Part 45

2. Whenever it is manifest that all Endeavours, either to extract, or to push down the Substance stopt in the Passage, are ineffectual, they should be discontinued; because the Inflammation occasioned by persisting in them, would be as dangerous as the Obstruction itself; as there have been Instances of People's dying in Consequence of the Inflammation; notwithstanding the Body, which caused the Obstruction, had been entirely removed.

3. While the Means already advised are making Use of, the Patient should often swallow, or if he cannot, he should frequently receive by Injection through a crooked Tube or Pipe, that may reach lower down than the Glottis, some very emollient Liquor, as warm Water, either alone or mixed with Milk, or a Decoction of Barley, of Mallows, or of Bran. A two-fold Advantage may arise from this; the first is, that these softening Liquors smooth and sooth the irritated Parts; and secondly, an Injection, strongly thrown in, has often been more successful in loosening the obstructing Body, than all Attempts with Instruments.

4. When after all we are obliged to leave this in the Part, the Patient must be treated as if he had an inflammatory Disease; he must be bled, ordered to a Regimen, and have his whole Neck surrounded with emollient Pultices. The like Treatment must also be used, though the obstructing Substance be removed; if there is Room to suppose any Inflammation left in the Passage.

5. A proper Degree of Agitation has sometimes loosened the inhering Body, more effectually than Instruments. It has been experienced that a Blow with the Fist on the Spine, the Middle of the Back, has often disengaged such obstructed and obstructing Bodies; and I have known two Instances of Patients who had Pins stopt in the Passage; and who getting on Horseback to ride out in Search of Relief at a neighbouring Village, found each of them the Pin disengaged after an Hour's riding: One spat it out, and the other swallowed it, without any ill Consequence.

6. When there is an immediate Apprehension of the Patient's being suffocated; when bleeding him has been of no Service; when all Hope of freeing the Passage in time is vanished, and Death seems at Hand, if Respiration be not restored; the Operation of Bronchotomy, or opening of the Wind-pipe, must be directly performed; an Operation neither difficult to a tolerably knowing and expert Surgeon, nor very painful to the Patient.

7. When the Substance that was stopt passes into the Stomach, the Patient must immediately be put into a very mild and smooth Regimen. He should avoid all sharp, irritating, inflaming Food; Wine, spirituous Liquors, all strong Drink, and Coffee; taking but little Nourishment at once, and no Solids, without their having been thoroughly well chewed. The best Diet would be that of farinaceous mealy Soups, made of various leguminous Grains, and of Milk and Water, which is much better than the usual Custom of swallowing different Oils.

Sec. 429. The Author of Nature has provided, that in eating, nothing should pass by the Glottis into the Wind-pipe. This Misfortune nevertheless does sometimes happen; at which very Instant there ensues an incessant and violent Cough, an acute Pain, with Suffocation; all the Blood being forced up into the Head, the Patient is in extreme Anguish, being agitated with violent and involuntary Motions, and sometimes dying on the Spot. A Hungarian Grenadier, by Trade a Shoemaker, was eating and working at the same time. He tumbled at once from his Seat, without uttering a single Word. His Comrades called out for Assistance; some Surgeons speedily arrived, but after all their Endeavours he discovered no Token of Life. On opening the Body, they found a Lump, or large Morsel, of Beef, weighing two Ounces, forced into the Windpipe, which it plugged up so exactly, that not the least Air could pass through it into the Lungs.

Sec. 430. In a Case so circumstanced, the Patient should be struck often on the Middle of the Back; some Efforts to vomit should be excited; he should be prompted to sneeze with Powder of Lilly of the Valley, Sage, or any cephalic Snuffs, which should be blown strongly up his Nose.

A Pea, pitched into the Mouth in playing, entered into the Wind-pipe, and sprung out again by vomiting the Patient with Oil. A little Bone was brought up by making another sneeze, with powdered Lilly of the Valley.

In short, if all these Means of assisting, or saving the Patient are evidently ineffectual, Bronchotomy must be speedily performed (See No. 6, of the preceding Section.) By this Operation, some Bones, a Bean, and a Fish-bone have been extracted, and the Patient has been delivered from approaching Death.

Sec. 431. Nothing should be left untried, when the Preservation of human Life is the Object. In those Cases, when an obstructing Body can neither be disengaged from the Throat, the Passage to the Stomach, nor be suffered to remain there without speedily killing the Patient, it has been proposed to make an Incision into this Passage, the Oesophagus, through which such a Body is to be extracted; and to employ the like Means, when a Substance which had slipt even into the Stomach itself, was of a Nature to excite such Symptoms, as must speedily destroy the Patient.

When the Oesophagus is so fully and strongly closed, that the Patient can receive no Food by the Mouth, he is to be nourished by Glysters of Soup, Gelly, and the like.

_Chapter XXX._

Of external Disorders, and such as require chirurgical Application. Of Burns, Wounds, Contusions or Bruises: Of Sprains, Ulcers, frostbitten Limbs, Chilblains, Ruptures, Boils. Of Fellons, Thorns or Splinters in the Fingers or Flesh; of Warts, and of Corns.

_Sect._ 432.

Labouring Countrymen are exposed in the Course of their daily Work, to many outward Accidents, such as Cuts, Contusions, &c. which, however considerable in themselves, very generally end happily; and that chiefly in Consequence of the pure and simple Nature of their Blood, which is generally much less acrimonious, or sharp, in the Country, than in great Towns or Cities. Nevertheless, the very improper Treatment of such Accidents, in the Country, frequently renders them, however light in themselves, very troublesome; and indeed, I have seen so many Instances of this, that I have thought it necessary to mark out here the proper Treatment of such Accidents, as may not necessarily require the Hand or Attendance of a Surgeon. I shall also add something very briefly, concerning some external Disorders, which at the same Time result from an inward Cause.

Of Burns.

Sec. 433. When a Burn is very trifling and superficial, and occasions no Vesication or Blister, it is sufficient to clap a Compress of several Folds of soft Linen upon it, dipt in cold Water, and to renew it every Quarter of an Hour, till the Pain is entirely removed. But when the Burn has blistered, a Compress of very fine Linen, spread over with the Pomatum, No. 64, should be applied over it, and changed twice a Day.

If the true Skin is burnt, and even the Muscles, the Flesh under it, be injured, the same Pomatum may be applied; but instead of a Compress, it should be spread upon a Pledget of soft Lint, to be applied very exactly over it, and over the Pledget again, a Slip of the simple Plaister No. 65, which every Body may easily prepare; or, if they should prefer it, the Plaister No. 66.

But, independently of these external Applications, which are the most effectual ones, when they are directly to be had; whenever the Burn has been very violent, is highly inflamed, and we are apprehensive of the Progress and the Consequences of the Inflammation, the same Means and Remedies must be recurred to, which are used in violent Inflammations: the Patient should be bled, and, if it is necessary, it should be repeated more than once, and he should be put into a Regimen; drink nothing but the Ptisans No. 2 and 4, and receive daily two simple Glysters.

If the Ingredients for the Ointment, called Nutritum, are not at Hand to make the Pomatum No. 64; one Part of Wax should be melted in eight such Parts of Oil, to two Ounces of which Mixture the Yolk of an Egg should be added. A still more simple and sooner prepared Application, is that of one Egg, both the Yolk and the White, beat up with two common Spoonfuls of the sweetest Oil, without any Rankness. When the Pain of the Burn, and all its other Symptoms have very nearly disappeared, it is sufficient to apply the Sparadrap, or Oil-cloth No. 66.

Of Wounds.

Sec. 434. If a Wound has penetrated into any of the Cavities, and has wounded any Part contained in the Breast, or in the Belly: Or if, without having entered into one of the Cavities, it has opened some great Blood-vessel; or if it has wounded a considerable Nerve, which occasions Symptoms much more violent, than would otherwise have happened; if it has penetrated even to and injured the Bone: in short, if any great and severe Symptom supervenes, there is an absolute Necessity for calling in a Surgeon. But whenever the Wound is not attended with any of these Circumstances; when it affects only the Skin, the fat Membrane beneath it, the fleshy Parts and the small Vessels, it may be easily and simply dressed without such Assistance; since, in general, all that is truly necessary in such Cases is, to defend the Wound from the Impressions of the Air; and yet not so, as to give any material Obstruction to the Discharge of the Matter, that is to issue from the Wound.

Sec. 435. If the Blood does not particularly flow out of any considerable Vessel, but trickles almost equally from every Spot of the Wound, it may very safely be permitted to bleed, while some Lint is speedily preparing. As soon as the Lint is ready, so much of it may be introduced into the Wound as will nearly fill it, without being forced in; which is highly improper, and would be attended with the same Inconveniences as Tents and Dossils. It should be covered over with a Compress dipt in sweet Oil, or with the Cerecloth No. 65; though I prefer the Compress for the earliest Dressings: and the whole Dressing should be kept on, with a Bandage of two Fingers Breadth, and of a Length proportioned to the Size of the Part it is to surround: This should be rolled on tight enough to secure the Dressings, and yet so moderately, as to bring on no Inflammation.

This Bandage with these Dressings are to remain on twenty-four or forty-eight Hours; Wounds being healed the sooner, for being less frequently drest. At the second Dressing all the Lint must be removed, which can be done with Ease, and with reasonable Speed, to the Wounded; and if any of it should stick close, in Consequence of the clogged and dried Blood, it should be left behind, adding a little fresh Lint to it; this Dressing in other Respects exactly resembling the first.

When, from the Continuance of this simple Dressing, the Wound is become very superficial, it is sufficient to apply the Cerecloth, or Plaister, without any Lint.

Such as have conceived an extraordinary Opinion of any medical Oils, impregnated with the Virtues of particular Plants, may, if that will increase their Satisfaction, make use of the common Oil of Yarrow, of Trefoil, of Lilies, of Chamomile, of Balsamines, or of red Roses; only being very careful, that such Oils are not become stale and rank.

Sec. 436. When the Wound is considerable, it must be expected to inflame before Suppuration (which, in such a Case, advances more slowly) can ensue; which Inflammation will necessarily be attended with Pain, with a Fever, and sometimes with a Raving, or Wandering, too. In such a Situation, a Pultice of Bread and Milk, with the Addition of a little Oil, that it may not stick too close, must be applied instead of the Compress or the Plaister: which Pultice is to be changed, but without uncovering the Wound, thrice and even four times every Day.