Frequent fomentations with lukewarm water, or a decoction of emollient

vegetables, are likewise beneficial. Flannel cloths dipped in these must

be applied to the region of the stomach, and removed as they grow cool.

They must neither be applied too warm, nor be suffered to continue till

they become quite cold, as either of these extremities would aggravate

the disease.

The feet and legs ought likewise to be frequently bathed in lukewarm

water, and warm bricks or poultices may be applied to the soles of the

feet. The warm bath, if it can be conveniently used, will be of great

service.

In this, and all other inflammations of the bowels, an epispastic, or

blistering-plaster, applied over the part affected, is one of the best

remedies I know. I have often used it, and do not recollect one instance

wherein it did not give relief to the patient.

The only internal medicines which we shall venture to recommend in this

disease, are mild clysters. These may be made of warm water, or thin

water-gruel; and if the patient is costive, a little sweet oil, honey,

or manna, may be added. Clysters answer the purpose of an internal

fomentation, while they keep the body open, and at the same time nourish

the patient, who is often in this disease unable to retain any food upon

his stomach. For these reasons they must not be neglected, as the

patient’s life may depend on them.

INFLAMMATION OF THE INTESTINES.

This is one of the most painful and dangerous diseases that mankind is

liable to. It generally proceeds from the same _causes_ as the

inflammation of the stomach; to which may be added costiveness, worms,

eating unripe fruits, or great quantities of nuts, drinking hard windy

malt liquors, as stale bottled beer or ale, sour wine, cyder, &c. It may

likewise be occasioned by a rupture, by schirrous tumours of the

intestines, or by their opposite sides growing together.

The inflammation of the intestines is denominated _Iliac passion,

Enteritis, &c._ according to the name of the parts affected. The

treatment however is nearly the same whatever part of the intestinal

canal be the seat of the disease; we shall therefore omit these

distinctions, lest they should perplex the reader.

The _symptoms_ here are nearly the same as in the foregoing disease;

only the pain, if possible, is more acute, and is situated lower. The

vomiting is likewise more violent, and sometimes even the excrements,

together with the clysters, are discharged by the mouth. The patient is

continually belching up wind, and has often an obstruction of his urine.

While the pain shifts, and the vomiting only returns at certain

intervals, and while the clysters pass downwards, there is ground for

hope; but when the clysters and _fæces_ are vomited, and the patient is

exceeding weak, with a low fluttering pulse, a pale countenance, and a

disagreeable or stinking breath, there is great reason to fear that the

consequences will prove fatal. Clammy sweats, black fœtid stools, with a

small intermitting pulse, and a total cessation of pain, are signs of a

mortification already begun, and of approaching death.

REGIMEN.——The regimen in this disease is in general the same as in an

inflammation of the stomach. The patient must be kept quiet, avoiding

cold, and all violent passions of the mind. His food ought to be very

light, and given in small quantities; his drink weak and diluting; as

clear whey, barley-water, and such like.

MEDICINE.——Bleeding in this, as well as in the inflammation of the

stomach, is of the greatest importance. It should be performed as soon

as the symptoms appear, and must be repeated according to the strength

of the patient, and the violence of the disease.

A blistering plaster is here likewise to be applied immediately over the

part where the most violent pain is. This not only relieves the pain of

the bowels, but even clysters and purgative medicines, which before had

no effect, will operate when the blister begins to rise.

Fomentations and laxative clysters are by no means to be omitted. The

patient’s feet and legs should frequently be bathed in warm water; and

cloths dipped in it applied to his belly. Bladders filled with warm

water may likewise be applied to the region of the navel, and warm

bricks, or bottles filled with warm water, to the soles of the feet. The

clysters may be made of barley-water or thin gruel with salt, and

softened with sweet oil or fresh butter. These may be administered every

two or three hours, or oftener, if the patient continues costive.

If the disease does not yield to clysters and fomentations, recourse

must be had to pretty strong purgatives; but as these, by irritating the

bowels, often increase their contraction, and by that means frustrate

their own intention, it will be necessary to join them with opiates,

which, by allaying the pain, and relaxing the spasmodic contractions of

the guts, greatly assist the operation of purgatives in this case.

What answers the purpose of opening the body very well, is a solution of

the bitter purging salts. Two ounces of these may be dissolved in an

English pint of warm water, or thin gruel, and a tea-cupful of it taken

every half hour till it operates. At the same time fifteen, twenty, or

twenty-five drops of laudanum may be given in a glass of peppermint or

simple cinnamon-water, to appease the irritation, and prevent the

vomiting, &c.

Acids have often a very happy effect in staying the vomiting, and

appeasing the other violent symptoms of this disease. It will therefore

be of use to sharpen the patient’s drink with cream of tartar, juice of

lemon; or, when these cannot be obtained, with vinegar.

But it often happens that no liquid whatever will stay on the stomach.

In this case the patient must take purging pills. I have generally found

the following answer very well: Take jalap in powder, and vitriolated

tartar, of each half a drachm, opium one grain, Castile soap as much as

will make the mass fit for pills. These must be taken at one dose, and

if they do not operate in a few hours, the dose may be repeated.

If a stool cannot be procured by any of the above means, it will be

necessary to immerse the patient in warm water up to the breast. I have

often seen this succeed when other means had been tried in vain. The

patient must continue in the water as long as he can easily bear it

without fainting, and if one immersion has not the desired effect, it

may be repeated as soon as the patient’s strength and spirits are

recruited. It is more safe for him to go frequently into the bath, than

to continue too long at a time; and it is often necessary to repeat it

several times before it has the desired effect.

It has sometimes happened, after all other means of procuring a stool

had been tried to no purpose, that this was brought about by immersing

the patient’s lower extremities in cold water, or making him walk upon a

wet pavement, and dashing his legs and thighs with the cold water. This

method, when others fail, at least merits a trial. It is indeed attended

with some danger; but a doubtful remedy is better than none.

In desperate cases it is common to give quicksilver. This may be given

to the quantity of several ounces, or even a pound, but should not

exceed that[116]. When there is reason to suspect a mortification of the

guts, this medicine ought not to be tried. In that case it cannot cure

the patient, and will only hasten his death. But when the obstruction is

occasioned by any cause that can be removed by force, quicksilver is not

only a proper medicine, but the best that can be administered, as it is

the fittest body we know for making its way through the intestinal

canal.

If the disease proceed from a rupture, the patient must be laid with his

head very low, and the intestines returned by gentle pressure with the

hand. If this, with fomentations and clysters, should not succeed,

recourse must be had to a surgical operation, which may give the patient

relief.

Such as would avoid this excruciating and dangerous disease, must take

care never to be too long without a stool. Some who have died of it have

had several pounds of hard dry _fæces_ taken out of their guts. They

should likewise beware of eating too freely of sour or unripe fruits, or

drinking stale windy liquors, &c. I have known it brought on by living

too much on baked fruits, which are seldom good. It likewise proceeds

frequently from cold caught by wet clothes, &c. but especially from wet

feet.

OF THE COLIC.

The colic has a great resemblance to the two preceding diseases, both in

its symptoms and method of cure. It is generally attended with

costiveness and acute pain of the bowels; and requires diluting diet,

evacuations, fomentations, &c.

Colics are variously denominated according to their causes, as the

_flatulent_, the _bilious_, the _hysteric_, the _nervous_, &c. As each

of these requires a particular method of treatment, we shall point out

their most general symptoms, and the means to be used for their relief.

The _flatulent_, or wind-colic, is generally occasioned by an indiscreet

use of unripe fruits, meats of hard digestion, windy vegetables,

fermenting liquors, and such like. It may likewise proceed from an

obstructed perspiration, or catching cold. Delicate people, whose

digestive powers are weak, are most liable to this kind of colic.

The flatulent colic may either affect the stomach or intestines. It is

attended with a painful stretching of the affected part. The patient

feels a rumbling in his guts, and is generally relieved by a discharge

of wind, either upwards or downwards. The pain is seldom confined to any

particular part, as the vapour wanders from one division of the bowels

to another till it finds a vent.

When the disease proceeds from windy liquor, green fruit, sour herbs, or

the like, the best medicine on the first appearance of the symptoms is a

dram of brandy, gin, or any good spirits. The patient should likewise

sit with his feet upon a warm hearth-stone, or apply warm bricks to

them; and warm cloths may be applied to his stomach and bowels.

This is the only colic wherein ardent spirits, spiceries, or any thing

of a hot nature, may be ventured upon. Nor indeed are they to be used

here unless at the very beginning, before any symptoms of inflammation

appear. We have reason to believe, that a colic occasioned by wind or

flatulent food might always be cured by spirits and warm liquors, if

they were taken immediately upon perceiving the first uneasiness; but

when the pain has continued for a considerable time, and there is reason

to fear an inflammation of the bowels is already begun, all hot things

are to be avoided as poison, and the patient is to be treated in the

same manner as for the inflammation of the intestines.

Several kinds of food, as honey, eggs, &c. occasion colics in some

particular constitutions. I have generally found the best method of cure

for these was to drink plentifully of small diluting liquors, as

water-gruel, small posset, water with toasted bread soaked in it, &c.

Colics which proceed from excess and indigestion generally cure

themselves by occasioning vomiting or purging. These discharges are by

no means to be stopped, but promoted by drinking plentifully of warm

water, or weak posset. When their violence is over, the patient may take

a dose of rhubarb, or any other gentle purge, to carry off the dregs of

his debauch.

Colics which are occasioned by wet feet, or catching cold, may generally

be removed at the beginning, by bathing the feet and legs in warm water,

and drinking such warm diluting liquors as will promote the

perspiration, as weak wine-whey, or water-gruel, with a small quantity

of spirits in it.

Those flatulent colics, which prevail so much among country people,

might generally be prevented were they careful to change their clothes

when they get wet. They ought likewise to take a dram, or to drink some

warm liquor after eating any kind of green trash. We do not mean to

recommend the practice of dram-drinking, but in this case ardent spirits

prove a real medicine, and indeed the best that can be administered. A

glass of good peppermint water will have nearly the same effect as a

glass of brandy, and in some cases is rather to be preferred.

The _bilious_ colic is attended with very acute pains about the region

of the navel. The patient complains of great thirst, and is generally

costive. He vomits a hot, bitter, yellow-coloured bile, which being

discharged, seems to afford some relief, but is quickly followed by the

same violent pain as before. As the distemper advances, the propensity

to vomit sometimes increases so as to become almost continual, and the

proper motion of the intestines is so far perverted, that there are all

the symptoms of an impending iliac passion.

If the patient be young and strong, and the pulse full and frequent, it

will be proper to bleed, after which clysters may be administered. Clear

whey or gruel, sharpened with the juice of lemon, or cream of tartar,

must be drank freely. Small chicken-broth, with a little manna dissolved

in it, or a slight decoction of tamarinds, are likewise very proper, or

any other thin, acid, opening liquor.

Besides bleeding and plentiful dilution, it will be necessary to foment

the belly with cloths dipped in warm water, and if this should not

succeed, the patient must be immersed up to the breast in warm water.

In the bilious colic the vomiting is often very difficult to restrain.

When this happens, the patient may drink a decoction of toasted bread,

or an infusion of garden-mint in boiling water. Should these not have

the desired effect, the saline draught, with a few drops of laudanum in

it, may be given, and repeated according to the urgency of the symptoms.

A small quantity of Venice treacle may be spread in form of a cataplasm,

and applied to the pit of the stomach. Clysters, with a proper quantity

of Venice treacle or liquid laudanum in them, may likewise be frequently

administered.

Such as are liable to frequent returns of the bilious colic should use

flesh sparingly, and live chiefly upon a light vegetable diet. They

should likewise take frequently a dose of cream of tartar with

tamarinds, or any other cool acid purge.

The _hysteric_ colic bears a great resemblance to the bilious. It is

attended with acute pains about the region of the stomach, vomiting, &c.

But what the patient vomits in this case is commonly of a greenish

colour. There is a great sinking of the spirits, with dejection of mind

and difficulty of breathing, which are the characteristic symptoms of

this disorder. Sometimes it is accompanied with the jaundice, but this

generally goes off of its own accord in a few days.

In this colic all evacuations, as bleeding, purging, vomiting, &c. do

hurt. Every thing that weakens the patient, or sinks the spirits, is to

be avoided. If however the vomiting should prove violent, lukewarm

water, or small posset, may be drank to cleanse the stomach. Afterwards

the patient may take fifteen, twenty, or twenty-five drops of liquid

laudanum in a glass of cinnamon water. This may be repeated every ten or

twelve hours till the symptoms abate.

The patient may likewise take four or five of the fœtid pills every six

hours, and drink a cup of penny-royal tea after them. If asafœtida

should prove disagreeable, which is sometimes the case, a tea-spoonful

of the tincture of castor in a cup of penny-royal tea, or thirty or

forty drops of the balsam of Peru dropped upon a bit of loaf-sugar, may

be taken in its stead. The anti-hysteric plaster may also be used, which

has often a good effect[117].

The _nervous_ colic prevails among miners, smelters of lead, plumbers,

the manufacturers of white lead, &c. It is very common in the cyder

counties of England, and is supposed to be occasioned by the leaden

vessels used in preparing that liquor. It is likewise a frequent disease

in the West Indies, where it is termed the dry belly-ache.

No disease of the bowels is attended with more excruciating pain than

this. Nor is it soon at an end. I have known it continue eight or ten

days with very little intermission, the body all the while continuing

bound in spite of medicine, yet at length yield, and the patient

recover[118]. It generally however leaves the patient weak, and often

ends in a palsy.

The general treatment of this disease is so nearly the same with that of

the iliac passion, or inflammation of the guts, that we shall not insist

upon it. The body is to be opened by mild purgatives given in small

doses, and frequently repeated, and their operation must be assisted by

soft oily clysters, fomentations, &c. The castor oil is reckoned

peculiarly proper in this disease. It may both be mixed with the

clysters and given by the mouth.

The Barbadoes tar is said to be an efficacious medicine in this

complaint. It may be taken to the quantity of two drachms three times a

day, or oftner if the stomach will bear it. This tar, mixed with an

equal quantity of strong rum, is likewise proper for rubbing the spine,

in case any tingling, or other symptoms of a palsy, are felt. When the

tar cannot be obtained, the back may be rubbed with strong spirits, or a

little oil of nutmegs or of rosemary.

If the patient remains weak and languid after this disease, he must take

exercise on horseback, and use an infusion of the Peruvian bark in wine.

When the disease ends in a palsy, the Bath-waters are found to be

extremely proper.

To avoid this kind of colic, people must shun all sour fruits, acids,

and austere liquors, &c. Those who work in lead ought never to go to

their business fasting, and their food should be oily or fat. They may

take a glass of sallad oil, with a little brandy or rum every morning,

but should never take spirits alone. Liquid aliment is best for them; as

fat broths, &c. but low living is bad. They should frequently go a

little out of the tainted air; and should never suffer themselves to be

costive. In the West Indies, and on the coast of Guinea, it has been

found of great use, for preventing this colic, to wear a piece of

flannel round the waist, and to drink an infusion of ginger by way of

tea.

Sundry other kinds of this disease might be mentioned, but too many

distinctions would tend only to perplex the reader. Those already

mentioned are the most material, and should indeed be attended to, as

their treatment is very different. But even persons who are not in a

condition to distinguish very accurately in these matters, may

nevertheless be of great service to patients in colics of every kind, by

only observing the following general rules, _viz._ To bathe the feet and

legs in warm water; to apply bladders filled with warm water, or cloths

dipped in it, to the stomach and bowels; to make the patient drink

freely of diluting mucilaginous liquors; and to give him an emollient

clyster every two or three hours. Should these not succeed, the patient

ought to be immersed in warm water.

INFLAMMATION OF THE KIDNEYS.

CAUSES.——This disease may proceed from any of those causes which produce

an inflammatory fever. It may likewise be occasioned by wounds or

bruises of the kidneys; small stones or gravel lodging within them; by

strong diuretic medicines; as spirits of turpentine, tincture of

cantharides, &c. Violent motion, as hard riding or walking, especially

in hot weather, or whatever drives the blood too forcibly into the

kidneys, may occasion this malady. It may likewise proceed from lying

too soft, too much on the back, involuntary contractions, or spasms, in

the urinary vessels, &c.

SYMPTOMS.——There is a sharp pain about the region of the kidneys, with

some degree of fever, and a stupor or dull pain in the thigh of the

affected side. The urine is at first clear, and afterwards of a reddish

colour; but in the worst kind of the disease it generally continues

pale, is passed with difficulty, and commonly in small quantities at a

time. The patient feels great uneasiness when he endeavours to walk or

sit upright. He lies with most ease on the affected side, and has

generally a nausea or vomiting, resembling that which happens in the

colic.

This disease however may be distinguished from the colic by the pain

being seated farther back, and by the difficulty of passing urine with

which it is constantly attended.

REGIMEN.——Every thing of a heating or stimulating nature is to be

avoided. The food must be thin and light; as panado, small broths, with

mild vegetables, and the like. Emollient and thin liquors must be

plentifully drank; as clear whey, or balm-tea sweetened with honey,

decoctions of marsh-mallow roots, with barley and liquorice, &c. The

patient, notwithstanding the vomiting, must constantly keep sipping

small quantities of these or other diluting liquors. Nothing so safely

and certainly abates the inflammation, and expels the obstructing cause,

as copious dilution. The patient must be kept easy, quiet, and free from

cold, as long as any symptoms of inflammation remain.

MEDICINE.——Bleeding is generally necessary, especially at the beginning.

Ten or twelve ounces may be let from the arm or foot with a lancet, and

if the pain and inflammation continue, the operation may be repeated in

twenty-four hours, especially if the patient be of a full habit. Leeches

may likewise be applied to the hæmorrhoidal veins, as a discharge from

these will greatly relieve the patient.

Cloths dipped in warm water, or bladders filled with it, must be applied

as near as possible to the part affected, and renewed as they grow cool.

If the bladders be filled with a decoction of mallows and camomile

flowers, to which a little saffron is added, and mixed with about a

third part of new milk, it will be still more beneficial.

Emollient clysters ought frequently to be administered; and if these do

not open the body, a little salt and honey or manna may be added to

them.

The same course is to be followed where gravel or stone is lodged in the

kidney, but when the gravel or stone is separated from the kidney, and

lodges in the Ureter[119], it will be proper, besides the fomentations,

to rub the small of the back with sweet oil, and to give gentle

diuretics; as juniper-water sweetened with the syrup of marsh-mallows: a

tea-spoonful of the sweet spirits of nitre, with a few drops of

laudanum, may now and then be put in a cup of the patient’s drink. He

ought likewise to take exercise on horseback, or in a carriage, if he be

able to bear it.

When the disease is protracted beyond the seventh or eighth day, and the

patient complains of a stupor and heaviness of the part, has frequent

returns of chillness, shivering, &c. there is reason to suspect that

matter is forming in the kidney, and that an abscess will ensue.

When matter in the urine shews that an ulcer is already formed in the

kidney, the patient must be careful to abstain from all acrid, sour, and

salted provisions; and to live chiefly upon mild mucilaginous herbs and

fruits, together with the broth of young animals, made with barley, and

common pot-herbs, &c. His drink may be whey, and butter-milk that is not

sour. The latter is by some reckoned a specific remedy in ulcers of the

kidneys. To answer this character, however, it must be drank for a

considerable time. Chalybeate waters have likewise been found beneficial

in this disease. This medicine is easily obtained, as it is found in

every part of Great Britain. It must likewise be used for a considerable

time, in order to produce any salutary effects.

Those who are liable to frequent returns of inflammation, or

obstructions of the kidneys, must abstain from wines, especially such as

abound with tartar; and their food ought to be light, and of easy

digestion. They should use moderate exercise, and should not lie too

hot, nor too much on their back.

INFLAMMATION OF THE BLADDER.

The inflammation of the bladder proceeds, in a great measure, from the

same causes as that of the kidneys. It is known by an acute pain towards

the bottom of the belly, and difficulty of passing urine, with some

degree of fever, a constant inclination to go to stool, and a perpetual

desire to make water.

This disease must be treated on the same principles as the one

immediately preceding. The diet must be light and thin, and the drink of

a cooling nature. Bleeding is very proper at the beginning, and in

robust constitutions it will often be necessary to repeat it. The lower

part of the belly should be fomented with warm water, or a decoction of

mild vegetables; and emollient clysters ought frequently to be

administered, &c.

The patient should abstain from every thing that is of a hot, acrid, and

stimulating quality, and should live entirely upon small broths, gruels,

or mild vegetables.

A stoppage of urine may proceed from other causes besides an

inflammation of the bladder; as a swelling of the hæmorrhoidal veins,

hard _fæces_ lodged in the _rectum_; a stone in the bladder;

excrescences in the urinary passages, a palsy of the bladder, hysteric

affections, &c. Each of these requires a particular treatment, which

does not fall under our present consideration. We shall only observe,

that in all of them mild and gentle applications are the safest, as

strong diuretic medicines, or things of an irritating nature, generally

increase the danger.

I have known some persons kill themselves by introducing probes into the

urinary passages, to remove, as they thought, somewhat that obstructed

the discharge of urine, and others bring on a violent inflammation of

the bladder, by using strong diuretics, as oil of turpentine, &c. for

that purpose.

INFLAMMATION OF THE LIVER.

The liver is less subject to inflammation than most of the other

viscera, as in it the circulation is slower; but when an inflammation

does happen, it is with difficulty removed, and often ends in a

suppuration or scirrhus.

CAUSES.——Besides the common causes of inflammation, we may here reckon

the following, _viz._ excessive fatness, a scirrhus of the liver itself,

violent shocks from strong vomits when the liver was before unsound, an

adust or atrabiliarian state of the blood, any thing that suddenly cools

the liver after it has been greatly heated, stones obstructing the

course of the bile, drinking strong wines and spirituous liquors, using

hot spicy aliment, obstinate hypochondriacal affections, &c.

SYMPTOMS.——This disease is known by a painful tension of the right side

under the false ribs, attended with some degree of fever, a sense of

weight, or fulness of the part, difficulty of breathing, loathing of

food, great thirst, with a pale or yellowish colour of the skin and

eyes.

The _symptoms_ here are various, according to the degree of

inflammation, and likewise according to the particular part of the liver

where the inflammation happens. Sometimes the pain is so inconsiderable,

that an inflammation is not so much as suspected; but when it happens in

the upper or convex part of the liver, the pain is more acute, the pulse

quicker, and the patient is often troubled with a dry cough, a hiccup,

and a pain extending to the shoulder, with difficulty of lying on the

left side, &c.

This disease may be distinguished from the pleurisy by the pain being

less violent, seated under the false ribs, the pulse not so hard, and by

the difficulty of lying on the left side. It may be distinguished from

the hysteric and hypochondriac disorders by the degree of fever with

which it is always attended.

This disease, if properly treated, is seldom mortal. A constant

hiccuping, violent fever, and excessive thirst, are bad symptoms. If it

ends in a suppuration, and the matter cannot be discharged outwardly,

the danger is great. When the scirrhus of the liver ensues, the patient,

if he observes a proper regimen, may nevertheless live a number of years

tolerably easy; but if he indulge in animal food and strong liquors, or

take medicines of an acrid or irritating nature, the scirrhus will be

converted into a cancer, which must infallibly prove fatal.

REGIMEN.——The same regimen is to be observed in this as in other

inflammatory disorders. All hot things are to be carefully avoided, and

cool diluting liquors, as whey, barley-water, &c. drank freely. The food

must be light and thin, and the body, as well as the mind, kept easy and

quiet.

MEDICINE.——Bleeding is proper at the beginning of this disease, and it

will often be necessary, even though the pulse should not feel hard, to

repeat it. All violent purgatives are to be avoided; the body however

must be kept gently open. A decoction of tamarinds, with a little honey

or manna, will answer this purpose very well. The side affected must be

fomented in the manner directed in the foregoing diseases. Mild laxative

clysters should be frequently administered; and, if the pain should

notwithstanding continue violent, a blistering plaster may be applied

over the part affected.

Medicines which promote the secretion of urine have a very good effect

here. For this purpose half a drachm of purified nitre, or a

tea-spoonful of the sweet spirits of nitre, may be taken in a cup of the

patient’s drink three or four times a-day.

When there is an inclination to sweat, it ought to be promoted, but not

by warm sudorifics. The only thing to be used for that purpose is plenty

of diluting liquors drank about the warmth of the human blood. Indeed

the patient in this case, as well as in all other topical inflammations,

ought to drink nothing that is colder than the blood.

If the stools should be loose, and even streaked with blood, no means

must be used to stop them, unless they be so frequent as to weaken the

patient. Loose stools often prove critical, and carry off the disease.

If an abscess or imposthume is formed in the liver, all methods should

be tried to make it break and discharge itself outwardly, as

fomentations, the application of poultices, ripening cataplasms, &c.

Sometimes indeed the matter of an abscess comes away in the urine, and

sometimes it is discharged by stool, but these are efforts of Nature

which no means can promote. When the abscess bursts into the cavity of

the _abdomen_ at large, death must ensue; nor will the event be more

favourable when the abscess is opened by an incision, unless in cases

where the liver adheres to the _peritonæum_, so as to form a bag for the

matter, and prevent it from falling into the cavity of the _abdomen_; in

which case opening the abscess by a sufficiently large incision will

probably save the patient’s life[120].

If the disorder, in spite of all endeavours to the contrary, should end

in a scirrhus, the patient must be careful to regulate his diet, &c. in

such a manner as not to aggravate the disease. He must not indulge in

flesh, fish, strong liquors, or any highly seasoned or salted

provisions; but should, for the most part, live on mild vegetables, as

fruits and roots; taking gentle exercise, and drinking whey,

barley-water, or butter-milk. If he takes any thing stronger, it should

be fine mild ale, which is less heating than wines or spirits.

We shall take no notice of inflammations of the other viscera. They must

in general be treated upon the same principles as those already

mentioned. The chief rule with respect to all of them, is to let blood,

to avoid every thing that is strong, or of a heating nature, to apply

warm fomentations to the part affected, and to cause the patient to

drink a sufficient quantity of warm diluting liquors.

CHAP. XXXI.

OF THE CHOLERA MORBUS, AND OTHER EXCESSIVE DISCHARGES FROM THE STOMACH

AND BOWELS.

The _cholera morbus_ is a violent purging and vomiting, attended with

gripes, sickness, and a constant desire to go to stool. It comes on

suddenly, and is most common in autumn. There is hardly any disease that

kills more quickly than this, when proper means are not used in due time

for removing it.

CAUSES.——It is occasioned by a redundancy and putrid acrimony of the

bile; cold; food that easily turns rancid or sour on the stomach; as

butter, bacon, sweetmeats, cucumbers, melons, cherries, and other cold

fruits[121]. It is sometimes the effect of strong acrid purges or

vomits, or of poisonous substances taken into the stomach. It may

likewise proceed from violent passions or affections of the mind; as

fear, anger, &c.

SYMPTOMS.——It is generally preceded by a _cardialgia_, or heart-burn,

sour belchings, and flatulencies, with pain of the stomach and

intestines. To these succeed excessive vomiting, and purging of green,

yellow, or blackish-coloured bile, with a distension of the stomach, and

violent griping pains. There is likewise a great thirst, with a very

quick unequal pulse, and often a fixed acute pain about the region of

the navel. As the disease advances, the pulse often sinks low as to

become quite imperceptible, the extremities grow cold, or cramped, and

are often covered with a clammy sweat, the urine is obstructed, and

there is a palpitation of the heart. Violent hiccuping, fainting, and

convulsions, are the signs of approaching death.

MEDICINE.——At the beginning of this disease the efforts of Nature to

expel the offending cause should be assisted, by promoting the purging

and vomiting. For this purpose the patient must drink freely of diluting

liquors; as whey, butter-milk, warm water, thin water-gruel, small

posset, or, what is perhaps preferable to any of them, very weak chicken

broth. This should not only be drank plentifully to promote the

vomiting, but a clyster of it given every hour in order to promote the

purging.

After these evacuations have been continued for some time, a decoction

of toasted oat-bread may be drank to stop the vomiting. The bread should

be toasted till it is of a brown colour, and afterwards boiled in spring

water. If oat-bread cannot be had, wheat-bread, or oatmeal well toasted,

may be used in its stead. If this does not put a stop to the vomiting,

two table-spoonfuls of the saline julep, with ten drops of laudanum, may

be taken every hour till it ceases.

The vomiting and purging however ought never to be stopped too soon. As

long as these discharges do not weaken the patient, they are salutary,

and may be allowed to go on, or rather ought to be promoted. But when

the patient is weakened by the evacuations, which may be known from the

sinking of his pulse, &c. recourse must immediately be had to opiates,

as recommended above; to which may be added strong wines, with

spirituous cinnamon-waters, and other generous cordials. Warm negus, or

strong wine-whey, will likewise be necessary to support the patient’s

spirits, and promote the perspiration. His legs should be bathed in warm

water, and afterwards rubbed with flannel cloths, or wrapped in warm

blankets, and warm bricks applied to the soles of his feet. Flannels

wrung out of warm spirituous fomentations should likewise be applied to

the region of the stomach.

When the violence of the disease is over, to prevent a relapse, it will

be necessary for some time to continue the use of small doses of

laudanum. Ten or twelve drops may be taken in a glass of wine, at least

twice a day, for eight or ten days. The patient’s food ought to be

nourishing, but taken in small quantities, and he should use moderate

exercise. As the stomach and intestines are generally much weakened, an

infusion of the bark, or other bitters, in small wine, sharpened with

the elixir of vitriol, may be drank for some time.

Though physicians are seldom called in due time in this disease, they

ought not to despair of relieving the patient even in the most desperate

circumstances. Of this I lately saw a very striking proof in an old man

and his son, who had been both seized with it about the middle of the

night.

I did not see them till next morning, when they had much more the

appearance of dead than of living men. No pulse could be felt; the

extremities were cold and rigid; the countenance was ghastly, and the

strength almost quite exhausted. Yet from this deplorable condition they

were both recovered by the use of opiates and cordial medicines.

OF A DIARRHŒA, or LOOSENESS.

A looseness, in many cases, is not to be considered as a disease, but

rather as a salutary evacuation. It ought therefore never to be stopped,

unless when it continues too long, or evidently weakens the patient. As

this however sometimes happens, we shall point out the most common

causes of a looseness, with the proper method of treatment.

When a looseness is occasioned by catching cold, or an obstructed

perspiration, the patient ought to keep warm, to drink freely of weak

diluting liquors, to bathe his feet and legs frequently in lukewarm

water, to wear flannel next his skin, and to take every other method to

restore the perspiration.

In a looseness which proceeds from excess or repletion, a vomit is the

proper medicine. Vomits not only cleanse the stomach, but promote all

the secretions, which renders them of great importance in carrying off a

debauch. Half a drachm of ipecacuanha in powder will answer this purpose

very well. A day or two after the vomit, the same quantity of rhubarb

may be taken, and repeated two or three times, if the looseness

continues. The patient ought to live upon light vegetable food of easy

digestion, and to drink whey, thin gruel, or barley-water.

A looseness, occasioned by the obstruction of any customary evacuation,

generally requires bleeding. If that does not succeed, other evacuations

may be substituted in the room of those which are obstructed. At the

same time, every method is to be taken to restore the usual discharges,

as not only the cure of the disease, but the patient’s life, may depend

on this.

A periodical looseness ought never to be stopped. It is always an effort

of Nature to carry off some offending matter, which, if retained in the

body, might have fatal effects. Children are very liable to this kind of

looseness, especially while teething. It is however so far from being

hurtful to them, that such children generally get their teeth with least

trouble. If these loose stools should at any time prove sour or griping,

a tea-spoonful of magnesia alba, with four or five grains of rhubarb,

may be given to the child in a little panado, or any other food. This,

if repeated three or four times, will generally correct the acidity, and

carry off the griping stools.

A diarrhœa, or looseness, which proceeds from violent passions or

affections of the mind, must be treated with the greatest caution.

Vomits in this case are highly improper. Nor are purges safe, unless

they be very mild, and given in small quantities. Opiates, and other

antispasmodic medicines, are most proper. Ten or twelve drops of liquid

laudanum may be taken in a cup of valerian or penny-royal tea every

eight or ten hours, till the symptoms abate. Ease, cheerfulness, and

tranquillity of mind, are here of the greatest importance.

When a looseness proceeds from acrid or poisonous substances taken into

the stomach, the patient must drink large quantities of diluting

liquors, with oil or fat broths, to promote vomiting and purging.

Afterwards, if there be reason to suspect that the bowels are inflamed,

bleeding will be necessary. Small doses of laudanum may likewise be

taken to remove their irritation.

When the gout, repelled from the extremities, occasions a looseness, it

ought to be promoted by gentle doses of rhubarb, or other mild

purgatives. The gouty matter is likewise to be solicited towards the

extremities by warm fomentations, cataplasms, &c. The perspiration ought

at the same time to be promoted by warm diluting liquors; as wine-whey,

with spirits of hartshorn, or a few drops of liquid laudanum, in it.

When a looseness proceeds from worms, which may be known from the

sliminess of the stools, mixed with pieces of decayed worms, &c.

medicines must be given to kill and carry off these vermin, as the

powder of tin with purges of rhubarb and calomel. Afterwards lime-water,

either alone, or with a small quantity of rhubarb infused, will be

proper to strengthen the bowels, and prevent the new generation of

worms.

A looseness is often occasioned by drinking bad water. When this is the

case, the disease generally proves epidemical. When there is reason to

believe that this or any other disease proceeds from the use of

unwholesome water, it ought immediately to be changed, or, if that

cannot be done, it may be corrected by mixing with it quicklime, chalk,

or the like.

In people whose stomachs are weak, violent exercise immediately after

eating will occasion a looseness. Though the cure of this is obvious,

yet it will be proper, besides avoiding violent exercise, to use such

medicines as tend to brace and strengthen the stomach, as infusions of

the bark, with other bitter and astringent ingredients, in white-wine.

Such persons ought likewise to take frequently a glass or two of old red

port, or good claret.

From whatever cause a looseness proceeds, when it is found necessary to

check it, the diet ought to consist of rice boiled with milk, and

flavoured with cinnamon; rice-jelly; sago, with red port; and the

lighter sorts of flesh-meat roasted. The drink may be thin water-gruel,

rice-water, or weak broth made from lean veal, or with a sheep’s head,

as being more gelatinous than mutton, beef, or chicken-broth.

Persons who, from a peculiar weakness, or too great an irritability of

the bowels, are liable to frequent returns of this disease, should live

temperately, avoiding crude summer fruits, all unwholesome food, and

meats of hard digestion. They ought likewise to beware of cold,

moisture, or whatever may obstruct the perspiration, and should wear

flannel next their skin. All violent passions, as fear, anger, &c. are

likewise carefully to be guarded against.

OF VOMITING.

Vomiting may proceed from various causes; as excess in eating and

drinking; foulness of the stomach; the acrimony of the aliments; a

translation of the morbific matter of ulcers, of the gout, the

erysipelas, or other diseases, to the stomach. It may likewise proceed

from a looseness having been too suddenly stopped; from the stoppage of

any customary evacuation, as the bleeding piles, the _menses_, &c. from

a weakness of the stomach, the colic, the iliac passion, a rupture, a

fit of the gravel, worms; or from any kind of poison taken into the

stomach. It is an usual symptom of injuries done to the brain; as

contusions, compressions, &c. It is likewise a symptom of wounds or

inflammations of the diaphragm, intestines, spleen, liver, kidneys, &c.

Vomiting may be occasioned by unusual motions; as sailing, being drawn

backwards in a cart or coach, &c. It may likewise be excited by violent

passions, or by the idea of nauseous or disagreeable objects, especially

of such things as have formerly produced vomiting. Sometimes it proceeds

from a regurgitation of the bile into the stomach: in this case, what

the patient vomits is generally of a yellow or greenish colour, and has

a bitter taste. Persons who are subject to nervous affections are often

suddenly seized with violent fits of vomiting. Lastly, vomiting is a

common symptom of pregnancy. In this case it generally comes on about

two weeks after the stoppage of the _menses_, and continues during the

first three or four months.

When vomiting proceeds from a foul stomach or indigestion, it is not to

be considered as a disease, but as the cure of a disease. It ought

therefore to be promoted by drinking lukewarm water, or thin gruel. If

this does not put a stop to the vomiting, a dose of ipecacuanha may be

taken, and worked off with weak camomile-tea.

When the retrocession of the gout, or the obstruction of customary

evacuations, occasion vomiting, all means must be used to restore these

discharges; or, if that cannot be effected, their place must be supplied

by others, as bleeding, purging, bathing the extremities in warm water,

opening issues, setons, perpetual blisters, &c.

When vomiting is the effect of pregnancy, it may generally be mitigated

by bleeding, and keeping the body gently open. The bleeding however

ought to be in small quantities at a time, and the purgatives should be

of the mildest kind, as figs, stewed prunes, manna, or senna. Pregnant

women are most apt to vomit in the morning, immediately after getting

out of bed, which is owing partly to the change of posture, but more to

the emptiness of the stomach. It may generally be prevented by taking a

dish of coffee, tea, or some light breakfast in bed. Pregnant women who

are afflicted with vomiting ought to be kept easy both in body and mind.

They should neither allow their stomachs to be quite empty, nor should

they eat much at once. Cold water is a very proper drink in this case;

if the stomach be weak, a little brandy may be added to it. If the

spirits are low, and the person apt to faint, a spoonful of

cinnamon-water, with a little marmalade of quinces or oranges, may be

taken.

If vomiting proceeds from weakness of the stomach, bitters will be of

service. Peruvian bark infused in wine or brandy, with as much rhubarb

as will keep the body gently open, is an excellent medicine in this

case. The elixir of vitriol is also a good medicine. It may be taken in

the dose of fifteen or twenty drops, twice or thrice a day, in a glass

of wine or water. Habitual vomitings are sometimes alleviated by making

oysters a principal part of diet.

A vomiting, which proceeds from acidities in the stomach, is relieved by

alkaline purges. The best medicine of this kind is the magnesia alba, a

tea-spoonful of which may be taken in a dish of tea or a little milk,

three or four times a day, or oftener if necessary, to keep the body

open.

When vomiting proceeds from violent passions, or affections of the mind,

all evacuants must be carefully avoided, especially vomits. These are

exceedingly dangerous. The patient in this case ought to be kept

perfectly easy and quiet, to have the mind soothed, and to take some

gentle cordial, as negus, or a little brandy and water, to which a few

drops of laudanum may occasionally be added.

When vomiting proceeds from spasmodic affections of the stomach, musk,

castor, and other antispasmodic medicines, are of use. Warm and aromatic

plasters have likewise a good effect. The stomach plaster of the London

or Edinburgh dispensatory may be applied to the pit of the stomach, or a

plaster of _theriaca_, which will answer rather better. Aromatic

medicines may likewise be taken inwardly, as cinnamon or mint-tea, wine

with spiceries boiled in it, &c. The region of the stomach may be rubbed

with æther, or, if that cannot be had, with strong brandy, or other

spirits. The belly should be fomented with warm water, or the patient

immersed up to the breast in a warm bath.

I have always found the saline draughts taken in the act of

effervescence, of singular use in stopping a vomiting, from whatever

cause it proceeded. These may be prepared by dissolving a drachm of the

salt of tartar in an ounce and half of fresh lemon-juice, and adding to

it an ounce of peppermint-water, the same quantity of simple

cinnamon-water, and a little white sugar. This draught must be swallowed

before the effervescence is quite over, and may be repeated every two

hours, or oftner, if the vomiting be violent. A violent vomiting has

sometimes been stopped by cupping on the region of the stomach after all

other means had failed.

As the least motion will often bring on the vomiting again, even after

it has been stopped, the patient must avoid all manner of action. The

diet must be so regulated as to sit easy upon the stomach, and nothing

should be taken that is hard of digestion. We do not however mean that

the patient should live entirely upon slops. Solid food, in this case,

often sits easier on the stomach than liquids.

CHAP. XXXII.

OF THE DIABETES, AND OTHER DISORDERS OF THE KIDNEYS AND BLADDER.

The diabetes is a frequent and excessive discharge of urine. It is

seldom to be met with among young people; but often attacks persons in

the decline of life, especially those who follow the more violent

employments, or have been hard drinkers in their youth.

CAUSES.——A diabetes is often the consequence of acute diseases, as

fevers, fluxes, &c. where the patient has suffered by excessive

evacuations; it may also be occasioned by great fatigue, as riding long

journies upon a hard-trotting horse, carrying heavy burdens, running,

&c. It may be brought on by hard drinking, or the use of strong

stimulating diuretic medicines, as tincture of cantharides, spirits of

turpentine, and such like. It is often the effect of drinking too great

quantities of mineral waters. Many imagine that these will do them no

service unless they be drank in great quantities, by which mistake it

often happens that they occasion worse diseases than those they were

intended to cure. In a word, this disease may either proceed from too

great a laxity of the organs which secrete the urine, from something

that stimulates the kidneys too much, or from a thin dissolved state of

the blood, which makes too great a quantity of it run off by the urinary

passages.

SYMPTOMS.——In a diabetes, the urine generally exceeds in quantity all

the liquid food which the patient takes. It is thin and pale, of a

sweetish taste, and an agreeable smell. The patient has a continual

thirst, with some degree of fever; his mouth is dry, and he spits

frequently a frothy spittle. The strength fails, the appetite decays,

and the flesh wastes away till the patient is reduced to skin and bone.

There is a heat of the bowels; and frequently the loins, testicles, and

feet are swelled.

This disease may generally be cured at the beginning; but after it has

continued long, the cure becomes very difficult. In drunkards, and very

old people, a perfect cure is not to be expected.

REGIMEN.——Every thing that stimulates the urinary passages, or tends to

relax the habit, must be avoided. For this reason the patient should

live chiefly on solid food. His thirst may be quenched with acids; as

sorrel, juice of lemon, or vinegar. The mucilaginous vegetables, as

rice, sago, and salop, with milk, are the most proper food. Of animal

substances, shell-fish are to be preferred; as oysters, crabs, &c.

The drink may be Bristol-water. When that cannot be obtained,

lime-water, in which a due proportion of oak bark has been macerated,

may be used. The white decoction[122], with isinglass dissolved in it,

is likewise a very proper drink.

The patient ought daily to take exercise, but it should be so gentle as

not to fatigue him. He should lie upon a hard bed or matrass. Nothing

hurts the kidneys more than lying too soft. A warm dry air, the use of

the flesh-brush, and every thing that promotes perspiration, is of

service. For this reason the patient ought to wear flannel next his

skin. A large strengthening plaster may be applied to the back; or, what

will answer better, a great part of the body may be wrapt in plaster.

MEDICINE.——Gentle purges, if the patient be not too much weakened by the

disease, have a good effect. They may consist of rhubarb, with cardamum

seeds, or any other spiceries, infused in wine, and may be taken in such

quantities as to keep the body gently open.

The patient must next have recourse to astringents and corroborants.

Half a drachm of powder made of equal parts of allum and the inspissated

juice commonly called _Terra Japonica_, may be taken four times a-day,

or oftner, if the stomach will bear it. The allum must first be melted

in a crucible; afterwards they may both be pounded together. Along with

every dose of this powder the patient may take a tea-cupful of the

tincture of roses[123].

If the patient’s stomach cannot bear the allum in substance, whey may be

made of it, and taken in the dose of a tea-cupful three or four times

a-day. The allum-whey is prepared by boiling two English quarts of milk

over a slow fire, with three drachms of allum, till the curd separates.

Opiates are of service in this disease, even though the patient rests

well. They take off spasm and irritation, and at the same time lessen

the force of the circulation. Ten or twelve drops of liquid laudanum may

be taken in a cup of the patient’s drink three or four times a-day.

The best corroborants which we know, are the Peruvian bark and wine. A

drachm of bark may be taken in a glass of red port or claret three times

a-day. The medicine will be both more efficacious and less disagreeable,

if fifteen or twenty drops of the acid elixir of vitriol be added to

each dose. Such as cannot take the bark in substance may use the

decoction, mixed with an equal quantity of red wine, and sharpened as

above.

There is a disease incident to labouring people in the decline of life,

called _an INCONTINENCY of urine_. But this is very different from a

diabetes, as the water passes off involuntarily by drops, and does not

exceed the usual quantity. This disease is rather troublesome than

dangerous. It is owing to a relaxation of the sphincter of the bladder,

and is often the effect of a palsy. Sometimes it proceeds from hurts, or

injuries occasioned by blows, bruises, preternatural labours, &c.

Sometimes it is the effect of a fever. It may likewise be occasioned by

a long use of strong diuretics, or of stimulating medicines injected

into the bladder.

This disease may be mitigated by the use of astringent and corroborating

medicines, such as have been mentioned above; but we do not remember

ever to have seen it cured.

In an incontinency of urine, from whatever cause, a piece of sponge

ought to be worn, or a bladder applied in such a manner as to prevent

the urine from galling and excoriating the parts.

OF A SUPPRESSION OF URINE.

It has already been observed, that a suppression of urine may proceed

from various causes; as an inflammation of the kidneys, or bladder;

small stones or gravel lodging in the urinary passages, hard _fæces_

lying in the _rectum_, pregnancy, a spasm or contraction of the neck of

the bladder, clotted blood in the bladder itself, a swelling of the

hæmorrhoidal veins, &c.

Some of these cases require the catheter, both to remove the obstructing

matter, and to draw off the urine; but as this instrument can only be

managed with safety by persons skilled in surgery, we shall say nothing

further of its use. A bougee may be used by any cautious hand, and will

often succeed better than the catheter.

We would chiefly recommend, in all obstructions of urine, fomentations

and evacuants. Bleeding, as far as the patient’s strength will permit,

is necessary, especially where there are symptoms of topical

inflammation. Bleeding in this case not only abates the fever, by

lessening the force of the circulation, but, by relaxing the solids, it

takes off the spasm or stricture upon the vessels which occasioned the

obstruction.

After bleeding, fomentations must be used. These may either consist of

warm water alone, or of decoctions of mild vegetables; as mallows,

camomile-flowers, &c. Cloths dipped in these may either be applied to

the part affected, or a large bladder filled with the decoction may be

kept continually upon it. Some put the herbs themselves into a flannel

bag, and apply them to the part, which is far from being a bad method.

These continue longer warm than cloths dipped in the decoction, and at

the same time keep the part equally moist.

In all obstructions of urine, the body ought to be kept open. This is

not however to be attempted by strong purgatives, but by emollient

clysters, or gentle infusions of senna and manna. Clysters in this case

not only open the body, but answer the purpose of an internal

fomentation, and greatly assist in removing the spasms of the bladder

and parts adjacent.

The food must be light, and taken in small quantities. The drink may be

weak broth, or decoctions and infusions of mucilaginous vegetables, as

marsh-mallow roots, lime-tree buds, &c. A tea-spoonful of the sweet

spirits of nitre, or a drachm of Castile soap, may be frequently put

into the patient’s drink; and, if there be no inflammation, he may drink

small gin-punch.

Persons subject to a suppression of urine ought to live very temperate.

Their diet should be light, and their liquor diluting. They should avoid

all acids and austere wines, should take sufficient exercise, lie hard,

and avoid study and sedentary occupations.

OF THE GRAVEL AND STONE.

When small stones are lodged in the kidneys, or discharged along with

the urine, the patient is said to be afflicted with the gravel. If one

of these stones happens to make a lodgment in the bladder for some time,

it accumulates fresh matter, and at length becomes too large to pass off

with the urine. In this case the patient is said to have the stone.

CAUSES.——The stone and gravel may be occasioned by high living; the use

of strong astringent wines; a sedentary life; lying too hot, soft, or

too much on the back; the constant use of water impregnated with earthy

or stony particles; aliments of an astringent or windy nature, &c. It

may likewise proceed from an hereditary disposition. Persons in the

decline of life, and those who have been much afflicted with the gout or

rheumatism, are most liable to it.

SYMPTOMS.——Small stones or gravel in the kidneys occasion pain in the

loins; sickness; vomiting; and sometimes bloody urine. When the stone

descends into the _ureter_, and is too large to pass along with ease,

all the above symptoms are increased; the pain extends towards the

bladder; the thigh and leg of the affected side are benumbed; the

testicles are drawn upwards, and the urine is obstructed.

A stone in the bladder is known from a pain, at the time, as well as

before and after making water; from the urine coming away by drops, or

stopping suddenly when it was running in a full stream; by a violent

pain in the neck of the bladder upon motion, especially on horseback, or

in a carriage on a rough road; from a white, thick, copious, stinking,

mucous sediment in the urine; from an itching in the top of the _penis_;

from bloody urine; from an inclination to go to stool during the

discharge of urine; from the patient’s passing his urine more easily

when lying than in an erect posture; from a kind of convulsive motion

occasioned by the sharp pain in discharging the last drops of the urine;

and lastly, from sounding or searching with the catheter.

REGIMEN.——Persons afflicted with the gravel or stone should avoid

aliments of a windy or heating nature, as salt meats, sour fruits, &c.

Their diet ought chiefly to consist of such things as tend to promote

the secretion of urine, and to keep the body open. Artichokes,

asparagus, spinnage, lettuce, parsley, succory, purslane, turnips,

potatoes, carrots, and radishes, may be safely eaten. Onions, leeks, and

celery are, in this case, reckoned medicinal. The most proper drinks are

whey, butter-milk, milk and water, barley-water; decoctions or infusions

of the roots of marsh-mallows, parsley, liquorice, or of other mild

mucilaginous vegetables, as linseed, lime-tree buds or leaves, &c. If

the patient has been accustomed to generous liquors, he may drink small

gin-punch.

Gentle exercise is proper; but violent motion is apt to occasion bloody

urine. We would therefore advise that it should be taken in moderation.

Persons afflicted with gravel often pass a great number of stones after

riding on horseback, or in a carriage; but those who have a stone in the

bladder are seldom able to bear these kinds of exercise. Where there is

a hereditary tendency to this disease, a sedentary life ought never to

be indulged. Were people careful, upon the first symptoms of gravel, to

observe a proper regimen of diet, and to take sufficient exercise, it

might often be carried off, or at least prevented from increasing; but

if the same course which occasioned the disease is persisted in, it must

be aggravated.

MEDICINE.——In what is called a fit of the gravel, which is commonly

occasioned by a stone sticking in the _ureter_ or some part of the

urinary passages, the patient must be bled, warm fomentations should

likewise be applied to the part affected, emollient clysters

administered, and diluting mucilaginous liquors drank, &c. The treatment

of this case has been fully pointed out under the articles,

_inflammation of the kidneys and bladder_, to which we refer.

Dr. Whytt advises patients who are subject to frequent fits of gravel in

the kidneys, but have no stone in the bladder, to drink every morning,

two or three hours before breakfast, an English pint of oyster or

cockle-shell lime-water. The Doctor very justly observes, that though

this quantity might be too small to have any sensible effect in

dissolving a stone in the bladder, yet it may very probably prevent its

growth.

When a stone is formed in the bladder, the Doctor recommends Alicant

soap, and oyster or cockle-shell lime-water[124], to be taken in the

following manner: The patient must swallow every day, in any form that

is least disagreeable, an ounce of the internal part of Alicant soap,

and drink three or four English pints of oyster or cockle shell

lime-water. The soap is to be divided into three doses; the largest to

be taken fasting in the morning early; the second at noon; and the third

at seven in the evening; drinking above each dose a large draught of the

lime-water; the remainder of which he may take any time betwixt dinner

and supper, instead of other liquors.

The patient should begin with a smaller quantity of the lime-water and

soap than that mentioned above; at first an English pint of the former,

and three drachms of the latter, may be taken daily. This quantity,

however, he may increase by degrees, and ought to persevere in the use

of these medicines, especially if he finds any abatement of his

complaints, for several months; nay, if the stone be very large, for

years. It may likewise be proper for the patient, if he be severely

pained, not only to begin with the soap and lime-water in small

quantities, but to take the second or third lime-water instead of the

first. However, after he has been for some time accustomed to these

medicines, he may not only take the first water, but, if he finds he can

easily bear it, heighten its dissolving power still more by pouring it a

second time on fresh calcined shells.

The caustic alkali, or soap-lees, is the medicine chiefly in vogue at

present for the stone. It is of a very acrid nature, and ought therefore

to be given in some gelatinous or mucilaginous liquor; as veal-broth,

new milk, linseed-tea, a solution of gum-arabic, or a decoction of

marsh-mallow roots. The patient must begin with small doses of the lees,

as thirty or forty drops, and increase by degrees, as far as the stomach

can bear it[125].

Though the soap-lees and lime-water are the most powerful medicines

which have hitherto been discovered for the stone; yet there are some

things of a more simple nature, which in certain cases are found to be

beneficial, and therefore deserve a trial. An infusion of the seeds of

_daucus sylvestris_, or wild carrot, sweetened with honey, has been

found to give considerable ease in cases where the stomach could not

bear any thing of an acrid nature. A decoction of raw coffee berries

taken morning and evening, to the quantity of eight or ten ounces, with

ten drops of sweet spirit of nitre, has likewise been found very

efficacious in bringing away large quantities of earthy matter in

flakes. Honey is likewise found to be of considerable service, and may

be taken in gruel, or in any other form that is more agreeable.

The only other medicine which we shall mention is the _uva ursi_. It has

been greatly extolled of late both for the gravel and stone. It seems

however to be in all respects inferior to the soap and lime-water; but

it is less disagreeable, and has frequently, to my knowledge, relieved

gravelly complaints. It is generally taken in powder from half a drachm

to a whole drachm, two or three times a day. It may however be taken to

the quantity of seven or eight drachms a day, with great safety and good

effect.

CHAP. XXXIII.

OF INVOLUNTARY DISCHARGES OF BLOOD.

Spontaneous or involuntary discharges of blood, often happen from

various parts of the body. These however are so far from being always

dangerous, that they often prove salutary. When such discharges are

critical, which is frequently the case in fevers, they ought not to be

stopped. Nor indeed is it proper at any time to stop them, unless they

be so great as to endanger the patient’s life. Most people, afraid of

the smallest discharge of blood from any part of the body, fly

immediately to the use of styptic and astringent medicines, by which

means an inflammation of the brain, or some other fatal disease, is

occasioned, which, had the discharge been allowed to go on, might have

been prevented.

Periodical discharges of blood, from whatever part of the body they

proceed, must not be stopped. They are always the efforts of Nature to

relieve herself; and fatal diseases have often been the consequence of

obstructing them. It may indeed be sometimes necessary to check the

violence of such discharges; but even this requires the greatest

caution. Instances might be given where the stopping of a small

periodical flux of blood, from one of the fingers, has proved fatal.

In the early period of life, bleeding at the nose is very common. Those

who are farther advanced in years are more liable to hæmoptoe, or

discharge of blood from the lungs. After the middle period of life,

hæmorrhoidal fluxes are most common; and in the decline of life,

discharges of blood from the urinary passages.

Involuntary fluxes of blood may proceed from very different, and often

from quite opposite causes. Sometimes they are owing to a particular

construction of the body, as a sanguine temperament, a laxity of the

vessels, a plethoric habit, &c. At other times they proceed from a

determination of the blood towards one particular part, as the head, the

hæmorrhoidal veins, &c. They may likewise proceed from an inflammatory

disposition of the blood, in which case there is generally some degree

of fever: this likewise happens when the flux is occasioned by an

obstructed perspiration, or a stricture upon the skin, the bowels, or

any particular part of the system.

But a dissolved state of the blood will likewise occasion hæmorrhages.

Thus, in putrid fevers, the dysentery, the scurvy, the malignant

small-pox, &c. there are often very great discharges of blood from

different parts of the body. They may likewise be brought on by too

liberal an use of medicines which tend to dissolve the blood, as

cantharides, the volatile alkaline salts, &c. Food of an acrid or

irritating quality may likewise occasion hæmorrhages; as also strong

purges and vomits, or any thing that greatly stimulates the bowels.

Violent passions or agitations of the mind will likewise have this

effect. These often cause bleeding at the nose, and I have known them

sometimes occasion an hæmorrhage in the brain. Violent efforts of the

body, by overstraining or hurting the vessels, may have the same effect,

especially when the body is long kept in an unnatural posture, as

hanging the head very low, &c.

The cure of an hæmorrhage must be adapted to its cause. When it proceeds

from too much blood, or a tendency to inflammation, bleeding, with

gentle purges, and other evacuations, will be necessary. It will

likewise be proper for the patient in this case to live chiefly upon a

vegetable diet, to avoid all strong liquors, and food that is of an

acrid, hot, or stimulating quality. The body should be kept cool, and

the mind easy.

When an hæmorrhage is owing to a putrid or dissolved state of the blood,

the patient ought to live chiefly upon acid fruits with milk, and

vegetables of a nourishing nature, as sago, salop, &c. His drink may be

wine diluted with water, and sharpened with the juice of lemon, vinegar,

or spirits of vitriol. The best medicine in this case is the Peruvian

bark, which may be taken according to the urgency of the symptoms.

When a flux of blood is the effect of acrid food, or of strong

stimulating medicines, the cure is to be effected by soft and

mucilaginous diet. The patient may likewise take frequently about the

bulk of a nutmeg of Locatelli’s balsam, or the same quantity of

sperma-ceti.

When an obstructed perspiration, or a stricture upon any part of the

system, is the cause of an hæmorrhage, it may be removed by drinking

warm diluting liquors, lying a-bed, bathing the extremities in warm

water, &c.

OF BLEEDING AT THE NOSE.

Bleeding at the nose is commonly preceded by some degree of quickness of

the pulse, flushing in the face, pulsation of the temporal arteries,

heaviness in the head, dimness of the sight, heat and itching of the

nostrils, &c.

To persons who abound with blood this discharge is very salutary. It

often cures a vertigo, the head-ach, a phrenzy, and even an epilepsy. In

fevers, where there is a great determination of blood towards the head,

it is of the utmost service. It is likewise beneficial in inflammations

of the liver and spleen, and often in the gout and rheumatism. In all

diseases where bleeding is necessary, a spontaneous discharge of blood

from the nose is of much more service than the same quantity let with a

lancet.

In a discharge of blood from the nose, the great point is to determine

whether it ought to be stopped or not. It is a common practice to stop

the bleeding, without considering whether it be a disease, or the cure

of a disease. This conduct proceeds from fear; but it has often bad, and

sometimes fatal consequences.

When a discharge of blood from the nose happens in an inflammatory

disease, there is always reason to believe that it may prove salutary;

and therefore it should be suffered to go on, at least as long as the

patient is not weakened by it.

When it happens to persons in perfect health, who are full of blood, it

ought not to be suddenly stopped, especially if the symptoms of

plethora, mentioned above, have preceded it. In this case it cannot be

stopped without risking the patient’s life.

In fine, whenever bleeding at the nose relieves any bad symptom, and

does not proceed so far as to endanger the patient’s life, it ought not

to be stopped. But when it returns frequently, or continues till the

pulse becomes low, the extremities begin to grow cold, the lips pale, or

the patient complains of being sick or faint, it must immediately be

stopped.

For this purpose the patient should be set nearly upright, with his head

reclining a little, and his legs immersed in water about the warmth of

new milk. His hands ought likewise to be put in lukewarm water, and his

garters may be tied a little tighter than usual. Ligatures may be

applied to the arms, about the place where they are usually made for

bleeding, and with nearly the same degree of tightness. These must be

gradually slackened as the blood begins to stop, and removed entirely as

soon as it gives over.

Sometimes dry lint put up the nostrils will stop the bleeding. When this

does not succeed, dossils of lint dipped in strong spirits of wine, may

be put up the nostrils, or if that cannot be had, they may be dipped in

brandy. Blue vitriol dissolved in water may likewise be used for this

purpose, or a tent dipped in the white of an egg beat up, may be rolled

in a powder made of equal parts of white sugar, burnt allum, and white

vitriol, and put up the nostril from whence the blood issues.

Internal medicines can hardly be of use here, as they have seldom time

to operate. It may not however be amiss to give the patient half an

ounce of Glauber’s salt, and the same quantity of manna, dissolved in

four or five ounces of barley-water. This may be taken at a draught, and

repeated, if it does not operate, in a few hours. Ten or twelve grains

of nitre may be taken in a glass of cold water and vinegar every hour,

or oftner, if the stomach will bear it. If a stronger medicine be

necessary, a tea-cupful of the tincture of roses, with twenty or thirty

drops of the weak spirit of vitriol, may be taken every hour. When these

things cannot be had, the patient may drink water, with a little common

salt in it, or equal parts of water and vinegar.

If the genitals be immersed for some time in cold water, it will

generally stop a bleeding at the nose. I have not known this fail.

Sometimes, when the bleeding is stopped outwardly, it continues

inwardly. This is very troublesome, and requires particular attention,

as the patient is apt to be suffocated with the blood, especially if he

falls asleep, which he is very ready to do after losing a great quantity

of blood.

When the patient is in danger of suffocation from the blood getting into

his throat, the passages may be stopped by drawing threads up the

nostrils, and bringing them out at the mouth, then fastening pieces of

spunge, or small rolls of linen cloth to their extremities; afterwards

drawing them back, and tying them on the outside with a sufficient

degree of tightness.

After the bleeding is stopped, the patient ought to be kept as easy and

quiet as possible. He should not pick his nose, nor take away the tents

or clotted blood, till they fall off of their own accord, and should not

lie with his head low.

Those who are affected with frequent bleeding at the nose ought to bathe

their feet often in warm water, and to keep them warm and dry. They

ought to wear nothing tight about their necks, to keep their body as

much in an erect posture as possible, and never to view any object

obliquely. If they have too much blood, a vegetable diet, with now and

then a cooling purge, is the safest way to lessen it.

But when the disease proceeds from a thin dissolved flare of the blood,

the diet should be rich and nourishing; as strong broths and jellies,

sago-gruel with wine and sugar, &c. Infusions of the Peruvian bark in

wine ought likewise to be taken and persisted in for a considerable

time.

OF THE BLEEDING AND BLIND PILES.

A discharge of blood from the hæmorrhoidal vessels is called the

_bleeding piles_. When the vessels only swell, and discharge no blood,

but are exceeding painful, the disease is called the _blind piles_.

Persons of a loose spungy fibre, of a bulky size, who live high, and

lead a sedentary inactive life, are most subject to this disease. It is

often owing to a hereditary disposition. Where this is the case, it

attacks persons more early in life than when it is accidental. Men are

more liable to it than women, especially those of a sanguine, plethoric,

or a scorbutic habit, or of a melancholy disposition.

The piles may be occasioned by an excess of blood, by strong aloetic

purges, high-seasoned food, drinking great quantities of sweet wines,

the neglect of bleeding, or other customary evacuations, much riding,

great costiveness, or any thing that occasions hard or difficult stools.

Anger, grief, or other violent passions, will likewise occasion the

piles. I have often known them brought on by sitting on the damp ground.

A pair of thin breeches will excite the disorder in a person who is

subject to it, and sometimes even in those who never had it before.

Pregnant women are often afflicted with the piles.

A flux of blood from the _anus_ is not always to be treated as a

disease. It is even more salutary than bleeding at the nose, and often

prevents or carries off diseases. It is peculiarly beneficial in the

gout, rheumatism, asthma, and hypochondriacal complaints, and often

proves critical in colics, and inflammatory fevers.

In the management of the patient, regard must be had to his habit of

body, his age, strength, and manner of living. A discharge which might

be excessive and prove hurtful to one, may be very moderate, and even

salutary to another. That only is to be esteemed dangerous which

continues too long, and is in such quantity as to waste the patient’s

strength, hurt the digestion, nutrition, and other functions necessary

to life.

When this is the case, the discharge must be checked by a proper

regimen, and astringent medicines. The DIET must be cool but nourishing,

consisting chiefly of bread, milk, cooling vegetables and broths. The

drink may be chalybeate water, orange-whey, decoctions or infusions of

the astringent and mucilaginous plants, as the tormentil root, bistort,

the marsh-mallow-roots, &c.

Old conserve of red roses is a very good medicine in this case. It may

be mixed with new milk, and taken in the quantity of an ounce three or

four times a-day. This medicine is in no great repute, owing to its

being seldom taken in such quantity as to produce any effects; but when

taken as here directed, and duly persisted in, I have known it perform

very extraordinary cures in violent hæmorrhages, especially when

assisted by the tincture of roses; a tea-cupful of which may be taken

about an hour after every dose of the conserve.

The Peruvian bark is likewise proper in this case, both as a

strengthener and astringent. Half a drachm of it may be taken in a glass

of red-wine, sharpened with a few drops of the elixir of vitriol, three

or four times a-day.

The bleeding piles are sometimes periodical, and return regularly once a

month, or once in three weeks. In this case they are always to be

considered as a salutary discharge, and by no means to be stopped. Some

have entirely ruined their health by stopping a periodical discharge of

blood from the hæmorrhoidal veins.

In the _blind piles_ bleeding is generally of use. The diet must be

light and thin, and the drink cool and diluting. It is likewise

necessary that the body be kept gently open. This may be done by small

doses of the flowers of brimstone and cream of tartar. These may be

mixed in equal quantities, and a tea-spoonful taken two or three times

a-day, or oftner if necessary. Or an ounce of the flowers of brimstone

and half an ounce of purified nitre may be mixed with three or four

ounces of the lenitive electuary, and a tea-spoonful of it taken three

or four times a-day.

Emollient clysters are here likewise beneficial; but there is sometimes

such an astriction of the _anus_, that they cannot be thrown up. In this

case I have known a vomit have a very good effect.

When the piles are exceeding painful and swelled, but discharge nothing,

the patient must sit over the steams of warm water. He may likewise

apply a linen cloth dipped in warm spirits of wine to the part, or

poultices made of bread and milk, or of leeks fried with butter. If

these do not produce a discharge, and the piles appear large, leeches

must be applied as near them as possible, or, if they will fix upon the

piles themselves, so much the better. When leeches will not fix, the

piles may be opened with a lancet. The operation is very easy, and is

attended with no danger.

Various ointments, and other external applications, are recommended in

the piles; but I do not remember to have seen any effects from these

worth mentioning. Their principal use is to keep the part moist, which

may be done as well by a soft poultice, or an emollient cataplasm. When

the pain however is very great, a liniment made of two ounces of

emollient ointment, and half an ounce of liquid laudanum, beat up with

the yolk of an egg, may be applied.

SPITTING OF BLOOD.

We mean here to treat of that discharge of blood from the lungs only

which is called an _hæmoptoe_, or _spitting of blood_. Persons of a

slender make, and a lax fibre, who have long necks and strait breasts,

are most liable to this disease. It is most common in the spring, and

generally attacks people before they arrive at the prime or middle

period of life. It is a common observation, that those who have been

subject to bleeding at the nose when young, are afterwards most liable

to an hæmoptoe.

CAUSES.——An hæmoptoe may proceed from excess of blood, from a peculiar

weakness of the lungs, or a bad conformation of the breast. It is often

occasioned by excessive drinking, running, wrestling, singing, or

speaking aloud. Such as have weak lungs ought to avoid all violent

exertions of that organ, as they value life. They should likewise guard

against violent passions, excessive drinking, and every thing that

occasions a rapid circulation of the blood.

This disease may likewise proceed from wounds of the lungs. These may

either be received from without, or they may be occasioned by hard

bodies getting into the wind-pipe, and so falling down upon the lungs,

and hurting that tender organ. The obstruction of any customary

evacuation may occasion a spitting of blood; as neglect of bleeding or

purging at the usual seasons, the stoppage of the bleeding piles in men,

or the menses in women, &c. It may likewise proceed from a polypus,

scirrhous concretions, or any thing that obstructs the circulation of

the blood in the lungs. It is often the effect of a long and violent

cough; in which case it is generally the forerunner of a consumption. A

violent degree of cold suddenly applied to the external parts of the

body will occasion an hæmoptoe. It may likewise be occasioned by

breathing air which is too much rarified to be able properly to expand

the lungs. This is often the case with those who work in hot places, as

furnaces, glasshouses, or the like. It is likewise said to happen to

such as ascend to the top of very high mountains, as the Peak of

Teneriff, &c.

Spitting of blood is not always to be considered as a primary disease.

It is often only a symptom, and in some diseases not an unfavourable

one. This is the case in pleurisies, peripneumonies, and sundry other

fevers. In a dropsy, scurvy, or consumption, it is a bad symptom, and

shews that the lungs are ulcerated.

SYMPTOMS.——Spitting of blood is generally preceded by a sense of weight,

and oppression of the breast, a dry tickling cough, hoarseness, and a

difficulty of breathing. Sometimes it is ushered in with shivering

coldness of the extremities, costiveness, great lassitude, flatulence,

pain of the back and loins, &c. As these shew a general stricture upon

the vessels, and a tendency of the blood to inflammation, they are

commonly the forerunners of a very copious discharge. The above symptoms

do not attend a discharge of blood from the gums or fauces, by which

means these may always be distinguished from an hæmoptoe. Sometimes the

blood that is spit up is thin, and of a florid red colour; and at other

times it is thick, and of a dark or blackish colour; nothing however can

be inferred from this circumstance, but that the blood has lain a longer

or shorter time in the breast before it was discharged.

Spitting of blood, in a strong healthy person, of a sound constitution,

is not very dangerous; but when it attacks the tender and delicate, or

persons of a weak lax fibre, it is with difficulty removed. When it

proceeds from a scirrhus or polypus of the lungs, it is bad. The danger

is greater when the discharge proceeds from the rupture of a large

vessel than of a small one. When the extravasated blood is not spit up,

but lodges in the breast, it corrupts, and greatly increases the danger.

When the blood proceeds from an ulcer in the lungs, it is generally

fatal.

REGIMEN.——The patient ought to be kept cool and easy. Every thing that

heats the body or quickens the circulation, increases the danger. The

mind ought likewise to be soothed, and every occasion of exciting the

passions avoided. The diet should be soft, cooling, and slender; as rice

boiled with milk, small broths, barley-gruels, panado, &c. The diet, in

this case, can scarce be too low. Even water-gruel is sufficient to

support the patient for some days. All strong liquors must be avoided.

The patient may drink milk and water, barley-water, whey, butter-milk,

and such like. Every thing however should be drank cold, and in small

quantities at a time. He should observe the strictest silence, or at

least speak with a very low voice.

MEDICINE.——This, like the other involuntary discharges of blood, ought

not to be suddenly stopped by astringent medicines. More mischief is

often done by these than if it were suffered to go on. It may however

proceed so far as to weaken the patient, and even endanger his life; in

which case proper means must be used for restraining it.

The body should be kept gently open by laxative diet; as roasted apples,

stewed prunes, and such like. If these should not have the desired

effect, a tea-spoonful of the lenitive electuary may be taken twice or

thrice a-day, as is found necessary. If the bleeding proves violent,

ligatures may be applied to the extremities, as directed for a bleeding

at the nose.

If the patient be hot or feverish, bleeding and small doses of nitre

will be of use; a scruple or half a drachm of nitre may be taken in a

cup of his ordinary drink twice or thrice a-day. His drink may likewise

be sharpened with acids, as juice of lemon, or a few drops of the spirit

of vitriol; or he may take frequently a cup of the tincture of roses.

Bathing the feet and legs in lukewarm water has likewise a very good

effect in this disease. Opiates too are sometimes beneficial; but these

must be administered with caution. Ten or twelve drops of laudanum may

be given in a cup of barley-water twice a-day, and continued for some

time, provided they be found beneficial.

The conserve of roses is likewise a very good medicine in this case,

provided it be taken in sufficient quantity, and long enough persisted

in. It may be taken to the quantity of three or four ounces a-day; and,

if the patient be troubled with a cough, it should be made into an

electuary with balsamic syrup, and a little of the syrup of poppies.

If stronger astringents be necessary, fifteen or twenty drops of the

elixir of vitriol may be given in a glass of water three or four times

a-day.

Those who are subject to frequent returns of this disease should avoid

all excess. Their diet should be light and cool, consisting chiefly of

milk and vegetables. Above all, let them beware of vigorous efforts of

the body, and violent agitations of the mind.

VOMITING OF BLOOD.

This is not so common as the other discharges of blood which have

already been mentioned; but it is very dangerous, and requires

particular attention.

Vomiting of blood is generally preceded by pain of the stomach,

sickness, and nausea; and is accompanied with great anxiety, and

frequent fainting fits.

This disease is sometimes periodical; in which case it is less

dangerous. It often proceeds from an obstruction of the menses in women;

and sometimes from the stopping of the hæmorrhoidal flux in men. It may

be occasioned by any thing that greatly stimulates or wounds the

stomach, as strong vomits or purges, acrid poisons, sharp or hard

substances taken into the stomach, &c. It is often the effect of

obstructions in the liver, the spleen, or some of the other viscera. It

may likewise proceed from external violence, as blows or bruises, or

from any of the causes which produce inflammation. In hysteric women,

vomiting of blood is a very common, but by no means a dangerous symptom.

A great part of the danger in this disease arises from the extravasated

blood lodging in the bowels, and becoming putrid, by which means a

dysentery or putrid fever may be occasioned. The best way of preventing

this, is to keep the body gently open, by frequently exhibiting

emollient clysters. Purges must not be given till the discharge is

stopt, otherwise they will irritate the stomach, and increase the

disorder. All the food and drink must be of a mild cooling nature, and

taken in small quantities. Even drinking cold water has sometimes proved

a remedy, but it will succeed better when sharpened with the weak

spirits of vitriol. When there are signs of an inflammation, bleeding

may be necessary; but the patient’s weakness will seldom permit it.

Opiates may be of use; but they must be given in very small doses, as

four or five drops of liquid laudanum twice or thrice a-day.

After the discharge is over, as the patient is generally troubled with

gripes, occasioned by the acrimony of the blood lodged in the

intestines, gentle purges will be necessary.

OF BLOODY URINE.

This is a discharge of blood from the vessels of the kidneys or bladder,

occasioned by their being either enlarged, broken, or eroded. It is more

or less dangerous according to the different circumstances which attend

it.

When pure blood is voided suddenly without interruption and without

pain, it proceeds from the kidneys; but if the blood be in small

quantity, of a dark colour, and emitted with heat and pain about the

bottom of the belly, it proceeds from the bladder. When bloody urine is

occasioned by a rough stone descending from the kidneys to the bladder,

which wounds the _ureters_, it is attended with a sharp pain in the

back, and difficulty of making water. If the coats of the bladder are

hurt by a stone, and the bloody urine follows, it is attended with the

most acute pain, and a previous stoppage of urine.

Bloody urine may likewise be occasioned by falls, blows, the lifting or

carrying of heavy burdens, hard riding, or any violent motion. It may

also proceed from ulcers of the bladder, from a stone lodged in the

kidneys, or from violent purges, or sharp diuretic medicines, especially

cantharides.

Bloody urine is always attended with some degree of danger: but it is

peculiarly so when mixed with purulent matter, as this shews an ulcer

somewhere in the urinary passages. Sometimes this discharge proceeds

from excess of blood, in which case it is rather to be considered as a

salutary evacuation than a disease. If the discharge however be very

great, it may waste the patient’s strength, and occasion an ill habit of

body, a dropsy, or a consumption.

The treatment of this disorder must be varied according to the different

causes from which it proceeds.

When it is owing to a stone in the bladder, the cure depends upon an

operation; a description of which would be foreign to our purpose.

If it be attended with a plethora, and symptoms of inflammation,

bleeding will be necessary. The body must likewise be kept open by

emollient clysters, or cooling purgative medicines; as cream of tartar,

rhubarb, manna, or small doses of lenitive electuary.

When bloody urine proceeds from a dissolved state of the blood, it is

commonly the symptom of some malignant disease; as the small-pox, a

putrid fever, or the like. In this case the patient’s life depends on

the liberal use of the Peruvian bark and acids, as has already been

shewn.

When there is reason to suspect an ulcer in the kidneys or bladder, the

patient’s diet must be cool, and his drink of a soft, healing, balsamic

quality, as decoctions of marsh-mallow roots with liquorice, solutions

of gum-arabic, &c. Three ounces of marsh-mallow roots, and half an ounce

of liquorice, may be boiled in two English quarts of water to one; two

ounces of gum-arabic, and half an ounce of purified nitre, may be

dissolved in the strained liquor, and a tea-cupful of it taken four or

five times a-day.

The early use of astringents in this disease has often bad consequences.

When the flux is stopped too soon, the grumous blood, by being confined

in the vessels, may produce inflammations, abscess, and ulcers. If

however the case be urgent, or the patient seems to suffer from the loss

of blood, gentle astringents may be necessary. In this case the patient

may take three or four ounces of lime-water, with half an ounce of the

tincture of Peruvian bark, three times a-day.

OF THE DYSENTERY, OR BLOODY FLUX.

This disease prevails in the spring and autumn. It is most common in

marshy countries, where, after hot and dry summers, it is apt to become

epidemic. Persons are most liable to it who are much exposed to the

night-air, or who live in places where the air is confined and

unwholesome. Hence it often proves fatal in camps, on shipboard, in

jails, hospitals, and such like places.

CAUSES.——The dysentery may be occasioned by any thing that obstructs the

perforation, or renders the humours putrid; as damp beds, wet clothes,

unwholesome diet, air, &c. But it is most frequently communicated by

infection. This ought to make people extremely cautious in going near

such persons as labour under the disease. Even the smell of the

patient’s excrements has been known to communicate the infection.

SYMPTOMS.——It is known by a flux of the belly, attended with violent

pain of the bowels, a constant inclination to go to stool, and generally

more or less blood in the stools. It begins, like other fevers, with

chillness, loss of strength, a quick pulse, great thirst, and an

inclination to vomit. The stools are at first greasy and frothy,

afterwards they are streaked with blood, and at last have frequently the

appearance of pure blood, mixed with small filaments resembling bits of

skin. Worms are sometimes passed both upwards and downwards through the

whole course of the disease. When the patient goes to stool, he feels a

bearing down, as if the whole bowels were falling out, and sometimes a

part of the intestine is actually protruded, which proves exceeding

troublesome, especially in children. Flatulency is likewise a

troublesome symptom, especially towards the end of the disease.

This disease may be distinguished from a diarrhœa or looseness, by the

acute pain of the bowels, and the blood which generally appears in the

stools. It may be distinguished from the _cholera morbus_ by its not

being attended with such violent and frequent fits of vomiting, &c.

When the dysentery attacks the old, the delicate, or such as have been

wasted by the gout, the scurvy, or other lingering diseases, it

generally proves fatal. Vomiting and hiccuping are bad signs, as they

shew an inflammation of the stomach. When the stools are green, black,

or have an exceeding disagreeable cadaverous smell, the danger is very

great, as it shows the disease to be of the putrid kind. It is an

unfavourable symptom when clysters are immediately returned; but still

more so, when the passage is so obstinately shut, that they cannot be

injected. A feeble pulse, coldness of the extremities, with difficulty

of swallowing, and convulsions, are signs of approaching death.

REGIMEN.——Nothing is of more importance in this disease than

cleanliness. It contributes greatly to the recovery of the patient, and

no less to the safety of such as attend him. In all contagious diseases

the danger is increased, and the infection spread, by the neglect of

cleanliness, but in no one more than this. Every thing about the patient

should be frequently changed. The excrements should never be suffered to

continue in his chamber, but removed immediately, and buried under

ground. A constant stream of fresh air should be admitted into the

chamber; and it ought frequently to be sprinkled with vinegar, juice of

lemon, or some other strong acid.

The patient must not be discouraged, but his spirits kept up in hopes of

a cure. Nothing tends more to render any putrid disease mortal, than the

fears and apprehensions of the sick. All diseases of this nature have a

tendency to sink and depress the spirits, and when that is increased by

fears and alarms from those whom the patient believes to be persons of

skill, it cannot fail to have the worst effects.

A flannel waistcoat worn next the skin has often a very good effect in

the dysentery. This promotes the perspiration without overheating the

body. Great caution however is necessary in leaving it off. I have often

known a dysentery brought on by imprudently throwing off a flannel

waistcoat before the season was sufficiently warm. For whatever purpose

this piece of dress is worn, it should never be left off but in a warm

season.

In this disease the greatest attention must be paid to the patient’s

diet. Flesh, fish, and every thing that has a tendency to turn putrid or

rancid on the stomach, must be abstained from. Apples boiled in milk,

water-pap, and plain light pudding, with broth made of the gelatinous

parts of animals, may constitute the principal part of the patient’s

food. Gelatinous broth not only answers the purpose of food, but

likewise of medicine. I have often known dysenteries, which were not of

a putrid nature, cured by it after pompous medicines had proved

ineffectual[126].

Another kind of food very proper in the dysentery, which may be used by

such as cannot take the broth mentioned above, is made by boiling a few

handfuls of fine flour, tied in a cloth, for six or seven hours, till it

becomes as hard as starch. Two or three table-spoonfuls of this may be

grated down, and boiled in such a quantity of new milk and water as to

be of the thickness of pap. This may be sweetened to the patient’s

taste, and taken for his ordinary food[127].

In a _putrid dysentery_ the patient may be allowed to eat freely of most

kinds of good ripe fruit; as apples, grapes, gooseberries,

currant-berries, strawberries, &c. These may either be eaten raw or

boiled, with or without milk, as the patient chuses. The prejudice

against fruit in this disease is so great, that many believe it to be

the common cause of dysenteries. This however is an egregious mistake.

Both reason and experience shew, that good fruit is one of the best

medicines, both for the prevention and cure of the dysentery. Good fruit

is in every respect calculated to counteract that tendency to

putrefaction, from whence the most dangerous kind of dysentery proceeds.

The patient in such a case ought therefore be allowed to eat as much

fruit as he pleases, provided it be ripe[128].

The most proper drink in this disorder is whey. The dysentery has often

been cured by the use of clear whey alone. It may be taken both for

drink and in form of clyster. When whey cannot be had, barley-water

sharpened with cream of tartar may be drank, or a decoction of barley

and tamarinds; two ounces of the former and one of the latter may be

boiled in two English quarts of water to one. Warm water, water-gruel,

or water wherein hot iron has been frequently quenched, are all very

proper, and may be drank in turns. Camomile-tea, if the stomach will

bear it, is an exceeding proper drink. It both strengthens the stomach,

and by its antiseptic quality tends to prevent a mortification of the

bowels.

MEDICINE.——At the beginning of this disease it is always necessary to

cleanse the first passages. For this purpose a vomit of ipecacuanha must

be given, and wrought off with weak camomile-tea. Strong vomits are

seldom necessary here. A scruple, or at most half a drachm of

ipecacuanha, is generally sufficient for an adult, and sometimes a very

few grains will suffice. The day after the vomit, half a drachm, or two

scruples of rhubarb, must be taken; or, what will answer the purpose

rather better, an ounce or an ounce and a half of Epsom salts. This dose

may be repeated every other day for two or three times. Afterwards small

doles of ipecacuanha may be taken for some time. Two or three grains of

the powder may be mixed in a table-spoonful of the syrup of poppies, and

taken three times a day.

These evacuations, and the regimen prescribed above, will often be

sufficient to effect a cure. Should it however happen otherwise, the

following astringent medicines may be used.

A clyster of starch or fat mutton-broth, with thirty or forty drops of

liquid laudanum in it, may be administered twice a-day. At the same time

an ounce of gum-arabic, and half an ounce of gum-tragacanth, may be

dissolved in an English pint of barley-water, over a slow fire, and a

table-spoonful of it taken every hour.

If these have not the desired effect, the patient may take, four times

a-day, about the bulk of a nutmeg of the _Japonic confection_, drinking

after it a tea-cupful of the decoction of logwood[129].

Persons who have been cured of this disease are very liable to suffer a

relapse; to prevent which, great circumspection with respect to diet is

necessary. The patient must abstain from all fermented liquors, except

now and then a glass of good wine; but he must drink no kind of

malt-liquor. He should likewise abstain from animal food, as fish and

flesh, and live principally on milk and vegetables.

Gentle exercise and wholesome air are likewise of importance. The

patient should go to the country as soon as his strength will permit,

and should take exercise daily on horseback, or in a carriage. He may

likewise use bitters infused in wine or brandy, and may drink twice

a-day a gill of lime-water mixed with an equal quantity of new milk.

When dysenteries prevail, we would recommend a strict attention to

cleanliness, a spare use of animal food, and the free use of sound ripe

fruits, and other vegetables. The night air is to be carefully avoided,

and all communication with the sick. Bad smells are likewise to be

shunned, especially those which arise from putrid animal substances. The

necessaries where the sick go are carefully to be avoided.

When the first symptoms of the dysentery appear, the patient ought

immediately to take a vomit, to go to bed, and drink plentifully of weak

warm liquor, to promote a sweat. This, with a dose or two of rhubarb at

the beginning, would often carry off the disease. In countries where

dysenteries prevail, we would advise such as are liable to them, to take

either a vomit or a purge every spring or autumn, as a preventive.

There are sundry other fluxes of the belly, as the LIENTERY and CŒLIAC

PASSION, which, though less dangerous than the dysentery, yet merit

consideration. These diseases generally proceed from a relaxed state of

the stomach and intestines, which is sometimes so great, that the food

passes through them without almost any sensible alterations; and the

patient dies merely from the want of nourishment.

When the lientery or cœliac passion succeeds to a dysentery, the case is

bad. They are always dangerous in old age, especially when the

constitution has been broken by excess or acute diseases. If the stools

be very frequent, and quite crude, the thirst great, with little urine,

the mouth ulcerated, and the face marked with spots of different

colours, the danger is very great.

The treatment of the patient is in general the same as in the dysentery.

In all obstinate fluxes of the belly, the cure must be attempted, by

first cleansing the stomach and bowels with gentle vomits and purges;

afterwards such a diet as has a tendency to heal and strengthen the

bowels, with opiates and astringent medicines, will generally perfect

the cure.

The same observation holds with respect to a TENESMUS, or frequent

desire of going to stool. This disease resembles the dysentery so much,

both in its symptoms and method of cure, that we think it needless to

insist upon it.

CHAP. XXXIV.

OF THE HEAD-ACH.

Aches and pains proceed from very different causes, and may affect any

part of the body; but we shall point out those only which occur most

frequently, and are attended with the greatest danger.

When the head-ach is slight, and affects a particular part of the head

only, it is called _cephalalgia_; when the whole head is affected,

_cephalæa_; and when on one side only, _hemicrania_. A fixed pain in the

forehead, which may be covered with the end of the thumb, is called the

_clavis hystericus_.

There are also other distinctions. Sometimes the pain is internal,

sometimes external; sometimes it is an original disease, and at other

times only symptomatic. When the head-ach proceeds from a hot bilious

habit, the pain is very acute and throbbing, with a considerable heat of

the part affected. When from a cold phlegmatic habit, the patient

complains of a dull heavy pain, and has a sense of coldness in the part.

This kind of head-ach is sometimes attended with a degree of stupidity

or folly.

Whatever obstructs the free circulation of the blood through the vessels

of the head, may occasion a head-ach. In persons of a full habit, who

abound with blood, or other humours, the head-ach often proceeds from

the suppression of customary evacuations; as bleeding at the nose,

sweating of the feet, &c. It may likewise proceed from any cause that

determines a great flux of blood towards the head; as coldness of the

extremities, or hanging down the head for a long time. Whatever prevents

the return of the blood from the head will likewise occasion a head-ach;

as looking long obliquely at any object, wearing any thing tight about

the neck, or the like.

When a head-ach proceeds from the stoppage of a running at the nose,

there is a heavy, obtuse, pressing pain in the fore-part of the head, in

which there seems to be such a weight, that the patient can scarce hold

it up. When it is occasioned by the caustic matter of the venereal

disease, it generally affects the skull, and often produces a _caries_

of the bones.

Sometimes the head-ach proceeds from the repulsion or retrocession of

the gout, the erysipelas, the small-pox, measles, itch, or other

eruptive diseases. What is called a _hemicrania_ generally proceeds from

crudities or indigestion. Inanition, or emptiness, will often also

occasion head-achs. I have often seen instances of this in nurses who

gave suck too long, or who did not take a sufficient quantity of solid

food.

There is likewise a most violent, fixed, constant, and almost

intolerable head-ach, which occasions great debility both of body and

mind, prevents sleep, destroys the appetite, causes a _vertigo_, dimness

of sight, a noise in the ears, convulsions, epileptic fits, and

sometimes vomiting, costiveness, coldness of the extremities, &c.

The head-ach is often symptomatic in continual and intermitting fevers,

especially quartans. It is likewise a very common symptom in hysteric

and hypochondriac complaints.

When a head-ach attends an acute fever, with pale urine, it is an

unfavourable symptom. In excessive head-achs, coldness of the

extremities is a bad sign.

When the disease continues long, and is very violent, it often

terminates in blindness, an apoplexy, deafness, a _vertigo_, the palsy,

epilepsy, &c.

In this disease the cool regimen in general is to be observed. The diet

ought to consist of such emollient substances as will correct the

acrimony of the humours, and keep the body open; as apples boiled in

milk, spinage, turnips, and such like. The drink ought to be diluting;

as barley-water, infusions of mild mucilaginous vegetables, decoctions

of the sudorific woods, &c. The feet and legs ought to be kept warm, and

frequently bathed in lukewarm water; the head should be shaved, and

bathed with water and vinegar. The patient ought as much as possible to

keep in an erect posture, and not to lie with his head too low.

When the head-ach is owing to excess of blood, or an hot bilious

constitution, bleeding is necessary. The patient may be bled in the

jugular vein, and the operation repeated if there be occasion. Cupping

also, or the application of leeches to the temples, and behind the ears,

will be of service. Afterwards a blistering-plaster may be applied to

the neck behind the ears, or to any part of the head that is most

affected. In some cases it will be proper to blister the whole head. In

persons of a gross habit, issues or perpetual blisters will be of

service. The body ought likewise to be kept open by gentle laxatives.

But when the head-ach proceeds from a copious vitiated _serum_

stagnating in the membranes, either within or without the skull, with a

dull, heavy, continual pain, which will neither yield to bleeding nor

gentle laxatives, then more powerful purgatives are necessary, as pills

made of aloes, resin of jalap, or the like. It will also be necessary in

this case to blister the whole head, and to keep the back part of the

neck open for a considerable time by a perpetual blister.

When the head-ach is occasioned by the stoppage of a running at the

nose, the patient should frequently smell to a bottle of volatile salts;

he may likewise take snuff, or any thing that will irritate the nose, so

as to promote a discharge from it; as the herb mastich, ground-ivy, &c.

A _hemicrania_, especially a periodical one, is generally owing to a

foulness of the stomach, for which gentle vomits must be administered,

as also purges of rhubarb. After the bowels have been sufficiently

cleared, chalybeate waters, and such bitters as strengthen the stomach,

will be necessary. A periodical head-ach has been cured by wearing a

piece of flannel over the forehead during the night.

When the head-ach arises from a vitiated state of the humours, as in the

scurvy and venereal disease, the patient, after proper evacuations, must

drink freely of the decoction of woods, or the decoction of

sarsaparilla, with raisins and liquorice[130]. These promote

perspiration, sweeten the humours, and, if duly persisted in, will

produce very happy effects. When a collection of matter is felt under

the skin, it must be discharged by an incision, otherwise it will render

the bone carious.

When the head-ach is so intolerable as to endanger the patient’s life,

or is attended with continual watching, delirium, &c. recourse must be

had to opiates. These, after proper evacuations by clysters or mild

purgatives, may be applied both externally and internally. The affected

part may be rubbed with Bate’s anodyne balsam, or a cloth dipped in it

may be applied to the part. The patient may, at the same time, take

twenty drops of laudanum, in a cup of valerian or penny-royal tea, twice

or thrice a day. This is only to be done in case of extreme pain. Proper

evacuations ought always to accompany and follow the use of

opiates[131].

When the patient cannot bear the loss of blood, his feet ought

frequently to be bathed in lukewarm water, and well rubbed with a coarse

cloth. Cataplasms with mustard or horse-radish ought likewise to be

applied to them. This course is peculiarly necessary when the pain

proceeds from a gouty humour affecting the head.

When the head-ach is occasioned by great heat, hard labour, or violent

exercise of any kind, it may be allayed by cooling medicines; as the

saline draughts with nitre, and the like.

A little of Ward’s essence, dropt into the palm of the hand, and applied

to the forehead, will sometimes remove a violent head-ach; and so will

æther, when applied in the same manner.

OF THE TOOTH-ACH.

This disease is so well known, that it needs no description. It has

great affinity with the rheumatism, and often succeeds pains of the

shoulders and other parts of the body.

It may proceed from obstructed perspiration, or any of the other causes

of inflammation. I have often known the tooth-ach occasioned by

neglecting some part of the usual coverings of the head, by sitting with

the head bare near an open window, or exposing it any how to a draught

of cold air. Food or drink taken either too hot or too cold is very

hurtful to the teeth. Great quantities of sugar, or other sweetmeats,

are likewise hurtful. Nothing is more destructive to the teeth than

cracking nuts, or chewing any kind of hard substances. Picking the teeth

with pins, needles, or any thing that may hurt the enamel with which

they are covered, does great mischief, as the tooth is sure to be

spoiled whenever the air gets into it. Breeding women are very subject

to the tooth-ach, especially during the first three or four months of

pregnancy. The tooth-ach often proceeds from scorbutic humours affecting

the gums. In this case the teeth are sometimes wasted, and fall out

without any considerable degree of pain. The more immediate cause of the

tooth-ach is a rotten or _carious_ tooth.

In order to relieve the tooth-ach, we must first endeavour to lessen the

flux of humours to the part affected. This may be done by mild

purgatives, scarifying the gums, or applying leeches to them, and

bathing the feet frequently with warm water. The perspiration ought

likewise to be promoted, by drinking freely of weak wine-whey, or other

diluting liquors, with small doses of nitre. Vomits too have often an

exceeding good effect in the tooth-ach. It is seldom safe to administer

opiates, or any kind of heating medicines, or even to draw a tooth, till

proper evacuations have been premised; and these alone will often effect

the cure.

If this fails, and the pain and inflammation still increase, a

suppuration may be expected, to promote which a toasted fig should be

held between the gum and the cheek; bags filled with boiled

camomile-flowers, flowers of elder, or the like, may be applied near the

part affected, with as great a degree of warmth as the patient can bear,

and renewed as they grow cool: the patient may likewise receive the

steams of warm water into his mouth, through an inverted funnel, or by

holding his head over the mouth of a porringer filled with warm water,

&c.

Such things as promote the discharge of saliva, or cause the patient to

spit, are generally of service. For this purpose, bitter, hot, or

pungent vegetables may be chewed; as gentian, calamus aromaticus, or

pellitory of Spain. Allen recommends the root of _yellow water

flower-de-luce_ in this case. This root may either be rubbed upon the

tooth, or a little of it chewed. Brookes says he hardly ever knew it

fail to ease the tooth-ach. It ought however to be used with caution.

Many other herbs, roots, and seeds, are recommended for curing the

tooth-ach; as the leaves of roots of millefoil or yarrow chewed, tobacco

smoked or chewed, staves-acre, or the seeds of mustard chewed, &c. These

bitter, hot, and pungent things, by occasioning a greater flow of

_saliva_, frequently give ease in the tooth-ach.

Opiates often relieve the tooth-ach. For this purpose a little cotton

wet with laudanum may be held between the teeth; or a piece of

sticking-plaster, about the bigness of a shilling, with a bit of opium

in the middle of it, of a size not to prevent the sticking of the other,

may be laid on the temporal artery, where the pulsation is most

sensible. _De la Motte_ affirms, that there are few cases wherein this

will not give relief. If there be a hollow tooth, a small pill made of

equal parts of camphire and opium, put into the hollow, is often

beneficial. When this cannot be had, the hollow tooth may be filled with

gum mastich, wax, lead, or any substance that will stick in it, and keep

out the external air.

Few applications give more relief in the tooth-ach than

blistering-plasters. These may be applied between the shoulders; but

they have the best effect when put behind the ears, and made so large as

to cover a great part of the lower jaw.

After all, when a tooth is carious, it is often impossible to remove the

pain without extracting it; and, as a spoilt tooth never becomes sound

again, it is prudent to draw it soon, lest it should affect the rest.

Tooth-drawing, like bleeding, is very much practiced by mechanics, as

well as persons of the medical profession. The operation however is not

without danger, and ought always to be performed with care. A person

unacquainted with the structure of the parts will be in danger of

hurting the jaw-bone, or of drawing a sound tooth instead of a rotten

one[132].

When the tooth-ach returns periodically, and the pain chiefly affects

the gums, it may be cured by the bark.

Some pretend to have found great benefit in the tooth-ach, from the

application of an artificial magnet to the affected tooth. We shall not

attempt to account for its mode of operation; but, if it be found to

answer, though only in particular cases, it certainly deserves a trial,

as it is attended with no expence, and cannot do any harm. Electricity

has likewise been recommended, and particular instruments have been

invented for sending a shock through the affected tooth.

Persons who have returns of the tooth-ach at certain seasons, as spring

and autumn, might often prevent it by taking a purge at these times.

Keeping the teeth clean has no doubt a tendency to prevent the

tooth-ach. The best method of doing this is to wash them daily with salt

and water, a decoction of the bark, or with cold water alone. All

brushing and scraping of the teeth is dangerous, and, unless it be

performed with great care, does mischief.

OF THE EAR-ACH.

This disorder chiefly affects the membrane which lines the inner cavity

of the ear called the _meatus auditorius_. It is often so violent as to

occasion great restlessness, anxiety, and even delirium. Sometimes

epileptic fits, and other convulsive disorders, have been brought on by

extreme pain in the ear.

The ear-ach may proceed from any of the causes which produce

inflammation. It often proceeds from a sudden suppression of

perspiration, or from the head being exposed to cold when covered with

sweat. It may also be occasioned by worms, or other insects getting into

the ear, or being bred there; or from any hard body sticking in the ear.

Sometimes it proceeds from the translation of morbific matter to the

ear. This often happens in the decline of malignant fevers, and

occasions deafness, which is generally reckoned a favourable symptom.

When the ear-ach proceeds from insects, or any hard body sticking in the

ear, every method must be taken to remove them as soon as possible. The

membranes may be relaxed by dropping into the ear oil of sweet almonds,

or olive oil. Afterwards the patient should be made to sneeze, by taking

snuff, or some strong sternutatory. If this should not force out the

body, it must be extracted by art. I have seen insects, which had got

into the ear, come out of their own accord upon pouring in oil, which is

a thing they cannot bear.

When the pain of the ear proceeds from inflammation, it must be treated

like other topical inflammations, by a cooling regimen, and opening

medicines. Bleeding at the beginning, either in the arm or jugular vein,

or cupping in the neck, will be proper. The ear may likewise be fomented

with steams of warm water; or flannel bags filled with boiled mallows

and camomile flowers may be applied to it warm; or bladders filled with

warm milk and water. An exceeding good method of fomenting the ear is to

apply it close to the mouth of a jug filled with warm water, or a strong

decoction of camomile flowers.

The patient’s feet should be frequently bathed in lukewarm water, and he

ought to take small doses of nitre and rhubarb, _viz._ a scruple of the

former, and ten grains of the latter, three times a-day. His drink may

be whey, or decoction of barley and liquorice with figs or raisins. The

parts behind the ear ought frequently to be rubbed with camphorated oil,

or a little of the volatile liniment.

When the inflammation cannot be discussed, a poultice of bread and milk,

or roasted onions, may be applied to the ear, and frequently renewed,

till the abscess breaks, or can be opened. Afterwards the humours may be

diverted from the part by gentle laxatives, blisters, or issues; but the

discharge must not be suddenly dried up by any external application.

PAIN OF THE STOMACH, &c.

This may proceed from various causes; as indigestion; wind; the acrimony

of the bile; sharp, acrid, or poisonous substances taken into the

stomach, &c. It may likewise be occasioned by worms; the stoppage of

customary evacuations; a translation of gouty matter to the stomach, the

bowels, &c.

Women in the decline of life are very liable to pains of the stomach and

bowels, especially such as are afflicted with hysteric complaints. It is

likewise very common to hypochondriac men of a sedentary and luxurious

life. In such persons it often proves so extremely obstinate as to

baffle all the powers of medicine.

When the pain of the stomach is most violent after eating, there is

reason to suspect that it proceeds from some fault either in the

digestion or the food. In this case the patient ought to change his

diet, till he finds what kind of food agrees best with his stomach, and

should continue chiefly to use it. If a change of diet does not remove

the complaint, the patient may take a gentle vomit, and afterwards a

dose or two of rhubarb. He ought likewise to take an infusion of

camomile flowers, or some other stomachic bitter, either in wine or

water. I have often known exercise remove this complaint, especially

sailing, or a long journey on horseback, or in a carriage.

When a pain of the stomach proceeds from flatulency, the patient is

constantly belching up wind, and feels an uneasy distention of the

stomach after meals. This is a most deplorable disease, and is seldom

thoroughly cured. In general, the patient ought to avoid all windy diet,

and every thing that sours on the stomach, as greens, roots, &c. This

rule however admits of some exceptions. There are many instances of

persons very much troubled with wind, who have received great benefit

from eating parched pease, though that grain is generally supposed to be

of a windy nature[133].

This complaint may likewise be greatly relieved by labour, especially

digging, reaping, mowing, or any kind of active employment by which the

bowels are alternately compressed and dilated. The most obstinate case

of this kind I ever met with was in a person of a sedentary occupation,

whom I advised, after he had tried every kind of medicine in vain, to

turn gardener; which he did, and has ever since enjoyed good health.

When a pain of the stomach is occasioned by the swallowing of acrid or

poisonous substances, they must be discharged by vomit; this may be

excited by butter, oils, or other soft things, which sheath and defend

the stomach from the acrimony of its contents.

When pain of the stomach proceeds from a translation of gouty matter,

warm cordials are necessary, as generous wines, French brandy, &c. Some

have drank a whole bottle of brandy or rum, in this case, in a few

hours, without being in the least intoxicated, or even feeling the

stomach warmed by it. It is impossible to ascertain the quantities

necessary upon these occasions. This must be left to the feelings and

discretion of the patient. The safer way however is, not to go too far.

When there is an inclination to vomit, it may be promoted by drinking an

infusion of camomile flowers, or _carduus benedictus_.

If a pain of the stomach proceed from the stoppage of customary

evacuations, bleeding will be necessary, especially in sanguine and very

full habits. It will likewise be of use to keep the body gently open by

mild purgatives; as rhubarb or senna, &c. When this disease affects

women, in the decline of life, after the stoppage of the _menses_,

making an issue in the leg or arm will be of peculiar service.

When the disease is occasioned by worms, they must be destroyed, or

expelled by such means as are recommended in the following section.

When the stomach is greatly relaxed and the digestion bad, which often

occasion flatulencies, the elixir of vitriol will be of singular

service. Fifteen or twenty drops of it may be taken in a glass of wine

or water twice or thrice a-day.

Persons afflicted with flatulency are generally unhappy unless they be

taking some purgative medicines; these, though they may give immediate

ease, tend to weaken and relax the stomach and bowels, and consequently

increase the disorder. Their best method is to mix purgatives and

stomachics together. Equal parts of Peruvian bark and rhubarb may be

infused in brandy or wine, and taken in such quantity as to keep the

body gently open.

CHAP. XXXV.

OF WORMS.

These are chiefly of three kinds, _viz._ the _tænia_, or tape-worm; the

_teres_, or round and long worm; and the _ascarides_, or round and short

worm. There are many other kinds of worms found in the human body; but

as they proceed, in a great measure, from similar causes, have nearly

the same symptoms, and require almost the same method of treatment as

these already mentioned, we shall not spend time in enumerating them.

The tape-worm is white, very long, and full of joints. It is generally

bred either in the stomach or small intestines. The round and long worm

is likewise bred in the small guts, and sometimes in the stomach. The

round and short worms commonly lodge in the _rectum_, or what is called

the end gut, and occasion a disagreeable itching about the seat.

The long round worms occasion squeamishness, vomiting, a disagreeable

breath, gripes, looseness, swelling of the belly, swoonings, loathing of

food, and at other times a voracious appetite, a dry cough, convulsions,

epileptic fits, and sometimes a privation of speech. These worms have

been known to perforate the intestines, and get into the cavity of the

belly. The effects of the tape-worm are nearly the same with those of

the long and round, but rather more violent.

Andry says, the following symptoms particularly attend the _solium_,

which is a species of the tape-worm, _viz._ swoonings, privation of

speech, and a voracious appetite. The round worms called _ascarides_,

besides an itching of the _anus_, cause swoonings, and tenesmus, or an

inclination to go to stool.

CAUSES.——Worms may proceed from various causes; but they are seldom

found except in weak and relaxed stomachs, where the digestion is bad.

Sedentary persons are more liable to them than the active and laborious.

Those who eat great quantities of unripe fruit, or who live much on raw

herbs and roots, are generally subject to worms. There seems to be a

hereditary disposition in some persons to this disease. I have often

seen all the children of a family subject to worms of a particular kind.

They seem likewise frequently to be owing to the nurse. Children of the

same family, nursed by one woman, have often worms, when those nursed by

another have none.

SYMPTOMS.——The common symptoms of worms are, paleness of the

countenance, and at other times, an universal flushing of the face;

itching of the nose; this however is doubtful, as children pick their

noses in all diseases; starting, and grinding of the teeth in sleep;

swelling of the upper lip; the appetite sometimes bad, at other times

quite voracious; looseness; a sour or stinking breath; a hard swelled

belly; great thirst; the urine frothy, and sometimes of a whitish

colour; griping, or colic pains; an involuntary discharge of _saliva_,

especially when asleep; frequent pains of the side, with a dry cough,

and unequal pulse; palpitations of the heart; swoonings; drowsiness;

cold sweats; palsy; epileptic fits, with many other unaccountable

nervous symptoms, which were formerly attributed to witchcraft, or the

influence of evil spirits. Small bodies in the excrements resembling

melon or cucumber seeds are symptoms of the tape-worm.

I lately saw some very surprising effect of worms in a girl about five

years of age, who used to lie for whole hours as if dead. She at last

expired, and, upon opening her body, a number of the _teres_, or long

round worms, were found in her guts, which were considerably inflamed;

and what anatomists call an _intus susceptio_, or involving of one part

of the gut within another, had taken place in no less than four

different parts of the intestinal canal[134].