Part 49

One of the best is to wear Day and Night, without ever putting it off, a Glove made of some smooth Skin, such as that of a Dog; which seldom fails to extinguish the Disorder in some Days time.

When the Feet are affected with Chilblains, Socks of the same Skin should be worn; and the Patient keep close to his Bed for some Days.

Sec. 469. When the Disorder is violent, the Use of cold Water prohibited, and the Gloves just recommended have but a slow Effect, the diseased Parts should be gently fomented or moistened several times a Day, with some Decoction, rather more than warm; which at the same time should be dissolving and emollient. Such is that celebrated Decoction of the Scrapings, the Peel of Radishes, whose Efficacy is still further increased, by adding one sixth Part of Vinegar to the Decoction.

Another Decoction, of whose great Efficacy I have been a Witness, but which dies the Hands yellow for a few Days, is the Prescription No. 71. Many others may be made, of nearly the same Virtues, with all the vulnerary Herbs, and even with the Faltranc.

Urine, which some boast of in these Cases, from their having used it with Success; and the Mixture of Urine and Lime-water have the like Virtues with the former Decoctions.

Chilblains may also be advantageously washed with Water and Flower of Mustard, which will concur, in a certain and easy Manner, both to cleanse and to cure them. E. L.

As soon as the Hands affected are taken out of these Decoctions, they must be defended from the Air by Gloves.

Sec. 470. Vapours or Steams are often more efficacious than Decoctions; whence instead of dipping the Hands into these already mentioned, we may expose them to their Vapours, with still more Success. That of hot Vinegar is one of the most powerful Remedies; those of Asphalt, or of Turpentine have frequently succeeded too. It may be needless to add that the affected Parts must be defended from the Air, as well after the Steams as the Decoctions; since it is from this Cause of keeping off the Air, that the Cerecloths are of Service; and hence also the Application of Suet has sometimes answered.

This is or should be, the same with the Bitumen Judaicum, formerly kept in the Shops; but which is never directed, except in that strange Medley the Venice Treacle, according to the old Prescription. The best is found in Egypt, and on the Red Sea: but a different Sort, from Germany, France, and Swisserland, is now generally substituted here. K.

When the Distemper is subdued by the Use of Bathings or Steams, which make the Skin supple and soft, then it should be strengthened by washing the Parts with a little camphorated Brandy, diluted with an equal Quantity of Water.

Sec. 471. When the Nose is affected with a Chilblain, the Steam of Vinegar, and an artificial Nose, or Covering for it, made of Dog-skin, are the most effectual Applications. The same Treatment is equally proper for the Ears and the Chin, when infested with them. Frequently washing these Parts in cold Water is a good Preservative from their being attacked.

Sec. 472. Whenever the Inflammation rises very high, and brings on some Degree of a Fever, the Patient's usual Quantity of strong Drink and of Flesh-meat must be lessened; his Body should be kept open by a few Glysters; he should take every Evening a Dose of Nitre as prescribed, No. 20; and if the Fever proved strong, he should lose some Blood too.

As many as are troubled with obstinate Chilblains, should always be denied the Use of strong Liquor and Flesh.

Sec. 473. When this Distemper prevails in its third Degree, and the Parts are ulcerated; besides keeping the Patients strictly to the Regimen of Persons in a Way of Recovery, and giving them a Purge of Manna, the swelled Parts should be exposed to the Steams of Vinegar; the Ulcerations should be covered with a Diapalma Plaister; and the whole Part should be enveloped in a smooth soft Skin, or in thin Cerecloths.

Sec. 474. The fourth Degree of this Disease, in which the Parts become gangrenous, must be prevented by the Method and Medicines which remove an Inflammation; but if unhappily a Gangrene has already appeared, the Assistance of a Surgeon proves indispensably necessary.

Of Ruptures.

Sec. 475. Hernias or Ruptures, which Country-People term being bursten, are a Disorder which sometimes occurs at the very Birth; though more frequently they are the Effects of violent crying, of a strong forcing Cough, or of repeated Efforts to vomit, in the first Months of Infancy.

They may happen afterwards indiscriminately at every Age, either as Consequences of particular Maladies, or Accidents, or from Peoples' violent Exertions of their Strength. They happen much oftner to Men than Women; and the most common Sort, indeed the only one of which I propose to treat, and that but briefly, is that which consists in the Descent of a Part of the Guts, or of the Cawl, into the Bag or Cod-piece.

It is not difficult to distinguish this Rupture. When it occurs in little Children, it is almost ever cured by making them constantly wear a Bandage which should be made only of Fustian, with a little Pillow or Pincushion, stuffed with Linen Rags, Hair or Bran. There should be at least two of these Bandages, to change them alternately; nor should it ever be applied, but when the Child is laid down on its Back, and after being well assured that the Gut or Cawl, which had fallen down, has been safely returned into the Cavity of the Belly; since without this Precaution it might occasion the worst Consequences.

The good Effect of the Bandage may be still further promoted, by applying upon the Skin, and within the Plait or Fold of the Groin (under which Place the Rings, or Passage out of the Belly into the Bag lie) some pretty astringent or strengthening Plaister, such as that commonly used for Fractures, or that I have already mentioned, Sec. 144. Here we may observe by the Way, that ruptured Children should never be set on a Horse, nor be carried by any Person on Horseback, before the Rupture is perfectly cured.

Sec. 476. In a more advanced Age, a Bandage only of Fustian is not sufficient; one must be procured with a Plate of Steel, even so as to constrain and incommode the Wearer a little at first: nevertheless it soon becomes habitual, and is then no longer inconvenient to them.

Sec. 477. Ruptures sometimes attain a monstrous Size; and a great Part of the Guts fall down in to the Scrotum or Bag, without any Symptom of an actual Disease. This Circumstance, nevertheless, is accompanied with very great Inconvenience, which disables Persons affected with it to work; and whenever the Malady is so considerable, and of a long Standing too, there are commonly some Obstacles that prevent a compleat Return of the Guts into the Belly. In this State indeed, the Application of the Bandage or Truss is impracticable, and the miserable Patients are condemned to carry their grievous Burthen for the Remainder of their Lives; which may however, be palliated a little by the Use of a Suspensory and Bag, adapted to the Size of the Rupture. This Dread of its increasing Magnitude is a strong Motive for checking the Progress of it, when it first appears. But there is another still stronger, which is, that Ruptures expose the Patient to a Symptom frequently mortal. This occurs when that Part of the Intestines fallen into the Scrotum inflames; when still increasing in its Bulk, and being extremely compressed, acute Pains come on: for now from the Increase of the Rupture's Extent, the Passage which gave Way to its Descent, cannot admit of its Return or Ascent; the Blood-vessels themselves being oppressed, the Inflammation increases every Moment; the Communication between the Stomach and the Fundament is often entirely cut off; so that nothing passes through, but incessant Vomitings come on [this being the Kind of Miserere, or Iliac Passion I have mentioned, Sec. 320] which are succeeded by the Hickup, Raving, Swooning, cold Sweats, and Death.

Sec. 478. This Symptom supervenes in Ruptures, when the Excrements become hard in that Part of the Guts fallen into the Scrotum; when the Patient is overheated with Wine, Drams, an inflammatory Diet, &c. or when he has received a Stroke on the ailing Part, or had a Fall.

Sec. 479. The best Means and Remedies are, 1, as soon as ever this Symptom or Accident is manifest, to bleed the Patient very plentifully, as he lies down in his Bed and upon his Back, with his Head a little raised, and his Legs somewhat bent, so that his Knees may be erect. This is the Attitude or Posture they should always preserve as much as possible. When the Malady is not too far advanced, the first Bleeding often makes a compleat Cure; and the Guts return up as soon as it is over. At other Times this Bleeding is less successful, and leaves a Necessity for its Repetition.

2, A Glyster must be thrown up consisting of a strong Decoction of the large white Beet Leaves, with a small Spoonful or Pinch of common Salt, and a Bit of fresh Butter of the Size of an Egg.

3, Folds of Linen dipt in Ice-water must be applied all over the Tumour, and constantly renewed every Quarter of an Hour. This Remedy, when immediately applied, has produced the most happy Effects; but if the Symptom has endured violently more than ten or twelve Hours, it is often too late to apply it; and then it is better to make Use of Flanels dipt in a warm Decoction of Mallow and Elder Flowers, shifting them frequently. It has been known however, that Ice-water, or Ice itself has succeeded as late as the third Day.

Pieces of Ice applied between two Pieces of Linen, directly upon the Rupture, as soon as possible after its first Appearance, is one of those extraordinary Remedies, which we should never hesitate to make immediate Use of. We may be certain by this Application, if the Rupture is simple, and not complicated from some aggravating Cause, to remove speedily, and with very little Pain, a Disorder, that might be attended with the most dreadful Consequences. But the Continuance of this Application must be proportioned to the Strength of the Person ruptured, which may be sufficiently estimated by the Pulse. E. L.

4, When these Endeavours are insufficient, Glysters of Tobacco Smoke must be tried, which has often redressed and returned Ruptures, when every Thing else had failed.