Part 58

Of Medicines taken by Way of Precaution, or Prevention.

_Sect._ 538.

I Have pointed out, in some Parts of this Work, the Means of preventing the bad Effects of several Causes of Diseases; and of prohibiting the Return of some habitual Disorders. In the present Chapter I shall adjoin some Observations, on the Use of the principal Remedies, which are employed as general Preservatives; pretty regularly too at certain stated Times, and almost always from meer Custom only, without knowing, and often with very little Consideration, whether they are right or wrong.

Nevertheless, the Use, the Habit of taking Medicines, is certainly no indifferent Matter: it is ridiculous, dangerous, and even criminal to omit them, when they are necessary, but not less so to take them when they are not wanted. A good Medicine taken seasonably, when there is some Disorder, some Disarrangement in the Body, which would in a short time occasion a Distemper, has often prevented it. But yet the very same Medicine, if given to a Person in perfect Health, if it does not directly make him sick, leaves him at the best in a greater Propensity to the Impressions of Diseases: and there are but too many Examples of People, who having very unhappily contracted a Habit, a Disposition to take Physick, have really injured their Health, and impaired their Constitution, however naturally strong, by an Abuse of those Materials which Providence has given for the Recovery and Re-establishment of it; an Abuse which, though it should not injure the Health of the Person, would occasion those Remedies, when he should be really sick, to be less efficacious and serviceable to him, from their having been familiar to his Constitution; and thus he becomes deprived of the Assistance he would have received from them, if taken only in those Times and Circumstances, in which they were necessary for him.

Of Bleeding.

Sec. 539. Bleeding is necessary only in these four Cases. 1, When there is too great a Quantity of Blood in the Body. 2, When there is any Inflammation, or an inflammatory Disease. 3, When some Cause supervenes, or is about to supervene, in the Constitution, which would speedily produce an Inflammation, or some other dangerous Symptom, if the Vessels were not relaxed by Bleeding. It is upon this Principle that Patients are bled after Wounds, and after Bruises; that Bleeding is directed for a pregnant Woman, if she has a violent Cough; and that Bleeding is performed, by Way of Precaution, in several other Cases. 4, We also advise Bleeding sometimes to asswage an excessive Pain, though such Pain is not owing to Excess of Blood, nor arises from an inflamed Blood; but in Order to appease and moderate the Pain by Bleeding; and thereby to obtain Time for destroying the Cause of it by other Remedies. But as these two last Reasons are in Effect involved or implied in the two first; it may be very generally concluded, that an Excess of Blood, and an inflamed State of it, are the only two necessary Motives for Bleeding.

Sec. 540. An Inflammation of the Blood is known by the Symptoms accompanying those Diseases, which that Cause produces. Of these I have already spoken, and I have at the same time regulated the Practice of Bleeding in such Cases. Here I shall point out those Symptoms and Circumstances, which manifest an Excess of Blood.

The first, then, is the general Course and Manner of the Patient's living, while in Health. If he is a great Eater, and indulges in juicy nutritious Food, and especially on much Flesh-meat; if he drinks rich and nourishing Wine, or other strong Drink, and at the same time enjoys a good Digestion; if he takes but little Exercise, sleeps much, and has not been subject to any very considerable Evacuation, he may well be supposed to abound in Blood. It is very obvious that all these Causes rarely occur in Country People; if we except only the Abatement of their Exercise, during some Weeks in Winter, which indeed may contribute to their generating more Blood than they commonly do.

The labouring Country-man, for much the greater part of his Time, lives only on Bread, Water and Vegetables; Materials but very moderately nourishing, as one Pound of Bread probably does not make, in the same Body, more Blood than one Ounce of Flesh; though a general Prejudice seems to have established a contrary Opinion. 2, The total Stopping or long Interruption of some involuntary Bleeding or Haemorrhage, to which he had been accustomed. 3, A full and strong Pulse, and Veins visibly filled with Blood, in a Body that is not lean and thin, and when he is not heated. 4, A florid lively Ruddiness. 5, A considerable and unusual Numbness; Sleep more profound, of more Duration, and yet less tranquil and calm, than at other times; a greater Propensity than ordinary to be fatigued after moderate Exercise or Work; and a little Oppression and Heaviness from walking. 6, Palpitations, accompanied sometimes with very great Dejection, and even with a slight fainting Fit; especially on being in any hot Place, or after moving about considerably. 7, Vertigos, or Swimmings of the Head, especially on bowing down and raising it up at once, and after sleeping. 8, Frequent Pains of the Head, to which the Person was not formerly subject; and which seem not to arise from any Defect in the Digestions. 9, An evident Sensation of Heat, pretty generally diffused over the whole Body. 10, A smarting Sort of Itching all over, from a very little more Heat than usual. And lastly, frequent Haemorrhages, and these attended with manifest Relief, and more Vivacity.

People should, notwithstanding, be cautious of supposing an unhealthy Excess of Blood, from any one of these Symptoms only. Many of them must concur; and they should endeavour to be certain that even such a Concurrence of them does not result from a very different Cause, and wholly opposite in Effect to that of an Excess of Blood.

But when it is certain, from the whole Appearance, that such an Excess doth really exist, then a single, or even a second Bleeding is attended with very good Effects. Nor is it material, in such Cases, from what Part the Blood is taken.

Sec. 541. On the other Hand, when these Circumstances do not exist, Bleeding is in no wise necessary: nor should it ever be practised in these following Conditions and Circumstances; except for some particular and very strong Reasons; of the due Force of which none but Physicians can judge.

First, when the Person is in a very advanced Age, or in very early Infancy. 2, When he is either naturally of a weakly Constitution, or it has been rendered such by Sickness, or by some other Accident. 3, When the Pulse is small, soft, feeble, and intermits, and the Skin is manifestly pale. 4, When the Limbs, the Extremities of the Body, are often cold, puffed up and soft. 5, When their Appetite has been very small for a long time; their Food but little nourishing, and their Perspiration too plentiful, from great Exercise. 6, When the Stomach has long been disordered, and the Digestion bad, whence very little Blood could be generated. 7, When the Patient has been considerably emptied, whether by Haemorrhages, a Looseness, profuse Urine or Sweat: or when the Crisis of some Distemper has been effected by any one of these Evacuations. 8, When the Patient has long been afflicted with some depressing Disease; and troubled with many such Obstructions as prevent the Formation of Blood. 9, Whenever a Person is exhausted, from whatever Cause. 10, When the Blood is in a thin, pale, and dissolved State.

Sec. 542, In all these Cases, and in some others less frequent, a single Bleeding often precipitates the Patient into an absolutely incurable State, an irreparable Train of Evils. Many dismal Examples of it are but too obvious.

Whatever, therefore, be the Situation of the Patient, and however naturally robust, that Bleeding, which is unnecessary, is noxious. Repeated, re-iterated Bleedings, weaken and enervate, hasten old Age, diminish the Force of the Circulation, thence fatten and puff up the Body; and next by weakening, and lastly by destroying, the Digestions, they lead to a fatal Dropsy. They disorder the Perspiration by the Skin, and leave the Patient liable to Colds and Defluxions: They weaken the nervous System, and render them subject to Vapours, to the hypochondriac Disorders, and to all nervous Maladies.

The ill Consequence of a single, though erroneous Bleeding is not immediately discernible: on the contrary, when it was not performed in such a Quantity, as to weaken the Patient perceivably, it appears to have been rather beneficial. Yet I still here insist upon it, that it is not the less true that, when unnecessary, it is prejudicial; and that People should never bleed, as sometimes has been done, for meer Whim, or, as it were, for Diversion. It avails nothing to affirm, that within a few Days after it, they have got more Blood than they had before it, that is, that they weigh more than at first, whence they infer the Loss of Blood very speedily repaired. The Fact of their augmented Weight is admitted; but this very Fact testifies against the real Benefit of that Bleeding; hence it is a Proof, that the natural Evacuations of the Body are less compleatly made; and that Humours, which ought to be expelled, are retained in it. There remains the same Quantity of Blood, and perhaps a little more; but it is not a Blood so well made, so perfectly elaborated; and this is so very true, that if the thing were otherwise; if some Days after the Bleeding they had a greater Quantity of the same Kind of Blood, it would amount to a Demonstration, that more re-iterated Bleedings must necessarily have brought on an inflammatory Disease, in a Man of a robust Habit of Body.

Sec. 543. The Quantity of Blood, which a grown Man may Part with, by Way of Precaution, is about ten Ounces.

Sec. 544. Persons so constituted as to breed much Blood, should carefully avoid all those Causes which tend to augment it, (See Sec. 540, No. 1) and when they are sensible of the Quantity augmented, they should confine themselves to a light frugal Diet, on Pulse, Fruits, Bread and Water; they should often bathe their Feet in warm Water, taking Night and Morning the Powder No. 20; drink of the Ptisan No. 1; sleep but very moderately, and take much Exercise. By using these Precautions they may either prevent any Occasion for Bleeding, or should they really be obliged to admit of it, they would increase and prolong its good Effects. These are also the very Means, which may remove all the Danger that might ensue from a Person's omitting to bleed, at the usual Season or Interval, when the Habit, the Fashion of Bleeding had been inveterately established in him.

Sec. 545. We learn with Horror and Astonishment, that some have been bled eighteen, twenty and even twenty-four times in two Days; and some others, some hundred times, in the Course of some Months. Such Instances irrefragably demonstrate the continual Ignorance of their Physician or Surgeon; and should the Patient escape, we ought to admire the inexhaustible Resources of Nature, that survived so many murderous Incisions.

How shocking is this! and yet how true in some Countries! I have been most certainly assured, that Bleeding has been inflicted and repeated in the last sinking and totally relaxing Stage of a Sea-Scurvy, whose fatal Termination it doubtless accelerated. This did not happen in our own Fleet; yet we are not as yet Wholly exempt on Shore, from some Abuse of Bleeding, which a few raw unthinking Operators are apt to consider as a meer Matter of Course. I have in some other Place stigmatized the Madness of Bleeding in Convulsions, from manifest Exhaustion and Emptiness, with the Abhorrence it deserves. K.

Sec. 546. The People entertain a common Notion, which is, that the first Time of bleeding certainly saves the Life of the Patient; but to convince them of the Falsity of this silly Notion, they need only open their Eyes, and see the very contrary Fact to this occur but too unhappily every Day; many People dying soon after their first Bleeding. Were their Opinion right, it would be impossible that any Person should die of the first Disease that seized him, which yet daily happens. Now the Extirpation of this absurd Opinion is really become important, as the Continuance of it is attended with some unhappy Consequences: their Faith in, their great Dependance on, the extraordinary Virtue of this first Bleeding makes them willing to omit it, that is, to treasure it up against a Distemper, from which they shall be in the greatest Danger; and thus it is deferred as long as the Patient is not extremely bad, in Hopes that if they can do without it then, they shall keep it for another and more pressing Occasion. Their present Disease in the mean time rises to a violent Height; and then they bleed, but when it is too late, and I have seen Instances of many Patients, who were permitted to die, that the first Bleeding might be reserved for a more important Occasion. The only Difference between the first Bleeding, and any subsequent one is, that the first commonly gives the Patient an Emotion, that is rather hurtful than salutary.

Of Purges.

Sec. 547. The Stomach and Bowels are emptied either by Vomiting, or by Stools, the latter Discharge being much more natural than the first, which is not effected without a violent Motion, and one indeed to which Nature is repugnant. Nevertheless, there are some Cases, which really require this artificial Vomiting; but these excepted (some of which I have already pointed out) we should rather prefer those Remedies, which empty the Belly by Stool.

Sec. 548. The Signs, which indicate a Necessity for Purging, are, 1, a disagreeable Tast or Savour of the Mouth in a Morning, and especially a bitter Tast; a foul, furred Tongue and Teeth, disagreable Eructations or Belchings, Windiness and Distension.

2, A Want of Appetite which increases very gradually, without any Fever, which degenerates into a Disgust or total Aversion to Food; and sometimes communicates a bad Tast to the very little such Persons do eat.

3, Reachings to vomit in a Morning fasting, and sometimes throughout the Day; supposing such not to depend on a Woman's Pregnancy, or some other Disorder, in which Purges would be either useless or hurtful.

4, A vomiting up of bitter, or corrupted, Humours.

5, A manifest Sensation of a Weight, or Heaviness in the Stomach, the Loins, or the Knees.