Part 54

Every swooning Fit leaves the Patient in Dejection and Weakness; the Secretions from the Blood are suspended; the Humours disposed to Stagnation; Grumosities, or Coagulations, and Obstructions are formed; and if the Motion of the Blood is totally intercepted, or considerably checked, Polypus's, and these often incurable, are formed in the Heart, or in the larger Vessels; the Consequences of which are dreadful, and sometimes give Rise to internal Aneurisms, which always prove mortal, after long Anxiety and Oppression.

Swoonings which attack old People, without any manifest Cause, always afford an unfavourable Prognostic.

Of Haemorrhages, or an involuntary Loss of Blood.

Sec. 512. Haemorrhages of the Nose, supervening in inflammatory Fevers, commonly prove a favourable Crisis; which Bleeding we should carefully avoid stopping; except it becomes excessive, and seems to threaten the Patient's Life.

As they scarcely ever happen in very healthy Subjects, but from a superfluous Abundance of Blood, it is very improper to check them too soon; lest some internal Stuffings and Obstructions should prove the Consequence.

A Swooning sometimes ensues after the Loss of only a moderate Quantity of Blood. This Swooning stops the Haemorrhage, and goes off without any further Assistance, except the smelling to Vinegar. But in other Cases there is a Succession of fainting Fits, without the Blood's stopping; while at the same time slight convulsive Motions and Twitchings ensue, attended with a Raving, when it becomes really necessary to stop the Bleeding: and indeed, without waiting till these violent Symptoms appear, the following Signs will sufficiently direct us, when it is right to stop the Flux of Blood, or to permit its Continuance--As long as the Pulse is still pretty full; while the Heat of the Body is equally extended to the very Extremities; and the Countenance and Lips preserve their natural Redness, no ill Consequence is to be apprehended from the Haemorrhage, though it has been very copious, and even somewhat profuse.

But whenever the Pulse begins to faulter and tremble; when the Countenance and the Lips grow pale, and the Patient complains of a Sickness at Stomach, it is absolutely necessary to stop the Discharge of Blood. And considering that the Operation of Remedies does not immediately follow the Exhibition or Application of them, it is safer to begin a little too early with them, than to delay them, though ever so little too long.

Sec. 513. First of all then, tight Bandages, or Ligatures, should be applied round both Arms, on the Part they are applied over in order to Bleeding; and round the lower Part of both Thighs, on the gartering Place; and all these are to be drawn very tight, with an Intention to detain and accumulate the Blood in the Extremities.

2, In Order to increase this Effect, the Legs are to be plunged in warm Water up to the Knees; for by relaxing the Blood-vessels of the Legs and Feet, they are dilated at the same time, and thence receive, and, in Consequence of the Ligatures above the Knees, retain the more Blood. If the Water were cold, it would repel the Blood to the Head; if hot, it would increase the Motion of it; and, by giving a greater Quickness to the Pulse, would even contribute to increase the Haemorrhage.

As soon however, as the Haemorrhage is stopt, these Ligatures [on the Thighs] may be relaxed a little, or one of them be entirely removed; allowing the others to continue on an Hour or two longer without touching them: but great Precaution should be taken not to slacken them entirely, nor all at once.

3, Seven or eight Grains of Nitre, and a Spoonful of Vinegar, in half a Glass of cool Water, should be given the Patient every half Hour.

4, One Drachm of white Vitriol must be dissolved in two common Spoonfuls of Spring Water; and a Tent of Lint, or Bits of soft fine Linen dipt in this Solution, are to be introduced into the Nostrils, horizontally at first, but afterwards to be intruded upwards, and as high as may be, by the Assistance of a flexible Bit of Wood or Whale-bone. But should this Application be ineffectual, the Mineral Anodyne Liquor of Hoffman is certain to succeed: and in the Country, where it often happens that neither of these Applications are to be had speedily, Brandy, and even Spirit of Wine, mixt with a third Part Vinegar, have answered entirely well, of which I have been a Witness.

The Prescription No. 67, which I have already referred to, on the Article of Wounds, may also be serviceable on this Occasion. It must be reduced to Powder, and conveyed up the Nostrils as high as may be, on the Point or Extremity of a Tent of Lint, which may easily be covered with it. Or a Quill, well charged with the Powder, may be introduced high into the Nostrils, and its Countents be strongly blown up from its other Extremity: though after all the former Method is preferable.

5, When the Flux of Blood is totally stopt, the Patient is to be kept as still and quiet as possible; taking great Care not to extract the Tent which remains in the Nose; nor to remove the Clots of coagulated Blood which fill up the Passage. The loosening and removing of these should be effected very gradually and cautiously; and frequently the Tent does not spring out spontaneously, till after many Days.

Sec. 514. I have not, hitherto, said any thing of artificial Bleeding in these Cases, as I think it at best unserviceable; since, though it may sometimes have stopt the morbid Loss of Blood, it has at other times increased it. Neither have I mentioned Anodynes here, whose constant Effect is to determine a larger Quantity of Blood to the Head.

Applications of cold Water to the Nape of the Neck ought to be wholly disused, having sometimes been attended with the most embarrassing Consequences.

In all Haemorrhages, all Fluxes of Blood, great Tranquillity, Ligatures, and the Use of the Drinks No. 2 or 4, are very useful.

Sec. 515. People who are very liable to frequent Haemorrhages, ought to manage themselves conformably to the Directions contained in the next Chapter, Sec. 544. They should take very little Supper; avoid all sharp and spirituous Liquors; Apartments that are over hot, and cover their Heads but very lightly.

When a Patient has for a long time been subject to Haemorrhages, if they cease, he should retrench from his usual Quantity of Food; accustom himself to artificial Bleedings at proper Intervals; and take some gentle opening Purges, especially that of No. 24, and frequently a little Nitre in an Evening.

Of Convulsion Fits.

Sec. 516. Convulsions are, in general, more terrifying than dangerous; they result from many and various Causes; and on the Removal or Extirpation of these, their Cure depends.

In the very Fit itself very little is to be done or attempted.

As nothing does shorten the Duration, nor even lessen the Violence, of an epileptic Fit, so nothing at all should be attempted in it; and the rather, because Means and Medicines often aggravate the Disease. We should confine our Endeavours solely to the Security of the Patient, by preventing him from giving himself any violent Strokes; by getting something, if possible, between his Teeth, such as a small Roller of Linen to prevent his Tongue from being hurt, or very dangerously squeezed and bruised, in a strong Convulsion.

The only Case which requires immediate Assistance in the Fit, is, when it is so extremely violent, the Neck so swelled, and the Face so very red, that there is Room to be apprehensive of an Apoplexy, which we should endeavour to obviate, by drawing eight or ten Ounces of Blood from the Arm.

As this terrible Disease is common in the Country, it is doing a real Service to the unfortunate Victims of it, to inform them how very dangerous it is to give themselves blindly up to take all the Medicines, which are cried up to them in such Cases. If there be any one Disease, which requires a more attentive, delicate, and exquisite Kind of Treatment, it is this very Disease. Some Species of it are wholly incurable: and such as may be susceptible of a Cure, require the utmost Care and Consideration of the most enlightned and most experienced Physicians: while those who pretend to cure all epileptic Patients, with one invariable Medicine, are either Ignorants, or Impostors, and sometimes both in one.

Sec. 517. Simple Convulsion Fits, which are not epileptic, are frequently of a long Continuance, persevering, with very few and short Intervals, for Days and even for Weeks.

The true genuine Cause should be investigated as strictly as possible, though nothing should be attempted in the Fit. The Nerves are, during that Term, in so high a Degree of Tension and Sensibility, that the very Medicines, supposed to be strongly indicated, often redouble the Storm they were intended to appease.

Thin watery Liquors, moderately imbued with Aromatics, are the least hurtful, the most innocent Things that can be given; such as Bawm, Lime-tree, and Elder Flower Tea. A Ptisan of Liquorice Root only has sometimes answered better than any other.