Chapter XVI: Part 16

The Prescription No. 67, which I have already referred to, on the Article of Wounds, may also be serviceable on this Occasion. It must be reduced to Powder, and conveyed up the Nostrils as high as may be, on the Point or Extremity of a Tent of Lint, which may easily be covered with it. Or a Quill, well charged with the Powder, may be introduced high into the Nostrils, and its Countents be strongly blown up from its other Extremity: though after all the former Method is preferable.

5, When the Flux of Blood is totally stopt, the Patient is to be kept as still and quiet as possible; taking great Care not to extract the Tent which remains in the Nose; nor to remove the Clots of coagulated Blood which fill up the Passage. The loosening and removing of these should be effected very gradually and cautiously; and frequently the Tent does not spring out spontaneously, till after many Days.

Sec. 514. I have not, hitherto, said any thing of artificial Bleeding in these Cases, as I think it at best unserviceable; since, though it may sometimes have stopt the morbid Loss of Blood, it has at other times increased it. Neither have I mentioned Anodynes here, whose constant Effect is to determine a larger Quantity of Blood to the Head.

Applications of cold Water to the Nape of the Neck ought to be wholly disused, having sometimes been attended with the most embarrassing Consequences.

In all Haemorrhages, all Fluxes of Blood, great Tranquillity, Ligatures, and the Use of the Drinks No. 2 or 4, are very useful.

Sec. 515. People who are very liable to frequent Haemorrhages, ought to manage themselves conformably to the Directions contained in the next Chapter, Sec. 544. They should take very little Supper; avoid all sharp and spirituous Liquors; Apartments that are over hot, and cover their Heads but very lightly.

When a Patient has for a long time been subject to Haemorrhages, if they cease, he should retrench from his usual Quantity of Food; accustom himself to artificial Bleedings at proper Intervals; and take some gentle opening Purges, especially that of No. 24, and frequently a little Nitre in an Evening.

_Of Convulsion Fits._

Sec. 516. Convulsions are, in general, more terrifying than dangerous; they result from many and various Causes; and on the Removal or Extirpation of these, their Cure depends.

In the very Fit itself very little is to be done or attempted.

As nothing does shorten the Duration, nor even lessen the Violence, of an epileptic Fit, so nothing at all should be attempted in it; and the rather, because Means and Medicines often aggravate the Disease. We should confine our Endeavours solely to the Security of the Patient, by preventing him from giving himself any violent Strokes; by getting something, if possible, between his Teeth, such as a small Roller of Linen to prevent his Tongue from being hurt, or very dangerously squeezed and bruised, in a strong Convulsion.

The only Case which requires immediate Assistance in the Fit, is, when it is so extremely violent, the Neck so swelled, and the Face so very red, that there is Room to be apprehensive of an Apoplexy, which we should endeavour to obviate, by drawing eight or ten Ounces of Blood from the Arm.

As this terrible Disease is common in the Country, it is doing a real Service to the unfortunate Victims of it, to inform them how very dangerous it is to give themselves blindly up to take all the Medicines, which are cried up to them in such Cases. If there be any one Disease, which requires a more attentive, delicate, and exquisite Kind of Treatment, it is this very Disease. Some Species of it are wholly incurable: and such as may be susceptible of a Cure, require the utmost Care and Consideration of the most enlightned and most experienced Physicians: while those who pretend to cure all epileptic Patients, with one invariable Medicine, are either Ignorants, or Impostors, and sometimes both in one.

Sec. 517. Simple Convulsion Fits, which are not epileptic, are frequently of a long Continuance, persevering, with very few and short Intervals, for Days and even for Weeks.

The true genuine Cause should be investigated as strictly as possible, though nothing should be attempted in the Fit. The Nerves are, during that Term, in so high a Degree of Tension and Sensibility, that the very Medicines, supposed to be strongly indicated, often redouble the Storm they were intended to appease.

Thin watery Liquors, moderately imbued with Aromatics, are the least hurtful, the most innocent Things that can be given; such as Bawm, Lime-tree, and Elder Flower Tea. A Ptisan of Liquorice Root only has sometimes answered better than any other.

_Of suffocating, or strangling Fits._

Sec. 518. These Fits (by whatever other Name they may be called) whenever they very suddenly attack a Person, whose Breathing was easy and natural just before, depend almost constantly on a Spasm or Contraction of the Nerves, in the Vesicles of the Lungs; or upon an Infarction, a Stuffing of the same Parts, produced by viscid clammy Humours.

That Suffocation which arises from a Spasm is not dangerous, it goes off of itself, or it may be treated like Swoonings owing to the same Cause. See Sec. 502.

Sec. 519. That Suffocation, which is the Effect of a sanguineous Fulness and Obstruction, may be distinguished by its attacking strong, vigorous, sanguine Persons, who are great Eaters, using much juicy nutritious Food, and strong Wine and Liquors, and who frequently eat and inflame themselves; and when the Fit has come on after any inflaming Cause; when the Pulse is full and strong, and the Countenance red.

Such are cured, 1, by a very plentiful Discharge of Blood from the Arm, which is to be repeated, if necessary.

2, By the Use of Glysters.

3, By drinking plentifully of the Ptisan No. 1; to each Pot of which, a Drachm of Nitre is to be added; and,

4, By the Vapour of hot Vinegar, continually received by Respiration or Breathing. See Sec. 55.

Sec. 520. There is Reason to think that one of these Fits is owing to a Quantity of tough viscid Humours in the Lungs, when it attacks Persons, whose Temperament, and whose Manner of living are opposite to those I have just described; such as valetudinary, weakly, phlegmatic, pituitous, inactive, and squeamish Persons, who feed badly, or on fat, viscid, and insipid Diet, and who drink much hot Water, either alone, or in Tea-like Infusions. And these Signs of Suffocation, resulting from such Causes, are still more probable, if the Fit came on in rainy Weather, and during a southerly Wind; and when the Pulse is soft and small, the Visage pale and hollow.

The most efficacious Treatment we can advise, is, 1, To give every half Hour half a Cup of the Potion, No. 8, if it can be readily had. 2, To make the Patient drink very plentifully of the Drink No. 12; and, 3, to apply two strong Blisters to the fleshy Parts of his Legs.

If he was strong and hearty before the Fit, and the Pulse still continues vigorous, and feels somewhat full withall, the Loss of seven or eight Ounces of Blood is sometimes indispensably necessary. A Glyster has also frequently been attended with extraordinary good Effects.

Those afflicted with this oppressing Malady are commonly relieved, as soon as they expectorate, and sometimes even by vomiting a little.

The Medicine No. 25, a Dose of which may be taken every two Hours, with a Cup of the Ptisan No. 12, often succeeds very well.

But if neither this Medicine, nor the Prescription of No. 8 are at Hand, which may be the Case in Country Places; an Onion of a moderate Size should be pounded in an Iron or Marble Mortar; upon this, a Glass of Vinegar is to be poured, and then strongly squeezed out again through a Piece of Linen. An equal Quantity of Honey is then to be added to it. A Spoonful of this Mixture, whose remarkable Efficacy I have been a Witness of, is to be given every half Hour.

_Of the violent Effects of Fear._

Sec. 521. Here I shall insert some Directions to prevent the ill Consequences of great Fear or Terror, which are very prejudicial at every Term of Life, but chiefly during Infancy.

The general Effects of Terror, are a great Straitening or Contraction of all the small Vessels, and a Repulsion of the Blood into the large and internal ones. Hence follows the Suppression of Perspiration, the general Seizure or Oppression, the Trembling, the Palpitations and Anguish, from the Heart and the Lungs being overcharged with Blood; and sometimes attended with Swoonings, irremediable Disorders of the Heart, and Death itself. A heavy Drowsiness, Raving, and a Kind of furious or raging _Delirium_ happen in other Cases, which I have frequently observed in Children, when the Blood-vessels of the Neck were swelled and stuffed up; and Convulsions, and even the Epilepsy have come on, all which have proved the horrible Consequence of a most senseless and wicked Foolery or Sporting. One half of those Epilepsies which do not depend on such Causes, as might exist before the Child's Birth, are owing to this detestable Custom; and it cannot be too much inculcated into Children, never to frighten one another; a Point which Persons intrusted with their Education, ought to have the strictest Regard to.

When the Humours that should have passed off by Perspiration, are repelled to the Intestines, a tedious and very obstinate Looseness is the frequent Consequence.

Sec. 522. Our Endeavours should be directed, to re-establish the disordered Circulation; to restore the obstructed Perspiration; and to allay the Agitation of the Nerves.

The popular Custom in these Cases has been to give the terrified Patient some cold Water directly; but when the Fright has been considerable, this is a very pernicious custom, and I have seen some terrible Consequences from it.

They should, on the contrary, be conveyed into some very quiet Situation, leaving there but very few Persons, and such only as they are thoroughly familiar with. They should take a few Cups of pretty warm Drink, particularly of an Infusion of Lime-tree Flowers and Bawm. Their Legs should be put into warm Water, and remain there an Hour, if they will patiently permit it, rubbing them gently now and then, and giving them every half-quarter of an Hour, a small Cup of the said Drink. When their Composure and Tranquillity are returned a little, and their Skin seems to have recovered its wonted and general Warmth, Care should be taken to dispose them to sleep, and to perspire plentifully. For this Purpose they may be allowed a few Spoonfuls of Wine, on putting them into Bed, with one Cup of the former Infusion; or, which is more certain and effectual, a few Drops of _Sydenham's_ Liquid Laudanum, No. 44; but should that not be near at Hand, a small Dose of _Venice_ Treacle.

Sec. 523. It sometimes happens that Children do not seem at first extremely terrified; but the Fright is renewed while they sleep, and with no small Violence. The Directions I have just given must then be observed, for some successive Evenings, before they are put to Bed.

Their Fright frequently returns about the latter End of the Night, and agitates them violently every Day. The same Treatment should be continued in such Cases; and we should endeavour to dispose them to be a-sleep at the usual Hour of its Return.

By this very Method, I have dissipated the dismal Consequences of Fear of Women in Child-bed, which is so commonly, and often speedily, mortal.

If a Suffocation from this Cause is violent, there is sometimes a Necessity for opening a Vein in the Arm.

These Patients should gradually be inured to an almost continual, but gentle, Kind of Exercise.

All violent Medicines render those Diseases, which are the Consequences of great Fear, incurable. A pretty common one is that of an Obstruction of the Liver, which has been productive of a Jaundice. [107]

[107] I have seen this actually verified by great and disagreeable
Surprize, attended indeed with much Concern, in a Person of
exquisite Sensations. _K._

_Of Accidents or Symptoms produced by the Vapours of Coal, and of Wine._

Sec. 524. Not a single Year passes over here, without the Destruction of many People by the Vapour of Charcoal, or of small Coal, and by the Steam or Vapour of Wine.

The Symptoms by Coal occur, when [108] small Coal, and especially when [109] Charcoal is burnt in a Chamber close shut, which is direct Poison to a Person shut up in it. The sulphureous Oil, which is set at Liberty and diffused by the Action of Fire, expands itself through the Chamber; while those who are in it perceive a Disorder and Confusion in their Heads; contract Vertigos, Sickness at Stomach, a Weakness, and very unusual Kind of Numbness; become raving, convulsed and trembling; and if they fail of Presence of Mind, or of Strength, to get out of the Chamber, they die within a short Time.

[108] _La Braise._

[109] _Charbon._ Dr. _Tissot_ informs me, their Difference consists in
this, that the Charcoal is prepared from Wood burnt in a close or
stifled Fire; and that the small Coal is made of Wood (and of
smaller Wood) burnt in an open Fire, and extinguished before it is
reduced to the State of a Cinder. He says the latter is smaller,
softer, less durable in the Fire, and the Vapour of it less
dangerous than that of Charcoal.

I have seen a Woman who had vertiginous Commotions in her Head for two Days, and almost continual Vomitings, from her having been confined less than six Minutes in a Chamber (and that notwithstanding, both one Window and one Door were open) in which there was a Chafing-dish with some burning Coals. Had the Room been quite close, she must have perished by it.

This Vapour is narcotic or stupefying, and proves mortal in Consequence of its producing a sleepy or apoplectic Disorder, though blended, at the same time, with something convulsive; which sufficiently appears from the Closure of the Mouth, and the strict Contraction or Locking of the Jaws.

The Condition of the Brain, in the dissected Bodies of Persons thus destroyed, proves that they die of an Apoplexy: notwithstanding it is very probable that Suffocation is also partly the Cause of their Deaths; as the Lungs have been found stuffed up with Blood and livid.

It has also been observed in some other such Bodies, that Patients killed by the Vapour of burning Coals, have commonly their whole Body swelled out to one third more than their Magnitude, when living. The Face, Neck, and Arms are swelled out, as if they had been blown up; and the whole human Machine appears in such a State, as the dead Body of a Person would, who had been violently strangled; and who had made all possible Resistance for a long time, before he was overpowered.

Sec. 525. Such as are sensible of the great Danger they are in, and retreat seasonably from it, are generally relieved as soon as they get into the open Air; or if they have any remaining Uneasiness, a little Water and Vinegar, or Lemonade, drank hot, affords them speedy Relief. But when they are so far poisoned, as to have lost their Feeling and Understanding, if there be any Means of reviving them, such Means consist,

1, In exposing them to a very pure, fresh and open Air.

2, In making them smell to some very penetrating Odour, which is somewhat stimulating and reviving, such as the volatile Spirit of Sal Ammoniac, the [110] _English_ Salt; and afterwards to surround them, as it were, with the Steam of Vinegar.

[110] See Note [105] Page 495.

3, In taking some Blood from their Arm.

4, In putting their Legs into warm or hot Water, and chafing them well.

5, In making them swallow, if practicable, much Lemonade, or Water and Vinegar, with the Addition of Nitre: and,

6, In throwing up some sharp Glysters.

As it is manifest there is something spasmodic in these Cases, it were proper to be provided with some antispasmodic Remedies, such as the Mineral Anodyne Liquid of _Hoffman_. Even Opium has sometimes been successfully given here, but it should be allowed to Physicians only to direct it in such Cases.

A Vomit would be hurtful; and the Reachings to vomit arise only from the Oppression on the Brain.

It is a common but erroneous Opinion, that if the Coal be suffered to burn for a Minute or so in the open Air, or in a Chimney, it is sufficient to prevent any Danger from the Vapour of it.

Hence it amounts even to a criminal Degree of Imprudence, to sleep in a Chamber while Charcoal or small Coal is burning in it; and the Number of such imprudent Persons, as have never awaked after it, is so considerable, and so generally known too, that the Continuance of this unhappy Custom is astonishing.

Sec. 526. The Bakers, who make Use of much small Coal, often keep great Quantities of it in their Cellars, which frequently abound so much with the Vapour of it, that it seizes them violently the Moment they enter into the Cellar. They sink down at once deprived of all Sensation, and die if they are not drawn out of it soon enough to be assisted, according to the Directions I have just given.

One certain Means of preventing such fatal Accidents is, upon going into the Cellar to throw some flaming Paper or Straw into it, and if these continue to flame out and consume, there is no Reason for dreading the Vapour: but if they should be extinguished, no Person should venture in. But after opening the Vent-hole, a Bundle of flaming Straw must be set at the Door, which serves to attract the external Air strongly. Soon after the Experiment of the flaming Paper must be repeated, and if it goes out, more Straw is to be set on Fire before the Cellar Door.

Sec. 527. Small Coal, burnt in an open Fire, is not near so dangerous as _Charcoal_, properly so called, the Danger of which arises from this, that in extinguishing it by the usual Methods, all those sulphureous Particles of it, in which its Danger consists, are concentred. Nevertheless, small Coal is not entirely deprived of all its noxious Quality, without some of which it could not strictly be Coal.

The common Method of throwing some Salt on live Coals, before they are conveyed into a Chamber; or of casting a Piece of Iron among them to imbibe some Part of their deadly narcotic Sulphur, is not without its Utility; though by no means sufficient to prevent all Danger from them.

Sec. 528. When the most dangerous Symptoms from this Cause disappear, and there remains only some Degree of Weakness, of Numbness, and a little Inappetency, or Loathing at Stomach, nothing is better than Lemonade with one fourth Part Wine, half a Cup of which should frequently be taken, with a small Crust of Bread.

Sec. 529. The Vapour which exhales from Wine, and in general from all fermenting Liquors, such as Beer, Cyder, _&c._ contains something poisonous, which kills in the like Manner with the Vapour of Coal; and there is always some Danger in going into a Cellar, where there is much Wine in the State of Fermentation; if it has been shut up close for several Hours. There have been many Examples of Persons struck dead on entering one, and of others who have escaped out of it with Difficulty.

When such unhappy Accidents occur, Men should not be successively exposed, one after another, to perish, by endeavouring to fetch out the first who sunk down upon his Entrance; but the Air should immediately be purified by the Method already directed, or by discharging some Guns into the Cellar; after which People may venture in with Precaution. And when the Persons unfortunately affected are brought out, they are to be treated like those, who were affected with the Coal-Vapour.

I saw a Man, about eight Years since, who was not sensible of the Application of Spirit of Sal Ammoniac, till about an Hour after he was struck down, and who was entirely freed at last by a plentiful Bleeding; though he had been so insensible, that it was several Hours before he discovered a very great Wound he had, which extended from the Middle of his Arm to his Armpit, and which was made by a Hook intended to be used, in Case of a House catching Fire, to assist Persons in escaping from the Flames.

Sec. 530. When subterraneous Caves that have been very long shut are opened; or when deep Wells are cleaned, that have not been emptied for several Years, the Vapours arising from them produce the same Symptoms I have mentioned, and require the same Assistance. They are to be cleansed and purified by burning Sulphur and Salt Petre in them, or Gunpowder, as compounded of both.

Sec. 531. The offensive Stink of Lamps and of Candles, especially when their Flames are extinguished, operate like other Vapours, though with less Violence, and less suddenly. Nevertheless there have been Instances of People killed by the Fumes of Lamps fed with Nut Oil, which had been extinguished in a close Room. These last Smells or Fumes prove noxious also, in Consequence of their Greasiness, which being conveyed, together with the Air, into the Lungs, prevent their Respiration: And hence we may observe, that Persons of weak delicate Breasts find themselves quickly oppressed in Chambers or Apartments, illuminated with many Candles.

The proper Remedies have been already directed, Sec. 525. The Steam of Vinegar is very serviceable in such Cases.

_Of Poisons._

Sec. 532. There are a great Number of Poisons, whose Manner of acting is not alike; and whose ill Effects are to be opposed by different Remedies: But Arsenic, or Ratsbane, and some particular Plants are the Poisons which are the most frequently productive of Mischief, in Country Places.

Sec. 533. It is in Consequence of its excessive Acrimony, or violent Heat and Sharpness, which corrodes or gnaws, that Arsenic destroys by an excessive Inflammation, with a burning Fire as it were, most torturing Pains in the Mouth, Throat, Stomach, Guts; with rending and often bloody Vomitings, and Stools, Convulsions, Faintings, _&c._

The best Remedy of all is pouring down whole Torrents of Milk, or, where there is not Milk, of warm Water. Nothing but a prodigious Quantity of such weak Liquids can avail such a miserable Patient. If the Cause of the Disorder is immediately known, after having very speedily taken down a large Quantity of warm Water, Vomiting may be excited with Oil, or with melted Butter, and by tickling the Inside of the Throat with a Feather. But when the Poison has already inflamed the Stomach and the Guts, we must not expect to discharge it by vomiting. Whatever is healing or emollient, Decoctions of mealy Pulse, of Barley, of Oatmeal, of Marsh-mallows, and Butter and Oil are the most suitable.

As soon as ever the tormenting Pains are felt in the Belly, and the Intestines seem attacked, Glysters of Milk must be very frequently thrown up.

If at the very Beginning of the Attack, the Patient has a strong Pulse, a very large Bleeding may be considerably serviceable by its delaying the Progress, and diminishing the Degree of Inflammation.

And even though it should happen that a Patient overcomes the first Violence of this dreadful Accident, it is too common for him to continue in a languid State for a long Time, and sometimes for all the Remainder of his Life. The most certain Method of preventing this Misery, is to live for some Months solely upon Milk, and some very new laid Eggs, just received from the Hen, and dissolved or blended in the Milk, without boiling them.

Sec. 534. The Plants which chiefly produce these unhappy Accidents are some Kinds of Hemlock, whether it be the Leaf or the Root, the Berries of the _Bella Donna_, or deadly Nightshade, which Children eat by mistake for Cherries; some Kind of Mushrooms, the Seed of the _Datura_, or the stinking Thorn-Apple.

All the Poisons of this Class prove mortal rather from a narcotic, or stupefying, than from an acrid, or very sharp Quality. Vertigos, Faintings, Reachings to vomit, and actual Vomitings are the first Symptoms produced by them.

The Patient should immediately swallow down a large Quantity of Water, moderately seasoned with Salt or with Sugar; and then a Vomiting should be excited as soon as possible by the Prescription No. 34 or 35: or, if neither of these is very readily procurable, with Radish-seed pounded, to the Quantity of a Coffee Spoonful, swallowed in warm Water, soon after forcing a Feather or a Finger into the Patient's Throat, to expedite the Vomiting.

After the Operation of the Vomit, he must continue to take a large Quantity of Water, sweetened with Honey or Sugar, together with a considerable Quantity of Vinegar, which is the true Specific, or Antidote, as it were, against those Poisons: the Intestines must also be emptied by a few Glysters.

Thirty-seven Soldiers having unhappily eaten, instead of Carrots, of the Roots of the _Oenanthe_; or Water-hemlock, became all extremely sick; when the Emetic, No. 34, with the Assistance of Glysters, and very plentiful drinking of warm Water, saved all but one of them, who died before he could be assisted.

Sec. 535. If a Person has taken too much Opium; or any Medicine into which it enters, as _Venice_ Treacle, Mithridate, Diascordium, _&c._ whether by Imprudence, Mistake, Ignorance, or through any bad Design, he must be bled upon the Spot, and treated as if he had a sanguine Apoplexy, (See Sec. 147) by Reason that Opium in Effect produces such a one. He should snuff up and inhale the Vapour of Vinegar plentifully, adding it also liberally to the Water he is to drink.

_Of acute Pains._

Sec. 536. It is not my Intention to treat here of those Pains, that accompany any evident known Disease, and which should be conducted as relating to such Diseases; nor of such Pains as infirm valetudinary Persons are habitually subject to; since Experience has informed such of the most effectual Relief for them: But when a Person sound and hale, finds himself suddenly attacked with some excessive Pain, in whatever Part it occurs, without knowing either the Nature, or the Cause of it, they may, till proper Advice can be procured,

1, Part with some Blood, which, by abating the Fulness and Tension, almost constantly asswages the Pains, at least for some Time: and it may even be repeated, if, without weakening the Patient much, it has lessened the Violence of the Pain.

2, The Patient should drink abundantly of some very mild temperate Drink, such as the Ptisan No. 2, the Almond Emulsion No. 4, or warm Water with a fourth or fifth Part Milk.

3, Several emollient Glysters should be given.

4, The whole Part that is affected, and the adjoining Parts should be covered with Cataplasms, or soothed with the emollient Fomentation, No. 9.

5, The warm Bath may also be advantagiously used.

6, If notwithstanding all these Assistances, the Pain should still continue violent, and the Pulse is neither full nor hard, the grown Patient may take an Ounce of Syrup of Diacodium, or sixteen Drops of liquid Laudanum; and when neither of these are to be had, [111] an _English_ Pint of boiling Water must be poured upon three or four Poppy-heads with their Seeds, but without the Leaves, and this Decoction is to be drank like Tea.

[111] _Une Quartette._

Sec. 537. Persons very subject to frequent Pains, and especially to violent Head-achs, should abstain from all strong Drink; such Abstinence being often the only Means of curing them: And People are very often mistaken in supposing Wine necessary for as many as seem to have a weak Stomach.

__Chapter XXXII.__

_Of Medicines taken by Way of Precaution, or Prevention._

__Sect.__ 538.

I Have pointed out, in some Parts of this Work, the Means of preventing the bad Effects of several Causes of Diseases; and of prohibiting the Return of some habitual Disorders. In the present Chapter I shall adjoin some Observations, on the Use of the principal Remedies, which are employed as general Preservatives; pretty regularly too at certain stated Times, and almost always from meer Custom only, without knowing, and often with very little Consideration, whether they are right or wrong.

Nevertheless, the Use, the Habit of taking Medicines, is certainly no indifferent Matter: it is ridiculous, dangerous, and even criminal to omit them, when they are necessary, but not less so to take them when they are not wanted. A good Medicine taken seasonably, when there is some Disorder, some _Disarrangement_ in the Body, which would in a short time occasion a Distemper, has often prevented it. But yet the very same Medicine, if given to a Person in perfect Health, if it does not directly make him sick, leaves him at the best in a greater Propensity to the Impressions of Diseases: and there are but too many Examples of People, who having very unhappily contracted a Habit, a Disposition to take Physick, have really injured their Health, and impaired their Constitution, however naturally strong, by an Abuse of those Materials which Providence has given for the Recovery and Re-establishment of it; an Abuse which, though it should not injure the Health of the Person, would occasion those Remedies, when he should be really sick, to be less efficacious and serviceable to him, from their having been familiar to his Constitution; and thus he becomes deprived of the Assistance he would have received from them, if taken only in those Times and Circumstances, in which they were necessary for him.

_Of Bleeding._

Sec. 539. Bleeding is necessary only in these four Cases. 1, When there is too great a Quantity of Blood in the Body. 2, When there is any Inflammation, or an inflammatory Disease. 3, When some Cause supervenes, or is about to supervene, in the Constitution, which would speedily produce an Inflammation, or some other dangerous Symptom, if the Vessels were not relaxed by Bleeding. It is upon this Principle that Patients are bled after Wounds, and after Bruises; that Bleeding is directed for a pregnant Woman, if she has a violent Cough; and that Bleeding is performed, by Way of Precaution, in several other Cases. 4, We also advise Bleeding sometimes to asswage an excessive Pain, though such Pain is not owing to Excess of Blood, nor arises from an inflamed Blood; but in Order to appease and moderate the Pain by Bleeding; and thereby to obtain Time for destroying the Cause of it by other Remedies. But as these two last Reasons are in Effect involved or implied in the two first; it may be very generally concluded, that an Excess of Blood, and an inflamed State of it, are the only two necessary Motives for Bleeding.

Sec. 540. An Inflammation of the Blood is known by the Symptoms accompanying those Diseases, which that Cause produces. Of these I have already spoken, and I have at the same time regulated the Practice of Bleeding in such Cases. Here I shall point out those Symptoms and Circumstances, which manifest an Excess of Blood.

The first, then, is the general Course and Manner of the Patient's living, while in Health. If he is a great Eater, and indulges in juicy nutritious Food, and especially on much Flesh-meat; if he drinks rich and nourishing Wine, or other strong Drink, and at the same time enjoys a good Digestion; if he takes but little Exercise, sleeps much, and has not been subject to any very considerable Evacuation, he may well be supposed to abound in Blood. It is very obvious that all these Causes rarely occur in Country People; if we except only the Abatement of their Exercise, during some Weeks in Winter, which indeed may contribute to their generating more Blood than they commonly do.

The labouring Country-man, for much the greater part of his Time, lives only on Bread, Water and Vegetables; Materials but very moderately nourishing, as one Pound of Bread probably does not make, in the same Body, more Blood than one Ounce of Flesh; though a general Prejudice seems to have established a contrary Opinion. 2, The total Stopping or long Interruption of some involuntary Bleeding or Haemorrhage, to which he had been accustomed. 3, A full and strong Pulse, and Veins visibly filled with Blood, in a Body that is not lean and thin, and when he is not heated. 4, A florid lively Ruddiness. 5, A considerable and unusual Numbness; Sleep more profound, of more Duration, and yet less tranquil and calm, than at other times; a greater Propensity than ordinary to be fatigued after moderate Exercise or Work; and a little Oppression and Heaviness from walking. 6, Palpitations, accompanied sometimes with very great Dejection, and even with a slight fainting Fit; especially on being in any hot Place, or after moving about considerably. 7, Vertigos, or Swimmings of the Head, especially on bowing down and raising it up at once, and after sleeping. 8, Frequent Pains of the Head, to which the Person was not formerly subject; and which seem not to arise from any Defect in the Digestions. 9, An evident Sensation of Heat, pretty generally diffused over the whole Body. 10, A smarting Sort of Itching all over, from a very little more Heat than usual. And lastly, frequent Haemorrhages, and these attended with manifest Relief, and more Vivacity.

People should, notwithstanding, be cautious of supposing an unhealthy Excess of Blood, from any one of these Symptoms only. Many of them must concur; and they should endeavour to be certain that even such a Concurrence of them does not result from a very different Cause, and wholly opposite in Effect to that of an Excess of Blood.

But when it is certain, from the whole Appearance, that such an Excess doth really exist, then a single, or even a second Bleeding is attended with very good Effects. Nor is it material, in such Cases, from what Part the Blood is taken.

Sec. 541. On the other Hand, when these Circumstances do not exist, Bleeding is in no wise necessary: nor should it ever be practised in these following Conditions and Circumstances; except for some particular and very strong Reasons; of the due Force of which none but Physicians can judge.

First, when the Person is in a very advanced Age, or in very early Infancy. 2, When he is either naturally of a weakly Constitution, or it has been rendered such by Sickness, or by some other Accident. 3, When the Pulse is small, soft, feeble, and intermits, and the Skin is manifestly pale. 4, When the Limbs, the Extremities of the Body, are often cold, puffed up and soft. 5, When their Appetite has been very small for a long time; their Food but little nourishing, and their Perspiration too plentiful, from great Exercise. 6, When the Stomach has long been disordered, and the Digestion bad, whence very little Blood could be generated. 7, When the Patient has been considerably emptied, whether by Haemorrhages, a Looseness, profuse Urine or Sweat: or when the _Crisis_ of some Distemper has been effected by any one of these Evacuations. 8, When the Patient has long been afflicted with some depressing Disease; and troubled with many such Obstructions as prevent the Formation of Blood. 9, Whenever a Person is exhausted, from whatever Cause. 10, When the Blood is in a thin, pale, and dissolved State.

Sec. 542, In all these Cases, and in some others less frequent, a single Bleeding often precipitates the Patient into an absolutely incurable State, an irreparable Train of Evils. Many dismal Examples of it are but too obvious.

Whatever, therefore, be the Situation of the Patient, and however naturally robust, that Bleeding, which is unnecessary, is noxious. Repeated, re-iterated Bleedings, weaken and enervate, hasten old Age, diminish the Force of the Circulation, thence fatten and puff up the Body; and next by weakening, and lastly by destroying, the Digestions, they lead to a fatal Dropsy. They disorder the Perspiration by the Skin, and leave the Patient liable to Colds and Defluxions: They weaken the nervous System, and render them subject to Vapours, to the hypochondriac Disorders, and to all nervous Maladies.

The ill Consequence of a single, though erroneous Bleeding is not immediately discernible: on the contrary, when it was not performed in such a Quantity, as to weaken the Patient perceivably, it appears to have been rather beneficial. Yet I still here insist upon it, that it is not the less true that, when unnecessary, it is prejudicial; and that People should never bleed, as sometimes has been done, for meer Whim, or, as it were, for Diversion. It avails nothing to affirm, that within a few Days after it, they have got more Blood than they had before it, that is, that they weigh more than at first, whence they infer the Loss of Blood very speedily repaired. The Fact of their augmented Weight is admitted; but this very Fact testifies against the real Benefit of that Bleeding; hence it is a Proof, that the natural Evacuations of the Body are less compleatly made; and that Humours, which ought to be expelled, are retained in it. There remains the same Quantity of Blood, and perhaps a little more; but it is not a Blood so well made, so perfectly elaborated; and this is so very true, that if the thing were otherwise; if some Days after the Bleeding they had a greater Quantity of the same Kind of Blood, it would amount to a Demonstration, that more re-iterated Bleedings must necessarily have brought on an inflammatory Disease, in a Man of a robust Habit of Body.

Sec. 543. The Quantity of Blood, which a grown Man may Part with, by Way of Precaution, is about ten Ounces.

Sec. 544. Persons so constituted as to breed much Blood, should carefully avoid all those Causes which tend to augment it, (See Sec. 540, No. 1) and when they are sensible of the Quantity augmented, they should confine themselves to a light frugal Diet, on Pulse, Fruits, Bread and Water; they should often bathe their Feet in warm Water, taking Night and Morning the Powder No. 20; drink of the Ptisan No. 1; sleep but very moderately, and take much Exercise. By using these Precautions they may either prevent any Occasion for Bleeding, or should they really be obliged to admit of it, they would increase and prolong its good Effects. These are also the very Means, which may remove all the Danger that might ensue from a Person's omitting to bleed, at the usual Season or Interval, when the Habit, the Fashion of Bleeding had been inveterately established in him.

Sec. 545. We learn with Horror and Astonishment, that some have been bled eighteen, twenty and even twenty-four times in two Days; and some others, some [112] hundred times, in the Course of some Months. Such Instances irrefragably demonstrate the continual Ignorance of their Physician or Surgeon; and should the Patient escape, we ought to admire the inexhaustible Resources of Nature, that survived so many murderous Incisions.

[112] How shocking is this! and yet how true in some Countries! I have
been most certainly assured, that Bleeding has been inflicted and
repeated in the last sinking and totally relaxing Stage of a
Sea-Scurvy, whose fatal Termination it doubtless accelerated. This
did not happen in our own Fleet; yet we are not as yet Wholly
exempt on Shore, from some Abuse of Bleeding, which a few raw
unthinking Operators are apt to consider as a meer Matter of
Course. I have in some other Place stigmatized the Madness of
Bleeding in Convulsions, from manifest Exhaustion and Emptiness,
with the Abhorrence it deserves. _K._

Sec. 546. The People entertain a common Notion, which is, that the first Time of bleeding certainly saves the Life of the Patient; but to convince them of the Falsity of this silly Notion, they need only open their Eyes, and see the very contrary Fact to this occur but too unhappily every Day; many People dying soon after their first Bleeding. Were their Opinion right, it would be impossible that any Person should die of the first Disease that seized him, which yet daily happens. Now the Extirpation of this absurd Opinion is really become important, as the Continuance of it is attended with some unhappy Consequences: their Faith in, their great Dependance on, the extraordinary Virtue of this first Bleeding makes them willing to omit it, that is, to treasure it up against a Distemper, from which they shall be in the greatest Danger; and thus it is deferred as long as the Patient is not extremely bad, in Hopes that if they can do without it then, they shall keep it for another and more pressing Occasion. Their present Disease in the mean time rises to a violent Height; and then they bleed, but when it is too late, and I have seen Instances of many Patients, who were permitted to die, that the first Bleeding might be reserved for a more important Occasion. The only Difference between the first Bleeding, and any subsequent one is, that the first commonly gives the Patient an Emotion, that is rather hurtful than salutary.

_Of Purges._

Sec. 547. The Stomach and Bowels are emptied either by Vomiting, or by Stools, the latter Discharge being much more natural than the first, which is not effected without a violent Motion, and one indeed to which Nature is repugnant. Nevertheless, there are some Cases, which really require this artificial Vomiting; but these excepted (some of which I have already pointed out) we should rather prefer those Remedies, which empty the Belly by Stool.

Sec. 548. The Signs, which indicate a Necessity for Purging, are, 1, a disagreeable Tast or Savour of the Mouth in a Morning, and especially a bitter Tast; a foul, furred Tongue and Teeth, disagreable Eructations or Belchings, Windiness and Distension.

2, A Want of Appetite which increases very gradually, without any Fever, which degenerates into a Disgust or total Aversion to Food; and sometimes communicates a bad Tast to the very little such Persons do eat.

3, Reachings to vomit in a Morning fasting, and sometimes throughout the Day; supposing such not to depend on a Woman's Pregnancy, or some other Disorder, in which Purges would be either useless or hurtful.

4, A vomiting up of bitter, or corrupted, Humours.

5, A manifest Sensation of a Weight, or Heaviness in the Stomach, the Loins, or the Knees.

6, A Want of Strength sometimes attended with Restlessness, ill Humour, or Peevishness, and Melancholy.

7, Pains of the Stomach, frequent Pains of the Head, or Vertigos; sometimes a Drowsiness, which increases after Meals.

8, Some Species of Cholics; irregular Stools which are sometimes very great in Quantity, and too liquid for many Days together; after which an obstinate Costiveness ensues.

9, A Pulse less regular, and less strong, than what is natural to the Patient, and which sometimes intermits.

Sec. 549. When these Symptoms, or some of them, ascertain the Necessity of purging a Person, not then attacked by any manifest Disease (for I am not speaking here of Purges in such Cases) a proper purging Medicine may be given him. The bad Tast in his Mouth; the continual Belchings; the frequent Reachings to vomit; the actual Vomitings and Melancholy discover, that the Cause of his Disorder resides in the Stomach, and shew that a Vomit will be of Service to him. But when such Signs or Symptoms are not evident, the Patient should take such purging or opening Remedies, as are particularly indicated by the Pains, whether of the Loins; from the Cholic; or by a Sensation of Weight or Heaviness in the Knees.

Sec. 550. But we should abstain from either vomiting or purging, 1, Whenever the Complaints of the Patients are founded in their Weakness, and their being already exhausted, 2, When there is a general Dryness of the Habit, a very considerable Degree of Heat, some Inflammation, or a strong Fever. 3, Whenever Nature is exerting herself in some other salutary Evacuation; whence purging must never be attempted in critical Sweats, during the monthly Discharges, nor during a Fit of the Gout. 4, Nor in such inveterate Obstructions as Purges cannot remove, and really do augment. 5, Neither when the nervous System is considerably weakened.

Sec. 551. There are other Cases again, in which it may be proper to purge, but not to give a Vomit. These Cases are, 1, When the Patient abounds too much with Blood, (See Sec. 540) since the Efforts which attend vomiting, greatly augment the Force of the Circulation; whence the Blood-vessels of the Head and of the Breast, being extremely distended with Blood, might burst, which must prove fatal on the Spot, and has repeatedly proved so. 2, For the same Reason they should not be given to Persons, who are subject to frequent Bleeding from the Nose, or to coughing up or vomiting of Blood; to Women who are subject to excessive or unseasonable Discharges of Blood, _&c._ from the _Vagina_, the Neck of the Womb; nor to those who are with Child. 3, Vomits are improper for ruptured Persons.

Sec. 552. When any Person has taken too acrid, too sharp, a Vomit, or a Purge, which operates with excessive Violence; whether this consists in the most vehement Efforts and Agitations, the Pains, Convulsions, or Swoonings, which are their frequent Consequences; or whether that prodigious Evacuation and Emptiness their Operation causes, (which is commonly termed a _Super-purgation_) and which may hurry the Patient off; Instances of which are but too common among the lower Class of the People, who much too frequently confide themselves to the Conduct of ignorant Men-slayers: In all such unhappy Accidents, I say, we should treat these unfortunate Persons, as if they had been actually poisoned, by violent corroding Poisons, (See Sec. 533) that is, we should fill them, as it were, with Draughts of warm Water, Milk, Oil, Barley-water, Almond Milk, emollient Glysters with Milk, and the Yolks of Eggs; and also bleed them plentifully, if their Pains are excessive, and their Pulses strong and feverish.

The Super-purgation, the excessive Discharge, is to be stopt, after having plied the Patient plentifully with diluting Drinks, by giving the calming Anodyne Medicines directed in the Removal of acute Pains, Sec. 536, No. 6.

Flanels dipt in hot Water, in which some _Venice_ Treacle is dissolved, are very serviceable: and should the Evacuations by Stool be excessive, and the Patient has not a high Fever, and a parching Kind of Heat, a Morsel of the same Treacle, as large as a Nutmeg, may be dissolved in his Glyster.

But should the Vomiting solely be excessive, without any Purging, the Number of the emollient Glysters with Oil and the Yolk of an Egg must be increased; and the Patient should be placed in a warm Bath.

Sec. 553. Purges frequently repeated, without just and necessary Indications, are attended with much the same ill Effects as frequent Bleedings. They destroy the Digestions; the Stomach no longer, or very languidly, exerts its Functions; the Intestines prove inactive; the Patient becomes liable to very severe Cholics; the Plight of the Body, deprived of its salutary Nutrition, falls off; Perspiration is disordered; Defluxions ensue; nervous Maladies come on, with a general Languor; and the Patient proves old, long before the Number of his Years have made him so.

Much irreparable Mischief has been done to the Health of Children, by Purges injudiciously given and repeated. They prevent them from attaining their utmost natural Strength, and frequently contract their due Growth. They ruin their Teeth; dispose young Girls to future Obstructions; and when they have been already affected by them, they render them still more obstinate.

It is a Prejudice too generally received, that Persons who have little or no Appetite need purging; since this is often very false, and most of those Causes, which lessen or destroy the Appetite, cannot be removed by purging; though many of them may be increased by it.

Persons whose Stomachs contain much glairy viscid Matter suppose, they may be cured by Purges, which seem indeed at first to relieve them: but this proves a very slight and deceitful Relief. These Humours are owing to that Weakness and Laxity of the Stomach, which Purges augment; since notwithstanding they carry off Part of these viscid Humours generated in it, at the Expiration of a few Days there is a greater Accumulation of them than before; and thus, by a Re-iteration of purging Medicines, the Malady soon becomes incurable, and Health irrecoverably lost. The real Cure of such Cases is effected by directly opposite Medicines. Those referred to, or mentioned, Sec. 272, are highly conducive to it.

Sec. 554. The Custom of taking stomachic Medicines infused in Brandy, Spirit of Wine, Cherry Water, _&c._ is always dangerous; for notwithstanding the present immediate Relief such Infusions afford in some Disorders of the Stomach, they really by slow Degrees impair and ruin that Organ; and it may be observed, that as many as accustom themselves to Drams, go off, just like excessive Drinkers, in Consequence of their having no Digestion; whence they sink into a State of Depression and Languor, and die dropsical.

Sec. 555. Either Vomits or Purges may be often beneficially omitted, even when they have some Appearance of seeming necessary, by abating one Meal a Day for some time; by abstaining from the most nourishing Sorts of Food; and especially from those which are fat; by drinking freely of cool Water, and taking extraordinary Exercise. The same Regimen also serves to subdue, without the Use of Purges, the various Complaints which often invade those, who omit taking purging Medicines, at those Seasons and Intervals, in which they have made it a Custom to take them.

Sec. 556. The Medicines, No. 34 and 35, are the most certain Vomits. The Powder, No. 21, is a good Purge, when the Patient is in no wise feverish.

The Doses recommended in the Table of Remedies are those, which are proper for a grown Man, of a vigorous Constitution. Nevertheless there are some few, for whom they may be too weak: in such Circumstances they may be increased by the Addition of a third or fourth Part of the Dose prescribed. But should they not operate in that Quantity, we must be careful not to double the Dose, much less to give a three-fold Quantity, which has sometimes been done, and that even without its Operation, and at the Risque of killing the Patient, which has not seldom been the Consequence. In Case of such purging not ensuing, we should rather give large Draughts of Whey sweetened with Honey, or of warm Water, in a Pot of which an Ounce, or an Ounce and a half of common Salt must be dissolved; and this Quantity is to be taken from time to time in small Cups, moving about with it.

The Fibres of Country People who inhabit the Mountains, and live almost solely on Milk, are so little susceptible of Sensation, that they must take such large Doses to purge them, as would kill all the Peasantry in the Vallies. In the Mountains of _Valais_ there are Men who take twenty, and even twenty-four Grains of Glass of Antimony for a single Dose; a Grain or two of which were sufficient to poison ordinary Men.