To restrain the flux, the patient should be kept quiet and easy both in

body and mind. If it be very violent, she ought to lie in bed with her

head low; to live upon a cool and slender diet, as veal or chicken

broths with bread; and to drink decoctions of nettle-roots, or the

greater comfrey. If these be not sufficient to stop the flux, stronger

astringents may be used, as Japan earth, allum, elixir of vitriol, the

Peruvian bark, &c.[179]

The _uterine flux_ may offend in quality as well as in quantity. What is

usually called the _fluor albus_, or whites, is a very common disease,

and proves extremely hurtful to delicate women. This discharge, however,

is not always white, but sometimes pale, yellow, green, or of a blackish

colour; sometimes it is sharp and corrosive, sometimes foul and fœtid,

&c. It is attended with a pale complexion, pain in the back, loss of

appetite, swelling of the feet, and other signs of debility. It

generally proceeds from a relaxed state of the body, arising from

indolence, the excessive use of tea, coffee, or other weak and watery

diet.

To remove this disease, the patient must take as much exercise as she

can bear without fatigue. Her food should be solid and nourishing, but

of easy digestion; and her drink rather generous, as red port or claret,

mixed with Pyrmont, Bristol, or lime-water. Tea and coffee are to be

avoided. I have often known strong broths have an exceeding good effect,

and sometimes a milk diet alone will perform a cure. The patient ought

not to lie too long a-bed. When medicine is necessary, we know none

preferable to the Peruvian bark, which in this case ought always to be

taken in substance. In warm weather, the cold bath will be of

considerable service.

That period of life at which the _menses_ cease to flow, is likewise

very critical to the sex. The stoppage of any customary evacuation,

however small, is sufficient to disorder the whole frame, and often to

destroy life itself. Hence it comes to pass, that so many women either

fall into chronic disorders, or die about this time. Such of them,

however, as survive it, without contracting any chronic disease, often

become more healthy and hardy than they were before, and enjoy strength

and vigour to a very great age.

If the _menses_ cease all of a sudden, in women of a full habit, they

ought to abate somewhat of their usual quantity of food, especially of

the more nourishing kind, as flesh, eggs, &c. They ought likewise to

take sufficient exercise, and to keep the body open. This may be done by

taking, once or twice a-week, a little rhubarb, or an infusion of hiera

picra in wine or brandy.

It often happens that women of a gross habit, at this period of life,

have ulcerous sores break out about their ancles, or in other parts of

the body. Such ulcers ought to be considered as critical, and should

either be suffered to continue open, or have artificial drains

substituted in their stead. Women who will have such sores dried up, are

often soon after carried off by acute diseases, or fall into those of a

chronic nature.

OF PREGNANCY.

Though pregnancy is not a disease, yet that state is often attended with

a variety of complaints which merit attention, and which sometimes

require the assistance of medicine. Some women indeed are more healthy

during their pregnancy than at any other time; but this is by no means

the general case: most of them _breed in sorrow_, and are frequently

indisposed during the whole time of pregnancy. Few fatal diseases,

however, happen during that period; and hardly any, except abortion,

that can be called dangerous. We shall therefore pay particular

attention to it, as it proves generally fatal to the child, and

sometimes so to the mother.

Pregnant women are often afflicted with the heart-burn. The method of

treating this complaint has been already pointed out. They are likewise,

in the more early periods of pregnancy, often harassed with sickness and

vomiting, especially in the morning. The method of relieving these

complaints has also been shewn. Both the head-ach and tooth-ach are very

troublesome symptoms of pregnancy. The former may generally be removed

by keeping the body gently open, by the use of prunes, figs, roasted

apples, and such like. When the pain is very violent, bleeding may be

necessary. For the treatment of the latter, we must refer to that

article. Several other complaints incident to pregnant women might be

mentioned, as a cough and difficulty of breathing, suppression and

incontinency of urine, &c.; but as all of these have been taken notice

of before, it is needless to repeat them.

Every pregnant woman is more or less in danger of abortion. This should

be guarded against with the greatest care, as it not only weakens the

constitution, but renders the woman liable to the same misfortune

afterwards[180]. Abortion may happen at any period of pregnancy, but it

is most common in the second or third month. Sometimes, however, it

happens in the fourth or fifth. If it happens within the first month, it

is usually called a false conception; if after the seventh month, the

child may often be kept alive by proper care.

The common causes of abortion are, the death of the child; weakness or

relaxation of the mother; great evacuations; violent exercise; raising

great weights; reaching too high; jumping, or stepping from an eminence;

vomiting; coughing; convulsion fits; blows on the belly; falls; fevers;

disagreeable smells; excess of blood; indolence; high living; or the

contrary; violent passions or affections of the mind, as fear, grief,

&c.

The signs of approaching abortion are, pain in the loins, or about the

bottom of the belly; a dull heavy pain in the inside of the thighs; a

slight degree of coldness, or shivering; sickness, palpitation of the

heart; the breasts become flat and soft; the belly falls; and there is a

discharge of blood or watery humours from the womb.

To prevent abortion, we would advise women of a weak or relaxed habit to

use solid food, avoiding great quantities of tea, and other weak and

watery liquors; to rise early and go soon to bed; to shun damp houses;

to take frequent exercise in the open air, but to avoid fatigue; and

never to go abroad in damp foggy weather, if they can shun it.

Women of a full habit ought to use a spare diet, avoiding strong

liquors, and every thing that may tend to heat the body, or increase the

quantity of blood. Their diet should be of an opening nature, consisting

principally of vegetable substances. Every woman with child ought to be

kept cheerful and easy in her mind. Her appetites, even though depraved,

ought to be indulged as far as prudence will permit.

When any signs of abortion appear, the woman ought to be laid in bed on

a mattrass, with her head low. She should be kept quiet, and her mind

soothed and comforted. She ought not to be kept too hot, nor to take any

thing of a heating nature. Her food should consist of broths, rice and

milk, jellies, gruels made of oatmeal, and the like, all of which ought

to be taken cold.

If she be able to bear it, she should lose at least half a pound of

blood from the arm. Her drink ought to be barley-water sharpened with

juice of lemon; or she may take half a drachm of powdered nitre, in a

cup of water-gruel, every five or six hours. If the woman be seized with

a violent looseness, she ought to drink the decoction of calcined

hartshorn prepared. If she be affected with vomiting, let her take

frequently two table-spoonfuls of the saline mixture. In general,

opiates are of service; but they should always be given with caution.

Sanguine robust women, who are liable to miscarry at a certain time of

pregnancy, ought always to be bled a few days before that period

arrives. By this means, and observing the regimen above prescribed, they

might often escape that misfortune.

Though we recommend due care for preventing abortion, we would not be

understood as restraining pregnant women from their usual exercises.

This would generally operate the quite contrary way. Want of exercise

not only relaxes the body, but induces a plethora, or too great a

fulness of the vessels, which are the two principal causes of abortion.

There are, however, some women of so delicate a texture, that it is

necessary for them to avoid almost every kind of exercise during the

whole period of pregnancy.

OF CHILD-BIRTH.

Many diseases proceed from the want of due care in child-bed; and the

more hardy part of the sex are most apt to despise the necessary

precautions in this state. This is peculiarly the case with young wives.

They think, when the labour-pains are ended, the danger is over; but in

truth it may only then be said to be begun. Nature, if left to herself,

will seldom fail to expel the _fœtus_; but proper care and management

are certainly necessary for the recovery of the mother. No doubt

mischief may be done by too much as well as by too little care. Hence

females who have the greatest number of attendants in child-bed

generally recover worst. But this is not peculiar to the state of

child-bed. Excessive care always defeats its own intention, and is

generally more dangerous than none at all[181].

During actual labour, nothing of a heating nature ought to be given. The

woman may now and then take a little panado, and her drink ought to be

toast and water, or thin groat-gruel. Spirits, wines, cordial waters,

and other things which are given with a view to strengthen the mother,

and promote the birth, for the most part tend only to increase the

fever, inflame the womb, and retard the labour. Besides, they endanger

the woman afterwards, as they often occasion violent and mortal

hæmorrhages, or dispose her to eruptive and other fevers.

When the labour proves tedious and difficult, to prevent inflammations,

it will be proper to bleed. An emollient clyster ought likewise

frequently to be administered; and the patient should sit over the

steams of warm water. The passage ought to be gently rubbed with a

little soft _pomatum_ or fresh butter, and cloths wrung out of warm

water applied over the belly. If nature seems to sink, and the woman is

greatly exhausted with fatigue, a draught of generous wine, or some

other cordial, may be given, but not otherwise. These directions are

sufficient in natural labours; and in all preternatural cases, a skilful

surgeon, or man-midwife, ought to be called as soon as possible.

After delivery, the woman ought to be kept as quiet and easy as

possible[182]. Her food should be light and thin, as gruel, panado, &c.

and her drink weak and diluting. To this rule, however, there are many

exceptions. I have known several women, whose spirits could not be

supported in child-bed without solid food and generous liquors; to such,

a glass of wine and a bit of chicken must be allowed.

Sometimes an excessive hæmorrhage or flooding happens after delivery. In

this case the patient should be laid with her head low, kept cool, and

be in all respects treated as for an excessive flux of the _menses_. If

the flooding proves violent, linen cloths, which have been wrung out of

a mixture of equal parts of vinegar and water, or red wine, should be

applied to the belly, the loins, and the thighs: these must be changed

as they grow dry; and may be discontinued as soon as the flooding

abates[183].

If there be violent pains after delivery, the patient ought to drink

plentifully of warm diluting liquors, as groat-gruel, or tea with a

little saffron in it; and to take small broths, with carrawayseeds, or a

bit of orange-peel in them; an ounce of the oil of sweet almonds may

likewise be frequently taken in a cup of any of the above liquors; and

if the patient be restless, a spoonful of the syrup of poppies may now

and then be mixed with a cup of her drink. If she be hot or feverish,

one of the following powders may be taken in a cup of her usual drink

every five or six hours[184].

An inflammation of the womb is a dangerous and not unfrequent disease

after delivery. It is known by pains in the lower part of the belly,

which are greatly increased upon touching; by the tension or tightness

of the parts; great weakness; change of countenance; a constant fever,

with a weak and hard pulse; a slight _delirium_ or raving; sometimes

incessant vomiting; a hiccup; a discharge of reddish, stinking, sharp

water from the womb; an inclination to go frequently to stool; a heat,

and sometimes total suppression of urine.

This must be treated like other inflammatory disorders, by bleeding and

plentiful dilution. The drink may be thin gruel or barley-water; in a

cup of which half a drachm of nitre may be dissolved, and taken three or

four times a-day. Clysters of warm milk and water must be frequently

administered; and the belly should be fomented by cloths wrung out of

warm water, or by applying bladders filled with warm milk and water to

it.

A suppression of the _lochia_, or usual discharges after delivery, and

the milk-fever, must be treated nearly in the same manner as an

inflammation of the womb. In all these cases, the safest course is

plentiful dilution, gentle evacuations, and fomentations of the parts

affected. In the milk-fever, the breads may be embrocated with a little

warm linseed oil, or the leaves of red cabbage may be applied to them.

The child should be often put to the breast, or it should be drawn by

some other person.

Nothing would tend more to prevent the milk-fever than putting the child

early to the breast. The custom of not allowing children to suck for the

first two or three days, is contrary to Nature and common sense, and is

very hurtful both to the mother and child.

Every mother who has milk in her breasts, ought either to suckle her own

child, or to have her breasts frequently drawn, at least for the first

month. This would prevent many of the diseases which prove fatal to

women in child-bed.

When an inflammation happens in the breast, attended with redness,

hardness, and other symptoms of suppuration, the safest application is a

poultice of bread and milk, softened with oil or fresh butter. This may

be renewed twice a-day, till the tumour be either discussed or brought

to suppuration. The use of repellents, in this case, is very dangerous;

they often occasion fevers, and sometimes cancers; whereas a suppuration

is seldom attended with any danger, and has often the most salutary

effects.

When the nipples are fretted or chapt, they may be anointed with a

mixture of oil and beeswax, or a little powdered gum-arabic may be

sprinkled on them. I have seen Hungary water applied to the nipples have

a very good effect. Should the complaint prove obstinate, a cooling

purge may be given, which generally removes it.

The miliary fever is a disease incident to women in child-bed; but as it

has been treated of already, we shall take no further notice of it. The

celebrated Hoffman observes, That this fever of child-bed women might

generally be prevented, if they, during their pregnancy, were regular in

their diet, used moderate exercise, took now and then a gentle laxative

of manna, rhubarb, or cream of tartar; not forgetting to bleed in the

first months, and avoid all sharp air. When the labour is coming on, it

is not to be hastened with forcing medicines, which inflame the blood

and humours, or put them into unnatural commotions. Care should be

taken, after the birth, that the natural excretions proceed regularly;

and if the pulse be quick, a little nitrous powder, or some other

cooling medicines, should be administered.

The most fatal disorder consequent upon delivery is the _puerperal_, or

child-bed fever. It generally makes its attack upon the second or third

day after delivery. Sometimes indeed it comes on sooner, and at other

times, though rarely, it does not appear before the fifth or sixth day.

It begins, like most other fevers, with a cold or shivering fit, which

is succeeded by restlessness, pain of the head, great sickness at

stomach, and bilious vomiting. The pulse is generally quick, the tongue

dry, and there is a remarkable depression of spirits and loss of

strength. A great pain is usually felt in the back, hips, and region of

the womb; a sudden change in the quantity or quality of the _lochia_

also takes place; and the patient is frequently troubled with a

_tenesmus_, or constant inclination to go to stool. The urine, which is

very high-coloured, is discharged in small quantity, and generally with

pain. The belly sometimes swells to a considerable bulk, and becomes

susceptible of pain from the slightest touch. When the fever has

continued for a few days, the symptoms of inflammation usually subside,

and the disease acquires a more putrid form. At this period, if not

sooner, a bilious or putrid looseness, of an obstinate and dangerous

nature, comes on, and accompanies the disease through all its future

progress.

There is not any disease that requires to be treated with more skill and

attention than this; consequently the best assistance ought always to be

obtained as soon as possible. In women of plethoric constitutions,

bleeding will generally be proper at the beginning; it ought however to

be used with caution, and not to be repeated unless where the signs of

inflammation rise high; in which case it will also be necessary to apply

a blistering-plaster to the region of the womb.

During the rigour, or cold fit, proper means should be used to abate its

violence, and shorten its duration. For this purpose the patient may

drink freely of warm diluting liquors, and, if low, may take now and

then a cup of whine-whey; warm applications to the extremities, as

heated bricks, bottles or bladders filled with warm water, and such

like, may also be used with advantage.

Emollient clysters of milk and water, or of chicken water, ought to be

frequently administered through the course of the disease. These prove

beneficial by promoting a discharge from the intestines, and also by

acting as a kindly fomentation to the womb and parts adjacent. Great

care however is requisite in giving them, on account of the tenderness

of the parts in the _pelvis_ at this time.

To evacuate the offending bile from the stomach, a vomit is generally

given. But as this is apt to increase the irritability of the stomach,

already too great, it will be safer to omit it, and to give in its stead

a gentle laxative, which will both tend to cool the body, and to procure

a free discharge of the bile[185].

The medicine which I have always found to succeed best in this disease

is the saline draught. This, if frequently repeated, will often put a

stop to the vomiting, and at the same time lessen the violence of the

fever. If it runs off by stool, or if the patient be restless, a few

drops of laudanum, or some syrup of poppies, may occasionally be added.

If the stools should prove so frequent as to weaken and exhaust the

patient, a starch clyster, with thirty or forty drops of laudanum in it,

may be administered as occasion shall require; and the drink may be

rice-water, in every English pint of which half an ounce of gum-arabic

has been dissolved. Should these fail, recourse must be had to

Columbo-root, or some other strong astringent.

Though in general the food ought to be light, and the drink diluting,

yet when the disease has been long protracted, and the patient is

greatly spent by evacuations, it will be necessary to support her with

nourishing diet and generous cordials.

It was observed that this fever, after continuing for some time, often

acquires a putrid form. In this case the Peruvian bark must be given,

either by itself, or joined with cordials, as circumstances may require.

As the bark in substance will be apt to purge, it may be given in

decoction or infusion mixed with the tincture of roses, or other gentle

astringents; or, a scruple of the extract of bark with half an ounce of

spirituous cinnamon-water, two ounces of common water, and ten drops of

laudanum, may be made into a draught, and given every second, third, or

fourth hour, as shall be found necessary.

When the stomach will not bear any kind of nourishment, the patient may

be supported for some time by clysters of beef tea, or chicken water.

To avoid this fever, every woman in child-bed ought to be kept perfectly

easy; her food should be light and simple, and her bed-chamber cool, and

properly ventilated. There is not any thing more hurtful to a woman in

this situation than being kept too warm. She ought not to have her body

bound too tight, nor to rise too soon from bed, after delivery; catching

cold is also to be avoided; and a proper attention should be paid to

cleanliness.

To prevent the milk-fever, the breast ought to be frequently drawn; and

if they are filled previous to the onset of a fever, they should, upon

its first appearance, be drawn, to prevent the milk from becoming acrid,

and its being absorbed in this state. Costiveness is likewise to be

avoided. This will be best effected by the use of mild clysters and a

laxative diet.

We shall conclude our observations on child-bed women by recommending it

to them, above all things, to beware of cold. Poor women, whose

circumstances oblige them to quit their bed too soon, often contract

diseases from cold, of which they never recover. It is pity the poor are

not better taken care of in this situation.

But the better sort of women run the greatest hazard from too much heat.

They are generally kept in a sort of bagnio for the first eight or ten

days, and then dressed out to see company. The danger of this conduct

must be obvious to every one.

The superstitious custom of obliging women to keep the house till they

go to church, is likewise a very common cause of catching cold. All

churches are damp, and most of them cold; consequently they are the very

word places to which a woman can go to make her first visit, after

having been confined in a warm room for a month.

OF BARRENNESS.

Barrenness may be very properly reckoned among the diseases of females,

as few married women who have not children enjoy a good state of health.

It may proceed from various causes, as high living, grief, relaxation,

&c. but it is chiefly owing to an obstruction or irregularity of the

menstrual flux.

It is very certain that high living vitiates the humours, and prevents

fecundity. We seldom find a barren woman among the labouring poor, while

nothing is more common among the rich and affluent. The inhabitants of

every country are prolific in proportion to their poverty; and it would

be an easy matter to adduce many instances of women, who, by being

reduced to live entirely upon a milk and vegetable diet, have conceived

and brought forth children, though they never had any before. Would the

rich use the same sort of food and exercise as the better sort of

peasants, they would seldom have cause to envy their poor vassals and

dependants the blessing of a numerous and healthy offspring, while they

pine in sorrow for the want of even a single heir to their extensive

domains.

Affluence begets indolence, which not only vitiates the humours, but

induces a general relaxation of the solids; a state, highly unfavourable

to procreation. To remove this, we would recommend the following course:

First, sufficient exercise in the open air; secondly, a diet consisting

chiefly of milk and vegetables[186]; thirdly, the use of astringent

medicines, as steel, allum, dragon’s blood, elixir of vitriol, the Spaw

or Tunbridge waters, Peruvian bark, &c.; and lastly, above all, the cold

bath.

Barrenness is often the consequence of grief, sudden fear, anxiety, or

any of the passions which tend to obstruct the menstrual flux. When

barrenness is suspected to proceed from affections of the mind, the

person ought to be kept as easy and cheerful as possible; all

disagreeable objects are to be avoided, and every method taken to amuse

and entertain the fancy.

CHAP. XLIX.

DISEASES OF CHILDREN.

Miserable indeed is the lot of man in the state of infancy! He comes

into the world more helpless than any other animal, and stands much

longer in need of the protection and care of his parents; but, alas!

this care is not always bestowed upon him; and when it is, he often

suffers as much from improper management as he would have done from

neglect. Hence the officious care of parents, nurses, and midwives,

becomes one of the most fruitful sources of the disorders of

infants[187].

It must be obvious to every attentive person, that the first diseases of

infants arise chiefly from their bowels. Nor is this in the least to be

wondered at, as they are in a manner poisoned with indigestible drugs

and improper diet as soon as they come into the world. Every thing that

the stomach cannot digest may be Considered as a poison; and unless it

can be thrown up, or voided by stool, it must occasion sickness, gripes,

spasmodic affections of the bowels, or what the good women call inward

fits, and at last convulsions and death.

As these symptoms evidently arise from somewhat that irritates the

intestines, doubtless the proper method of cure must be to expel it as

soon as possible. The most safe and effectual method of doing this is by

gentle vomits. Five or six grains of the powder of ipecacuanha may be

mixed in two table-spoonfuls of water, and sweetened with a little

sugar. A tea-spoonful of this may be given to the infant every quarter

of an hour till it operates; or, what will more certainly answer the

purpose, a grain of emetic tartar may be dissolved in three ounces of

water, sweetened with a little syrup, and given as above. Those who are

unwilling to use the emetic tartar, may give six or seven drops of the

antimonial wine, in a tea-spoonful of water or thin gruel. Small doses

of the ipecacuanha wine will be found more gentle than any of the above,

and ought to be preferred.

These medicines will not only cleanse the stomach, but will generally

likewise open the body. Should this however not happen, and if the child

be costive, some gentle purge will be necessary: for this purpose, some

manna and pulp of cassia may be dissolved in boiling water, and given in

small quantities till it operates; or, what will answer rather better, a

few grains of _magnesia alba_ may be mixed in any kind of food that is

given to the child, and continued till it has the desired effect. If

these medicines be properly administered, and the child’s belly and

limbs frequently rubbed with a warm hand before the fire, they will

seldom fail to relieve those affections of the stomach and bowels from

which infants suffer so much.

These general directions include most of what can be done for relieving

the internal disorders of infants. They will likewise go a considerable

way in alleviating those which appear externally, as the rash, _gum_, or

_fellon_, &c. These, as was formerly observed, are principally owing to

too hot a regimen, and consequently will be most effectually relieved by

gentle evacuations. Indeed, evacuations of one kind or other constitute

a principal part of the medicine of infants, and will seldom, if

administered with prudence, in any of their diseases, fail to give

relief.

OF THE MECONIUM.

The stomach and bowels of a new-born infant are filled with a

blackish-coloured matter of the consistence of syrup, commonly called

the _meconium_. This is generally passed soon after the birth, by the

mere effort of Nature; in which case it is not necessary to give the

infant any kind of medicine. But if it should be retained, or not

sufficiently carried off, a little manna or _magnesia alba_ may be

given, as mentioned above; or, if these should not be at hand, a common

spoonful of whey, sweetened with a little honey, or raw sugar, will

answer the purpose.

The most proper medicine for expelling the _meconium_ is the mother’s

milk, which is always at first of a purgative quality. Were children

allowed to suck as soon as they shew an inclination for the breast, they

would seldom have occasion for medicines to discharge the _meconium_;

but even where this is not allowed, they ought never to have daubs of

syrup, oils, and other indigestible stuff, crammed down their throats.

THE APHTHÆ OR THRUSH.

The aphthæ are little whitish ulcers affecting the whole inside of the

mouth, tongue, throat, and stomach of infants. Sometimes they reach

through the whole intestinal canal; in which case they are very

dangerous, and often put an end to the infant’s life.

If the aphthæ are of a pale colour, pellucid, few in number, soft,

superficial, and fall easily off, they are not dangerous; but if opake,

yellow, brown, black, thick, or running together, they ought to be

dreaded.

It is generally thought that the aphthæ owe their origin to acid

humours; we have reason however to believe, they are more frequently

owing to too hot a regimen both of the mother and child. It is a rare

thing to find a child who is not dosed with wine, punch,

cinnamon-waters, or some other hot and inflaming liquors, almost as soon

as it is born. It is well known that these will occasion inflammatory

disorders even in adults; is it any wonder then that they should heat

and inflame the tender bodies of infants, and set as it were the whole

constitution on a blaze?

The most proper medicines for the aphthæ are vomits, such as have been

already recommended, and gentle laxatives. Five grains of rhubarb and

half a drachm of _magnesia alba_ may be rubbed together, and divided

into six doses, one of which may be given to the infant every four or

five hours till they operate. These powders may either be given in the

child’s food, or a little of the syrup of pale roses, and may be

repeated as often as is found necessary to keep the body open. It is

common in this case to administer calomel; but as that medicine

sometimes occasions gripes, it ought always to be given to infants with

caution.

Many things have been recommended for gargling the mouth and throat in

this disease; but it is not easy to apply these in very young infants;

we would therefore recommend it to the nurse to rub the child’s mouth

frequently with a little borax and honey; or with the following mixture:

Take fine honey an ounce, borax a drachm, burnt alum half a drachm,

rose-water two drachms; mix them together. A very proper application in

this case, is a solution of ten or twelve grains of white vitriol in

eight ounces of barley-water. These may be applied with the finger, or

by means of a bit of soft rag tied to the end of a probe.

OF ACIDITIES.

The food of children being for the most part of an acescent nature, it

readily turns sour upon the stomach, especially if the body be any way

disordered. Hence most diseases of children are accompanied with evident

signs of acidity, as green stools, gripes, &c. These appearances have

induced many to believe, that all the diseases of children were owing to

an acid abounding in the stomach and bowels; but whoever considers the

matter attentively, will find that these symptoms of acidity are oftner

the effect than the cause of their diseases.

Nature evidently intended, that the food of children should be acescent;

and unless the body be disordered, or the digestion hurt, from some

other cause, we will venture to say, that the acescent quality of their

food is seldom injurious to them. Acidity, however, is often a symptom

of disorders in children, and, as it is sometimes a troublesome one, we

shall point out the method of relieving it.

When green stools, gripes, purgings, sour smells, &c. shew that the

bowels abound with an acid, the child should have a little small broth,

with light white bread in it; and should have sufficient exercise in

order to promote the digestion. It has been customary in this case to

give the pearl-julep, chalk, crabs eyes, and other testaceous powders.

These, indeed, by their absorbent quality, may correct the acidity; but

they are attended with this inconvenience, that they are apt to lodge in

the bowels, and occasion costiveness, which may prove very hurtful to

the infant. For this reason they should never be given unless mixed with

purgative medicines; as rhubarb, manna, or such like.

The best medicine which we know, in all cases of acidity, is that fine

insipid powder called _magnesia alba_. It purges, and at the same time

corrects the acidity: by which means it not only removes the disease,

but carries off its cause. It may be given in any kind of food, or in a

mixture, as recommended in the Appendix[188].

When an infant is troubled with gripes, it ought not at first to be

dosed with brandy, spiceries, and other hot things, but should have its

body opened with an emollient clyster, or the medicine mentioned above;

and at the same time a little brandy may be rubbed on its belly with a

warm hand before the fire. I have seldom seen this fail to ease the

gripes of infants. If it should happen, however, not to succeed, a

little brandy or other spirits may be mixed with thrice the quantity of

warm water, and a tea-spoonful of it given frequently till the infant be

easier. Sometimes a little peppermint-water will answer this purpose

very well.

GALLING AND EXCORIATION.

These are very troublesome to children. They happen chiefly about the

groin and wrinkles of the neck, under the arms, behind the ears, and in

other parts that are moistened by the sweat or urine.

As these complaints are, in a great measure, owing to want of

cleanliness, the most effectual means of preventing them are, to wash

the parts frequently with cold water, to change the linen often, and, in

a word, to keep the child in all respects thoroughly clean. When this is

not sufficient, the excoriated parts may be sprinkled with absorbent or

drying powders; as burnt hartshorn, tutty, chalk, crabs claws prepared,

and the like. When the parts affected are very sore, and tend to a real

ulceration, it will be proper to add a little sugar of lead to the

powders; or to anoint the place with the camphorated ointment. If the

parts be washed with spring water, in which a little white vitriol has

been dissolved, it will dry and heal them very powerfully. One of the

best applications for this purpose, is to dissolve some fuller’s earth

in a sufficient quantity of hot water; and after it has stood till it is

cold, to rub it gently upon the galled parts once or twice a-day.

STOPPAGE OF THE NOSE.

The nostrils of infants are often plugged up with a gross _mucus_, which

prevents their breathing freely, and likewise renders it difficult for

them to suck or swallow.

Some in this case order, after a suitable purge, two or three grains of

white vitriol dissolved in half an ounce of marjoram-water, and

filtered, to be applied now and then to the nostrils with a linen rag.

Wedelius says, If two grains of white vitriol, and the same quantity of

_elaterium_, be dissolved in half an ounce of marjoram-water, and

applied to the nose, as above directed, that it brings away the _mucus_

without sneezing.

In obstinate cases these medicines may be tried; but I have never found

any thing necessary, besides rubbing the nose at bed-time with a little

sweet oil, or fresh butter. This resolves the filth, and renders the

breathing more free[189].

OF VOMITING.

From the delicate state of children, and the great sensibility of their

organs, a vomiting or looseness may be induced by any thing that

irritates the nerves of the stomach or intestines. Hence these disorders

are much more common in childhood than in the more advanced periods of

life. They are seldom however dangerous, and ought never to be

considered as diseases, unless when they are violent, or continue so

long as to exhaust the strength of the patient.

Vomiting may be excited by an over-quantity of food; by food that is of

such a nature as to irritate the nerves of the stomach too much; or by

the sensibility of the nerves being so much increased as to render them

unable to bear the stimulus of even the mildest element.

When vomiting is occasioned by too much food, it ought to be promoted,

as the cure will depend upon cleansing the stomach. This may be done

either by a few grains of ipecacuanha, or a weak solution of emetic

tartar, as mentioned before. When it is owing to food of an acrid or

irritating quality, the diet ought to be changed, and aliment of a

milder nature substituted in its stead.

When vomiting proceeds from an increased degree of sensibility, or too

great an irritability of the nerves of the stomach, such medicines as

have a tendency to brace and strengthen that organ, and to abate its

sensibility, must be used. The first of these intentions may be answered

by a slight infusion of the Peruvian bark, with the addition of a little

rhubarb and orange-peel; and the second by the saline draughts, to which

a few drops of liquid laudanum may be occasionally added.

In obstinate vomitings the operation of internal medicines may be

assisted by aromatic fomentations made with wine, applied warm to the

pit of the stomach; or the use of the stomach plaster, with the addition

of a little _Theriaca_.

OF A LOOSENESS.

A looseness may generally be reckoned salutary when the stools are sour,

slimy, green, or curdled. It is not the discharge, but the production of

such stools, which ought to be remedied. Even where the purging is thin

and watery, it ought not to be checked too suddenly, as it often proves

critical, especially when the child has caught cold, or an eruption on

the skin has disappeared. Sometimes an evacuation of this kind succeeds

a humid state of the atmosphere, in which case it may also prove of

advantage, by carrying off a quantity of watery humours, which would

otherwise tend to relax the habit.

As the principal intention of the cure of a looseness is to evacuate the

offending matter, it is customary to give the patient a gentle vomit of

ipecacuanha, and afterwards to exhibit small and frequent doses of

rhubarb; interposing absorbent medicines, to mitigate the acrimony of

the humours. The best purge, however, in this case, is _magnesia alba_.

It is at the same time absorbent and laxative, and operates without

exciting gripes.

The antimonial wine, which acts both as an emetic and purge, is also an

excellent medicine in this case. By being diluted with water, it may be

proportioned to the weakest constitution; and, not being disagreeable to

the palate, it may be repeated as often as occasion requires. Even one

dose will frequently mitigate the disease, and pave the way for the use

of absorbents. If, however, the patient’s strength will permit, the

medicine ought to be repeated every six or eight hours, till the stools

begin to assume a more natural appearance; afterwards a longer space may

be allowed to intervene between the doses. When it is necessary to

repeat the medicine frequently, the dose ought always to be a little

increased, as its efficacy is generally diminished by use.

Some, upon the first appearance of a looseness, fly immediately to the

use of absorbent medicines and astringents. If these be administered

before the offending humours are discharged, though the disease may

appear to be mitigated for a little time, it soon afterwards breaks

forth with greater violence, and often proves fatal. After proper

evacuations, however, these medicines may be administered with

considerable advantage.

Should any gripings or restlessness remain after the stomach and bowels

have been cleansed, a tea-spoonful of the syrup of poppies may be given

in a little simple cinnamon-water, three or four times a-day till these

symptoms have ceased.

OF ERUPTIONS.

Children, while on the breast, are seldom free from eruptions of one

kind or other. These, however, are not often dangerous, and ought never

to be dried up but with the greatest caution. They tend to free the

bodies of infants from hurtful humours, which, if retained, might

produce fatal disorders.

The eruptions of children are chiefly owing to improper food and neglect

of cleanliness. If a child be stuffed at all hours with food that its

stomach is not able to digest, such food, not being properly

assimilated, instead of nourishing the body, fills it with gross

humours. These must either break out in form of eruptions upon the skin,

or remain in the body, and occasion fevers and other internal disorders.

That neglect of cleanliness is a very general cause of eruptive

disorders, must be obvious to every one. The children of the poor, and

of all who despise cleanliness, are almost constantly found to swarm

with vermin, and are generally covered with the scab, itch, and other

eruptions.

When eruptions are the effect of improper food, or want of cleanliness,

a proper attention to these alone will generally be sufficient to remove

them. If this should not be the case, some drying medicines will be

necessary. When they are applied, the body ought at the same time to be

kept open, and cold is carefully to be avoided. We know no medicine that

is more safe for drying up cutaneous eruptions than sulphur, provided it

be prudently used. A little of the flour of sulphur may be mixed with

fresh butter, oil, or hog’s lard, and the parts affected frequently

touched with it.

The most obstinate of all the eruptions incident to children are, the

_tinea capitis_, or scabbed head, and chilblains. The scabbed head is

often exceeding difficult to cure, and sometimes indeed the cure proves

worse than the disease. I have frequently known children seized with

internal disorders, of which they died soon after their scabbed heads

had been healed by the application of drying medicines[190]. The cure

ought always first to be attempted by keeping the head very clean,

cutting off the hair, combing and brushing away the scabs, &c. If this

is not sufficient, let the head be shaved once a-week, washed daily with

soap suds, and gently anointed with a liniment made of train oil eight

ounces, red precipitate, in fine powder, one drachm. And if there be

proud flesh, it should be touched with a bit of blue vitriol, sprinkled

with a little burnt allum. While these things are doing, the patient

must be confined to a regular light diet, the body should be kept gently

open; and cold, as far as possible, ought to be avoided. To prevent any

bad consequences from stopping this discharge, it will be proper,

especially in children of a gross habit, to make an issue in the neck or

arm, which may be kept open till the patient becomes more strong, and

the constitution be somewhat mended.

Chilblains commonly attack children in cold weather. They are generally

occasioned by the feet or hands being kept long wet or cold, and

afterwards suddenly heated. When children are cold, instead of taking

exercise to warm themselves gradually, they run to the fire. This

occasions a sudden rarefaction of the humours, and an infarction of the

vessels; which being often repeated, the vessels are at last

over-distended, and forced to give way.

To prevent it, violent cold and sudden heat must be equally avoided.

When the parts begin to look red and swell, the patient ought to be

purged, and to have the affected parts frequently rubbed with mustard

and brandy, or something of a warming nature. They ought likewise to be

covered with flannel, and kept warm and dry. Some apply warm ashes

between cloths to the swelled parts, which frequently help to reduce

them. When there is a sore, it must be dressed with Turner’s cerate, the

ointment of tutty, the plaster of cerus, or some other drying ointment.

These sores are indeed troublesome, but seldom dangerous. They generally

heal as soon as the warm weather sets in.

OF THE CROUP.

Children are often seized very suddenly with this disease, which, if not

quickly relieved, proves mortal. It is known by various names in

different parts of Britain. On the east coast of Scotland it is called

the _croup_. On the west they call it the _chock_ or _stuffing_. In some

parts of England, where I have observed it, the good women call it _the

rising of the lights_. It seems to be a species of _asthma_, attended

with very acute and violent catarrhal symptoms.

This disease generally prevails in cold and wet seasons. It is most

common upon the sea-coast, and in low marshy countries. Children of a

gross and lax habit are most liable to it. I have sometimes known it

hereditary. It generally attacks children in the night, after having

been much exposed to damp cold easterly winds through the day. Damp

houses, wet feet, thin shoes, wet clothes, or any thing that obstructs

the perspiration, may occasion the croup.

It is attended with a frequent pulse, quick and laborious breathing,

which is performed with a peculiar kind of croaking noise, that may be

heard at a considerable distance. The voice is sharp and shrill, and the

face is generally much flushed, though sometimes it is of a livid

colour.

When a child is seized with the above symptoms, his feet should

immediately be put into warm water. He ought likewise to be bled[191],

and to have a laxative clyster administered as soon as possible. He

should be made to breathe over the steams of warm water and vinegar; or

an emollient decoction, and emollient cataplasms or fomentations may be

applied round his neck. If the symptoms do not abate, a blistering

plaster must be applied round the neck, or between the shoulders, and

the child may take frequently a table-spoonful of the following julep:

Take penny-royal water three ounces, syrup of althea and balsamic syrup,

each one ounce, mix them together.

Asafœtida is found to have a good effect in this case. It may be both

given in form of clyster, and taken by the mouth. Two drachms of

asafœtida may be dissolved in one ounce of Mindererus’s spirit, and

three ounces of penny-royal water. A table-spoonful of this mixture may

be given every hour, or oftner, if the patient’s stomach be able to bear

it. If the child cannot be brought to take this medicine, two drachms of

the asafœtida may be dissolved in a common clyster, and administered

every six or eight hours, till the violence of the disease abates[192].

To prevent a return of the disorder, all those things which occasion it

must be carefully avoided; as wet feet, cold, damp, easterly winds, &c.

Children who have had frequent returns of this disease, or whose

constitutions seem to dispose them to it, ought to have their diet

properly regulated; all food that is viscid or hard of digestion, and

all crude, raw, trashy fruits, are to be avoided. They ought likewise to

have a drain constantly kept open in some part of their body, by means

of a seton or issue. I have sometimes known a Burgundy-pitch plaster,

worn continually between the shoulders for several years, have a very

happy effect in preventing the return of this dreadful disorder.

OF TEETHING.

Dr. Arbuthnot observes, that above a tenth part of infants die in

teething, by symptoms proceeding from the irritation of the tender

nervous parts of the jaws, occasioning inflammations, fevers,

convulsions, gangrenes, &c. These symptoms are in a great measure owing

to the great delicacy and exquisite sensibility of the nervous system at

this time of life, which is too often increased by an effeminate

education. Hence it comes to pass, that children who are delicately

brought up, always suffer most in teething, and often fall by convulsive

disorders.

About the sixth or seventh month the teeth generally begin to make their

appearance; first, the _incisores_, or fore-teeth; next, the _canini_,

or dogteeth; and, lastly, the _molares_, or grinders. About the seventh

year, there comes a new set; and about the twentieth, the two inner

grinders, called _dentes sapientiæ_, the teeth of wisdom.

Children, about the time of cutting their teeth, slaver much, and have

generally a looseness. When the teething is difficult, especially when

the dogteeth begin to make their way through the gums, the child has

startings in his sleep, tumours of the gums, watchings, gripes, green

stools, the thrush, fever, difficult breathing, and convulsions.

Difficult teething requires nearly the same treatment as an inflammatory

disease. If the body be bound, it must be opened either by emollient

clysters or gentle purgatives; as manna, _magnesia alba_, rhubarb,

senna, or the like. The food should be light, and in small quantity; the

drink plentiful, but weak and diluting, as infusions of balm, or of the

lime-tree flowers; to which about a third or fourth part of milk may be

added.

If the fever be high, bleeding will be necessary; but this in very young

children ought always to be sparingly performed. It is an evacuation

which they bear the worst of any. Purging, vomiting, or sweating, agree

much better with them, and are generally more beneficial. Harris,

however, observes, that, when an inflammation appears, the physician

will labour in vain, if the _cure_ be not begun with applying a leech

under each ear. If the child be seized with convulsion-fits, a

blistering-plaster may be applied between the shoulders, or one behind

each ear.

Sydenham says, that in fevers occasioned by teething, he never found any

remedy so effectual as two, three, or four drops of spirits of hartshorn

in a spoonful of simple water, or other convenient vehicle, given every

four hours. The number of doses may be four, five, or six. I have often

prescribed this medicine with success, but always found a larger dose

necessary. It may be given from five drops to fifteen or twenty,

according to the age of the child, and, when costiveness does not forbid

it, three or four drops of laudanum may be added to each dose.

In Scotland, it is very common, when children are cutting their teeth,

to put a small Burgundy-pitch plaster between their shoulders. This

generally eases the tickling cough which attends teething, and is by no

means an useless application. When the teeth are cut with difficulty, it

ought to be kept on during the whole time of teething. It may be

enlarged as occasion requires, and ought to be renewed at least once a

fortnight.

Several things have been recommended for rubbing the gums, as oils,

mucilages, &c.; but from these much is not to be expected. If any thing

of this kind is to be used, we would recommend a little fine honey,

which may be rubbed on with the finger three or four times a-day.

Children are generally at this time disposed to chew whatever they get

into their hands. For this reason they ought never to be without

somewhat that will yield a little to the pressure of their gums, as a

crust of bread, a wax-candle, a bit of liquorice-root, or such like.

With regard to cutting the gums, we have seldom known it of any great

benefit. In obstinate cases, however, it ought to be tried. It may be

performed by the finger-nail, the edge of a six-penny piece that is worn

thin, or any sharp body which can be with safety introduced into the

mouth; but the lancet, in a skilful hand, is certainly the most proper.

In order to render the teething less difficult, parents ought to take

care that their children’s food be light and wholesome, and that their

nerves be braced by sufficient exercise without doors, the use of the

cold bath, &c. Were these things duly regarded, they would have a much

better effect than _teething necklaces_, or other nonsensical amulets

worn for that purpose.

OF THE RICKETS.

This disease generally attacks children between the age of nine months

and two years. It appeared first in England about the time when

manufactures began to flourish, and still prevails most in towns where

the inhabitants follow sedentary employments, by which means they

neglect either to take proper exercise themselves, or to give it to

their children.

CAUSES.——One cause of the rickets is diseased parents. Mothers of a weak

relaxed habit, who neglect exercise, and live upon weak watery diet, can

neither be expected to bring forth strong and healthy children, or to be

able to nurse them, after they are brought forth. Accordingly we find,

that the children of such women generally die of the rickets, the

scrophula, consumptions, or such like diseases. Children begotten by men

in the decline of life, who are subject to the gout, the gravel, or

other chronic diseases, or who have been often affected with the

venereal disease in their youth, are likewise very liable to the

rickets.

Any disorder that weakens the constitution, or relaxes the habit of

children, as the small-pox, measles, teething, the hooping-cough, &c.

disposes them to this disease. It may likewise be occasioned by improper

diet, as food that is either too weak and watery, or so viscid that the

stomach cannot digest it.

Bad nursing is the chief cause of this disease. When the nurse is either

diseased, or has not enough of milk to nourish the child, it cannot

thrive. But children suffer oftner by want of care in nurses than want

of food. Allowing an infant to lie or sit too much, or not keeping it

thoroughly clean in its clothes, has the most pernicious effects.

The want of free air is likewise very hurtful to children in this

respect. When a nurse lives in a close small house, where the air is

damp and confined, and is too indolent to carry her child abroad into

the open air, it will hardly escape this disease. A healthy child should

always be in motion, unless when asleep; if it be suffered to lie, or

sit, instead of being tossed and dandled about, it will not thrive.

SYMPTOMS.——At the beginning of this disease the child’s flesh grows soft

and flabby; its strength is diminished; it loses its wonted

cheerfulness, looks more grave and composed than is natural for its age,

and does not chuse to be moved. The head and belly become too large in

proportion to the other parts; the face appears full, and the complexion

florid. Afterwards the bones begin to be affected, especially in the

more soft and spungy parts. Hence the wrists and ancles become thicker

than usual; the spine or backbone puts on an unnatural shape; the breast

is likewise often deformed; and the bones of the arms and legs grow

crooked. All these symptoms vary according to the violence of the

disease. The pulse is generally quick, but feeble; the appetite and

digestion for the most part bad; the teeth come slowly and with

difficulty, and they often rot and fall out afterwards. Ricketty

children generally have great acuteness of mind, and an understanding

above their years. Whether this is owing to their being more in the

company of adults than other children, or to the preternatural

enlargement of the brain, is not material.

REGIMEN.——As this disease is always attended with evident signs of

weakness and relaxation, our chief aim in the cure must be to brace and

strengthen the solids, and to promote digestion and the due preparation

of the fluids. These important ends will be best answered by wholesome

nourishing diet, suited to the age and strength of the patient, open dry

air, and sufficient exercise. If the child has a bad nurse, who either

neglects her duty, or does not understand it, she should be changed. If

the season be cold, the child ought to be kept warm; and when the

weather is hot, it ought to be kept cool; as sweating is apt to weaken

it, and too great a degree of cold has the same effect. The limbs should

be rubbed frequently with a warm hand, and the child kept as cheerful as

possible.

The diet ought to be dry and nourishing, as good bread, roasted flesh,

&c. Biscuit is generally reckoned the best bread; and pigeons, pullets,

veal, rabbits, or mutton roasted or minced, are the most proper flesh.

If the child be too young for flesh-meats, he may have rice, millet, or

pearl-barley boiled with raisins, to which may be added a little wine

and spice. His drink may be good claret, mixed with an equal quantity of

water. Those who cannot afford claret, may give the child now and then a

wine-glass of mild ale, or good porter.

MEDICINE.——Medicines are here of little avail. The disease may often be

cured by the nurse, but seldom by the physician. In children of a gross

habit, gentle vomits and repeated purges of rhubarb may sometimes be of

use, but they will seldom carry off the disease; that must depend

chiefly upon such things as brace and strengthen the system: for which

purpose, besides the regimen mentioned above, we would recommend the

cold bath, especially in the warm season. It must however be used with

prudence, as some ricketty children cannot bear it. The best time for

using the cold bath is in the morning, and the child should be well

rubbed with a dry cloth immediately after he comes out of it. If the

child should be weakened by the cold bath, it must be discontinued.

Sometimes issues have been found beneficial in this disease. They are

peculiarly necessary for children who abound with gross humours. An

infusion of the Peruvian bark in wine or ale would be of service, were

it possible to bring children to take it. We might here mention many

other medicines which have been recommended for the rickets; but as

there is far more danger in trusting to these than in neglecting them

altogether, we chuse rather to pass them over, and to recommend a proper

regimen as the thing chiefly to be depended on.

OF CONVULSIONS.

Though more children are said to die of convulsions than of any other

disease, yet they are for the most part only a symptom of some other

malady. Whatever greatly irritates or stimulates the nerves, may

occasion convulsions. Hence infants whose nerves are easily affected,

are often thrown into convulsions by any thing that irritates the

alimentary canal; likewise by teething; strait clothes; the approach of

the small-pox, measles, or other eruptive diseases.

When convulsions proceed from an irritation of the stomach or bowels,

whatever clears them of their acrid contents, or renders these mild and

inoffensive, will generally perform a cure: wherefore, if the child be

costive, the best way will be to begin with a clyster, and afterwards to

give a gentle vomit, which may be repeated occasionally, and the body in

the mean time kept open by gentle doses of _magnesia alba_, or small

quantities of rhubarb mixed with the powder of crabs claws.

Convulsions which precede the eruption of the small-pox or measles

generally go off upon these making their appearance. The principal

danger in this case arises from the fears and apprehensions of those who

have the care of the patient. Convulsions are very alarming, and

something must be done to appease the affrighted parents, nurses, &c.

Hence the unhappy infant often undergoes bleeding, blistering, and

several other operations, to the great danger of its life, when a little

time, bathing the feet in warm water, and throwing in a mild clyster,

would have set all to rights.

When convulsion fits arise from the cutting of teeth, besides gentle

evacuations, we would recommend blistering, and the use of antispasmodic

medicines, as the tincture of soot, asafœtida, or castor. A few drops of

any of these may be mixed in a cup of white-wine whey, and given

occasionally.

When convulsions proceed from any external cause, as the pressure

occasioned by strait clothes or bandages, &c. these ought immediately to

be removed; though in this case taking away the cause will not always

remove the effect, yet it ought to be done. It is not likely that the

patient will recover, as long as the cause which first gave rise to the

disorder continues to act.

When a child is seized with convulsions without having any complaint in

the bowels, or symptoms of teething; or any rash or other discharge

which has been suddenly dried up; we have reason to conclude that it is

a primary disease, and proceeds immediately from the brain. Cases of

this kind, however, happen but seldom, which is very fortunate, as

little can be done to relieve the unhappy patient. When a disease

proceeds from an origial fault in the formation or structure of the

brain itself, we cannot expect that it should yield to medicine. But as

this is not always the cause, even of convulsions which proceed

immediately from the brain, some attempts should be made to remove them.

The chief intention to be pursued for this purpose, is to make some

derivation from the head, by blistering, purging, and the like. Should

these fail, issues or setons may be put in the neck, or between the

shoulders.

OF WATER IN THE HEAD.

Though water in the head, or a dropsy of the brain, may affect adults as

well as children, yet, as the latter are more peculiarly liable to it,

we thought it would be most proper to place it among the diseases of

infants.

CAUSES.——A dropsy of the brain may proceed from injuries done to the

brain itself by falls, blows, or the like; it may likewise proceed from

an original laxity or weakness of the brain; from scirrhous tumours or

excrescences within the skull; a thin watery state of the blood; a

diminished secretion of urine; and, lastly, from tedious and lingering

diseases, which waste and consume the patient.

SYMPTOMS.——This disease has at first the appearance of a slow fever; the

patient complains of a pain in the crown of his head, or over his eyes;

he shuns the light; is sick, and sometimes vomits; his pulse is

irregular and generally low: though he seems heavy and dull, yet he does

not sleep: he is sometimes delirious, and frequently sees objects

double; towards the end of this commonly fatal disease, the pulse

becomes more frequent, the pupils are generally dilated, the cheeks

flushed, the patient becomes comatose, and convulsions ensue.

MEDICINE.——No medicine has hitherto been found sufficient to carry off a

dropsy of the brain. It is laudable, however, to make some attempts, as

time or chance may bring many things to light, of which at present we

have no idea. The medicines generally used are, purges of rhubarb or

jalap with calomel, and blistering-plasters applied to the neck or back

part of the head. To which we would beg leave to add diuretics, or

medicines which promote the secretion of urine, such as are recommended

in the common dropsy. A discharge from the nose ought likewise to be

promoted by causing the patient to snuff the powder of asarum, white

hellebore, or the like.

Some practitioners have of late pretended to cure this disease by the

use of mercury. I have not been so happy as to see any instances of a

cure being performed in a confirmed dropsy of the brain; but in so

desperate a malady every thing deserves a trial[193].

CHAP. L.

OF SURGERY.

To describe all the operations of surgery, and to point out the

different diseases in which these operations are necessary, would extend

this article far beyond the limits allotted to it: we must therefore

confine our observations to such cases as most generally occur, and in

which proper assistance is either not asked, or not always to be

obtained.

Though an acquaintance with the structure of the human body is

indispensably necessary to qualify a man for being an expert surgeon;

yet many things may be done to save the lives of their fellow-men in

emergencies by those who are no adepts in anatomy. It is amazing with

what facility the peasants daily perform operations upon brute animals,

which are not of a less difficult nature than many of those performed on

the human species; yet they seldom fail of success.

Indeed every man is in some measure a surgeon whether he will or not. He

feels an inclination to assist his fellow-men in distress, and accidents

happen every hour which give occasion to exercise this feeling. The

feelings of the heart, however, when not directed by the judgment, are

apt to mislead. Thus one, by a rash attempt to save his friend, may

sometimes destroy him; while another, for fear of doing amiss, stands

still and sees his bosom-friend expire without so much as attempting to

relieve him, even when the means are in his power. As every good man

would wish to steer a course different from either of these, it will no

doubt be agreeable to him to know what ought to be done upon such

emergencies.

OF BLEEDING.

No operation of surgery is so frequently necessary as bleeding; it ought

therefore to be very generally understood. But though practised by

midwives, gardeners, blacksmiths, we have reason to believe that very

few know when it is proper. Even physicians themselves have been so much

the dupes of theory in this article, as to render it the subject of

ridicule. It is however an operation of great importance, and must, when

seasonably and properly performed, be of singular service to those in

distress.

Bleeding is proper at the beginning of all inflammatory fevers, as

pleurisies, peripneumonies, &c. It is likewise proper in all topical

inflammations, as those of the intestines, womb, bladder, stomach,

kidnies, throat, eyes, &c. as also in the asthma, sciatic pains, coughs,

head-achs, rheumatisms, the apoplexy, epilepsy, and bloody flux. After

falls, blows, bruises, or any violent hurt received either externally or

internally, bleeding is necessary. It is likewise necessary for persons

who have had the misfortune to be strangled, drowned, suffocated with

foul air, the fumes of metal, or the like. In a word, whenever the vital

motions have been suddenly stopt from any cause whatever, except in

swoonings occasioned by mere weakness or hysteric affections, it is

proper to open a vein. But in all disorders proceeding from a relaxation

of the solids, and an impoverished state of the blood, as dropsies,

cacochymies, &c. bleeding is improper.

Bleeding for topical inflammations ought always to be performed as near

the part affected as possible. When this can be done with a lancet, it

is to be preferred to any other method; but where a vein cannot be

found, recourse must be had to leeches or cupping.

The quantity of blood to be let must always be regulated by the

strength, age, constitution, manner of life, and other circumstances

relating to the patient. It would be ridiculous to suppose that a child

could bear to lose as much blood as a grown person, or that a delicate

lady should be bled to the same extent as a robust man.

From whatever part of the body blood is to be let, a bandage must be

applied between that part and the heart. As it is often necessary, in

order to raise the vein, to make the bandage pretty tight, it will be

proper in such cases, as soon as the blood begins to flow, to slacken it

a little. The bandage ought to be applied at least an inch, or an inch

and half from the place where the wound is intended to be made.

Persons not skilled in anatomy ought never to bleed in a vein that lies

over an artery or a tendon, if they can avoid it. The former may easily

be known from its pulsation or beating, and the latter from its feeling

hard or tight like a whipcord under the finger.

It was formerly a rule, even among those who had the character of being

regular practitioners, to bleed their patients in certain diseases till

they fainted. Surely a more ridiculous rule could not be proposed. One

person will faint at the very sight of a lancet, while another will lose

almost the whole blood of his body before he faints. Swooning depends

more upon the state of the mind than of the body; besides, it may often

be occasioned or prevented by the manner in which the operation is

performed.

Children are generally bled with leeches. This, though sometimes

necessary, is a very troublesome and uncertain practice. It is

impossible to know what quantity of blood is taken away by leeches;

besides, the bleeding is often very difficult to stop, and the wounds

are not easily healed. Would those who practice bleeding take a little

more pains, and accustom themselves to bleed children, they would not

find it such a difficult operation as they imagine.

Certain hurtful prejudices with regard to bleeding still prevail among

the country people. They talk, for instance, of head-veins, heart-veins,

breast-veins, &c. and believe that bleeding in these will certainly cure

all diseases of the parts from whence they are supposed to come, without

considering that all the blood-vessels arise from the heart, and return

to it again; for which reason, unless in topical inflammations, it

signifies very little from what part of the body blood is taken. But

this, though a foolish prejudice, is not near so hurtful as the vulgar

notion that the first bleeding will perform wonders. This belief makes

them often postpone the operation when necessary, in order to reserve it

for some more important occasion, and, when they think themselves in

extreme danger, they fly to it for relief, whether it be proper or not.

Bleeding at certain dated periods or seasons has likewise bad effects.

It is a common notion that bleeding in the feet draws the humours

downwards, and consequently cures diseases of the head and other

superior parts: but we have already observed that, in all topical

affections, the blood ought to be drawn as near the part as possible.

When it is necessary, however, to bleed in the foot or hand, as the

veins are small, and the bleeding is apt to stop too soon, the part

ought to be immersed in warm water, and kept there till a sufficient

quantity of blood be let.

We shall not spend time in describing the manner of performing this

operation: that will be better learned by example than precept. Twenty

pages of description would not convey so just an idea of the operation

as seeing it once performed by an expert hand. Neither is it necessary

to point out the different parts of the body from whence blood may be

taken, as the arm, foot, forehead, temples, neck, &c. These will readily

occur to every intelligent person, and the foregoing observations will

be sufficient for determining which of them is most proper upon any

particular occasion. In all cases where the intention is merely to

lessen the general mass of blood, the arm is the most commodious part of

the body in which the operation can be performed.

OF INFLAMMATIONS AND ABSCESSES.

From whatever cause an inflammation proceeds, it must terminate either

by dispersion, suppuration, or gangrene. Though it is impossible to

foretel with certainty in which of these ways any particular

inflammation will terminate, yet a probable conjecture may be formed

with regard to the event, from a knowledge of the patient’s age and

constitution. Inflammations happening in a slight degree upon colds, and

without any previous indisposition, will most probably be dispersed;

those which follow close upon a fever, or happen to persons of a gross

habit of body, will generally suppurate; and those which attack very old

people, or persons of a dropsical habit, will have a strong tendency to

gangrene.

If the inflammation be slight, and the constitution sound, the

dispersion ought always to be attempted. This will be best promoted by a

slender diluting diet, plentiful bleeding, and repeated purges. The part

itself must be fomented, and, if the skin be very tense, it may be

embrocated with a mixture of three-fourths of sweet oil, and one-fourth

of vinegar, and afterwards covered with a piece of wax plaster.

If, notwithstanding these applications, the symptomatic fever increases,

and the tumour becomes larger, with violent pain and pulsation, it will

be proper to promote the suppuration. The best application for this

purpose is a soft poultice, which may be renewed twice a day. If the

suppuration proceeds but slowly, a raw onion cut small or bruised may be

spread upon the poultice. When the abscess is ripe or fit for opening,

which may easily be known from the thinness of the skin in the most

prominent part of it, a fluctuation of matter which may be felt under

the finger, and, generally speaking, an abatement of the pain, it may be

opened either with a lancet or by means of caustic.

The last way in which an inflammation terminates, is in a gangrene or

mortification, the approach of which may be known by the following

symptoms: the inflammation loses its redness, and becomes duskish or

livid; the tension of the skin goes off, and it feels flabby; little

bladders filled with ichor of different colours spread all over it; the

tumour subsides, and from a duskish complexion becomes black; a quick

low pulse, with cold clammy sweats, are the immediate forerunners of

death.

When these symptoms first appear, the part ought to be dressed with

London treacle, or a cataplasm made of lixivium and bran. Should the

symptoms become worse, the part must be scarified, and afterwards

dressed with basilicum softened with oil of turpentine. All the

dressings must be applied warm. With regard to internal medicines, the

patient must be supported with generous cordials, and the Peruvian bark

exhibited in as large doses as the stomach will bear it. If the

mortified parts should separate, the wound will become a common ulcer,

and must be treated accordingly.

This article includes the treatment of all those diseases, which, in

different parts of the country, go by the names of _biles_,

_imposthumes_, _whitloes_, &c. They are all abscesses in consequence of

a previous inflammation, which, if possible, ought to be discussed; but

when this cannot be done, the suppuration should be promoted, and the

matter discharged by an incision, if necessary; afterwards the sore may

be dressed with yellow basilicum, or some other digestive ointment.

OF WOUNDS.

No part of medicine has been more mistaken than the treatment or cure of

wounds. Mankind in general believe that certain herbs, ointments, and

plasters are possessed of wonderful healing powers, and imagine that no

wound can be cured without the application of them. It is however a

fact, that no external application whatever contributes towards the cure

of a wound, any other way than by keeping the parts soft, clean, and

defending them from the external air, which may be as effectually done

by dry lint, as by the most pompous applications, while it is exempt

from many of the bad consequences attending them.

The same observation holds with respect to internal applications. These

only promote the cure of wounds as far as they tend to prevent a fever,

or to remove any cause that might obstruct or impede the operations of

Nature. It is Nature alone that cures wounds. All that Art can do is to

remove obstacles, and to put the parts in such a condition as is the

most favourable to Nature’s efforts.

With this simple view we shall consider the treatment of wounds, and

endeavour to point out such steps as ought to be taken to facilitate

their cure.

The first thing to be done when a person has received a wound, is to

examine whether any foreign body be lodged in it, as wood, stone, iron,

lead, glass, dirt, bits of cloth, or the like. These, if possible, ought

to be extracted, and the wound cleaned, before any dressings be applied.

When that cannot be effected with safety, on account of the patient’s

weakness, or loss of blood, they must be suffered to remain in the

wound, and afterwards extracted when he is more able to bear it.

When a wound penetrates into any of the cavities of the body, as the

breast, the bowels, &c. or where any considerable blood-vessel is cut, a

skilful surgeon ought immediately to be called, otherwise the patient

may lose his life. But sometimes the discharge of blood is so great,

that if it be not stopt, the patient may die even before a surgeon,

though at no great distance, can arrive. In this case, something must be

done by those who are present. If the wound be in any of the limbs, the

bleeding may generally be stopt by applying a tight ligature or bandage

round the member a little above the wound. The best method of doing this

is to put a strong broad garter round the part, but so slack as easily

to admit a small piece of stick to be put under it, which must be

twisted, in the same manner as a countryman does a cart-rope to secure

his loading, till the bleeding stops. Whenever this is the case, he must

take care to twist it no longer, as straining it too much might occasion

an inflammation of the parts, and endanger a gangrene.

In parts where this bandage cannot be applied, various other methods may

be tried to stop the bleeding, as the application of styptics,

astringents, &c. Cloths dipped in a solution of blue vitriol in water,

or the _styptic water_ of the Dispensatories, may be applied to the

wound. When these cannot be obtained, strong spirits of wine may be

used. Some recommend the _agaric_[194] of the oak as preferable to any

of the other styptics; and indeed it deserves considerable encomiums. It

is easily obtained, and ought to be kept in every family, in case of

accidents. A piece of it must be laid upon the wound, and covered with a

good deal of lint, above which a bandage may be applied so tight as to

keep it firmly on.

Though spirits, tinctures, and hot balsams may be used, in order to stop

the bleeding when it is excessive, they are improper at other times.

They do not promote but retard the cure, and often change a simple wound

into an ulcer. People imagine, because hot balsams congeal the blood,

and seem, as it were, to solder up the wound, that they therefore heal

it; but this is only a deception. They may indeed stop the flowing

blood, by searing the mouths of the vessels; but, by rendering the parts

callous, they obstruct the cure.

In slight wounds, which do not penetrate much deeper than the skin, the

best application is a bit of the common black sticking-plaster. This

keeps the sides of the wound together, and prevents the air from hurting

it, which is all that is necessary. When a wound penetrates deep, it is

not safe to keep its lips quite close: this keeps in the matter, and is

apt to make the wound fester. In this case the best way is to fill the

wound with soft lint, commonly called _caddis_. It however must not be

stuffed in too hard, otherwise it will do hurt. The lint may be covered

with a cloth dipped in oil, or spread with the common wax plaster[195];

and the whole must be kept on by a proper bandage.

We shall not spend time in describing the different bandages that may be

proper for wounds in different parts of the body; common sense will

generally suggest the most commodious method of applying a bandage;

besides, descriptions of this kind are not easily understood or

remembered.

The first dressing ought to continue on for at least two days; after

which it may be removed, and fresh lint applied as before. If any part

of the first dressing sticks so close as not to be removed with ease or

safety to the patient, it may be allowed to continue, and fresh lint

dipped in sweet oil laid over it. This will soften it, so as to make it

come off easily at next dressing. Afterwards the wound may be dressed

twice a-day in the same manner till it be quite healed. Those who are

fond of salves or ointments, may, after the wound is become very

superficial, dress it with the yellow _basilicum_[196]; and if fungous,

or what is called _proud flesh_, should rise in the wound, it may be

checked, by mixing with the ointment a little burnt alum or red

precipitate of mercury.

When a wound is greatly inflamed, the most proper application is a

poultice of bread and milk, softened with a little sweet oil or fresh

butter. This must be applied instead of a plaster, and should be changed

twice a-day.

If the wound be large, and there is reason to fear an inflammation, the

patient should be kept on a very low diet. He must abstain from flesh,

strong liquors, and every thing that is of a heating nature. If he be of

a full habit, and has lost but little blood from the wound, he must be

bled; and, if the symptoms be urgent, the operation may be repeated. But

when the patient has been greatly weakened by loss of blood from the

wound, it will be dangerous to bleed him, even though a fever should

ensue. Nature should never be too far exhausted. It is always more safe

to allow her to struggle with the disease in her own way, than to sink

the patient’s strength by excessive evacuations.

Wounded persons ought to be kept perfectly quiet and easy. Every thing

that ruffles the mind or moves the passions, as love, anger, fear,

excessive joy, &c. are very hurtful. They ought above all things to

abstain from venery. The body should be kept gently open, either by

laxative clysters, or by a cool vegetable diet, as roasted apples,

stewed prunes, boiled spinage, and such like.

OF BURNS.

In slight burns which do not break the skin, it is customary to hold the

part near the fire for a competent time, to rub it with salt, or to lay

a compress upon it dipped in spirits of wine or brandy. But when the

burn has penetrated so deep as to blister or break the skin, it must be

dressed with some of the liniment for burns mentioned in the Appendix,

or with the emollient and gently drying ointment, commonly called

_Turner’s cerate_[197]. This may be mixed with an equal quantity of

fresh olive oil, and spread upon a soft rag, and applied to the part

affected. When this ointment cannot be had, an egg may be beat up with

about an equal quantity of the sweetest salad-oil. This will serve very

well till a proper ointment can be prepared. When the burning is very

deep, after the first two or three days, it should be dressed with equal

parts of yellow _basilicum_ and _Turner’s cerate_ mixed together.

When the burn is violent, or has occasioned a high degree of

inflammation, and there is reason to fear a gangrene or mortification,

the same means must be used to prevent it as are recommended in other

violent inflammations. The patient, in this case, must live low, and

drink freely of weak diluting liquors. He must likewise be bled, and

have his body kept open. But if the burnt parts should become livid or

black, with other symptoms of mortification, it will be necessary to

bathe them frequently with warm camphorated spirits of wine, tincture of

myrrh, or other antiseptics, mixed with a decoction of the bark. In this

case the bark must likewise be taken internally, and the patient’s diet

must be more generous.

As example teaches better than precept, I shall relate the treatment of

the most dreadful case of this kind that has occurred in my practice. A

middle-aged man, of a good constitution, fell into a large vessel full

of boiling water, and miserably scalded about one half of his body. As

his clothes were on, the burning in some parts was very deep before they

could be got off. For the first two days the scalded parts had been

frequently anointed with a mixture of lime-water and oil, which is a

very proper application for recent burnings. On the third day, when I

first saw him, his fever was high, and his body costive, for which he

was bled, and had an emollient clyster administered. Poultices of bread

and milk, softened with fresh butter, were likewise applied to the

affected parts, to abate the heat and inflammation. His fever still

continuing high, he was bled a second time, was kept strictly on the

cooling regimen, took the saline mixture with small doses of nitre, and

had an emollient clyster administered once a-day. When the inflammation

began to abate, the parts were dressed with a digestive composed of

brown cerate and yellow basilicum. Where any black spots appeared, they

were slightly scarified, and touched with the tincture of myrrh; and, to

prevent their spreading, the Peruvian bark was administered. By this

course, the man was so well in three weeks as to be able to attend his

business.

OF BRUISES.

Bruises are generally productive of worse consequences than wounds. The

danger from them does not appear immediately, by which means it often

happens that they are neglected. It is needless to give any definition

of a disease so universally known; we shall therefore proceed to point

out the method of treating it.

In slight bruises it will be sufficient to bathe the part with warm

vinegar, to which a little brandy or rum may occasionally be added, and

to keep cloths wet with this mixture constantly applied to it. This is

more proper than rubbing it with brandy, spirits of wine, or other

ardent spirits, which are commonly used in such cases.

In some parts of the country the peasants apply to a recent bruise a

cataplasm of fresh cow-dung. I have often seen this cataplasm applied to

violent contusions occasioned by blows, falls, bruises, and such like,

and never knew it fail to have a good effect.

When a bruise is very violent, the patient ought immediately to be bled,

and put upon a proper regimen. His food should be light and cool, and

his drink weak, and of an opening nature; as whey sweetened with honey,

decoctions of tamarinds, barley, cream-tartar-whey, and such like. The

bruised part must be bathed with vinegar and water, as directed above;

and a poultice made by boiling crumb of bread, elder-flowers, and

camomile-flowers, in equal quantities of vinegar and water, applied to

it. This poultice is peculiarly proper when a wound is joined to the

bruise. It may be renewed two or three times a-day.

As the structure of the vessels is totally destroyed by a violent

bruise, there often ensues a great loss of substance, which produces an

ulcerous sore very difficult to cure. If the bone be affected, the sore

will not heal before an exfoliation takes place; that is, before the

diseased part of the bone separates, and comes out through the wound.

This is often a very slow operation, and may even require several years

to be completed. Hence it happens, that these sores are frequently

mistaken for the king’s evil, and treated as such, though in fact they

proceed solely from the injury which the solid parts received from the

blow.

Patients in this situation are pestered with different advices. Every

one who sees them proposes a new remedy, till the sore is so much

irritated with various and opposite applications, that it is often at

length rendered absolutely incurable. The best method of managing such

sores is, to take care that the patient’s constitution does not suffer

by confinement, or improper medicine, and to apply nothing to them

besides simple ointment spread upon soft lint, over which a poultice of

bread and milk, with boiled camomile-flowers, or the like, may be put,

to nourish the part, and keep it soft and warm. Nature, thus assisted,

will generally in time operate a cure, by throwing off the diseased

parts of the bone, after which the sore soon heals.

OF ULCERS.

Ulcers may be the consequence of wounds, bruises, or imposthumes

improperly treated; they may likewise proceed from an ill state of the

humours, or what may be called a bad habit of body.

In the latter case, they ought not to be hastily dried up, otherwise it

may prove fatal to the patient. Ulcers happen most commonly in the

decline of life; and persons who neglect exercise, and live grossly, are

most liable to them. They might often be prevented by retrenching some

part of the solid food, or by opening artificial drains, as issues,

setons, or the like.

An ulcer may be distinguished from a wound by its discharging a thin

watery humour, which is often so acrid as to inflame and corrode the

skin; by the hardness and perpendicular situation of its sides or edges,

by the time of its duration, &c.

It requires considerable skill to be able to judge whether or not an

ulcer ought to be dried up. In general, all ulcers which proceed from a

bad habit of body, should be suffered to continue open, at least till

the constitution has been so far changed by proper regimen, or the use

of medicine, that they seem disposed to heal of their own accord. Ulcers

which are the effect of malignant fevers, or other acute diseases, may

generally be healed with safety after the health has been restored for

some time. The cure ought not however to be attempted too soon, nor at

any time without the use of purging medicines and a proper regimen. When

wounds or bruises have, by wrong treatment, degenerated into ulcers, if

the constitution be good, they may generally be healed with safety. When

ulcers either accompany chronical diseases, or come in their stead, they

must be cautiously healed. If an ulcer conduces to the patient’s health,

from whatever cause it proceeds, it ought not to be healed; but if, on

the contrary, it wastes the strength, and consumes the patient by a slow

fever, it should be healed as soon as possible.

We would earnestly recommend a strict attention to these particulars, to

all who have the misfortune to labour under this disorder, particularly

persons in the decline of life; as we have frequently known people throw

away their lives by the want of it, while they were extolling and

generously rewarding those whom they ought to have looked upon as their

executioners.

The most proper regimen for promoting the cure of ulcers, is to avoid

all spices, salted and high-seasoned food, all strong liquors, and to

lessen the usual quantity of flesh meat. The body ought to be kept

gently open by a diet consisting chiefly of cooling laxative vegetables,

and by drinking butter-milk, whey sweetened with honey, or the like. The

patient ought to be kept cheerful, and should take as much exercise as

he can easily bear.

When the bottom and sides of an ulcer seem hard and callous, they may be

sprinkled twice a-day with a little red precipitate of mercury, and

afterwards dressed with the yellow _basilicum_ ointment. Sometimes it

will be necessary to have the edges of the ulcer scarified with the

lancet.

Lime-water has frequently been known to have very happy effects in the

cure of obstinate ulcers. It may be used in the same manner as directed

for the stone and gravel.

My late learned and ingenious friend, Dr. Whytt, strongly recommends the

use of the solution of corrosive sublimate of mercury in brandy, for the

cure of obstinate ill conditioned ulcers. I have frequently found this

medicine, when given according to the Doctor’s directions, prove very

successful. The dose is a table-spoonful night and morning; at the same

time washing the sore twice or thrice a-day with it. In a letter which I

had from the Doctor a little before his death, he informed me, “That he

observed washing the sore thrice a-day with the solution of a triple

strength was very beneficial[198].”

A fistulous ulcer can seldom be cured without an operation. It must

either be laid open so as to have its callous parts destroyed by some

corrosive application, or they must be entirely cut away by the knife:

but as this operation requires the hand of an expert surgeon, there is

no occasion to describe it. Ulcers about the _anus_ are most apt to

become fistulous, and are very difficult to cure. Some indeed pretend to

have found Ward’s Fistula paste very successful in this complaint. It is

not a dangerous medicine, and being easily procured, it may deserve a

trial; but as these ulcers generally proceed from an ill habit of body,

they will seldom yield to any thing except a long course of regimen,

assisted by medicines, which are calculated to correct that particular

habit, and to induce an almost total change in the constitution.

CHAP. LI.

OF DISLOCATIONS.

When a bone is moved out of its place or articulation, so as to impede

its proper functions, it is said to be _luxated_ or _dislocated_. As

this often happens to persons in situations where no medical assistance

can be obtained, by which means limbs, and even lives, are frequently

lost, we shall endeavour to point out the method of reducing the most

common luxations, and those which require immediate assistance. Any

person of common sense and resolution, who is present when a dislocation

happens, may often be of more service to the patient, than the most

expert surgeon can after the swelling and inflammation have come on.

When these are present, it is difficult to know the state of the joint,

and dangerous to attempt a reduction; and by waiting till they are gone

off, the muscles become so relaxed, and the cavity filled up, that the

bone can never afterwards be retained in its place.

A recent dislocation may generally be reduced by extension alone, which

must always be greater or less according to the strength of the muscles

which move the joint, the age, robustness, and other circumstances of

the patient. When the bone has been out of its place for any

considerable time, and a swelling or inflammation has come on, it will

be necessary to bleed the patient, and, after fomenting the part, to

apply soft poultices with vinegar to it for some time before the

reduction is attempted.

All that is necessary after the reduction, is to apply cloths dipt in

vinegar or camphorated spirits of wine to the part, and to keep it

perfectly easy. Many bad consequences proceed from the neglect of this

rule. A dislocation seldom happens without the tendons and ligaments of

the joint being stretched and sometimes torn. When these are kept easy

till they recover their strength and tone, all goes on very well; but is

the injury be increased by too frequent an exertion of the parts, no

wonder if they be found weak and diseased ever after.

DISLOCATION OF THE JAW.

The lower jaw may be luxated by yawning, blows, falls, chewing hard

substances, or the like. It is easily known from the patient’s being

unable to shut his mouth, or to eat any thing, as the teeth of the under

jaw do not correspond with those of the upper; besides, the chin either

hangs down, or is thrown toward one side, and the patient is neither

able to speak distinctly, nor to swallow without considerable

difficulty.

The usual method of reducing a dislocated jaw, is to set the patient

upon a low stool, so as an assistant may hold the head firm by pressing

it against his breast. The operator is then to thrust his two thumbs,

being first wrapped up with linen cloths that they may not slip, as far

back into the patient’s mouth as he can, while his fingers are applied

to the jaw externally. After he has got firm hold of the jaw, he is to

press it strongly downwards and backwards, by which means the elapsed

heads of the jaw may be easily pushed into their former cavities.

The peasants in some parts of the country have a peculiar way of

performing this operation. One of them puts a handkerchief under the

patient’s chin, then turning his back to that of the patient, pulls him

up by the chin so as to suspend him from the ground. This method often

succeeds, but we think it a dangerous one, and therefore recommend the

former.

DISLOCATION OF THE NECK.

The neck may be dislocated by falls, violent blows, or the like. In this

case, if the patient receives no assistance, he soon dies, which makes

people imagine the neck was broken; it is, however, for the most part

only partially dislocated, and may be reduced by almost any person who

has resolution enough to attempt it. A complete dislocation of the neck

is instantaneous death.

When the neck is dislocated, the patient is immediately deprived of all

sense and motion; his neck swells, his countenance appears bloated; his

chin lies upon his breast, and his face is generally turned towards one

side.

To reduce this dislocation, the unhappy person should immediately be

laid upon his back on the ground, and the operator must place himself

behind him so as to be able to lay hold of his head with both hands,

while he makes a resistance by placing his knees against the patient’s

shoulders. In this posture he must pull the head with considerable

force, gently twisting it at the same time, if the face be turned to one

side, till he perceives that the joint is replaced, which may be known

from the noise which the bones generally make when going in, the

patient’s beginning to breathe, and the head continuing in its natural

posture.

This is one of those operations which it is more easy to perform than

describe. I have known instances of its being happily performed even by

women, and often by men of no medical education. After the neck is

reduced, the patient ought to be bled, and should be suffered to rest

for some days, till the parts recover their proper tone.

DISLOCATION OF THE RIBS.

As the articulation of the ribs with the backbone is very strong, they

are not often dislocated. It does however sometimes happen, which is a

sufficient reason for our taking notice of it. When a rib is dislocated

either upwards or downwards, in order to replace it, the patient should

be laid upon his belly on a table, and the operator must endeavour to

push the head of the bone into its proper place. Should this method not

succeed, the arm of the disordered side may be suspended over a gate or

ladder, and, while the ribs are thus stretched asunder, the heads of

such as are out of place may be thrust into their former situation.

Those dislocations wherein the heads of the ribs are forced inwards, are

both more dangerous and the most difficult to reduce, as neither the

hand nor any instrument can be applied internally to direct the luxated

heads of the ribs. Almost the only thing that can be done is, to lay the

patient his belly over a cask, or some gibbous body, and to move the

fore-part of the rib inward towards the back, sometimes shaking it; by

this means the heads of the luxated ribs may slip into their former

place.

DISLOCATION OF THE SHOULDER.

The humerus or upper bone of the arm may be dislocated in various

directions: it happens however most frequently downwards, but very

seldom directly upwards. From the nature of its articulation, as well as

from its exposure to external injuries, this bone is the most subject to

dislocation of any in the body. A dislocation of the humerus may be

known by a depression or cavity on the top of the shoulder, and an

inability to move the arm. When the dislocation is downward or forward,

the arm is elongated, and a ball or lump is perceived under the arm-pit;

but when it is backward, there appears a protuberance behind the

shoulder, and the arm is thrown forwards toward the breast.

The usual method of reducing dislocations of the shoulder is to seat the

patient upon a low stool, and to cause an assistant to hold his body so

that it may not give way to the extension, while another lays hold of

the arm a little above the elbow, and gradually extends it. The operator

then puts a napkin under the patient’s arm, and causes it to be tied

behind his own neck: by this, while a sufficient extension is made, he

lifts up the head of the bone, and with his hands directs it into its

proper place. There are various machines invented for facilitating this

operation, but the hand of an expert surgeon is always more safe. In

young and delicate patients, I have generally found it a very easy

matter to reduce the shoulder, by extending the arm with one hand, and

thrusting in the head of the bone with the other. In making the

extension, the arm ought always to be a little bent.

DISLOCATION OF THE ELBOW.

The bones of the fore-arm may be dislocated in any direction. When this

is the case, a protuberance may be observed on that side of the arm

towards which the bone is pushed, from which, and the patient’s

inability to bend his arm, a dislocation of this joint may easily be

known.

Two assistants are generally necessary for reducing a dislocation of the

elbow; one of them must lay hold of the arm above, and the other below

the joint, and make a pretty strong extension, while the operator

returns the bones into their proper place. Afterwards the arm must be

bent, and suspended for some time with a sling about the neck.

Luxations of the wrist and fingers are to be reduced in the same manner

as those of the elbow, _viz._ by making an extension in different

directions, and thrusting the head of the bone into its place.

DISLOCATION OF THE THIGH.

When the thigh-bone is dislocated forward and downward, the knee and

foot are turned out, and the leg is longer than the other; but when it

is displaced backward, it is usually pushed upward at the same time, by

which means the limb is shortened, and the foot is turned inwards.

When the thigh-bone is displaced forward and downward, the patient, in

order to have it reduced, must be laid upon his back, and made fast by

bandages, or held by assistants, while by others an extension is made by

means of slings fixed about the bottom of the thigh a little above the

knee. While the extension is made, the operator must push the head of

the bone outward, till it gets into the socket. If the dislocation be

outward, the patient must be laid upon his face, and, during the

extension, the head of the bone must be pushed inward.

Dislocations of the _knees_, _ancles_, and _toes_, are reduced much in

the same manner as those of the upper extremities, _viz._ by making an

extension in opposite directions, while the operator replaces the bones.

In many cases, however, the extension alone is sufficient, and the bone

will slip into its place merely by pulling the limb with sufficient

force. It is not hereby meant, that force alone is sufficient for the

reduction of dislocations. Skill and address will often succeed better

than force. I have known a dislocation of the thigh reduced by one man,

after all the force that could be used by six had proved ineffectual.

CHAP. LII.

OF BROKEN BONES, &c.

There is, in most country villages, some person who pretends to the art

of reducing fractures. Though in general such persons are very ignorant,

yet some of them are very successful; which evidently proves, that a

small degree of learning, with a sufficient share of common sense and a

mechanical head, will enable a man to be useful in this way. We would,

however, advise people never to employ such operators, when an expert

and skilful surgeon can be had; but when that is impracticable, they

must be employed: we shall therefore recommend the following hints to

their consideration:

When a large bone is broken, the patient’s diet ought in all respects to

be the same as in an inflammatory fever. He should likewise be kept

quiet and cool, and his body open by emollient clysters; or, if these

cannot be conveniently administered, by food that is. of an opening

quality; as stewed prunes, apples boiled in milk, boiled spinage, and

the like. It ought however to be here remarked, that persons who have

been accustomed to live high, are not all of a sudden to be reduced to a

very low diet. This might have fatal effects. There is often a necessity

for indulging even bad habits, in some measure, where the nature of the

disease might require a different treatment.

It will generally be necessary to bleed the patient immediately after a

fracture, especially if he be young, of a full habit, or has at the same

time received any bruise or contusion. This operation should not only be

performed soon after the accident happens, but if the patient be very

feverish, it may be repeated next day. When several of the ribs are

broken, bleeding is peculiarly necessary.

If any of the large bones which support the body are broken, the patient

must keep his bed for several weeks. It is by no means necessary,

however, that he should lie all that time, as is customary, upon his

back. This situation sinks the spirits, galls and frets the patient’s

skin, and renders him very uneasy. After the second week he may be

gently raised up, and may sit several hours, supported by a bed-chair,

or the like, which will greatly relieve him. Great care, however, must

be taken in raising him up, and laying him down, that he make no

exertions himself, otherwise the action of the muscles may pull the bone

out of its place[199].

It is of great importance to keep the patient dry and clean while in

this situation. By neglecting this, he is often so galled and

excoriated, that he is forced to keep shifting places for ease. I have

known a fractured thigh-bone, after it had been kept straight for above

a fortnight, displaced by this means, and continue bent for life, in

spite of all that could be done.

It has been customary when a bone was broken, to keep the limb for five

or six weeks continually upon the stretch. But this is a bad posture. It

is both uneasy to the patient, and unfavourable to the cure. The best

situation is to keep the limb a little bent. This is the posture into

which every animal puts its limbs when it goes to rest, and in which

fewest muscles are upon the stretch. It is easily effected, by either

laying the patient upon his side, or making the bed so as to favour this

position of the limb.

Bone-setters ought carefully to examine whether the bone be not

shattered or broken into several pieces. In this case it will sometimes

be necessary to have the limb immediately taken off, otherwise a

gangrene or mortification may ensue. The horror which attends the very

idea of an amputation often occasions its being delayed in such cases

till too late. I have known this principle operate so strongly, that a

limb, where the bones were shattered into more than twenty pieces, was

not amputated before the third day after the accident, when the gangrene

had proceeded so far as to render the operation useless.

When a fracture is accompanied with a wound, it must be dressed in all

respects as a common wound.

All that art can do towards the cure of a broken bone, is to lay it

perfectly straight, and to keep it quite easy. All tight bandages do

hurt. They had much better be wanting altogether. A great many of the

bad consequences which succeed to fractured bones are owing to tight

bandages. This is one of the ways in which the excess of art, or rather

the abuse of it, does more mischief than would be occasioned by the want

of it. Some of the most sudden cures of broken bones which were ever

known, happened where no bandages were applied at all. Some method

however must be taken to keep the member steady; but this may be done

many ways without bracing it with a tight bandage.

The best method of retention is by two or more splints made of leather

or pasteboard. These, if moistened before they be applied, soon assume

the shape of the included member, and are sufficient, by the assistance

of a very slight bandage, for all the purposes of retention. The bandage

which we would recommend is that made with twelve or eighteen tails. It

is much easier applied and taken off than rollers, and answers all the

purposes of retention equally well. The splints should always be as long

as the limb, with holes cut for the ancles when the fracture is in the

leg.

In fractures of the ribs, where a bandage cannot be properly used, an

adhesive plaster may be applied over the part. The patient in this case

ought to keep himself quite easy, avoiding every thing that may occasion

sneezing, laughing, coughing, or the like. He ought to keep his body in

a straight posture, and should take care that his stomach be constantly

distended, by taking frequently some light food, and drinking freely of

weak watery liquors.

The most proper external application for a fracture is _oxycrate_, or a

mixture of vinegar and water. The bandages should be wet with this at

every dressing.

OF STRAINS.

Strains are often attended with worse consequences than broken bones.

The reason is obvious; they are generally neglected. When a bone is

broken, the patient is obliged to keep the member easy, because he

cannot make use of it; but when a joint is only strained, the person,

finding he can still make a shift to move it, is sorry to lose his time

for so trifling an ailment. In this way he deceives himself, and

converts into an incurable malady what might have been removed by only

keeping the part easy for a few days.

Country people generally immerse a strained limb in cold water. This is

very proper, provided it be done immediately, and not kept in too long.

But the custom of keeping the part immersed in cold water for a long

time is certainly dangerous. It relaxes instead of bracing the part, and

is more likely to produce a disease than remove one.

Wrapping a garter, or some other bandage, pretty tight about the

strained part, is likewise of use. It helps to restore the proper tone

of the vessels, and prevents the action of the parts from increasing the

disease. It should not however be applied too tight. I have frequently

known bleeding near the affected part have a very good effect: but what

we would recommend above all is _ease_. It is more to be depended on

than any medicine, and seldom fails to remove the complaint[200].

OF RUPTURES.

Children and old people are most liable to this disease. In the former

it is generally occasioned by excessive crying, coughing, vomiting, or

the like. In the latter, it is commonly the effect of blows or violent

exertions of the strength, as leaping, carrying great weights, &c. In

both, a relaxed habit, indolence, and an oily or very moist diet,

dispose the body to this disease.

A rupture sometimes proves fatal before it is discovered. Whenever

sickness, vomiting, and obstinate costiveness give reason to suspect an

obstruction of the bowels, all those places where ruptures usually

happen ought carefully to be examined. The protrusion of a very small

part of the gut will occasion all these symptoms; and, if not returned

in due time, will prove mortal.

On the first appearance of a rupture in an infant, it ought to be laid

upon its back, with its head very low. While in this posture, if the gut

does not return of itself, it may easily be put up by gentle pressure.

After it is returned, a piece of sticking-plaster may be applied over

the part, and a proper truss or bandage must be constantly worn for a

considerable time. The method of making and applying these

rupture-bandages for children is pretty well known. The child must, as

far as possible, be kept from crying, and from all violent exertions,

till the rupture is quite healed.

In adults, when the gut has been forced down with great violence, or

happens from any cause to be inflamed, there is often great difficulty

in returning it, and sometimes the thing is quite impracticable without

an operation; a description of which is foreign to our purpose. As I

have been fortunate enough, however, always to succeed in my attempts to

return the gut, without having recourse to any other means than what are

in the power of every man, I shall briefly mention the method which I

generally pursue.

After the patient has been bled, he must be laid upon his back, with his

head very low, and his breech raised high with pillows. In this

situation flannel cloths wrung out of a decoction of mallows and

camomile-flowers, or, if these are not at hand, of warm water, must be

applied for a considerable time. A clyster made of this decoction, with

a large spoonful of butter and an ounce or two of salt, may be

afterwards thrown up. If these should not prove successful, recourse

must be had to pressure. If the tumour be very hard, considerable force

will be necessary; but it is not force alone which succeeds here. The

operator, at the same time that he makes a pressure with the palms of

his hand, must with his fingers artfully conduct the gut in by the same

aperture through which it came out. The manner of doing this can be much

easier conceived than described. Should these endeavours prove

ineffectual, clysters of the smoke of tobacco may be tried. These have

been often known to succeed where every other method failed.

There is reason to believe that, by persisting in the use of these, and

such other means as the circumstances of the case may suggest, most

_hernias_ might be reduced without an operation. Cutting for the

_hernia_ is a nice and difficult matter. I would therefore advise

surgeons to try every method of returning the gut before they have

recourse to the knife. I have once and again succeeded by persevering in

my endeavours, after eminent surgeons had declared the reduction of the

gut impracticable without an operation[201].

An adult, after the gut has been returned, must wear a steel bandage. It

is needless to describe this, as it may always be had ready made from

the artists. Such bandages are generally uneasy to the wearer for some

time, but by custom they become quite easy. No person who has had a

rupture after he arrived at man’s estate should ever be without one of

these bandages.

Persons who have a rupture ought carefully to avoid all violent

exercise, carrying great weights, leaping, running, and the like. They

should likewise avoid windy aliment and strong liquors; and should

carefully guard against catching cold.

CHAP. LIII.

OF CASUALTIES.

It is certain that life, when to all appearance lost, may often, by due

care, be restored. Accidents frequently prove fatal, merely because

proper means are not used to counteract their effects, No person ought

to be looked upon as killed by any accident, unless where the structure

of the heart, brain, or some organ necessary to life, is evidently

destroyed. The action of these organs may be so far impaired as even to

be for some time imperceptible, when life is by no means gone. In this

case, however, if the fluids be suffered to grow cold, it will be

impossible to put them again in motion, even though the solids should

recover their power of acting. Thus, when the motion of the lungs has

been stopt by unwholesome vapour, the action of the heart by a stroke on

the breast, or the functions of the brain by a blow on the head, if the

person be suffered to grow cold, he will in all probability continue so;

but, if the body be kept warm, as soon as the injured part has recovered

its power of acting, the fluids will again begin to move, and all the

vital functions will be restored.

It is a horrid custom immediately to consign over to death every person

who has the misfortune, by a fall, a blow, or the like, to be deprived

of the appearance of life. The unhappy person, instead of being carried

into a warm house, and laid by the fire, or put to a warm bed, is

generally hurried away to church, or a barn, or some other cold damp

house, where, after a fruitless attempt has been made to bleed him,

perhaps by one who knew nothing of the matter, he is given over for

dead, and no further notice taken of him. This conduct seems to be the

result of ignorance, supported by an ancient superstitious notion, which

forbids the body of any person killed by accident to be laid in an house

that is inhabited. What the ground of this superstition may be, we shall

not pretend to inquire; but surely the conduct founded upon it is

contrary to all the principles of reason, humanity, and common sense.

When a person seems to be suddenly deprived of life, our first business

is to inquire into the cause. We ought carefully to observe whether any

substance be lodged in the wind-pipe or gullet; and, if that is the

case, attempts must be made to remove it. When unwholesome air is the

cause, the patient ought immediately to be removed out of it. If the

circulation be suddenly stopped, from any cause whatever, except mere

weakness, the patient should be bled. If the blood does not flow, he may

be immersed in warm water, or rubbed with warm cloths, &c. to promote

the circulation. When the cause cannot be suddenly removed, our great

aim must be to keep up the vital warmth, by rubbing the patient with hot

cloths, or salt, and covering his body with warm sand, ashes, or the

like.

I should now proceed to treat more fully of those accidents, which,

without immediate assistance, would often prove fatal, and to point out

the most likely means for relieving the unhappy sufferers; but as I have

been happily anticipated in this part of my subject by the learned and

humane Dr. Tissot, I shall content myself with selecting such of his

observations as seem to be the most important, and adding such of my own

as have occurred in the course of practice.

OF SUBSTANCES STOPT BETWEEN THE MOUTH AND STOMACH.

Though accidents of this kind are very common, and extremely dangerous,

yet they are generally the effect of carelessness. Children should be

taught to chew their food well, and to put nothing into their mouths

which it would be dangerous for them to swallow. But children are not

the only persons guilty of this piece of imprudence. I know many adults

who put pins, nails, and other sharp-pointed substances in their mouths

upon every occasion, and some who even sleep with the former there all

night. This conduct is exceedingly injudicious, as a fit of coughing, or

twenty other accidents, may force over the substance before the person

is aware[202].

When any substance is detained in the gullet, there are two ways of

removing it, _viz._ either by extracting it, or pushing it down. The

safest and most certain way is to extract it; but this is pot always the

easiest; it may therefore be more eligible sometimes to thrust it down,

especially when the obstructing body is of such a nature, that there is

no danger from its reception into the stomach. The substances which may

be pushed down without danger are, all common nourishing ones, as bread,

flesh, fruits, and the like. All indigestible bodies, as cork, wood,

bones, pieces of metal, and such like, ought if possible to be

extracted, especially if these bodies be sharp pointed, as pins,

needles, fish-bones, bits of glass, &c.

When such substances have not passed in too deep, we should endeavour to

extract them with our fingers, which method often succeeds. When they

are lower, we must make use of nippers, or a small pair of forceps, such

as surgeons use. But this attempt to extract rarely succeeds, if the

substance be of a flexible nature, and has descended far into the

gullet.

If the fingers and nippers fail, or cannot be duly applied, crotchets, a

kind of hooks, must be employed. These may be made at once, by bending a

piece of pretty strong iron wire at one end. It must be introduced in

the flat way; and for the better conducing it, there should likewise be

a curve or bending at the end it is held by, to serve as a kind of

handle to it; which has this further use, that it may be secured by a

string tied to it, a circumstance not to be omitted in any instrument

employed on such occasions, to avoid such ill accidents as have

sometimes ensued from these instruments slipping out of the operator’s

hand. After the crotchet has passed below the substance that obstructs

the passage, it is drawn up again, and hooks up the body along with it.

The crotchet is also very convenient, when a substance somewhat

flexible, as a pin or fish-bone, sticks across the gullet, the hook, in

such cases, seizing them about their middle part, crooks and thus

disengages them; or, if they are very brittle substances, serves to

break them.

When the obstructing bodies are small, and only stop up a part of the

passage, and which may either easily elude the hook, or straiten it by

their resistance, a kind of rings, made either of wire, wool, or silk,

may be used. A piece of fine wire of a proper length may be bent into a

circle, about the middle, of about an inch diameter, and the long unbent

sides brought parallel, and near each other: these are to be held in the

hand, and the circular part or ring introduced into the gullet, in order

to be conduced about the obstructing body, and so to extract it. More

flexible rings may be made of wool, thread, silk, or small pack-thread,

which may be waxed for their greater strength and consistence. One of

these is to be tied fast to a handle of iron wire, whale-bone, or any

kind of flexible wood, and by this means introduced, in order to

surround the obstructing substance, and to draw it out. Several of these

rings passed through one another may be used, the more certainly to lay

hold of the obstructing body, which may be involved by one, if another

should miss it. These rings have one advantage, which is, that when the

substance to be extracted is once laid hold of, it may then, by turning

the handle, be retained so strongly in the ring thus twitted, as to be

moved every way, which must in many cases be a considerable advantage.

Another material employed on these unhappy occassions is the sponge. Its

property of swelling considerably on being wet is the principal

foundation of its usefulness here. If any substance is stopt in the

gullet, but without filling up the whole passage, a bit of sponge may be

introduced into that part which is unstopt, and beyond the substance.

The sponge soon dilates, and grows larger in this moist situation; and

indeed the enlargement of it may be forwarded by making the patient

swallow a few drops of water. Afterwards it is to be drawn back by the

handle to which it is fastened; and as it is now too large to return

through the small cavity by which it was conveyed in, it draws out the

obstructing body along with it.

The compressibility of sponge is another foundation of its usefulness in

such cases. A pretty large piece of sponge may be compressed or squeezed

into a small size, by winding a string of tape closely about it, which

may be easily unwound, and withdrawn, after the sponge has been

introduced. A bit of sponge may likewise be, compressed by a piece of

whale-bone split at one end; but this can hardly be introduced in such a

manner as not to hurt the patient.

I have often known pins and other sharp bodies, which had stuck in the

throat, brought up by causing the person to swallow a bit of tough meat

tied to a thread, and drawing it quickly up again. This is safer than

swallowing sponge, and will often answer the purpose equally well.

When all these methods prove unsuccessful, there remains one more, which

is, to make the patient vomit: but this can scarcely be of any service,

unless when such obstructing bodies are simply engaged in, and not

hooked or stuck into the sides of the gullet, as in this case vomiting

might sometimes occasion further mischief. If the patient can swallow,

vomiting may be excited by taking half a drachm or two scruples of

ipecacuanha in powder made into a draught. If he is not able to swallow,

an attempt may be made to excite vomiting, by tickling his throat with a

feather; and, if that should not succeed, a clyster of tobacco may be

administered. It is made by boiling an ounce of tobacco in a sufficient

quantity of water: this has often been found to succeed, when other

attempts to excite vomiting had failed.

When the obstructing body is of such a nature that it may with safety be

pushed downwards, this may be attempted by means of a wax-candle oiled,

and a little heated, so as to make it flexible; or a piece of

whale-bone, wire, or flexible wood, with a sponge fastened to one end.

Should it be impossible to extract even those bodies which it is

dangerous to admit into the stomach, we must then prefer the least of

two evils, and rather run the hazard of pushing them down than suffer

the patient to perish in a few minutes; and we ought to scruple this

resolution the less, as a great many instances have happened, where the

swallowing of such hurtful and indigestible substances has been followed

by no disorder.

Whenever it is manifest that all endeavours either to extract or push

down the substance must prove ineffectual, they should be discontinued;

because the inflammation occasioned by persisting in them might be as

dangerous as the obstruction itself. Some have died in consequence of

the inflammation, even after the body which caused the obstruction had

been entirely removed.

While the means recommended above are making use of, the patient should

often swallow, or, if he cannot, he should frequently receive by

injection through a crooked tube or pipe that may reach down to the

gullet, some emollient liquor, as warm milk and water, barley-water, or

a decoction of mallows. Injections of this kind not only soften and

sooth the irritated parts, but, when thrown in with force, are often

more successful in loosening the obstruction than all attempts with

instruments.

When, after all our endeavours, we are obliged to leave the obstructing

body in the part, the patient must be treated as if he had an

inflammatory disease. He should be bled, kept upon a low diet, and have

his whole neck surrounded with emollient poultices. The like treatment

must also be used, if there be any reason to suspect an inflammation of

the passages, though the obstructing body be removed.

A proper degree of agitation has sometimes loosened the inhering body

more effectually than instruments. Thus, a blow on the back has often

forced up a substance which stuck in the gullet; but this is still more

proper and efficacious when the substance gets into the wind-pipe. In

this case, vomiting and sneezing are likewise to be excited. Pins, which

stuck in the gullet, have been frequently discharged by riding on

horseback, or in a carriage.

When any indigestible substance has been forced down into the stomach,

the patient should use a very mild and smooth diet, consisting chiefly

of fruits and farinaceous substances, as puddings, pottage, and soups.

He should avoid all heating and irritating things, as wine, punch,

pepper, and such like; and his drink should be milk and water,

barley-water, or whey.

When the gullet is so strongly and fully closed, that the patient can

receive no food by the mouth, he must be nourished by clysters of soup,

jelly, and the like.

When the patient is in danger of being immediately suffocated, and all

hope of freeing the passage is vanished, so that death seems at hand, if

respiration be not restored; the operation of _bronchotomy_, or opening

of the wind-pipe, must be directly performed. As this operation is

neither difficult to an expert surgeon, nor very painful to the patient,

and is often the only method which can be taken to preserve life in

these emergencies, we thought proper to mention it, though it should

only be attempted by persons skilled in surgery.

OF DROWNED PERSONS.

When a person has remained above a quarter of an hour under water, there

can be no considerable hopes of his recovery. But as several

circumstances, may happen to have continued life, in such an unfortunate

situation, beyond the ordinary term, we should never too soon resign the

unhappy object to his fate, but try every method for his relief, as

there are many well attested proofs of the recovery of persons to life

and health who had been taken out of the water apparently dead, and who

remained a considerable time without exhibiting any signs of life.

The first thing to be done, after the body is taken out of the water, is

to convey it as soon as possible to some convenient place where the

necessary operations for its recovery may be performed. In doing this,

care must be taken not to bruise or injure the body by carrying it in

any unnatural posture with the head downwards, or the like. If an adult

body, it ought to be laid on a bed, or on straw, with the head a little

raised, and carried on a cart or on men’s shoulders, and kept in as

natural and easy a position as possible. A small body may be carried in

the arms.

In attempting to recover persons apparently drowned, the principal

intention to be pursued is, _to restore the natural warmth_, upon which

all the vital functions depend; and to excite these functions by the

application of stimulants, not only to the skin, but likewise to the

lungs, intestines, &c.

Though cold was by no means the cause of the person’s death, yet it will

prove an effectual obstacle to his recovery. For this reason, after

stripping him of his wet clothes, his body must be strongly rubbed for a

considerable time with coarse linen cloths, as warm as they can be made;

and, as soon as a well-heated bed can be got ready, he may be laid in

it, and the rubbing should be continued. Warm cloths ought likewise to

be frequently applied to the stomach and bowels, and hot bricks, or

bottles of warm water, to the soles of his feet, and to the palms of his

hands.

Strong volatile spirits should be frequently applied to the nose; and

the spine of the back and pit of the stomach may be rubbed with warm

brandy or spirit of wine. The temples ought always to be chafed with

volatile spirits; and stimulating powders, as that of tobacco or

marjoram, may be blown up the nostrils.

To renew the breathing, a strong person may blow his own breath into the

patient’s mouth with all the force he can, holding his nostrils at the

same time. When it can be perceived by the rising of the chest or belly

that the lungs are filled with air, the person ought to desist from

blowing, and should press the breast and belly so as to expel the air

again; and this operation may be repeated for some time, alternately

inflating and depressing the lungs so as to imitate natural respiration.