Chapter XV: Part 15

Sec. 471. When the Nose is affected with a Chilblain, the Steam of Vinegar, and an artificial Nose, or Covering for it, made of Dog-skin, are the most effectual Applications. The same Treatment is equally proper for the Ears and the Chin, when infested with them. Frequently washing these Parts in cold Water is a good Preservative from their being attacked.

Sec. 472. Whenever the Inflammation rises very high, and brings on some Degree of a Fever, the Patient's usual Quantity of strong Drink and of Flesh-meat must be lessened; his Body should be kept open by a few Glysters; he should take every Evening a Dose of Nitre as prescribed, No. 20; and if the Fever proved strong, he should lose some Blood too.

As many as are troubled with obstinate Chilblains, should always be denied the Use of strong Liquor and Flesh.

Sec. 473. When this Distemper prevails in its third Degree, and the Parts are ulcerated; besides keeping the Patients strictly to the Regimen of Persons in a Way of Recovery, and giving them a Purge of Manna, the swelled Parts should be exposed to the Steams of Vinegar; the Ulcerations should be covered with a Diapalma Plaister; and the whole Part should be enveloped in a smooth soft Skin, or in thin Cerecloths.

Sec. 474. The fourth Degree of this Disease, in which the Parts become gangrenous, must be prevented by the Method and Medicines which remove an Inflammation; but if unhappily a Gangrene has already appeared, the Assistance of a Surgeon proves indispensably necessary.

_Of Ruptures._

Sec. 475. _Hernias_ or Ruptures, which Country-People term _being bursten_, are a Disorder which sometimes occurs at the very Birth; though more frequently they are the Effects of violent crying, of a strong forcing Cough, or of repeated Efforts to vomit, in the first Months of Infancy.

They may happen afterwards indiscriminately at every Age, either as Consequences of particular Maladies, or Accidents, or from Peoples' violent Exertions of their Strength. They happen much oftner to Men than Women; and the most common Sort, indeed the only one of which I propose to treat, and that but briefly, is that which consists in the Descent of a Part of the Guts, or of the Cawl, into the Bag or Cod-piece.

It is not difficult to distinguish this Rupture. When it occurs in little Children, it is almost ever cured by making them constantly wear a Bandage which should be made only of Fustian, with a little Pillow or Pincushion, stuffed with Linen Rags, Hair or Bran. There should be at least two of these Bandages, to change them alternately; nor should it ever be applied, but when the Child is laid down on its Back, and after being well assured that the Gut or Cawl, which had fallen down, has been safely returned into the Cavity of the Belly; since without this Precaution it might occasion the worst Consequences.

The good Effect of the Bandage may be still further promoted, by applying upon the Skin, and within the Plait or Fold of the Groin (under which Place the Rings, or Passage out of the Belly into the Bag lie) some pretty astringent or strengthening Plaister, such as that commonly used for Fractures, or that I have already mentioned, Sec. 144. Here we may observe by the Way, that ruptured Children should never be set on a Horse, nor be carried by any Person on Horseback, before the Rupture is perfectly cured.

Sec. 476. In a more advanced Age, a Bandage only of Fustian is not sufficient; one must be procured with a Plate of Steel, even so as to constrain and incommode the Wearer a little at first: nevertheless it soon becomes habitual, and is then no longer inconvenient to them.

Sec. 477. Ruptures sometimes attain a monstrous Size; and a great Part of the Guts fall down in to the _Scrotum_ or Bag, without any Symptom of an actual Disease. This Circumstance, nevertheless, is accompanied with very great Inconvenience, which disables Persons affected with it to work; and whenever the Malady is so considerable, and of a long Standing too, there are commonly some Obstacles that prevent a compleat Return of the Guts into the Belly. In this State indeed, the Application of the Bandage or Truss is impracticable, and the miserable Patients are condemned to carry their grievous Burthen for the Remainder of their Lives; which may however, be palliated a little by the Use of a Suspensory and Bag, adapted to the Size of the Rupture. This Dread of its increasing Magnitude is a strong Motive for checking the Progress of it, when it first appears. But there is another still stronger, which is, that Ruptures expose the Patient to a Symptom frequently mortal. This occurs when that Part of the Intestines fallen into the _Scrotum_ inflames; when still increasing in its Bulk, and being extremely compressed, acute Pains come on: for now from the Increase of the Rupture's Extent, the Passage which gave Way to its Descent, cannot admit of its Return or Ascent; the Blood-vessels themselves being oppressed, the Inflammation increases every Moment; the Communication between the Stomach and the Fundament is often entirely cut off; so that nothing passes through, but incessant Vomitings come on [this being the Kind of _Miserere_, or Iliac Passion I have mentioned, Sec. 320] which are succeeded by the Hickup, Raving, Swooning, cold Sweats, and Death.

Sec. 478. This Symptom supervenes in Ruptures, when the Excrements become hard in that Part of the Guts fallen into the _Scrotum_; when the Patient is overheated with Wine, Drams, an inflammatory Diet, _&c._ or when he has received a Stroke on the ailing Part, or had a Fall.

Sec. 479. The best Means and Remedies are, 1, as soon as ever this Symptom or Accident is manifest, to bleed the Patient very plentifully, as he lies down in his Bed and upon his Back, with his Head a little raised, and his Legs somewhat bent, so that his Knees may be erect. This is the Attitude or Posture they should always preserve as much as possible. When the Malady is not too far advanced, the first Bleeding often makes a compleat Cure; and the Guts return up as soon as it is over. At other Times this Bleeding is less successful, and leaves a Necessity for its Repetition.

2, A Glyster must be thrown up consisting of a strong Decoction of the large white Beet Leaves, with a small Spoonful or Pinch of common Salt, and a Bit of fresh Butter of the Size of an Egg.

3, Folds of Linen dipt in Ice-water must be applied all over the Tumour, and constantly renewed every Quarter of an Hour. This Remedy, when immediately applied, has produced the most happy Effects; but if the Symptom has endured violently more than ten or twelve Hours, it is often too late to apply it; and then it is better to make Use of Flanels dipt in a warm Decoction of Mallow and Elder Flowers, shifting them frequently. It has been known however, that Ice-water, or Ice itself has succeeded as late as the third Day. [102]

[102] Pieces of Ice applied between two Pieces of Linen, directly upon
the Rupture, as soon as possible after its first Appearance, is one
of those extraordinary Remedies, which we should never hesitate to
make immediate Use of. We may be certain by this Application, if
the Rupture is simple, and not complicated from some aggravating
Cause, to remove speedily, and with very little Pain, a Disorder,
that might be attended with the most dreadful Consequences. But the
Continuance of this Application must be proportioned to the
Strength of the Person ruptured, which may be sufficiently
estimated by the Pulse. _E. L._

4, When these Endeavours are insufficient, Glysters of Tobacco Smoke must be tried, which has often redressed and returned Ruptures, when every Thing else had failed.

5, And lastly, if all these Attempts are fruitless, the Operation must be resolved on, without losing a Moment's Time; as this local Disease proves sometimes mortal in the Space of two Days; but for this Operation an excellent Surgeon is indispensably necessary. The happy Consequence with which I have ordered it, in a most desperate Case since the first Edition of this Work, on the sixth Day after a Labour, has convinced me, still more than any former Observation I had made, that the Trial of it ought never to be omitted, when other Attempts have been unavailing. It cannot even hasten the Patient's Death, which must be inevitable without it, but it rather renders that more gentle, where it might fail to prevent it. When it is performed as Mr. _Levade_ effected it, in the Case I have just referred to, the Pain attending it is very tolerable and soon over.

I shall not attempt to describe the Operation, as I could not explain myself sufficiently to instruct an ignorant Surgeon in it; and an excellent and experienced one must be sufficiently apprized of all I could say concerning it.

A certain Woman in this Place, but now dead, had the great and impudent Temerity to attempt this Operation, and killed her Patients after the most excruciating Torments, and an Extirpation, or cutting away of the Testicle; which Quacks and ignorant Surgeons always do, but which a good Surgeon never does in this Operation. This is often the Custom too (in Country Places) of those Caitiffs, who perform this Operation without the least Necessity; and mercilessly emasculate a Multitude of Infants; whom Nature, if left to her own Conduct, or assisted only by a simple Bandage, would have perfectly cured; instead of which, they absolutely kill a great many, and deprive those of their Virility, who survive their Robbery and Violence. It were religiously to be wished such Caitiffs were to be duly, that is, severely punished; and it cannot be too much inculcated into the People, that this Operation (termed the _Bubonocele_) in the Manner it is performed by the best Surgeons, is not necessary; except in the Symptoms and Circumstances I have mentioned, and that the cutting off the Testicle never is so.

_Of Phlegmons or Boils._

Sec. 480. Every Person knows what Boils are at Sight, which are considerably painful when large, highly inflamed, or so situated as to incommode the Motions, or different Positions of the Body. Whenever their Inflammation is very considerable; when there are a great many of them at once, and they prevent the Patients from sleeping, it becomes necessary to enter them into a cooling Regimen; to throw up some opening Glysters; and to make them drink plentifully of the Ptisan, No. 2. Sometimes it is also necessary to bleed the Patient.

Should the Inflammation be very high indeed, a Pultice of Bread and Milk, or of Sorrel a little boiled and bruised, must be applied to it. But if the Inflammation is only moderate, a Mucilage Plaister, or one of the simple Diachylon, may be sufficient. Diachylon with the Gums is more active and efficacious; but it so greatly augments the Pain of some Persons afflicted with Boils, that they cannot bear it.

Boils, which often return, signify some Fault in the Temperament, and frequently one so considerable, that might dispose a Physician to be so far apprehensive of its Consequences, as to enquire into the Cause, and to attempt the Extinction of it. But the Detail of this is no Part nor Purpose of the present Work.

Sec. 481. The Phlegmon, or Boil, commonly terminates in Suppuration, but a Suppuration of a singular Kind. It breaks open at first on its Top, or the most pointed Part, when some Drops of a _Pus_ like that of an Abscess comes out, after which the Germ, or what is called the Core of it may be discerned. This is a purulent Matter or Substance, but so thick and tenacious, that it appears like a solid Body; which may be drawn out entirely in the Shape of a small Cylinder, like the Pith of Elder, to the Length of some Lines of an Inch; sometimes to the Length of a full Inch, and even more. The Emission of this Core is commonly followed by the Discharge of a certain Quantity, according to the Size of the Tumour, of liquid Matter, spread throughout the Bottom of it. As soon as ever this Discharge is made, the Pain goes entirely off; and the Swelling disappears at the End of a few Days, by continuing to apply the simple Diachylon, or the Ointment No. 66.

_Of Fellons or Whitlows._

Sec. 482. The Danger of these small Tumours is much greater than is generally supposed. It is an Inflammation at the Extremity or End of a Finger, which is often the Effect of a small Quantity of Humour extravasated, or stagnant, in that Part; whether this has happened in Consequence of a Bruise, a Sting, or a Bite. At other times it is evident that it has resulted from no external Cause, but is the Effect of some inward one.

It is distinguished into many Kinds, according to the Place in which the Inflammation begins; but the essential Nature of the Malady is always the same, and requires the same Sort of Remedies. Hence such as are neither Physicians nor Surgeons, may spare themselves the Trouble of enquiring into the Divisions of this Distemper; which, though they vary the Danger of it, and diversify the Manner of the Surgeons Operation, yet have no Relation to the general Treatment of it; the Power and Activity of which must be regulated by the Violence of the Symptoms.

Sec. 483. This Disorder begins with a slow heavy Pain, attended by a slight Pulsation, without Swelling, without Redness, and without Heat; but in a little Time the Pain, Heat, and Pulsation or Throbbing becomes intolerable. The Part grows very large and red; the adjoining Fingers and the whole Hand swelling up. In some Cases a Kind of red and inflated Fuse or Streak may be observed, which, beginning at the affected Part, is continued almost to the Elbow; neither is it unusual for the Patients to complain of a very sharp Pain under the Shoulder; and sometimes the whole Arm is excessively inflamed and swelled. The Sick have not a Wink of Sleep, the Fever and other Symptoms quickly increasing. If the Distemper rises to a violent Degree indeed, a _Delirium_ and Convulsions supervene.

This Inflammation of the Finger determines, either in Suppuration, or in a Gangrene. When the last of these occurs, the Patient is in very great Danger, if he is not very speedily relieved; and it has proved necessary more than once to cut off the Arm, for the Preservation of his Life. When Suppuration is effected, if the Matter lies very deep and sharp, or if the Assistance of a Surgeon has arrived too late, the Bone of the last _Phalanx_, or Row of Bones of the Finger, is generally carious and lost. But how gentle soever the Complaint has been, the Nail is very generally separated and falls off.

Sec. 484. The internal Treatment in Whitlows, is the same with that in other inflammatory Distempers. The Patient must enter upon a Regimen more or less strict, in Proportion to the Degree of the Fever; and if this runs very high, and the Inflammation be very considerable, there may be a Necessity for several Bleedings.

The external Treatment consists in allaying the Inflammation; in softening the Skin; and in procuring a Discharge of the Matter, as soon as it is formed. For this Purpose,

1, The Finger affected is to be plunged, as soon as the Disorder is manifest, in Water a little more than warm: the Steam of boiling Water may also by admitted into it; and by doing these Things almost constantly for the first Day, a total Dissipation of the Malady has often been obtained. But unhappily it has been generally supposed, that such slight Attacks could have but very slight Consequences, whence they have been neglected until the Disorder has greatly advanced; in which State Suppuration becomes absolutely necessary.

2, This Suppuration therefore may be forwarded, by continually involving the Finger, as it were, in a Decoction of Mallow Flowers boiled in Milk, or with a Cataplasm of Bread and Milk. This may be rendered still more active and ripening, by adding a few white Lilly Roots, or a little Honey. But this last must not be applied before the Inflammation is somewhat abated, and Suppuration begins; before which Term, all sharp Applications are very dangerous. At this Time, Yeast or Leaven may be advantagiously used, which powerfully promotes Suppuration. The Sorrel Pultice, mentioned Sec. 480, is also a very efficacious one.

Sec. 485. A speedy Discharge of the ripe Matter is of considerable Importance, but this particularly requires the Attention of the Surgeon; as it is not proper to wait till the Tumour breaks and discharges of itself; and this the rather, as from the Skin's proving sometimes extremely hard, the Matter might be inwardly effused between the Muscles, and upon their Membranes, before it could penetrate through the Skin. For this Reason, as soon as Matter is suspected to be formed, a Surgeon should be called in, to determine exactly on the Time, when an Opening should be made; which had better be performed a little too soon than too late; and a little too deep, than not deep enough.

When the Orifice has been made, and the Discharge is effected, it is to be dressed up with the Plaister No. 66, spread upon Linen, or with the Cerecloth; and these Dressings are to be repeated daily.

Sec. 486. When the Whitlow is caused by a Humour extravasated very near the Nail, an expert Surgeon speedily checks its Progress, and cures it effectually by an Incision which lets out the Humour. Yet, notwithstanding this Operation is in no wise difficult, all Surgeons are not qualified to perform it, and but too many have no Idea at all of it.

Sec. 487. Fungous, or, as it is commonly called, proud Flesh sometimes appears during the incarning or healing of the Incision. Such may be kept down with sprinkling a little _Minium_ (red Lead) or burnt Alum over it.

Sec. 488. If a _Caries_, a Rottenness of the Bone, should be a Consequence, there is a Necessity for a Surgeon's Attendance, as much as if there was a Gangrene; for which Reason, I shall add nothing with Respect to either of these Symptoms; only observing, there are three very essential Remedies against the last; _viz._ the Bark, No. 14, a Drachm of which must be taken every two Hours; Scarifications throughout the whole gangrened Part; and Fomentations with a Decoction of the Bark, and the Addition of Spirit of Sulphur. This Medicine is certainly no cheap one; but a Decoction of other bitter Plants, with the Addition of Spirit of Salt, may sometimes do instead of it. And here I take leave to insist again upon it, that in most Cases of gangrened Limbs, it is judicious not to proceed to an Amputation of the mortified Part, till the Gangrene stops, which may be known by a very perceivable Circle, (and easily distinguished by the most ignorant Persons) that marks the Bounds of the Gangrene, and separates the living from the mortified Parts.

_Of Thorns, Splinters, or other pointed Substances piercing into the
Skin, or Flesh._

Sec. 489. It is very common for the Hands, Feet or Legs, to be pierced by the forcible Intrusion of small pointed Substances, such as Thorns or Prickles, whether of Roses, Thistles or Chestnuts, or little Splinters of Wood, Bone, _&c._

If such Substances are immediately and entirely extracted, the Accident is generally attended with no bad Consequences; though more certainly to obviate any such, Compresses of Linen dipt in warm Water may be applied to the Part, or it may be kept a little while in a warm Bath. But if any such pointed penetrating Body cannot be directly extracted, or if a Part of it be left within, it causes an Inflammation, which, in its Progress, soon produces the same Symptoms as a Whitlow: or if it happens in the Leg, it inflames and forms a considerable Abscess there.

Sec. 490. To prevent such Consequences, if the penetrating Substance is still near the Surface, and an expert Surgeon is at Hand, he must immediately make a small Incision, and thence extract it. But if the Inflammation were already formed, this would be useless, and even dangerous.

When the Incision, therefore, is improper; there should be applied to the affected Part, (after conveying the Steam of some hot Water into it) either some very emollient Pultices of the Crumb of Bread, Milk and Oil, or some very emollient unctuous Matter alone, the Fat of a [103] Hare being generally employed in such Cases, and being indeed very effectual to relax and supple the Skin; and, by thus diminishing its Resistance, to afford the offensive penetrating Body an Opportunity of springing forth. Nothing however, but the grossest Prejudice, could make any one imagine, that this Fat attracted the Splinter, Thorn, or any other intruded Substance by any sympathetic Virtue; no other Sympathy in Nature being clearly demonstrated, except that very common one between wrong Heads, and absurd extravagant Opinions.

[103] These Creatures perhaps are fatter in _Swisserland_, than we often
see them here. _K._

It is absolutely necessary that the injured Part should be kept in the easiest Posture, and as immoveable as possible.

If Suppuration has not been prevented by an immediate Extraction of the offending Substance, the Abscess should be opened as soon as ever Matter is formed. I have known very troublesome Events from its being too long delayed.

Sec. 491. Sometimes the Thorn, after having very painfully penetrated through the Teguments, the Skin, enters directly into the Fat; upon which the Pain ceases, and the Patient begins to conclude no sharp prickling Substance had ever been introduced into the Part; and of Course supposes none can remain there. Nevertheless some Days after, or, in other Instances, some Weeks, fresh Pains are excited, to which an Inflammation and Abscess succeed, which are to be treated as usual, with Emollients, and seasonably opened.

A Patient has been reduced to lose his Hand, in Consequence of a sharp Thorn's piercing into his Finger; from its having been neglected at first, and improperly treated afterwards.

_Of Warts._

Sec. 492. Warts are sometimes the Effects of a particular Fault in the Blood, which feeds and extrudes a surprizing Quantity of them. This happens to some Children, from four to ten Years old, and especially to those who feed most plentifully on Milk or Milk-meats. They may be removed by a moderate Change of their Diet, and the Pills prescribed No. 18.

But they are more frequently an accidental Disorder of the Skin, arising from some external Cause.

In this last Case, if they are very troublesome in Consequence of their great Size, their Situation or their long Standing, they may be destroyed, 1, by tying them closely with a Silk Thread, or with a strong flaxen one waxed. 2, By cutting them off with a sharp Scissars or a Bistory, and applying a Plaister of Diachylon, with the Gums, over the cut Wart, which brings on a small Suppuration that may destroy or dissolve the Root of the Wart: and, 3, By drying, or, as it were, withering them up by some moderately corroding Application, such as that of the milky Juice of [104] Purslain, of Fig-leaves, of _Chelidonium_ (Swallow-wort) or of Spurge. But besides these corroding vegetable Milks being procurable only in Summer, People who have very delicate thin Skins should not make Use of them, as they may occasion a considerable and painful Swelling. Strong Vinegar, charged with as much common Salt as it will dissolve, is a very proper Application to them. A Plaister may also be composed from Sal Ammoniac and some Galbanum, which being kneaded up well together and applied, seldom fails of destroying them.

[104] Our Garden Purslain, though a very juicy Herb, cannot strictly be
termed milky. In the hotter Climates where it is wild, and grows
very rankly, they sometimes boil the Leaves and Stalks (besides
eating them as a cooling Salad) and find the whole an insipid
mucilaginous Pot-herb. But Dr. _Tissot_ observes to me, that its
Juice will inflame the Skin; and that some Writers on Diet, who
disapprove it internally, affirm they have known it productive of
bad Effects. Yet none such have ever happened to myself, nor to
many others, who have frequently eaten of it. Its Seeds have
sometimes been directed in cooling Emulsions. The Wart Spurge is a
very milky and common Herb, which flowers in Summer here. _K._

The most powerful Corrosives should never be used, without the Direction of a Surgeon; and even then it is full as prudent not to meddle with them, any more than with actual Cauteries. I have lately seen some very tedious and troublesome Disorders and Ulcerations of the Kidnies, ensue the Application of a corrosive Water, by the Advice of a Quack. Cutting them away is a more certain, a less painful, and a less dangerous Way of removing them.

Wens, if of a pretty considerable Size, and Duration, are incurable by any other Remedy, except Amputation.

_Of Corns._

Sec. 493. The very general or only Causes of Corns, are Shoes either too hard and stiff, or too small.

The whole Cure consists in softening the Corns by repeated Washings and Soakings of the Feet in pretty hot Water; then in cutting them, when softened, with a Penknife or Scissars, without wounding the sound Parts (which are the more sensible, in Proportion as they are more extended than usual) and next in applying a Leaf of House-leek, of Ground-ivy, or of Purslain dipt in Vinegar, upon the Part. Instead of these Leaves, if any Person will give himself the little Trouble of dressing them every Day, he may apply a Plaister of simple Diachylon, or of Gum Ammoniacum softened in Vinegar.

The Increase or Return of Corns can only be prevented, by avoiding the Causes that produce them.

__Chapter XXXI.__

_Of some Cases which require immediate Assistance; such as
Swoonings; Haemorrhages, or involuntary Loss of Blood; Convulsion
Fitts, and Suffocations; the sudden Effects of great Fear; of
Disorders caused by noxious Vapours; of Poisons, and of acute
Pains._

_Of Swoonings._

__Sect.__ 494.

There are many Degrees of Swooning, or fainting away: the slightest is that in which the Patient constantly perceives and understands, yet without the Power of speaking. This is called a Fainting, which happens very often to vapourish Persons, and without any remarkable Alteration of the Pulse.

If the Patient entirely loses Sensation, or Feeling, and Understanding, with a very considerable Sinking of the Pulse, this is called a _Syncope_, and is the second Degree of Swooning.

But if this _Syncope_ is so violent, that the Pulse seems totally extinguished; without any discernible Breathing; with a manifest Coldness of the whole Body; and a wanly livid Countenance, it constitutes a third and last Degree, which is the true Image of Death, that in Effect sometimes attends it, and it is called an _Asphixy_, which may signify a total Resolution.

Swoonings result from many different Causes, of which I shall only enumerate the principal; and these are, 1, Too large a Quantity of Blood. 2, A Defect or insufficient Proportion of it, and a general Weakness. 3, A Load at and violent Disorders of the Stomach. 4, Nervous Maladies. 5, The Passions; and, 6, some Kinds of Diseases.

_Of Swoonings occasioned by Excess of Blood._

Sec. 495. An excessive Quantity of Blood is frequently a Cause of Swooning; and it may be inferred that it is owing to this Cause, when it attacks sanguine, hearty and robust Persons; and more especially when it attacks them, after being combined with any additional or supervening Cause, that suddenly increased the Motion of the Blood; such as heating Meats or Drinks, Wine, spirituous Liquors: smaller Drinks, if taken very hot and plentifully, such as Coffee, Indian Tea, Bawm Tea and the like; a long Exposure to the hot Sun, or being detained in a very hot Place; much and violent Exercise; an over intense and assiduous Study or Application, or some excessive Passion.

In such Cases, first of all the Patient should be made to smell to, or even to snuff up, some Vinegar; and his Forehead, his Temples and his Wrists should be bathed with it; adding an equal Quantity of warm Water, if at Hand. Bathing them with distilled or spirituous Liquids would be prejudicial in this Kind of Swooning.

2, The Patient should be made, if possible, to swallow two or three Spoonfuls of Vinegar, with four or five Times as much Water.

3, The Patient's Garters should be tied very tightly above his Knees; as by this Means a greater Quantity of Blood is retained in the Legs, whence the Heart may be less overladen with it.

4, If the Fainting proves obstinate, that is, if it continues longer than a Quarter of an Hour, or degenerates into a _Syncope_, an Abolition of Feeling and Understanding, he must be bled in the Arm, which quickly revives him.

5, After the Bleeding, the Injection of a Glyster will be highly proper; and then the Patient should be kept still and calm, only letting him drink, every half Hour, some Cups of Elder Flower Tea, with the Addition of a little Sugar and Vinegar.

When Swoonings which result from this Cause occur frequently in the same Person, he should, in Order to escape them, pursue the Directions I shall hereafter mention, Sec. 544, when treating of Persons who superabound with Blood.

The very same Cause, or Causes, which occasion these Swoonings, also frequently produce violent Palpitations, under the same Circumstances; the Palpitation often preceding or following the _Deliquium_, or Swooning.

_Of Swoonings occasioned by Weakness._

Sec. 496. If too great a Quantity of Blood, which may be considered as some Excess of Health, is sometimes the Cause of Swooning, this last is oftener the Effect of a very contrary Cause, that is, of a Want of Blood, or an Exhaustion of too much.

This Sort of Swooning happens after great Haemorrhages, or Discharges of Blood; after sudden or excessive Evacuations, such as one of some Hours Continuance in a _Cholera Morbus_ (Sec. 321) or such as are more slow, but of longer Duration, as for Instance, after an inveterate _Diarrhoea_, or Purging; excessive Sweats; a Flood of Urine; such Excesses as tend to exhaust Nature; obstinate Wakefulness; a long Inappetency, which, by depriving the Body of its necessary Sustenance, is attended with the same Consequence as profuse Evacuations.

These different Causes of Swooning should be opposed by the Means and Remedies adapted to each of them. A Detail of all these would be improper here; but the Assistances that are necessary at the Time of Swooning, are nearly the same for all Cases of this Class; excepting for that attending a great Loss of Blood, of which I shall treat hereafter: first of all, the Patients should be laid down on a Bed, and being covered, should have their Legs and Thighs, their Arms, and their whole Bodies rubbed pretty strongly with hot Flanels; and no Ligature should remain on any Part of them.

2, They should have very spirituous Things to smell or snuff up, such as the Carmelite Water, Hungary Water, the [105] _English_ Salt, Spirit of Sal Ammoniac, strong smelling Herbs, such as Rue, Sage, Rosemary, Mint, Wormwood, and the like.

[105] Dr. _Tissot_ informs me, that in _Swisserland_, they call a
volatile Salt of Vipers, or the volatile Salt of raw Silk, _Sel.
d'Angleterre_, of which one _Goddard_ made a Secret, and which he
brought into Vogue the latter End of the last Century. But he
justly observes at the same Time, that on the present Occasion
every other volatile Alkali will equally answer the Purpose; and
indeed the Smell of some of them, as the Spirit of Sal Ammoniac
with Quicklime, _Eau de Luce_, _&c._ seem more penetrating. _K._

3, These should be conveyed into their Mouths; and they should be forced, if possible, to swallow some Drops of Carmelite Water, or of Brandy, or of some other potable Liquor, mixed with a little Water; while some hot Wine mixed with Sugar and Cinnamon, which makes one of the best Cordials, is getting ready.

4, A Compress of Flanel, or of some other woollen Stuff, dipt in hot Wine, in which some aromatic Herb has been steeped, must be applied to the Pit of the Stomach.

5, If the Swooning seems likely to continue, the Patient must be put into a well heated Bed, which has before been perfumed with burning Sugar and Cinnamon; the Frictions of the whole Body with hot Flanels being still continued.

6, As soon as the Patient can swallow, he should take some Soup or Broth, with the Yolk of an Egg; or a little Bread or Biscuit; soaked in the hot spiced Wine.

7, Lastly, during the whole Time that all other Precautions are taken to oppose the Cause of the Swooning, Care must be had for some Days to prevent any _Deliquium_ or Fainting, by giving them often, and but little at a time, some light yet strengthening Nourishment, such as Panada made with Soup instead of Water, new laid Eggs very lightly poached, light roast Meats with sweet Sauce, Chocolate, Soups of the most nourishing Meats, Jellies, Milk, _&c._

Sec. 497. Those Swoonings, which are the Effect of Bleeding, or of the violent Operation of some Purge, are to be ranged in this Class.

Such as happen after artificial Bleeding, are generally very moderate, commonly terminating as soon as the Patient is laid upon the Bed: and Persons subject to this Kind, should be bled lying down, in Order to prevent it. But should the Fainting continue longer than usual, some Vinegar smelt to, and a little swallowed with some Water, is a very good Remedy.

The Treatment of such Faintings or Swoonings, as are the Consequences of too violent Vomits or Purges, may be seen hereafter Sec. 552.

_Of Faintings occasioned by a Load, or Uneasiness, at Stomach._

Sec. 498. It has been already observed, Sec. 308, that Indigestions were sometimes attended with Swoonings, and indeed such vehement ones, as required speedy and very active Succour too, such as that of a Vomit. The Indigestion is sometimes less the Effect of the Quantity, than of the Quality, or the Corruption of the Food, contained in the Stomach. Thus we see there are some Persons, who are disordered by eating Eggs, Fish, Craw Fish, or any fat Meat; being thrown by them into inexpressible Anguish attended with Swooning too. It may be supposed to depend on this Cause, when these very Aliments have been lately eaten; and when it evidently neither depends on the other Causes I have mentioned; nor on such as I shall soon proceed to enumerate.

We should in Cases of this Sort, excite and revive the Patients as in the former, by making them receive some very strong Smell, of whatever Kind is at hand; but the most essential Point is to make them swallow down a large Quantity of light warm Fluid; which may serve to drown, as it were, the indigested Matter; which may soften its Acrimony; and either effect the Discharge of it by vomiting, or force it down into the Chanel of the Intestines.

A light Infusion of Chamomile Flowers, of Tea, of Sage, of Elder Flowers, or of _Carduus Benedictus_, operate with much the same Efficacy; though the Chamomile and Carduus promote the Operation of vomiting rather more powerfully; which warm Water alone will sometimes sufficiently do.

The Swooning ceases, or at least, considerably abates in these Cases, as soon as ever the Vomiting commences. It frequently happens too, that, during the Swooning, Nature herself brings on certain _Nausea_, a Wambling and sickish Commotion of the Stomach, that revives or rouses the Patient for a Moment; but yet not being sufficient to excite an actual Vomiting, lets him soon sink down again into this temporary Dissolution, which often continues a pretty considerable Time; leaving behind it a Sickness at Stomach, Vertigos, and a Depression and Anxiety, which do not occur in the former Species of this Malady.

Whenever these Swoonings from this Cause are entirely terminated, the Patient must be kept for some Days to a very light Diet, and take, at the same Time, every Morning fasting, a Dose of the Powder, No. 38, which relieves and exonerates the Stomach of whatever noxious Contents might remain in it; and then restores its natural Strength and Functions.

Sec. 499. There is another Kind of Swooning, which also results from a Cause in the Stomach; but which is, nevertheless, very different from this we have just been treating of; and which requires a very different Kind of Assistance. It arises from an extraordinary Sensibility of this important Organ, and from a general Weakness of the Patient.

Those subject to this Malady are valetudinary weakly Persons, who are disordered from many slight Causes, and whose Stomachs are at once very feeble and extremely sensible. They have almost continually a little Uneasiness after a Meal, though they should indulge but a little more than usual; or if they eat of any Food not quite so easy of Digestion, they have some Qualm or Commotion after it: Nay, should the Weather only be unfavourable, and sometimes without any perceivable assignable Cause, their Uneasiness terminates in a Swoon.

Patients swooning, from these Causes, have a greater Necessity for great Tranquillity and Repose, than for any other Remedy; and it might be sufficient to lay them down on the Bed: But as the Bystanders in such Cases find it difficult to remain inactive Spectators of Persons in a Swoon, some spirituous Liquid may be held to their Nose, while their Temples and Wrists are rubbed with it; and at the same Time a little Wine should be given them. Frictions are also useful in these Cases.

This Species of Swooning is oftener attended with a little Feverishness than the others.

_Of those Swoonings, which arise from nervous Disorders._

Sec. 500. This Species of Swooning is almost wholely unknown to those Persons, for whom this Treatise is chiefly intended. Yet as there are some Citizens who pass a Part of their Lives in the Country; and some Country People who are unhappily afflicted with the Ailments of the Inhabitants of large Towns and Cities, it seemed necessary to treat briefly of them.

By Disorders of the Nerves, I understand in this Place, only that Fault or Defect in them, which is the Cause of their exciting in the Body, either irregular Motions, that is, Motions without any external Cause, at least any perceivable one; and without our Will's consenting to the Production of them: or such Motions, as are greatly more considerable than they should be, if they had been proportioned to the Force of the Impression from without. This is very exactly that State, or Affection termed the _Vapours_; and by the common People, the _Mother_: And as there is no Organ unprovided with Nerves; and none, or hardly any Function, in which the Nerves have not their Influence; it may be easily comprehended, that the Vapours being a State or Condition, which arises from the Nerves exerting irregular involuntary Motions, without any evident Cause, and all the Functions of the Body depending partly on the Nerves; there is no one Symptom of other Diseases which the Vapours may not produce or imitate; and that these Symptoms, for the same Reason, must vary infinitely, according to those Branches of the Nerves which are disordered. It may also hence be conceived, why the Vapours of one Person have frequently no Resemblance to those of another: and why the Vapours of the very same Person, in one Day, are so very different from those in the next. It is also very conceivable that the Vapours are a certain, a real Malady; and that Oddity of the Symptoms, which cannot be accounted for, by People unacquainted with the animal Oeconomy, has been the Cause of their being considered rather as the Effect of a depraved Imagination, than as a real Disease. It is very conceiveable, I say, that this surprizing Oddity of the Symptoms is a necessary Effect of the Cause of the Vapours; and that no Person can any more prevent his being invaded by the Vapours, than he can prevent the Attack of a Fever, or of the Tooth-ach.

Sec. 501. A few plain Instances will furnish out a more compleat Notion of the Mechanism, or Nature, of Vapours. An Emetic, a vomiting Medicine, excites the Act, or rather the Passion, the Convulsion of Vomiting, chiefly by the Irritation it gives to the Nerves of the Stomach; which Irritation produces a Spasm, a Contraction of this Organ. Now if in Consequence of this morbid or defective Texture of the Nerves, which constitutes the Vapours, those of the Stomach are excited to act with the same Violence, as in Consequence of taking a Vomit, the Patient will be agitated and worked by violent Efforts to vomit, as much as if he had really taken one.

If an involuntary unusual Motion in the Nerves, that are distributed through the Lungs, should constrain and straiten the very little Vesicles, or Bladders, as it were, which admit the fresh Air at every Respiration, the Patient will feel a Degree of Suffocation; just as if that Straitening or Contraction of the Vesicles were occasioned by some noxious Steam or Vapour.

Should the Nerves which are distributed throughout the whole Skin, by a Succession of these irregular morbid Motions, contract themselves, as they may from external Cold, or by some stimulating Application, Perspiration by the Pores will be prevented or checked; whence the Humours, which should be evacuated through the Pores of the Skin, will be thrown upon the Kidnies, and the Patient will make a great Quantity of thin clear Urine, a Symptom very common to vapourish People; or it may be diverted to the Glands of the Intestines, the Guts, and terminate in a watery _Diarrhoea_, or Looseness, which frequently proves a very obstinate one.

Sec. 502. Neither are Swoonings the least usual Symptoms attending the Vapours: and we may be certain they spring from this Source, when they happen to a Person subject to the Vapours; and none of the other Causes producing them are evident, or have lately preceded them.

Such Swoonings, however, are indeed very rarely dangerous, and scarcely require any medical Assistance. The Patient should be laid upon a Bed; the fresh Air should be very freely admitted to him; and he should be made to smell rather to some disagreeable and fetid, than to any fragrant, Substance. It is in such Faintings as these that the Smell of burnt Leather, of Feathers, or of Paper, have often proved of great Service.

Sec. 503. Patients also frequently faint away, in Consequence of fasting too long; or from having eat a little too much; from being confined in too hot a Chamber; from having seen too much Company; from smelling too over-powering a Scent; from being too costive; from being too forcibly affected with some Discourse or Sentiments; and, in a Word, from a great Variety of Causes, which might not make the least Impression on Persons in perfect Health; but which violently operate upon those vapourish People, because, as I have said, the Fault of their Nerves consists in their being too vividly, too acutely affected; the Force of their Sensation being nowise proportioned to the external Cause of it.

As soon as that particular Cause is distinguished from all the rest, which has occasioned the present Swooning; it is manifest that this Swooning is to be remedied by removing that particular Cause of it.

_Of Swoonings occasioned by the Passions._

Sec. 504. There have been some Instances of Persons dying within a Moment, through excessive Joy. But such Instances are so very rare and sudden, that Assistance has seldom been sought for on this Occasion. The Case is otherwise with Respect to those produced from Rage, Vexation, and Dread or Horror. I shall treat in a separate Article of those resulting from great Fear; and shall briefly consider here such as ensue from Rage, and vehement Grief or Disappointment.

Sec. 505. Excessive Rage and violent Affliction are sometimes fatal in the Twinkling of an Eye; though they oftener terminate in fainting only. Excessive Grief or Chagrine is especially accompanied with this Consequence; and it is very common to see Persons thus affected, sink into successive Faintings for several Hours. It is plainly obvious that very little Assistance can be given in such Cases: it is proper, however, they should smell to strong Vinegar; and frequently take a few Cups of some hot and temperately cordial Drink, such as Bawm Tea, or Lemonade with a little Orange or Lemon-peel.

The calming asswaging Cordial, that has seemed the most efficacious to me, is one small Coffee Spoonful of a Mixture of three Parts of the Mineral Anodyne Liquor of _Hoffman_, [106] and one Part of the spirituous Tincture of Amber, which should be swallowed in a Spoonful of Water; taking after it a few Cups of such Drinks as I shall presently direct.

[106] Our sweet Spirit of Vitriol is a similar, and as effectual a
Medicine. _K._

It is not to be supposed that Swoonings or Faintings, from excessive Passions, can be cured by Nourishment. The physical State or Condition, into which vehement Grief throws the Body, is that, of all others, in which Nourishment would be most injurious to it: and as long as the Vehemence of the Affliction endures, the Sufferer should take nothing but some Spoonfuls of Soup or Broth, or a few Morsels of some light Meat roasted.

Sec. 506. When Wrath or Rage has risen to so high a Pitch, that the human Machine, the Body, entirely exhausted, as it were, by that violent Effort, sinks down at once into excessive Relaxation, a Fainting sometimes succeeds, and even the most perilous Degree of it, a _Syncope_.

It is sufficient, or rather the most that can be done here, to let the Patient be perfectly still a while in this State; only making him smell to some Vinegar. But when he is come to himself, he should drink plentifully of hot Lemonade, and take one or more of the Glysters No. 5.

Sometimes there remain in these Cases Sicknesses at Stomach, Reachings to vomit, a Bitterness in the Mouth, and some vertiginous Symptoms which seem to require a Vomit. But such a Medicine must be very carefully avoided, since it may be attended with the most fatal Consequence; and Lemonade with Glysters generally and gradually remove these Swoonings. If the _Nausea_ and Sickness at Stomach continue, the utmost Medicine we should allow besides, would be that of No. 23, or a few Doses of No. 24.

_Of symptomatical Swoonings, or such, as happen in the Progress of other
Diseases._

Sec. 507. Swoonings, which supervene in the Course of other Diseases, never afford a favourable Prognostic; as they denote Weakness, and Weakness is an Obstacle to Recovery.

In the Beginning of putrid Diseases, they also denote an Oppression at Stomach, or a Mass of corrupt Humours; and they cease as soon as an Evacuation supervenes, whether by Vomit or Stool.

When they occur at the Beginning of malignant Fevers, they declare the high Degree of their Malignancy, and the great Diminution of the Patient's natural Strength.

In each of these Cases Vinegar, used externally and internally, is the best Remedy during the Exacerbation or Height of the Paroxysm; and Plenty of Lemon Juice and Water after it.

Sec. 508. Swoonings which supervene in Diseases, accompanied with great Evacuations, are cured like those which are owing to Weakness; and Endeavours should be used to restrain or moderate the Evacuations.

Sec. 509. Those who have any inward Abscess or Imposthume are apt to swoon frequently. They may sometimes be revived a little by Vinegar, but they prove too frequently mortal.

Sec. 510. Many Persons have a slighter or a deeper Swooning, at the End of a violent Fit of an intermitting Fever, or at that of each Exacerbation of a continual Fever; this constantly shews the Fever has run very high, the Swooning having been the Consequence of that great Relaxation, which has succeeded to a very high Tension. A Spoonful or two of light white Wine, with an equal Quantity of Water, affords all the Succour proper in such a Case.

Sec. 511. Persons subject to frequent Swoonings, should neglect nothing that may enable them to remove them when known; since the Consequences of them are always detrimental, except in some Fevers, in which they seem to mark the _Crisis_.

Every swooning Fit leaves the Patient in Dejection and Weakness; the Secretions from the Blood are suspended; the Humours disposed to Stagnation; Grumosities, or Coagulations, and Obstructions are formed; and if the Motion of the Blood is totally intercepted, or considerably checked, _Polypus's_, and these often incurable, are formed in the Heart, or in the larger Vessels; the Consequences of which are dreadful, and sometimes give Rise to internal Aneurisms, which always prove mortal, after long Anxiety and Oppression.

Swoonings which attack old People, without any manifest Cause, always afford an unfavourable Prognostic.

_Of Haemorrhages, or an involuntary Loss of Blood._

Sec. 512. Haemorrhages of the Nose, supervening in inflammatory Fevers, commonly prove a favourable _Crisis_; which Bleeding we should carefully avoid stopping; except it becomes excessive, and seems to threaten the Patient's Life.

As they scarcely ever happen in very healthy Subjects, but from a superfluous Abundance of Blood, it is very improper to check them too soon; lest some internal Stuffings and Obstructions should prove the Consequence.

A Swooning sometimes ensues after the Loss of only a moderate Quantity of Blood. This Swooning stops the Haemorrhage, and goes off without any further Assistance, except the smelling to Vinegar. But in other Cases there is a Succession of fainting Fits, without the Blood's stopping; while at the same time slight convulsive Motions and Twitchings ensue, attended with a Raving, when it becomes really necessary to stop the Bleeding: and indeed, without waiting till these violent Symptoms appear, the following Signs will sufficiently direct us, when it is right to stop the Flux of Blood, or to permit its Continuance--As long as the Pulse is still pretty full; while the Heat of the Body is equally extended to the very Extremities; and the Countenance and Lips preserve their natural Redness, no ill Consequence is to be apprehended from the Haemorrhage, though it has been very copious, and even somewhat profuse.

But whenever the Pulse begins to faulter and tremble; when the Countenance and the Lips grow pale, and the Patient complains of a Sickness at Stomach, it is absolutely necessary to stop the Discharge of Blood. And considering that the Operation of Remedies does not immediately follow the Exhibition or Application of them, it is safer to begin a little too early with them, than to delay them, though ever so little too long.

Sec. 513. First of all then, tight Bandages, or Ligatures, should be applied round both Arms, on the Part they are applied over in order to Bleeding; and round the lower Part of both Thighs, on the gartering Place; and all these are to be drawn very tight, with an Intention to detain and accumulate the Blood in the Extremities.

2, In Order to increase this Effect, the Legs are to be plunged in warm Water up to the Knees; for by relaxing the Blood-vessels of the Legs and Feet, they are dilated at the same time, and thence receive, and, in Consequence of the Ligatures above the Knees, retain the more Blood. If the Water were cold, it would repel the Blood to the Head; if hot, it would increase the Motion of it; and, by giving a greater Quickness to the Pulse, would even contribute to increase the Haemorrhage.

As soon however, as the Haemorrhage is stopt, these Ligatures [on the Thighs] may be relaxed a little, or one of them be entirely removed; allowing the others to continue on an Hour or two longer without touching them: but great Precaution should be taken not to slacken them entirely, nor all at once.

3, Seven or eight Grains of Nitre, and a Spoonful of Vinegar, in half a Glass of cool Water, should be given the Patient every half Hour.

4, One Drachm of white Vitriol must be dissolved in two common Spoonfuls of Spring Water; and a Tent of Lint, or Bits of soft fine Linen dipt in this Solution, are to be introduced into the Nostrils, horizontally at first, but afterwards to be intruded upwards, and as high as may be, by the Assistance of a flexible Bit of Wood or Whale-bone. But should this Application be ineffectual, the Mineral Anodyne Liquor of _Hoffman_ is certain to succeed: and in the Country, where it often happens that neither of these Applications are to be had speedily, Brandy, and even Spirit of Wine, mixt with a third Part Vinegar, have answered entirely well, of which I have been a Witness.