Chapter XVI: Part II: Of Diseases (6)

What answers the purpose of opening the body very well, is a solution of the bitter purging salts. Two ounces of these may be dissolved in an English pint of warm water, or thin gruel, and a tea-cupful of it taken every half hour till it operates. At the same time fifteen, twenty, or twenty-five drops of laudanum may be given in a glass of peppermint or simple cinnamon-water, to appease the irritation, and prevent the vomiting, &c.

Acids have often a very happy effect in staying the vomiting, and appeasing the other violent symptoms of this disease. It will therefore be of use to sharpen the patient’s drink with cream of tartar, juice of lemon; or, when these cannot be obtained, with vinegar.

But it often happens that no liquid whatever will stay on the stomach. In this case the patient must take purging pills. I have generally found the following answer very well: Take jalap in powder, and vitriolated tartar, of each half a drachm, opium one grain, Castile soap as much as will make the mass fit for pills. These must be taken at one dose, and if they do not operate in a few hours, the dose may be repeated.

If a stool cannot be procured by any of the above means, it will be necessary to immerse the patient in warm water up to the breast. I have often seen this succeed when other means had been tried in vain. The patient must continue in the water as long as he can easily bear it without fainting, and if one immersion has not the desired effect, it may be repeated as soon as the patient’s strength and spirits are recruited. It is more safe for him to go frequently into the bath, than to continue too long at a time; and it is often necessary to repeat it several times before it has the desired effect.

It has sometimes happened, after all other means of procuring a stool had been tried to no purpose, that this was brought about by immersing the patient’s lower extremities in cold water, or making him walk upon a wet pavement, and dashing his legs and thighs with the cold water. This method, when others fail, at least merits a trial. It is indeed attended with some danger; but a doubtful remedy is better than none.

In desperate cases it is common to give quicksilver. This may be given to the quantity of several ounces, or even a pound, but should not exceed that[116]. When there is reason to suspect a mortification of the guts, this medicine ought not to be tried. In that case it cannot cure the patient, and will only hasten his death. But when the obstruction is occasioned by any cause that can be removed by force, quicksilver is not only a proper medicine, but the best that can be administered, as it is the fittest body we know for making its way through the intestinal canal.

If the disease proceed from a rupture, the patient must be laid with his head very low, and the intestines returned by gentle pressure with the hand. If this, with fomentations and clysters, should not succeed, recourse must be had to a surgical operation, which may give the patient relief.

Such as would avoid this excruciating and dangerous disease, must take care never to be too long without a stool. Some who have died of it have had several pounds of hard dry _fæces_ taken out of their guts. They should likewise beware of eating too freely of sour or unripe fruits, or drinking stale windy liquors, &c. I have known it brought on by living too much on baked fruits, which are seldom good. It likewise proceeds frequently from cold caught by wet clothes, &c. but especially from wet feet.

OF THE COLIC.

The colic has a great resemblance to the two preceding diseases, both in its symptoms and method of cure. It is generally attended with costiveness and acute pain of the bowels; and requires diluting diet, evacuations, fomentations, &c.

Colics are variously denominated according to their causes, as the _flatulent_, the _bilious_, the _hysteric_, the _nervous_, &c. As each of these requires a particular method of treatment, we shall point out their most general symptoms, and the means to be used for their relief.

The _flatulent_, or wind-colic, is generally occasioned by an indiscreet use of unripe fruits, meats of hard digestion, windy vegetables, fermenting liquors, and such like. It may likewise proceed from an obstructed perspiration, or catching cold. Delicate people, whose digestive powers are weak, are most liable to this kind of colic.

The flatulent colic may either affect the stomach or intestines. It is attended with a painful stretching of the affected part. The patient feels a rumbling in his guts, and is generally relieved by a discharge of wind, either upwards or downwards. The pain is seldom confined to any particular part, as the vapour wanders from one division of the bowels to another till it finds a vent.

When the disease proceeds from windy liquor, green fruit, sour herbs, or the like, the best medicine on the first appearance of the symptoms is a dram of brandy, gin, or any good spirits. The patient should likewise sit with his feet upon a warm hearth-stone, or apply warm bricks to them; and warm cloths may be applied to his stomach and bowels.

This is the only colic wherein ardent spirits, spiceries, or any thing of a hot nature, may be ventured upon. Nor indeed are they to be used here unless at the very beginning, before any symptoms of inflammation appear. We have reason to believe, that a colic occasioned by wind or flatulent food might always be cured by spirits and warm liquors, if they were taken immediately upon perceiving the first uneasiness; but when the pain has continued for a considerable time, and there is reason to fear an inflammation of the bowels is already begun, all hot things are to be avoided as poison, and the patient is to be treated in the same manner as for the inflammation of the intestines.

Several kinds of food, as honey, eggs, &c. occasion colics in some particular constitutions. I have generally found the best method of cure for these was to drink plentifully of small diluting liquors, as water-gruel, small posset, water with toasted bread soaked in it, &c.

Colics which proceed from excess and indigestion generally cure themselves by occasioning vomiting or purging. These discharges are by no means to be stopped, but promoted by drinking plentifully of warm water, or weak posset. When their violence is over, the patient may take a dose of rhubarb, or any other gentle purge, to carry off the dregs of his debauch.

Colics which are occasioned by wet feet, or catching cold, may generally be removed at the beginning, by bathing the feet and legs in warm water, and drinking such warm diluting liquors as will promote the perspiration, as weak wine-whey, or water-gruel, with a small quantity of spirits in it.

Those flatulent colics, which prevail so much among country people, might generally be prevented were they careful to change their clothes when they get wet. They ought likewise to take a dram, or to drink some warm liquor after eating any kind of green trash. We do not mean to recommend the practice of dram-drinking, but in this case ardent spirits prove a real medicine, and indeed the best that can be administered. A glass of good peppermint water will have nearly the same effect as a glass of brandy, and in some cases is rather to be preferred.

The _bilious_ colic is attended with very acute pains about the region of the navel. The patient complains of great thirst, and is generally costive. He vomits a hot, bitter, yellow-coloured bile, which being discharged, seems to afford some relief, but is quickly followed by the same violent pain as before. As the distemper advances, the propensity to vomit sometimes increases so as to become almost continual, and the proper motion of the intestines is so far perverted, that there are all the symptoms of an impending iliac passion.

If the patient be young and strong, and the pulse full and frequent, it will be proper to bleed, after which clysters may be administered. Clear whey or gruel, sharpened with the juice of lemon, or cream of tartar, must be drank freely. Small chicken-broth, with a little manna dissolved in it, or a slight decoction of tamarinds, are likewise very proper, or any other thin, acid, opening liquor.

Besides bleeding and plentiful dilution, it will be necessary to foment the belly with cloths dipped in warm water, and if this should not succeed, the patient must be immersed up to the breast in warm water.

In the bilious colic the vomiting is often very difficult to restrain. When this happens, the patient may drink a decoction of toasted bread, or an infusion of garden-mint in boiling water. Should these not have the desired effect, the saline draught, with a few drops of laudanum in it, may be given, and repeated according to the urgency of the symptoms. A small quantity of Venice treacle may be spread in form of a cataplasm, and applied to the pit of the stomach. Clysters, with a proper quantity of Venice treacle or liquid laudanum in them, may likewise be frequently administered.

Such as are liable to frequent returns of the bilious colic should use flesh sparingly, and live chiefly upon a light vegetable diet. They should likewise take frequently a dose of cream of tartar with tamarinds, or any other cool acid purge.

The _hysteric_ colic bears a great resemblance to the bilious. It is attended with acute pains about the region of the stomach, vomiting, &c. But what the patient vomits in this case is commonly of a greenish colour. There is a great sinking of the spirits, with dejection of mind and difficulty of breathing, which are the characteristic symptoms of this disorder. Sometimes it is accompanied with the jaundice, but this generally goes off of its own accord in a few days.

In this colic all evacuations, as bleeding, purging, vomiting, &c. do hurt. Every thing that weakens the patient, or sinks the spirits, is to be avoided. If however the vomiting should prove violent, lukewarm water, or small posset, may be drank to cleanse the stomach. Afterwards the patient may take fifteen, twenty, or twenty-five drops of liquid laudanum in a glass of cinnamon water. This may be repeated every ten or twelve hours till the symptoms abate.

The patient may likewise take four or five of the fœtid pills every six hours, and drink a cup of penny-royal tea after them. If asafœtida should prove disagreeable, which is sometimes the case, a tea-spoonful of the tincture of castor in a cup of penny-royal tea, or thirty or forty drops of the balsam of Peru dropped upon a bit of loaf-sugar, may be taken in its stead. The anti-hysteric plaster may also be used, which has often a good effect[117].

The _nervous_ colic prevails among miners, smelters of lead, plumbers, the manufacturers of white lead, &c. It is very common in the cyder counties of England, and is supposed to be occasioned by the leaden vessels used in preparing that liquor. It is likewise a frequent disease in the West Indies, where it is termed the dry belly-ache.

No disease of the bowels is attended with more excruciating pain than this. Nor is it soon at an end. I have known it continue eight or ten days with very little intermission, the body all the while continuing bound in spite of medicine, yet at length yield, and the patient recover[118]. It generally however leaves the patient weak, and often ends in a palsy.

The general treatment of this disease is so nearly the same with that of the iliac passion, or inflammation of the guts, that we shall not insist upon it. The body is to be opened by mild purgatives given in small doses, and frequently repeated, and their operation must be assisted by soft oily clysters, fomentations, &c. The castor oil is reckoned peculiarly proper in this disease. It may both be mixed with the clysters and given by the mouth.

The Barbadoes tar is said to be an efficacious medicine in this complaint. It may be taken to the quantity of two drachms three times a day, or oftner if the stomach will bear it. This tar, mixed with an equal quantity of strong rum, is likewise proper for rubbing the spine, in case any tingling, or other symptoms of a palsy, are felt. When the tar cannot be obtained, the back may be rubbed with strong spirits, or a little oil of nutmegs or of rosemary.

If the patient remains weak and languid after this disease, he must take exercise on horseback, and use an infusion of the Peruvian bark in wine. When the disease ends in a palsy, the Bath-waters are found to be extremely proper.

To avoid this kind of colic, people must shun all sour fruits, acids, and austere liquors, &c. Those who work in lead ought never to go to their business fasting, and their food should be oily or fat. They may take a glass of sallad oil, with a little brandy or rum every morning, but should never take spirits alone. Liquid aliment is best for them; as fat broths, &c. but low living is bad. They should frequently go a little out of the tainted air; and should never suffer themselves to be costive. In the West Indies, and on the coast of Guinea, it has been found of great use, for preventing this colic, to wear a piece of flannel round the waist, and to drink an infusion of ginger by way of tea.

Sundry other kinds of this disease might be mentioned, but too many distinctions would tend only to perplex the reader. Those already mentioned are the most material, and should indeed be attended to, as their treatment is very different. But even persons who are not in a condition to distinguish very accurately in these matters, may nevertheless be of great service to patients in colics of every kind, by only observing the following general rules, _viz._ To bathe the feet and legs in warm water; to apply bladders filled with warm water, or cloths dipped in it, to the stomach and bowels; to make the patient drink freely of diluting mucilaginous liquors; and to give him an emollient clyster every two or three hours. Should these not succeed, the patient ought to be immersed in warm water.

INFLAMMATION OF THE KIDNEYS.

CAUSES.——This disease may proceed from any of those causes which produce an inflammatory fever. It may likewise be occasioned by wounds or bruises of the kidneys; small stones or gravel lodging within them; by strong diuretic medicines; as spirits of turpentine, tincture of cantharides, &c. Violent motion, as hard riding or walking, especially in hot weather, or whatever drives the blood too forcibly into the kidneys, may occasion this malady. It may likewise proceed from lying too soft, too much on the back, involuntary contractions, or spasms, in the urinary vessels, &c.

SYMPTOMS.——There is a sharp pain about the region of the kidneys, with some degree of fever, and a stupor or dull pain in the thigh of the affected side. The urine is at first clear, and afterwards of a reddish colour; but in the worst kind of the disease it generally continues pale, is passed with difficulty, and commonly in small quantities at a time. The patient feels great uneasiness when he endeavours to walk or sit upright. He lies with most ease on the affected side, and has generally a nausea or vomiting, resembling that which happens in the colic.

This disease however may be distinguished from the colic by the pain being seated farther back, and by the difficulty of passing urine with which it is constantly attended.

REGIMEN.——Every thing of a heating or stimulating nature is to be avoided. The food must be thin and light; as panado, small broths, with mild vegetables, and the like. Emollient and thin liquors must be plentifully drank; as clear whey, or balm-tea sweetened with honey, decoctions of marsh-mallow roots, with barley and liquorice, &c. The patient, notwithstanding the vomiting, must constantly keep sipping small quantities of these or other diluting liquors. Nothing so safely and certainly abates the inflammation, and expels the obstructing cause, as copious dilution. The patient must be kept easy, quiet, and free from cold, as long as any symptoms of inflammation remain.

MEDICINE.——Bleeding is generally necessary, especially at the beginning. Ten or twelve ounces may be let from the arm or foot with a lancet, and if the pain and inflammation continue, the operation may be repeated in twenty-four hours, especially if the patient be of a full habit. Leeches may likewise be applied to the hæmorrhoidal veins, as a discharge from these will greatly relieve the patient.

Cloths dipped in warm water, or bladders filled with it, must be applied as near as possible to the part affected, and renewed as they grow cool. If the bladders be filled with a decoction of mallows and camomile flowers, to which a little saffron is added, and mixed with about a third part of new milk, it will be still more beneficial.

Emollient clysters ought frequently to be administered; and if these do not open the body, a little salt and honey or manna may be added to them.

The same course is to be followed where gravel or stone is lodged in the kidney, but when the gravel or stone is separated from the kidney, and lodges in the Ureter[119], it will be proper, besides the fomentations, to rub the small of the back with sweet oil, and to give gentle diuretics; as juniper-water sweetened with the syrup of marsh-mallows: a tea-spoonful of the sweet spirits of nitre, with a few drops of laudanum, may now and then be put in a cup of the patient’s drink. He ought likewise to take exercise on horseback, or in a carriage, if he be able to bear it.

When the disease is protracted beyond the seventh or eighth day, and the patient complains of a stupor and heaviness of the part, has frequent returns of chillness, shivering, &c. there is reason to suspect that matter is forming in the kidney, and that an abscess will ensue.

When matter in the urine shews that an ulcer is already formed in the kidney, the patient must be careful to abstain from all acrid, sour, and salted provisions; and to live chiefly upon mild mucilaginous herbs and fruits, together with the broth of young animals, made with barley, and common pot-herbs, &c. His drink may be whey, and butter-milk that is not sour. The latter is by some reckoned a specific remedy in ulcers of the kidneys. To answer this character, however, it must be drank for a considerable time. Chalybeate waters have likewise been found beneficial in this disease. This medicine is easily obtained, as it is found in every part of Great Britain. It must likewise be used for a considerable time, in order to produce any salutary effects.

Those who are liable to frequent returns of inflammation, or obstructions of the kidneys, must abstain from wines, especially such as abound with tartar; and their food ought to be light, and of easy digestion. They should use moderate exercise, and should not lie too hot, nor too much on their back.

INFLAMMATION OF THE BLADDER.

The inflammation of the bladder proceeds, in a great measure, from the same causes as that of the kidneys. It is known by an acute pain towards the bottom of the belly, and difficulty of passing urine, with some degree of fever, a constant inclination to go to stool, and a perpetual desire to make water.

This disease must be treated on the same principles as the one immediately preceding. The diet must be light and thin, and the drink of a cooling nature. Bleeding is very proper at the beginning, and in robust constitutions it will often be necessary to repeat it. The lower part of the belly should be fomented with warm water, or a decoction of mild vegetables; and emollient clysters ought frequently to be administered, &c.

The patient should abstain from every thing that is of a hot, acrid, and stimulating quality, and should live entirely upon small broths, gruels, or mild vegetables.

A stoppage of urine may proceed from other causes besides an inflammation of the bladder; as a swelling of the hæmorrhoidal veins, hard _fæces_ lodged in the _rectum_; a stone in the bladder; excrescences in the urinary passages, a palsy of the bladder, hysteric affections, &c. Each of these requires a particular treatment, which does not fall under our present consideration. We shall only observe, that in all of them mild and gentle applications are the safest, as strong diuretic medicines, or things of an irritating nature, generally increase the danger.

I have known some persons kill themselves by introducing probes into the urinary passages, to remove, as they thought, somewhat that obstructed the discharge of urine, and others bring on a violent inflammation of the bladder, by using strong diuretics, as oil of turpentine, &c. for that purpose.

INFLAMMATION OF THE LIVER.

The liver is less subject to inflammation than most of the other viscera, as in it the circulation is slower; but when an inflammation does happen, it is with difficulty removed, and often ends in a suppuration or scirrhus.

CAUSES.——Besides the common causes of inflammation, we may here reckon the following, _viz._ excessive fatness, a scirrhus of the liver itself, violent shocks from strong vomits when the liver was before unsound, an adust or atrabiliarian state of the blood, any thing that suddenly cools the liver after it has been greatly heated, stones obstructing the course of the bile, drinking strong wines and spirituous liquors, using hot spicy aliment, obstinate hypochondriacal affections, &c.

SYMPTOMS.——This disease is known by a painful tension of the right side under the false ribs, attended with some degree of fever, a sense of weight, or fulness of the part, difficulty of breathing, loathing of food, great thirst, with a pale or yellowish colour of the skin and eyes.

The _symptoms_ here are various, according to the degree of inflammation, and likewise according to the particular part of the liver where the inflammation happens. Sometimes the pain is so inconsiderable, that an inflammation is not so much as suspected; but when it happens in the upper or convex part of the liver, the pain is more acute, the pulse quicker, and the patient is often troubled with a dry cough, a hiccup, and a pain extending to the shoulder, with difficulty of lying on the left side, &c.

This disease may be distinguished from the pleurisy by the pain being less violent, seated under the false ribs, the pulse not so hard, and by the difficulty of lying on the left side. It may be distinguished from the hysteric and hypochondriac disorders by the degree of fever with which it is always attended.

This disease, if properly treated, is seldom mortal. A constant hiccuping, violent fever, and excessive thirst, are bad symptoms. If it ends in a suppuration, and the matter cannot be discharged outwardly, the danger is great. When the scirrhus of the liver ensues, the patient, if he observes a proper regimen, may nevertheless live a number of years tolerably easy; but if he indulge in animal food and strong liquors, or take medicines of an acrid or irritating nature, the scirrhus will be converted into a cancer, which must infallibly prove fatal.

REGIMEN.——The same regimen is to be observed in this as in other inflammatory disorders. All hot things are to be carefully avoided, and cool diluting liquors, as whey, barley-water, &c. drank freely. The food must be light and thin, and the body, as well as the mind, kept easy and quiet.

MEDICINE.——Bleeding is proper at the beginning of this disease, and it will often be necessary, even though the pulse should not feel hard, to repeat it. All violent purgatives are to be avoided; the body however must be kept gently open. A decoction of tamarinds, with a little honey or manna, will answer this purpose very well. The side affected must be fomented in the manner directed in the foregoing diseases. Mild laxative clysters should be frequently administered; and, if the pain should notwithstanding continue violent, a blistering plaster may be applied over the part affected.

Medicines which promote the secretion of urine have a very good effect here. For this purpose half a drachm of purified nitre, or a tea-spoonful of the sweet spirits of nitre, may be taken in a cup of the patient’s drink three or four times a-day.

When there is an inclination to sweat, it ought to be promoted, but not by warm sudorifics. The only thing to be used for that purpose is plenty of diluting liquors drank about the warmth of the human blood. Indeed the patient in this case, as well as in all other topical inflammations, ought to drink nothing that is colder than the blood.

If the stools should be loose, and even streaked with blood, no means must be used to stop them, unless they be so frequent as to weaken the patient. Loose stools often prove critical, and carry off the disease.

If an abscess or imposthume is formed in the liver, all methods should be tried to make it break and discharge itself outwardly, as fomentations, the application of poultices, ripening cataplasms, &c. Sometimes indeed the matter of an abscess comes away in the urine, and sometimes it is discharged by stool, but these are efforts of Nature which no means can promote. When the abscess bursts into the cavity of the _abdomen_ at large, death must ensue; nor will the event be more favourable when the abscess is opened by an incision, unless in cases where the liver adheres to the _peritonæum_, so as to form a bag for the matter, and prevent it from falling into the cavity of the _abdomen_; in which case opening the abscess by a sufficiently large incision will probably save the patient’s life[120].

If the disorder, in spite of all endeavours to the contrary, should end in a scirrhus, the patient must be careful to regulate his diet, &c. in such a manner as not to aggravate the disease. He must not indulge in flesh, fish, strong liquors, or any highly seasoned or salted provisions; but should, for the most part, live on mild vegetables, as fruits and roots; taking gentle exercise, and drinking whey, barley-water, or butter-milk. If he takes any thing stronger, it should be fine mild ale, which is less heating than wines or spirits.

We shall take no notice of inflammations of the other viscera. They must in general be treated upon the same principles as those already mentioned. The chief rule with respect to all of them, is to let blood, to avoid every thing that is strong, or of a heating nature, to apply warm fomentations to the part affected, and to cause the patient to drink a sufficient quantity of warm diluting liquors.

CHAP. XXXI.
OF THE CHOLERA MORBUS, AND OTHER EXCESSIVE DISCHARGES FROM THE STOMACH
AND BOWELS.

The _cholera morbus_ is a violent purging and vomiting, attended with gripes, sickness, and a constant desire to go to stool. It comes on suddenly, and is most common in autumn. There is hardly any disease that kills more quickly than this, when proper means are not used in due time for removing it.

CAUSES.——It is occasioned by a redundancy and putrid acrimony of the bile; cold; food that easily turns rancid or sour on the stomach; as butter, bacon, sweetmeats, cucumbers, melons, cherries, and other cold fruits[121]. It is sometimes the effect of strong acrid purges or vomits, or of poisonous substances taken into the stomach. It may likewise proceed from violent passions or affections of the mind; as fear, anger, &c.

SYMPTOMS.——It is generally preceded by a _cardialgia_, or heart-burn, sour belchings, and flatulencies, with pain of the stomach and intestines. To these succeed excessive vomiting, and purging of green, yellow, or blackish-coloured bile, with a distension of the stomach, and violent griping pains. There is likewise a great thirst, with a very quick unequal pulse, and often a fixed acute pain about the region of the navel. As the disease advances, the pulse often sinks low as to become quite imperceptible, the extremities grow cold, or cramped, and are often covered with a clammy sweat, the urine is obstructed, and there is a palpitation of the heart. Violent hiccuping, fainting, and convulsions, are the signs of approaching death.

MEDICINE.——At the beginning of this disease the efforts of Nature to expel the offending cause should be assisted, by promoting the purging and vomiting. For this purpose the patient must drink freely of diluting liquors; as whey, butter-milk, warm water, thin water-gruel, small posset, or, what is perhaps preferable to any of them, very weak chicken broth. This should not only be drank plentifully to promote the vomiting, but a clyster of it given every hour in order to promote the purging.

After these evacuations have been continued for some time, a decoction of toasted oat-bread may be drank to stop the vomiting. The bread should be toasted till it is of a brown colour, and afterwards boiled in spring water. If oat-bread cannot be had, wheat-bread, or oatmeal well toasted, may be used in its stead. If this does not put a stop to the vomiting, two table-spoonfuls of the saline julep, with ten drops of laudanum, may be taken every hour till it ceases.

The vomiting and purging however ought never to be stopped too soon. As long as these discharges do not weaken the patient, they are salutary, and may be allowed to go on, or rather ought to be promoted. But when the patient is weakened by the evacuations, which may be known from the sinking of his pulse, &c. recourse must immediately be had to opiates, as recommended above; to which may be added strong wines, with spirituous cinnamon-waters, and other generous cordials. Warm negus, or strong wine-whey, will likewise be necessary to support the patient’s spirits, and promote the perspiration. His legs should be bathed in warm water, and afterwards rubbed with flannel cloths, or wrapped in warm blankets, and warm bricks applied to the soles of his feet. Flannels wrung out of warm spirituous fomentations should likewise be applied to the region of the stomach.

When the violence of the disease is over, to prevent a relapse, it will be necessary for some time to continue the use of small doses of laudanum. Ten or twelve drops may be taken in a glass of wine, at least twice a day, for eight or ten days. The patient’s food ought to be nourishing, but taken in small quantities, and he should use moderate exercise. As the stomach and intestines are generally much weakened, an infusion of the bark, or other bitters, in small wine, sharpened with the elixir of vitriol, may be drank for some time.

Though physicians are seldom called in due time in this disease, they ought not to despair of relieving the patient even in the most desperate circumstances. Of this I lately saw a very striking proof in an old man and his son, who had been both seized with it about the middle of the night.

I did not see them till next morning, when they had much more the appearance of dead than of living men. No pulse could be felt; the extremities were cold and rigid; the countenance was ghastly, and the strength almost quite exhausted. Yet from this deplorable condition they were both recovered by the use of opiates and cordial medicines.

OF A DIARRHŒA, or LOOSENESS.

A looseness, in many cases, is not to be considered as a disease, but rather as a salutary evacuation. It ought therefore never to be stopped, unless when it continues too long, or evidently weakens the patient. As this however sometimes happens, we shall point out the most common causes of a looseness, with the proper method of treatment.

When a looseness is occasioned by catching cold, or an obstructed perspiration, the patient ought to keep warm, to drink freely of weak diluting liquors, to bathe his feet and legs frequently in lukewarm water, to wear flannel next his skin, and to take every other method to restore the perspiration.

In a looseness which proceeds from excess or repletion, a vomit is the proper medicine. Vomits not only cleanse the stomach, but promote all the secretions, which renders them of great importance in carrying off a debauch. Half a drachm of ipecacuanha in powder will answer this purpose very well. A day or two after the vomit, the same quantity of rhubarb may be taken, and repeated two or three times, if the looseness continues. The patient ought to live upon light vegetable food of easy digestion, and to drink whey, thin gruel, or barley-water.

A looseness, occasioned by the obstruction of any customary evacuation, generally requires bleeding. If that does not succeed, other evacuations may be substituted in the room of those which are obstructed. At the same time, every method is to be taken to restore the usual discharges, as not only the cure of the disease, but the patient’s life, may depend on this.

A periodical looseness ought never to be stopped. It is always an effort of Nature to carry off some offending matter, which, if retained in the body, might have fatal effects. Children are very liable to this kind of looseness, especially while teething. It is however so far from being hurtful to them, that such children generally get their teeth with least trouble. If these loose stools should at any time prove sour or griping, a tea-spoonful of magnesia alba, with four or five grains of rhubarb, may be given to the child in a little panado, or any other food. This, if repeated three or four times, will generally correct the acidity, and carry off the griping stools.

A diarrhœa, or looseness, which proceeds from violent passions or affections of the mind, must be treated with the greatest caution. Vomits in this case are highly improper. Nor are purges safe, unless they be very mild, and given in small quantities. Opiates, and other antispasmodic medicines, are most proper. Ten or twelve drops of liquid laudanum may be taken in a cup of valerian or penny-royal tea every eight or ten hours, till the symptoms abate. Ease, cheerfulness, and tranquillity of mind, are here of the greatest importance.

When a looseness proceeds from acrid or poisonous substances taken into the stomach, the patient must drink large quantities of diluting liquors, with oil or fat broths, to promote vomiting and purging. Afterwards, if there be reason to suspect that the bowels are inflamed, bleeding will be necessary. Small doses of laudanum may likewise be taken to remove their irritation.

When the gout, repelled from the extremities, occasions a looseness, it ought to be promoted by gentle doses of rhubarb, or other mild purgatives. The gouty matter is likewise to be solicited towards the extremities by warm fomentations, cataplasms, &c. The perspiration ought at the same time to be promoted by warm diluting liquors; as wine-whey, with spirits of hartshorn, or a few drops of liquid laudanum, in it.

When a looseness proceeds from worms, which may be known from the sliminess of the stools, mixed with pieces of decayed worms, &c. medicines must be given to kill and carry off these vermin, as the powder of tin with purges of rhubarb and calomel. Afterwards lime-water, either alone, or with a small quantity of rhubarb infused, will be proper to strengthen the bowels, and prevent the new generation of worms.

A looseness is often occasioned by drinking bad water. When this is the case, the disease generally proves epidemical. When there is reason to believe that this or any other disease proceeds from the use of unwholesome water, it ought immediately to be changed, or, if that cannot be done, it may be corrected by mixing with it quicklime, chalk, or the like.

In people whose stomachs are weak, violent exercise immediately after eating will occasion a looseness. Though the cure of this is obvious, yet it will be proper, besides avoiding violent exercise, to use such medicines as tend to brace and strengthen the stomach, as infusions of the bark, with other bitter and astringent ingredients, in white-wine. Such persons ought likewise to take frequently a glass or two of old red port, or good claret.

From whatever cause a looseness proceeds, when it is found necessary to check it, the diet ought to consist of rice boiled with milk, and flavoured with cinnamon; rice-jelly; sago, with red port; and the lighter sorts of flesh-meat roasted. The drink may be thin water-gruel, rice-water, or weak broth made from lean veal, or with a sheep’s head, as being more gelatinous than mutton, beef, or chicken-broth.

Persons who, from a peculiar weakness, or too great an irritability of the bowels, are liable to frequent returns of this disease, should live temperately, avoiding crude summer fruits, all unwholesome food, and meats of hard digestion. They ought likewise to beware of cold, moisture, or whatever may obstruct the perspiration, and should wear flannel next their skin. All violent passions, as fear, anger, &c. are likewise carefully to be guarded against.

OF VOMITING.

Vomiting may proceed from various causes; as excess in eating and drinking; foulness of the stomach; the acrimony of the aliments; a translation of the morbific matter of ulcers, of the gout, the erysipelas, or other diseases, to the stomach. It may likewise proceed from a looseness having been too suddenly stopped; from the stoppage of any customary evacuation, as the bleeding piles, the _menses_, &c. from a weakness of the stomach, the colic, the iliac passion, a rupture, a fit of the gravel, worms; or from any kind of poison taken into the stomach. It is an usual symptom of injuries done to the brain; as contusions, compressions, &c. It is likewise a symptom of wounds or inflammations of the diaphragm, intestines, spleen, liver, kidneys, &c.

Vomiting may be occasioned by unusual motions; as sailing, being drawn backwards in a cart or coach, &c. It may likewise be excited by violent passions, or by the idea of nauseous or disagreeable objects, especially of such things as have formerly produced vomiting. Sometimes it proceeds from a regurgitation of the bile into the stomach: in this case, what the patient vomits is generally of a yellow or greenish colour, and has a bitter taste. Persons who are subject to nervous affections are often suddenly seized with violent fits of vomiting. Lastly, vomiting is a common symptom of pregnancy. In this case it generally comes on about two weeks after the stoppage of the _menses_, and continues during the first three or four months.

When vomiting proceeds from a foul stomach or indigestion, it is not to be considered as a disease, but as the cure of a disease. It ought therefore to be promoted by drinking lukewarm water, or thin gruel. If this does not put a stop to the vomiting, a dose of ipecacuanha may be taken, and worked off with weak camomile-tea.

When the retrocession of the gout, or the obstruction of customary evacuations, occasion vomiting, all means must be used to restore these discharges; or, if that cannot be effected, their place must be supplied by others, as bleeding, purging, bathing the extremities in warm water, opening issues, setons, perpetual blisters, &c.

When vomiting is the effect of pregnancy, it may generally be mitigated by bleeding, and keeping the body gently open. The bleeding however ought to be in small quantities at a time, and the purgatives should be of the mildest kind, as figs, stewed prunes, manna, or senna. Pregnant women are most apt to vomit in the morning, immediately after getting out of bed, which is owing partly to the change of posture, but more to the emptiness of the stomach. It may generally be prevented by taking a dish of coffee, tea, or some light breakfast in bed. Pregnant women who are afflicted with vomiting ought to be kept easy both in body and mind. They should neither allow their stomachs to be quite empty, nor should they eat much at once. Cold water is a very proper drink in this case; if the stomach be weak, a little brandy may be added to it. If the spirits are low, and the person apt to faint, a spoonful of cinnamon-water, with a little marmalade of quinces or oranges, may be taken.

If vomiting proceeds from weakness of the stomach, bitters will be of service. Peruvian bark infused in wine or brandy, with as much rhubarb as will keep the body gently open, is an excellent medicine in this case. The elixir of vitriol is also a good medicine. It may be taken in the dose of fifteen or twenty drops, twice or thrice a day, in a glass of wine or water. Habitual vomitings are sometimes alleviated by making oysters a principal part of diet.

A vomiting, which proceeds from acidities in the stomach, is relieved by alkaline purges. The best medicine of this kind is the magnesia alba, a tea-spoonful of which may be taken in a dish of tea or a little milk, three or four times a day, or oftener if necessary, to keep the body open.

When vomiting proceeds from violent passions, or affections of the mind, all evacuants must be carefully avoided, especially vomits. These are exceedingly dangerous. The patient in this case ought to be kept perfectly easy and quiet, to have the mind soothed, and to take some gentle cordial, as negus, or a little brandy and water, to which a few drops of laudanum may occasionally be added.

When vomiting proceeds from spasmodic affections of the stomach, musk, castor, and other antispasmodic medicines, are of use. Warm and aromatic plasters have likewise a good effect. The stomach plaster of the London or Edinburgh dispensatory may be applied to the pit of the stomach, or a plaster of _theriaca_, which will answer rather better. Aromatic medicines may likewise be taken inwardly, as cinnamon or mint-tea, wine with spiceries boiled in it, &c. The region of the stomach may be rubbed with æther, or, if that cannot be had, with strong brandy, or other spirits. The belly should be fomented with warm water, or the patient immersed up to the breast in a warm bath.

I have always found the saline draughts taken in the act of effervescence, of singular use in stopping a vomiting, from whatever cause it proceeded. These may be prepared by dissolving a drachm of the salt of tartar in an ounce and half of fresh lemon-juice, and adding to it an ounce of peppermint-water, the same quantity of simple cinnamon-water, and a little white sugar. This draught must be swallowed before the effervescence is quite over, and may be repeated every two hours, or oftner, if the vomiting be violent. A violent vomiting has sometimes been stopped by cupping on the region of the stomach after all other means had failed.

As the least motion will often bring on the vomiting again, even after it has been stopped, the patient must avoid all manner of action. The diet must be so regulated as to sit easy upon the stomach, and nothing should be taken that is hard of digestion. We do not however mean that the patient should live entirely upon slops. Solid food, in this case, often sits easier on the stomach than liquids.

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

The diabetes is a frequent and excessive discharge of urine. It is seldom to be met with among young people; but often attacks persons in the decline of life, especially those who follow the more violent employments, or have been hard drinkers in their youth.

CAUSES.——A diabetes is often the consequence of acute diseases, as fevers, fluxes, &c. where the patient has suffered by excessive evacuations; it may also be occasioned by great fatigue, as riding long journies upon a hard-trotting horse, carrying heavy burdens, running, &c. It may be brought on by hard drinking, or the use of strong stimulating diuretic medicines, as tincture of cantharides, spirits of turpentine, and such like. It is often the effect of drinking too great quantities of mineral waters. Many imagine that these will do them no service unless they be drank in great quantities, by which mistake it often happens that they occasion worse diseases than those they were intended to cure. In a word, this disease may either proceed from too great a laxity of the organs which secrete the urine, from something that stimulates the kidneys too much, or from a thin dissolved state of the blood, which makes too great a quantity of it run off by the urinary passages.

SYMPTOMS.——In a diabetes, the urine generally exceeds in quantity all the liquid food which the patient takes. It is thin and pale, of a sweetish taste, and an agreeable smell. The patient has a continual thirst, with some degree of fever; his mouth is dry, and he spits frequently a frothy spittle. The strength fails, the appetite decays, and the flesh wastes away till the patient is reduced to skin and bone. There is a heat of the bowels; and frequently the loins, testicles, and feet are swelled.

This disease may generally be cured at the beginning; but after it has continued long, the cure becomes very difficult. In drunkards, and very old people, a perfect cure is not to be expected.

REGIMEN.——Every thing that stimulates the urinary passages, or tends to relax the habit, must be avoided. For this reason the patient should live chiefly on solid food. His thirst may be quenched with acids; as sorrel, juice of lemon, or vinegar. The mucilaginous vegetables, as rice, sago, and salop, with milk, are the most proper food. Of animal substances, shell-fish are to be preferred; as oysters, crabs, &c.

The drink may be Bristol-water. When that cannot be obtained, lime-water, in which a due proportion of oak bark has been macerated, may be used. The white decoction[122], with isinglass dissolved in it, is likewise a very proper drink.

The patient ought daily to take exercise, but it should be so gentle as not to fatigue him. He should lie upon a hard bed or matrass. Nothing hurts the kidneys more than lying too soft. A warm dry air, the use of the flesh-brush, and every thing that promotes perspiration, is of service. For this reason the patient ought to wear flannel next his skin. A large strengthening plaster may be applied to the back; or, what will answer better, a great part of the body may be wrapt in plaster.

MEDICINE.——Gentle purges, if the patient be not too much weakened by the disease, have a good effect. They may consist of rhubarb, with cardamum seeds, or any other spiceries, infused in wine, and may be taken in such quantities as to keep the body gently open.

The patient must next have recourse to astringents and corroborants. Half a drachm of powder made of equal parts of allum and the inspissated juice commonly called _Terra Japonica_, may be taken four times a-day, or oftner, if the stomach will bear it. The allum must first be melted in a crucible; afterwards they may both be pounded together. Along with every dose of this powder the patient may take a tea-cupful of the tincture of roses[123].

If the patient’s stomach cannot bear the allum in substance, whey may be made of it, and taken in the dose of a tea-cupful three or four times a-day. The allum-whey is prepared by boiling two English quarts of milk over a slow fire, with three drachms of allum, till the curd separates.

Opiates are of service in this disease, even though the patient rests well. They take off spasm and irritation, and at the same time lessen the force of the circulation. Ten or twelve drops of liquid laudanum may be taken in a cup of the patient’s drink three or four times a-day.

The best corroborants which we know, are the Peruvian bark and wine. A drachm of bark may be taken in a glass of red port or claret three times a-day. The medicine will be both more efficacious and less disagreeable, if fifteen or twenty drops of the acid elixir of vitriol be added to each dose. Such as cannot take the bark in substance may use the decoction, mixed with an equal quantity of red wine, and sharpened as above.

There is a disease incident to labouring people in the decline of life, called _an INCONTINENCY of urine_. But this is very different from a diabetes, as the water passes off involuntarily by drops, and does not exceed the usual quantity. This disease is rather troublesome than dangerous. It is owing to a relaxation of the sphincter of the bladder, and is often the effect of a palsy. Sometimes it proceeds from hurts, or injuries occasioned by blows, bruises, preternatural labours, &c. Sometimes it is the effect of a fever. It may likewise be occasioned by a long use of strong diuretics, or of stimulating medicines injected into the bladder.

This disease may be mitigated by the use of astringent and corroborating medicines, such as have been mentioned above; but we do not remember ever to have seen it cured.

In an incontinency of urine, from whatever cause, a piece of sponge ought to be worn, or a bladder applied in such a manner as to prevent the urine from galling and excoriating the parts.

OF A SUPPRESSION OF URINE.

It has already been observed, that a suppression of urine may proceed from various causes; as an inflammation of the kidneys, or bladder; small stones or gravel lodging in the urinary passages, hard _fæces_ lying in the _rectum_, pregnancy, a spasm or contraction of the neck of the bladder, clotted blood in the bladder itself, a swelling of the hæmorrhoidal veins, &c.

Some of these cases require the catheter, both to remove the obstructing matter, and to draw off the urine; but as this instrument can only be managed with safety by persons skilled in surgery, we shall say nothing further of its use. A bougee may be used by any cautious hand, and will often succeed better than the catheter.

We would chiefly recommend, in all obstructions of urine, fomentations and evacuants. Bleeding, as far as the patient’s strength will permit, is necessary, especially where there are symptoms of topical inflammation. Bleeding in this case not only abates the fever, by lessening the force of the circulation, but, by relaxing the solids, it takes off the spasm or stricture upon the vessels which occasioned the obstruction.

After bleeding, fomentations must be used. These may either consist of warm water alone, or of decoctions of mild vegetables; as mallows, camomile-flowers, &c. Cloths dipped in these may either be applied to the part affected, or a large bladder filled with the decoction may be kept continually upon it. Some put the herbs themselves into a flannel bag, and apply them to the part, which is far from being a bad method. These continue longer warm than cloths dipped in the decoction, and at the same time keep the part equally moist.

In all obstructions of urine, the body ought to be kept open. This is not however to be attempted by strong purgatives, but by emollient clysters, or gentle infusions of senna and manna. Clysters in this case not only open the body, but answer the purpose of an internal fomentation, and greatly assist in removing the spasms of the bladder and parts adjacent.

The food must be light, and taken in small quantities. The drink may be weak broth, or decoctions and infusions of mucilaginous vegetables, as marsh-mallow roots, lime-tree buds, &c. A tea-spoonful of the sweet spirits of nitre, or a drachm of Castile soap, may be frequently put into the patient’s drink; and, if there be no inflammation, he may drink small gin-punch.

Persons subject to a suppression of urine ought to live very temperate. Their diet should be light, and their liquor diluting. They should avoid all acids and austere wines, should take sufficient exercise, lie hard, and avoid study and sedentary occupations.

OF THE GRAVEL AND STONE.

When small stones are lodged in the kidneys, or discharged along with the urine, the patient is said to be afflicted with the gravel. If one of these stones happens to make a lodgment in the bladder for some time, it accumulates fresh matter, and at length becomes too large to pass off with the urine. In this case the patient is said to have the stone.