess of Blood, from any one of these Symptoms only. Many of them must
concur; and they should endeavour to be certain that even such a
Concurrence of them does not result from a very different Cause, and
wholly opposite in Effect to that of an Excess of Blood.
But when it is certain, from the whole Appearance, that such an Excess
doth really exist, then a single, or even a second Bleeding is attended
with very good Effects. Nor is it material, in such Cases, from what
Part the Blood is taken.
Sec. 541. On the other Hand, when these Circumstances do not exist,
Bleeding is in no wise necessary: nor should it ever be practised in
these following Conditions and Circumstances; except for some particular
and very strong Reasons; of the due Force of which none but Physicians
can judge.
First, when the Person is in a very advanced Age, or in very early
Infancy. 2, When he is either naturally of a weakly Constitution, or it
has been rendered such by Sickness, or by some other Accident. 3, When
the Pulse is small, soft, feeble, and intermits, and the Skin is
manifestly pale. 4, When the Limbs, the Extremities of the Body, are
often cold, puffed up and soft. 5, When their Appetite has been very
small for a long time; their Food but little nourishing, and their
Perspiration too plentiful, from great Exercise. 6, When the Stomach has
long been disordered, and the Digestion bad, whence very little Blood
could be generated. 7, When the Patient has been considerably emptied,
whether by Haemorrhages, a Looseness, profuse Urine or Sweat: or when the
_Crisis_ of some Distemper has been effected by any one of these
Evacuations. 8, When the Patient has long been afflicted with some
depressing Disease; and troubled with many such Obstructions as prevent
the Formation of Blood. 9, Whenever a Person is exhausted, from whatever
Cause. 10, When the Blood is in a thin, pale, and dissolved State.
Sec. 542, In all these Cases, and in some others less frequent, a single
Bleeding often precipitates the Patient into an absolutely incurable
State, an irreparable Train of Evils. Many dismal Examples of it are but
too obvious.
Whatever, therefore, be the Situation of the Patient, and however
naturally robust, that Bleeding, which is unnecessary, is noxious.
Repeated, re-iterated Bleedings, weaken and enervate, hasten old Age,
diminish the Force of the Circulation, thence fatten and puff up the
Body; and next by weakening, and lastly by destroying, the Digestions,
they lead to a fatal Dropsy. They disorder the Perspiration by the Skin,
and leave the Patient liable to Colds and Defluxions: They weaken the
nervous System, and render them subject to Vapours, to the hypochondriac
Disorders, and to all nervous Maladies.
The ill Consequence of a single, though erroneous Bleeding is not
immediately discernible: on the contrary, when it was not performed in
such a Quantity, as to weaken the Patient perceivably, it appears to
have been rather beneficial. Yet I still here insist upon it, that it is
not the less true that, when unnecessary, it is prejudicial; and that
People should never bleed, as sometimes has been done, for meer Whim,
or, as it were, for Diversion. It avails nothing to affirm, that within
a few Days after it, they have got more Blood than they had before it,
that is, that they weigh more than at first, whence they infer the Loss
of Blood very speedily repaired. The Fact of their augmented Weight is
admitted; but this very Fact testifies against the real Benefit of that
Bleeding; hence it is a Proof, that the natural Evacuations of the Body
are less compleatly made; and that Humours, which ought to be expelled,
are retained in it. There remains the same Quantity of Blood, and
perhaps a little more; but it is not a Blood so well made, so perfectly
elaborated; and this is so very true, that if the thing were otherwise;
if some Days after the Bleeding they had a greater Quantity of the same
Kind of Blood, it would amount to a Demonstration, that more re-iterated
Bleedings must necessarily have brought on an inflammatory Disease, in a
Man of a robust Habit of Body.
Sec. 543. The Quantity of Blood, which a grown Man may Part with, by Way of
Precaution, is about ten Ounces.
Sec. 544. Persons so constituted as to breed much Blood, should carefully
avoid all those Causes which tend to augment it, (See Sec. 540, No. 1) and
when they are sensible of the Quantity augmented, they should confine
themselves to a light frugal Diet, on Pulse, Fruits, Bread and Water;
they should often bathe their Feet in warm Water, taking Night and
Morning the Powder No. 20; drink of the Ptisan No. 1; sleep but very
moderately, and take much Exercise. By using these Precautions they may
either prevent any Occasion for Bleeding, or should they really be
obliged to admit of it, they would increase and prolong its good
Effects. These are also the very Means, which may remove all the Danger
that might ensue from a Person's omitting to bleed, at the usual Season
or Interval, when the Habit, the Fashion of Bleeding had been
inveterately established in him.
Sec. 545. We learn with Horror and Astonishment, that some have been bled
eighteen, twenty and even twenty-four times in two Days; and some
others, some [112] hundred times, in the Course of some Months. Such
Instances irrefragably demonstrate the continual Ignorance of their
Physician or Surgeon; and should the Patient escape, we ought to admire
the inexhaustible Resources of Nature, that survived so many murderous
Incisions.
[112] How shocking is this! and yet how true in some Countries! I have
been most certainly assured, that Bleeding has been inflicted and
repeated in the last sinking and totally relaxing Stage of a
Sea-Scurvy, whose fatal Termination it doubtless accelerated. This
did not happen in our own Fleet; yet we are not as yet Wholly
exempt on Shore, from some Abuse of Bleeding, which a few raw
unthinking Operators are apt to consider as a meer Matter of
Course. I have in some other Place stigmatized the Madness of
Bleeding in Convulsions, from manifest Exhaustion and Emptiness,
with the Abhorrence it deserves. _K._
Sec. 546. The People entertain a common Notion, which is, that the first
Time of bleeding certainly saves the Life of the Patient; but to
convince them of the Falsity of this silly Notion, they need only open
their Eyes, and see the very contrary Fact to this occur but too
unhappily every Day; many People dying soon after their first Bleeding.
Were their Opinion right, it would be impossible that any Person should
die of the first Disease that seized him, which yet daily happens. Now
the Extirpation of this absurd Opinion is really become important, as
the Continuance of it is attended with some unhappy Consequences: their
Faith in, their great Dependance on, the extraordinary Virtue of this
first Bleeding makes them willing to omit it, that is, to treasure it up
against a Distemper, from which they shall be in the greatest Danger;
and thus it is deferred as long as the Patient is not extremely bad, in
Hopes that if they can do without it then, they shall keep it for
another and more pressing Occasion. Their present Disease in the mean
time rises to a violent Height; and then they bleed, but when it is too
late, and I have seen Instances of many Patients, who were permitted to
die, that the first Bleeding might be reserved for a more important
Occasion. The only Difference between the first Bleeding, and any
subsequent one is, that the first commonly gives the Patient an Emotion,
that is rather hurtful than salutary.
_Of Purges._