Part 46

Sec. 437. Should some pretty considerable Blood-vessel be opened by the Wound, there must be applied over it, a Piece of Agaric of the Oak, No. 67, with which no Country place ought to be unprovided. It is to be kept on, by applying a good deal of Lint over it; covering the whole with a thick Compress, and then with a Bandage a little tighter than usual. If this should not be sufficient to prevent the Bleeding from the large Vessel, and the Wound be in the Leg or Arm, a strong Ligature must be made above the Wound with a Turniquet, which is made in a Moment with a Skain of Thread, or of Hemp, that is passed round the Arm circularly, into the Middle of which is inserted a Piece of Wood or Stick of an Inch Thickness, and four or five Inches long; so that by turning round this Piece of Wood, any Tightness or Compression may be effected at Pleasure; exactly as a Country-man secures a Hogshead, or a Piece of Timber on his Cart, with a Chain and Ring. But Care must be taken, 1, to dispose the Skain in such a Manner, that it must always be two Inches wider than the Part it surrounds: and, 2, not to strain it so tight as to bring on an Inflammation, which might terminate in a Gangrene.

Sec. 438. All the boasted Virtues of a Multitude of Ointments are downright Nonsense or Quackery. Art, strictly considered, does not in the least contribute to the healing of Wounds; the utmost we can do amounting only to our removing those Accidents, which are so many Obstacles to their Re-union. On this Account, if there is any extraneous Body in the Wound, such as Iron, Lead, Wood, Glass, Bits of Cloth or Linen, they must be extracted, if that can be very easily done; but if not, Application must be made to a good Surgeon, who considers what Measures are to be taken, and then dresses the Wound, as I have already advised.

Very far from being useful, there are many Ointments that are pernicious on these Occasions; and the only Cases in which they should be used, are those in which the Wounds are distinguished with some particular Appearances, which ought to be removed by particular Applications: But a simple recent Wound, in a healthy Man, requires no other Treatment but what I have already directed, besides that of the general Regimen.

Spirituous Applications are commonly hurtful, and can be suitable and proper but in a few Cases, which Physicians and Surgeons only can distinguish.

When Wounds occur in the Head, instead of the Compress dipt in Oil, or of the Cerecloth, the Wound should be covered with a Betony Plaister; or, when none is to be had in time, with a Compress squeezed out of hot Wine.

Sec. 439. As the following Symptoms, of which we should be most apprehensive, are such as attend on Inflammations, the Means we ought to have Recourse to are those which are most likely to prevent them; such as Bleeding, the usual Regimen, moderate Coolers and Glysters.

Should the Wound be very inconsiderable in its Degree, and in its Situation, it may be sufficient to avoid taking any Thing heating; and above all Things to retrench the Use of any strong Drink, and of Flesh-meat.

But when it is considerable, and an Inflammation must be expected, there is a Necessity for Bleeding; the Patient should be kept in the most quiet and easy Situation; he should be ordered immediately to a Regimen; and sometimes the Bleeding also must be repeated. Now all these Means are the more indispensably necessary, when the Wound has penetrated to some internal Part; in which Situation, no Remedy is more certain than that of an extremely light Diet. Such wounded Persons as have been supposed incapable of living many Hours, after Wounds in the Breast, in the Belly, or in the Kidnies, have been completely recovered, by living for the Course of several Weeks, on nothing but a Barley, or other farinaceous mealy, Ptisans, without Salt, without Soup, without any Medicine; and especially without the Use of any Ointments.

Sec. 440. In the same Proportion that Bleeding, moderately and judiciously employed, is serviceable, in that very same an Excess of it becomes pernicious. Great Wounds are generally attended with a considerable Loss of Blood, which has already exhausted the wounded Person; and the Fever is often a Consequence of this copious Loss of Blood. Now if under such a Circumstance, Bleeding should be ordered and performed, the Patient's Strength is totally sunk; the Humours stagnate and corrupt; a Gangrene supervenes, and he dies miserably, at the End of two or three Days, of a Series of repeated Bleedings, but not of the Wound. Notwithstanding the Certainty of this, the Surgeon frequently boasts of his ten, twelve, or even his fifteen Bleedings; assuring his Hearers of the insuperable Mortality of the Wound, since the letting out such a Quantity of Blood could not recover the Patient; when it really was that excessive artificial Profusion of it, that downright dispatched him.------The Pleasures of Love are very mortal ones to the Wounded.

Sec. 441. The Balsams and vulnerary Plants, which have often been so highly celebrated for the Cure of Wounds, are very noxious, when taken inwardly; because the Introduction of them gives or heightens the Fever, which ought to have been abated.

Of Contusions, or Bruises.

Sec. 442. A Contusion, which is commonly called a Bruise, is the Effect of the forcible Impression or Stroke of a Substance not sharp or cutting, on the Body of a Man, or any Animal; whether such an Impression be violently made on the Man, as when he is struck by a Stick, or by a Stone thrown at him; or whether the Man be involuntarily forced against a Post, a Stone, or any hard Substance by a Fall; or whether, in short, he is squeezed and oppressed betwixt two hard Bodies, as when his Finger is squeezed betwixt the Door and the Door-Post, or the whole Body jammed in betwixt any Carriage and the Wall. These Bruises, however, are still more frequent in the Country than Wounds, and commonly more dangerous too; and indeed the more so, as we cannot judge so exactly, and so soon, of the whole Injury that has been incurred; and because all that is immediately visible of it is often but a small Part of the real Damage attending it: since it frequently happens that no Hurt appears for a few successive Days; nor does it become manifest, until it is too late to admit of an effectual Cure.

Sec. 443. It is but a few Weeks since a Cooper came to ask my Advice. His Manner of breathing, his Aspect, the Quickness, Smallness, and Irregularity of his Pulse, made me apprehensive at once, that some Matter was formed within his Breast. Nevertheless he still kept up, and went about, working also at some Part of his Trade. He had fallen in removing some Casks or Hogsheads; and the whole Weight of his Body had been violently impressed upon the right Side of his Breast. Notwithstanding this, he was sensible of no Hurt at first; but some Days afterwards he began to feel a dull heavy Pain in that Part, which continued and brought on a Difficulty of Breathing, Weakness, broken Sleep and Loss of Appetite. I ordered him immediately to Stillness and Repose, and I advised him to drink a Ptisan of Barley sweetened with Honey, in a plentiful Quantity. He regularly obeyed only the latter Part of my Directions: yet on meeting him a few Days after, he told me he was better. The very same Week, however, I was informed he had been found dead in his Bed. The Imposthume had undoubtedly broke, and suffocated him.

Sec. 444. A young Man, run away with by his Horse, was forced with Violence against a Stable-Door, without being sensible of any Damage at the Time. But at the Expiration of twelve Days, he found himself attacked by some such Complaints, as generally occur at the Beginning of a Fever. This Fever was mistaken for a putrid one, and he was very improperly treated, for the Fever it really was, above a Month. In short, it was agreed at a Consultation, that Matter was collected in the Breast. In Consequence of this, he was more properly attended, and at length happily cured by the Operation for an Empyema, after languishing a whole Year. I have published these two Instances, to demonstrate the great Danger of neglecting violent Strokes or Bruises; since the first of these Patients might have escaped Death; and the second a tedious and afflicting Disorder, if they had taken, immediately after each Accident, the necessary Precautions against its Consequences.

Sec. 445. Whenever any Part is bruised, one of two Things always ensues, and commonly both happen together; especially if the Contusion is pretty considerable: Either the small Blood-vessels of the contused Part are broken, and the Blood they contained is spread about in the adjoining Parts; or else, without such an Effusion of it, these Vessels have lost their Tone, their active Force, and no longer contributing to the Circulation, their Contents stagnate. In each of these Cases, if Nature, either without or with the Assistance of Art, does not remove the Impediment, an Inflammation comes on, attended with an imperfect, unkindly Suppuration, with Putrefaction and a Gangrene; without mentioning the Symptoms that arise from the Contusion of some particular Substance, as a Nerve, a large Vessel, a Bone, &c. Hence we may also conceive the Danger of a Contusion, happening to any inward Part, from which the Blood is either internally effused, or the Circulation wholly obstructed in some vital Organ. This is the Cause of the sudden Death of Persons after a violent Fall; or of those who have received the violent Force of heavy descending Bodies on their Heads; or of some violent Strokes, without any evident external Hurt or Mark.

There have been many Instances of sudden Deaths after one Blow on the Pit of the Stomach, which has occasioned a Rupture of the Spleen.

It is in Consequence of Falls occasioning a general slight Contusion, as well internal as external, that they are sometimes attended with such grievous Consequences, especially in old Men, where Nature, already enfeebled, is less able to redress such Disorders. And thus in Fact has it been, that many such, who had before enjoyed a firm State of Health, have immediately lost it after a Fall (which seemed at first to have affected them little or not at all) and languished soon after to the Moment of their Death, which such Accidents very generally accelerate.

Sec. 446. Different external and internal Remedies are applicable in Contusions. When the Accident has occurred in a slight Degree, and there has been no great nor general Shock, which might produce an internal Soreness or Contusion, external Applications may be sufficient. They should consist of such Things as are adapted, first, to attenuate and resolve the effused and stagnant Blood, which shews itself so apparently; and which, from its manifest Blackness very soon after the Contusion, becomes successively brown, yellow, and greyish, in Proportions as the Magnitude of the Suffusion or Sealing decreases, till at last it disappears entirely, and the Skin recovers its Colour, without the Blood's having been discharged through the external Surface, as it has been insensibly and gradually dissolved, and been taken in again by the Vessels: And secondly, the Medicines should be such as are qualified to restore the Tone, and to recover the Strength of the affected Vessels.

The best Application is Vinegar, diluted, if very sharp, with twice as much warm Water; in which Mixture Folds of Linnen are to be dipt, within which the contused Parts are to be involved; and these Folds are to be remoistened and re-applied every two Hours on the first Day.

Parsley, Chervil, and Houseleek Leaves, lightly pounded, have also been successfully employed; and these Applications are preferable to Vinegar, when a Wound is joined to the Bruise. The Pultices, No. 68, may also be used with Advantage.

Sec. 447. It has been a common Practice immediately to apply spirituous Liquors, such as Brandy, Arquebussade and Alibour Water, and the like; but a long Abuse ought not to be established by Prescription. These Liquids which coagulate the Blood, instead of resolving it, are truly pernicious; notwithstanding they are sometimes employed without any visible Disadvantage on very slight Occasions. Frequently by determining the settled Blood towards the Insterstices of the Muscles, the fleshy Parts; or sometimes even by preventing the Effusion, or visible Settling of the Blood, and fixing it, as it were, within the bruised Vessels, they seem to be well; though this only arises from their concentring and concealing the Evil, which, at the End of a few Months, breaks forth again in a very troublesome Shape. Of this I have seen some miserable Examples, whence it has been abundantly evinced, that Applications of this Sort should never be admitted; and that Vinegar should be used instead of them. At the utmost it should only be allowed, (after there is Reason to suppose all the stagnant Blood resolved and resorbed into the Circulation) to add a third Part of Arquebusade Water to the Vinegar; with an Intention to restore some Strength to the relaxed and weakened Parts.

This, Dr. Tissot informs me, is a Solution of white Vitriol and some other Drugs in Spirit of Wine, and is never used in regular Practice now. It has its Name from the Author of the Solution. K.

Sec. 448. It is still a more pernicious Practice to apply, in Bruises, Plaisters composed of greasy Substances, Rosins, Gums, Earths, &c. The most boasted of these is always hurtful, and there have been many Instances of very slight Contusions being aggravated into Gangrenes by such Plaisters ignorantly applied; which Bruises would have been entirely subdued by the Oeconomy of Nature, if left to herself, in the Space of four Days.

Those Sacs or Suffusions of coagulated Blood, which are visible under the Skin, should never be opened, except for some urgent Reason; since however large they may be, they insensibly disappear and dissipate; instead of which Termination, by opening them, they sometimes terminate in a dangerous Ulceration.

Sec. 449. The internal Treatment of Contusions is exactly the same with that of Wounds; only that in these Cases the best Drink is the Prescription, No. 1, to each Pot of which a Drachm of Nitre must be added.

When any Person has got a violent Fall; has lost his Senses, or is become very stupid; when the Blood starts out of his Nostrils, or his Ears; when he is greatly oppressed, or his Belly feels very tight and tense, which import an Effusion of Blood either into the Head, the Breast or the Belly, he must, first of all, be bled upon the Spot, and all the Means must be recurred to, which have been mentioned Sec. 439, giving the wretched Patient the least possible Disturbance or Motion; and by all means avoiding to jog or shake him, with a Design to bring him to his Senses; which would be directly and effectually killing him, by causing a further Effusion of Blood. Instead of this the whole Body should be fomented, with some one of the Decoctions already mentioned: and when the Violence has been chiefly impressed on the Head, Wine and Water should be prefered to Vinegar.

Falls attended with Wounds, and even a Fracture of the Skull, and with the most alarming Symptoms, have been cured by these internal Remedies, and without any other external Assistance, except the Use of the aromatic Fomentation, No. 68.

A Man from Pully-petit came to consult me some Months ago, concerning his Father, who had a high Fall out of a Tree. He had been twenty-four Hours without Feeling or Sense, and without any other Motion than frequent Efforts to vomit; and Blood had issued both from his Nose and Ears. He had no visible outward Hurt neither on his Head, nor any other Part; and, very fortunately for him, they had not as yet exerted the least Effort to relieve him. I immediately directed a plentiful Bleeding in the Arm; and a large Quantity of Whey sweetened with Honey to be drank, and to be also injected by Way of Glyster. This Advice was very punctually observed; and fifteen Days after the Father came to Lausanne, which is four Leagues from Pully-petit, and told me he was very well. It is proper, in all considerable Bruises, to open the Patient's Belly with a mild cooling Purge, such as No. 11, 23, 32, 49. The Prescription No. 24, and the honyed Whey are excellent Remedies, from the same Reason.