Part 47

Sec. 450. In these Circumstances, Wine, distiled Spirits, and whatever has been supposed to revive and to rouse, is mortal. For this Reason People should not be too impatient, because the Patients remain some Time without Sense or Feeling. The giving of Turpentine is more likely to do Mischief than Good; and if it has been sometimes serviceable, it must have been in Consequence of its purging the Patient, who probably then needed to be purged. The Fat of a Whale, (Sperma caeti) Dragons Blood, Crabs-Eyes, and Ointments of whatsoever Sort are at least useless and dangerous Medicine, if the Case be very hazardous; either by the Mischief they do, or the Good they prevent from being done. The proper Indication is to dilute the Blood, to render it more fluid and disposed to circulate; and the Medicines just mentioned produce a very contrary Effect.

Sec. 451. When an aged Person gets a Fall, which is the more dangerous in Proportion to his Age and Grossness; notwithstanding he should not seem in the least incommoded by it, if he is sanguine and still somewhat vigorous, he should part with three or four Ounces of Blood. He should take immediately a few successive Cups of a lightly aromatic Drink, which should be given him hot; such, for Instance, as an Infusion of Tea sweetened with Honey, and he should be advised to move gently about. He must retrench a little from the usual Quantity of his Food, and accustom himself to very gentle, but very frequent, Exercise.

Sec. 452. Sprains or Wrenches, which very often happen, produce a Kind of Contusion, in the Parts adjoining to the sprained Joint. This Contusion is caused by the violent Friction of the Bone against the neighbouring Parts; and as soon as the Bones are immediately returned into their proper Situation, the Disorder should be treated as a Contusion. Indeed if the Bones should not of themselves return into their proper natural Position, Recourse must be had to the Hand of a Surgeon.

The best Remedy in this Case is absolute Rest and Repose, after applying a Compress moistened in Vinegar and Water, which is to be renewed and continued, till the Marks of the Contusion entirely disappear; and there remains not the smallest Apprehension of an Inflammation. Then indeed, and not before, a little Brandy or Arquebusade Water may be added to the Vinegar; and the Part (which is almost constantly the Foot) should be strengthened and secured for a considerable Time with a Bandage; as it might otherwise be liable to fresh Sprains, which would daily more and more enfeeble it: and if this Evil is overlooked too much in its Infancy, the Part never recovers its full Strength; and a small Swelling often remains to the End of the Patient's Life.

If the Sprain is very slight and moderate, a Plunging of the Part into cold Water is excellent; but if this is not done at once immediately after the Sprain, or if the Contusion is violent, it is even hurtful.

The Custom of rolling the naked Foot upon some round Body is insufficient, when the Bones are not perfectly replaced; and hurtful, when the Sprain is accompanied with a Contusion.

It happens continually almost that Country People, who encounter such Accidents, apply themselves either to ignorant or knavish Imposters, who find, or are determined to find, a Disorder or Dislocation of the Bones, where there is none; and who, by their violent Manner of handling the Parts, or by the Plaisters they surround them with, bring on a dangerous Inflammation, and change the Patient's Dread of a small Disorder, into a very grievous Malady.

These are the very Persons who have created, or indeed rather imagined, some impossible Diseases, such as the Opening, the Splitting of the Stomach, and of the Kidnies. But these big Words terrify the poor Country People, and dispose them to be more easily and effectually duped.

Of Ulcers.

Sec. 453. Whenever Ulcers arise from a general Fault of the Blood, it is impossible to cure them, without destroying the Cause and Fuel of them. It is in Fact imprudent to attempt to heal them up by outward Remedies; and a real Misfortune to the Patient, if his Assistant effectually heals and closes them.

But, for the greater Part, Ulcers in the Country are the Consequence of some Wound, Bruise, or Tumour improperly treated; and especially of such as have been dressed with too sharp, or too spirituous Applications. Rancid Oils are also one of the Causes, which change the most simple Wounds into obstinate Ulcers, for which Reason they should be avoided; and Apothecaries should be careful, when they compound greasy Ointments, to make but little at a Time, and the oftner, as a very considerable Quantity of any of them becomes rank before it is all sold; notwithstanding sweet fresh Oil may have been employed in preparing them.

Sec. 454. What serves to distinguish Ulcers from Wounds, is the Dryness and Hardness of the Sides or Borders of Ulcers, and the Quality of the Humour discharged from them; which, instead of being ripe consistent Matter, is a Liquid more thin, less white, sometimes yielding a disagreable Scent, and so very sharp, that if it touch the adjoining Skin, it produces Redness, Inflammation, or Pustules there; sometimes a serpiginous, or Ring-worm like Eruption, and even a further Ulceration.

Sec. 455. Such Ulcers as are of a long Duration, which spread wide, and discharge much, prey upon the Patient, and throw him into a slow Fever, which melts and consumes him. Besides, when an Ulcer is of a long Standing, it is dangerous to dry it up; and indeed this never should be done, but by substituting in the Place of one Discharge that is become almost natural, some other Evacuation, such as Purging from Time to Time.

We may daily see sudden Deaths, or very tormenting Diseases, ensue the sudden drying up such Humours and Drains as have been of a long Continuance: and whenever any Quack (and as many as promise the speedy Cure of such, deserve that Title) assures the Patient of his curing an inveterate Ulcer in a few Days, he demonstrates himself to be a very dangerous and ignorant Intermeddler, who must kill the Patient, if he keeps his Word. Some of these impudent Impostors make use of the most corrosive Applications, and even arsenical ones; notwithstanding the most violent Death is generally the Consequence of them.

Sec. 456. The utmost that Art can effect, with Regard to Ulcers, which do not arise from any Fault in the Humours, is to change them into Wounds. To this End, the Hardness and Dryness of the Edges of the Ulcer, and indeed of the whole Ulcer, must be diminished, and its Inflammation removed. But sometimes the Hardness is so obstinate, that this cannot be mollified any other Way, than by scarifying the Edges with a Lancet. But when it may be effected by other Means, let a Pledget spread with the Ointment, No. 69, be applied all over the Ulcer; and this Pledget be covered again with a Compress of several Folds, moistened in the Liquid, No. 70, which should be renewed three times daily; though it is sufficient to apply a fresh Pledget only twice.

As I have already affirmed that Ulcers were often the Consequence of sharp and spirituous Dressings, it is evident such should be abstained from, without which Abstinence they will prove incurable.

To forward the Cure, salted Food, Spices, and strong Drink should be avoided; the Quantity of Flesh-meat should be lessened; and the Body be kept open by a Regimen of Pulse, of Vegetables, and by the habitual Use of Whey sweetened with Honey.

If the Ulcers are in the Legs, a very common Situation of them, it is of great Importance, as well as in Wounds of the same Parts, that the Patient should walk about but little; and yet never stand up without walking. This indeed is one of these Cases, in which those, who have some Credit and Influence in the Estimation of the People, should omit nothing to make them thoroughly comprehend the Necessity of confining themselves, some Days, to undisturbed Tranquillity and Rest; and they should also convince them, that this Term of Rest is so far from being lost Time, that it is likely to prove their most profitable Time of Life. Negligence, in this material Point, changes the slightest Wounds into Ulcers, and the most trifling Ulcers into obstinate and incurable ones: insomuch that there is scarcely any Man, who may not observe some Family in his Neighbourhood, reduced to the Hospital, from their having been too inattentive to the due Care of some Complaint of this Sort.

This seems just the same as coming on the Parish, or being received into an Alms house here; in Consequence of such an incurable Disability happening to the poor working Father of a Family. K.

I conclude this Article on Ulcers with repeating, that those which are owing to some internal Cause; or even such as happen from an external one, in Persons of a bad Habit of Body, frequently require a more particular Treatment.

Of Frozen Limbs.

Sec. 457. It is but too common, in very rigorous Winters, for some Persons to be pierced with so violent a Degree of Cold, that their Hands or Feet, or sometimes both together are frozen at once, just like a Piece of Flesh-meat exposed to the Air.

If a Person thus pierced with the Cold, dispose himself to walk about, which seems so natural and obvious a Means to get warm; and especially, if he attempts to warm the Parts that have been frozen, his Case proves irrecoverable. Intolerable Pains are the Consequence, which Pains are speedily attended with an incurable Gangrene; and there is no Means left to save the Patient's Life, but by cutting off the gangrened Limbs.

The Reason of the Fatality of Heat, in these Cases, and of the Success of an opposite Application, (See Sec. 459) seems strictly and even beautifully analogous to what Hippocrates has observed of the Danger, and even Fatality, of all great and sudden Changes in the human Body, whether from the Weather or otherwise. Whence this truly great Founder of Physick, when he observes elsewhere, that Diseases are to be cured by something contrary to their Causes, very consistently advises, not a direct and violent Contrariety, but a gradual and regulated one, a Sub-contrariety. K.

There was a very late and terrible Example of this, in the Case of an Inhabitant at Cossonay, who had both his Hands frozen. Some greasy Ointments were applied hot to them, the Consequence of which was, the Necessity of cutting off six of his Fingers.

Sec. 458. In short, there is but one certain Remedy in such Cases, and this is to convey the Person affected into some Place where it does not freeze, but where, however, it is but very moderately hot, and there continually to apply, to the frozen Parts, Snow, if it be at hand; and if not, to keep washing them incessantly, but very gently (since all Friction would at this Juncture prove dangerous) in Ice-water, as the Ice thaws in the Chamber. By this Application the Patients will be sensible of their Feeling's returning very gradually to the Part, and that they begin to recover their Motion. In this State they may Safely be moved into a Place a little warmer, and drink some Cups of the Potion No. 13, or of another of the like Quality.

Sec. 459. Every Person may be a competent judge of the manifest Danger of attempting to relieve such Parts by heating them, and of the Use of Ice-water, by a common, a daily Experience. Frozen Pears, Apples, and Radishes, being put into Water just about to freeze, recover their former State, and prove quickly eatable. But if they are put into warm Water, or into a hot Place, Rottenness, which is one Sort of Gangrene, is the immediate Effect. The following Case will make this right Method of treating them still more intelligible, and demonstrate its Efficacy.

A Man was travelling to the Distance of six Leagues in very cold Weather; the Road being covered with Snow and Ice. His Shoes, not being very good, failed him on his March, so that he walked the three last Leagues bare-footed; and felt, immediately after the first Half League, sharp Pains in his Legs and Feet, which increased as he proceeded. He arrived at his Journey's End in a Manner nearly deprived of his lower Extremities. They set him before a great Fire, heated a Bed well, and put him into it. His Pains immediately became intolerable: he was incessantly in the most violent Agitations, and cried out in the most piercing and affecting Manner. A Physician, being sent for in the Night, found his Toes of a blackish Colour, and beginning to lose their Feeling. His Legs and the upper Part of his Feet, which were excessively swelled, of a purplish Red, and varied with Spots of a violet Colour, were still sensible of the most excruciating Pains. The Physician ordered in a Pail of Water from the adjoining River, adding more to it, and some Ice withal. In this he obliged the Patient to plunge his Legs; they were kept in near an Hour, and within that Time, the Pains became less violent. After another Hour he ordered a second cold Bath, from which the Patient perceiving still further Relief, prolonged it to the Extent of two Hours. During that Time, some Water was taken out of the Pail, and some Ice and Snow were put into it. Now his Toes, which had been black, grew red; the violet Spots in his Legs disappeared; the Swelling abated; the Pains became moderate, and intermitted. The Bath was nevertheless repeated six times; after which there remained no other Complaint, but that of a great Tenderness or extraordinary Sensibility in the Soles of his Feet, which hindered him from walking. The Parts were afterwards bathed with some aromatic Fomentations; and he drank a Ptisan of Sarsaparilla [one of Elder Flowers would have answered the same Purpose, and have been less expensive.] On the eighth Day from his Seizure he was perfectly recovered, and returned home on Foot on the fifteenth.