Part 33

6, After Bleeding, warm Bathing, repeated Glysters and Fomentations, if each and all of these have availed nothing; the Fume or Smoak of Tobacco may be introduced in the Manner of a Glyster, of which I shall speak further, in the Chapter on Persons drowned.

I cured a Person of this Disease, by conveying him into a Bath, immediately after bleeding him, and giving him a Purge on his going into the Bath.

Sec. 319. If the Pain abates before the Patient has quite lost his Strength; if the Pulse improves at the same Time; if the Vomitings are less in Number, and in the Quantity of the Matter brought up; if that Matter seems in a less putrid offensive State; if he feels some Commotion and Rumbling in his Bowels; if he has some little Discharge by Stool; and if at the same Time he feels himself a little stronger than before, his Cure may reasonably be expected; but if he is otherwise circumstanced he will soon depart. It frequently happens, a single Hour before Death, that the Pain seems to vanish, and a surprising Quantity of extremely foetid Matter is discharged by Stool: the Patient is suddenly seized with a great Weakness and Sinking, falls into a cold Sweat, and immediately expires.

Sec. 320. This is the Disease which the common People attribute to, and term, the Twisting of the Guts; and in which they make the Patients swallow Bullets, or large Quantities of Quick-silver. This twisting, tangling, or Knoting of the Guts is an utter, an impossible Chimera; for how can they admit of such a Circumstance, as one of their Extremities, their Ends, is connected to the Stomach, and the other irremoveably fastened to the Skin of the Fork or Cleft of the Buttocks? In Fact this Disease results from a Variety of Causes, which have been discovered on a Dissection of those who have died of it. It were to be wished indeed this prudent Custom, so extremely conducive to enrich, and to perfect, the Art of Physick, were to prevail more generally; and which we ought rather to consider as a Duty to comply with, than a Difficulty to submit to; as it is our Duty to contribute to the Perfection of a Science, on which the Happiness of Mankind so considerably depends. I shall not enter into a Detail of these Causes; but whatever they are, the Practice of swallowing Bullets in the Disease is always pernicious, and the like Use of Mercury must be often so. Each of these pretended Remedies may aggravate the Disease, and contribute an insurmountable Obstacle to the Cure--Of that Iliac Passion, which is sometimes a Consequence of Ruptures, I shall treat in another Place.

Of the Cholera-morbus.

Sec. 321. This Disease is a sudden, abundant, and painful Evacuation by vomiting and by Stool.

It begins with much Flatulence, or Wind, with Swelling and slight Pains in the Belly, accompanied with great Dejection; and followed with large Evacuations either by Stool or by Vomit at first, but whenever either of them has begun, the other quickly follows. The Matter evacuated is either yellowish, green, brown, whitish, or black; the Pains in the Belly violent; the Pulse, almost constantly feverish, is sometimes strong at first, but soon sinks into Weakness, in Consequence of the prodigious Discharge. Some Patients purge a hundred Times in the Compass of a few Hours: they may even be seen to fall away; and if the Disease exists in a violent Degree, they are scarcely to be known within three or four Hours from the Commencement of these Discharges. After a great Number of them they are afflicted with Spasms, or Cramps, in their Legs, Thighs, and Arms, which torment them as much as the Pains in the Belly. When the Disease rages too highly to be asswaged, Hiccups, Convulsions and a Coldness of the Extremities approach; there is a scarcely intermitting Succession of fainting, or swooning Fits, the Patient dying either in one of them, or in Convulsions.

Sec. 322. This Disease, which constantly depends on a Bile raised to the highest Acrimony, commonly prevails towards the End of July and in August: especially if the Heats have been very violent, and there have been little or no Summer Fruits, which greatly conduce to attempt: and allay the putrescent Acrimony of the Bile.

Sec. 323. Nevertheless, however violent this Distemper may be, it is less dangerous, and also less tormenting than the former, many Persons recovering from it.

1, Our first Endeavour should be to dilute, or even to drown this acrid Bile, by Draughts, by Deluges, of the most mitigating Drinks; the irritation being so very great, that every Thing having the least Sharpness is injurious. Wherefore the patient should continually take in, by Drink, and by Way of Glyster, either Barley-Water, Almond-Milk, or pure Water, with one eighth Part Milk, which has succeeded very well in my Practice. Or he may use a very light Decoction, or Ptisan, as it were, of Bread, which is made by gently boiling a Pound of toasted Bread, in three or four Pots of Water for half an Hour. In Swisserland we prefer Oat bread. We also successfully use pounded Rye, making a light Ptisan of it.

A very light thin Soup made of a Pullet, a Chicken, or of one Pound of lean Veal, in three Pots of Water, is very proper too in this Disease. Whey is also employed to good Purpose; and in those Places, where it can easily be had, Butter-milk is the best Drink of any. But, whichever of these Drinks shall be thought preferable, it is a necessary Point to drink very plentifully of it; and the Glysters should be given every two Hours.

2, If the Patient is of a robust Constitution, and sanguine Complexion, with a strong Pulse at the Time of the Attack, and the Pains are very severe, a first, and in some Cases, a second Bleeding, very early in the Invasion, asswages the Violence of the Malady, and allows more Leisure for the Assistance of other Remedies. I have seen the Vomiting cease almost entirely, after the first Bleeding.

The Rage of this Disease abates a little after a Duration of five or six Hours: we must not however, during this Remission or Abatement, forbear to throw in proper Remedies; since it returns soon after with great Force, which Return however indicates no Alteration of the Method already entered upon.

3, In general the warm Bath refreshes the Patient while he continues in it; but the Pains frequently return soon after he is taken out, which, however, is no Reason for omitting it, since it has frequently been found to give a more durable Relief. The Patient should continue in it a considerable Time, and, during that Time, he should take six or seven Glasses of the Potion No. 32, which has been very efficacious in this Disease. By these Means the Vomiting has been stopt; and the Patient, upon going out of the Bath, has had several large Stools, which very considerably diminished the Violence of the Disease.

4, If the Patient's Attendants are terrified by these great Evacuations, and determine to check them (however prematurely) by Venice Treacle, Mint Water, Syrup of white Poppies, called Diacodium, by Opium or Mithridate, it either happens, that the Disease and all its Symptoms are heightened, to which I have been a Witness; or, if the Evacuations should actually be stopt, the Patient, in Consequence of it, is thrown into a more dangerous Condition. I have been obliged to give a Purge, in order to renew the Discharges, to a Man, who had been thrown into a violent Fever, attended with a raging Delirium, by a Medicine composed of Venice Treacle, Mithridate and Oil. Such Medicines ought not to be employed, until the Smallness of the Pulse, great Weakness, violent and almost continual Cramps, and even the Insufficience of the Patient's Efforts to vomit, make us apprehensive of his sinking irrecoverably. In such Circumstances indeed he should take, every Quarter or half Quarter of an Hour, a Spoonful of the Mixture No. 50, still continuing the diluting Drinks. After the first Hour, they should only be given every Hour, and that only to the Extent of eight Doses. But I desire to insist upon it here, that this Medicine should not be given too early in this Distemper.

Sec. 324. If the Patient is likely to recover, the Pains and the Evacuations gradually abate; the Thirst is less; the Pulse continues very quick, but it becomes regular. There have been Instances of their Propensity to a heavy kind of Drowsiness at this Time; for perfect refreshing Sleep advances but slowly after this Disease. It will still be proper to persevere in the Medicines already directed, though somewhat less frequently. And now we may begin to allow the Patient a few Soups from farinaceous mealy Substances; and as soon as the Evacuations accompanying this Disease are evidently ceased, and the Pains are vanished; though an acute Sensibility and great Weakness continues, beside such Soups, he may be allowed some new-laid Eggs, very lightly boiled, or even raw, for some Days. After this he must be referred to the Regimen so frequently recommended to Persons in a State of Recovery: when the concurring Use of the Powder No. 24, taken twice a Day, will greatly assist to hasten and to establish his Health.

_Chapter XXIII._

Of a Diarrhoea, or Looseness.

_Sect._ 325.

Every one knows what is meant by a Looseness or Purging, which the Populace frequently call a Flux, and sometimes a Cholic.

There are certain very chronical, or tedious and obstinate ones, which arise from some essential Fault in the Constitution. Of such, as foreign to my Plan, I shall say nothing.

Those which come on suddenly, without any preceding Disorder, except sometimes a slight Qualm or short Loathing, and a Pain in the Loins and Knees; which are not attended with smart Pains nor a Fever (and frequently without any Pain, or any other Complaint) are oftener of Service than prejudicial. They carry off a Heap of Matter that may have been long amassed and corrupted in the Body; which, if not discharged, might have produced some Distemper; and, far from weakening the Body, such Purgings as these render it more strong, light and active.

Sec. 326. Such therefore ought by no Means to be stopped, nor even speedily checked: they generally cease of themselves, as soon as all the noxious Matter is discharged; and as they require no Medicine, it is only necessary to retrench considerably from the ordinary Quantity of Nourishment; to abstain from Flesh, Eggs and Wine or other strong Drink; to live only on some Soups, on Pulse, or on a little Fruit, whether raw or baked, and to drink rather less than usual. A simple Ptisan with a little Syrup of Capillaire, or Maiden-hair, is sufficient in these Purgings, which require no Venice Treacle, Confection, nor any Drug whatever.

Sec. 327. But should it continue more than five or six Days, and manifestly weaken the Patient; if the Pain attending it grows a little severe; and especially if the Irritation, the urging to Stool, proves more frequent, it becomes seasonable to check, or to stop, it. For this Purpose the Patient is to be put into a Regimen; and if the Looseness has been accompanied with a great Loathing, with Risings or Wamblings at Stomach, with a foul furred Tongue, and a bad Taste in the Mouth, he must take the Powder No. 35. But if these Symptoms do not appear, give him that of No. 51: and during the three following Hours, let him take, every half Hour, a Cup of weak light Broth, without any Fat on it.

If the Purging, after being restrained by this Medicine, should return within a few Days, it would strongly infer, there was still some tough viscid Matter within, that required Evacuation. To effect this he should take the Medicines No. 21, 25 or 27; and afterwards take fasting, for two successive Mornings, half the Powder, No. 51.

On the Evening of that Day when the Patient took No. 35, or No. 51, or any other Purge, he may take a small Dose of Venice Treacle.

Sec. 328. A Purging is often neglected for a long Time, without observing the least Regimen, from which Neglect they degenerate into tedious and as it were habitual, perpetual ones, and entirely weaken the Patient. In such Cases, the Medicine No. 35 should be given first; then, every other Day for four Times successively, he should take No. 51: during all which Time he should live on nothing but Panada (See Sec. 57) or on Rice boiled in weak Chicken-broth. A strengthing stomachic Plaister has sometimes been successfully applied, which may be often moistened in a Decoction of Herbs boiled in Wine. Cold and Moisture should be carefully avoided in these Cases, which frequently occasion immediate Relapses, even after the Looseness had ceased for many Days.

_Chapter XXIV._