Part 59

6, A Want of Strength sometimes attended with Restlessness, ill Humour, or Peevishness, and Melancholy.

7, Pains of the Stomach, frequent Pains of the Head, or Vertigos; sometimes a Drowsiness, which increases after Meals.

8, Some Species of Cholics; irregular Stools which are sometimes very great in Quantity, and too liquid for many Days together; after which an obstinate Costiveness ensues.

9, A Pulse less regular, and less strong, than what is natural to the Patient, and which sometimes intermits.

Sec. 549. When these Symptoms, or some of them, ascertain the Necessity of purging a Person, not then attacked by any manifest Disease (for I am not speaking here of Purges in such Cases) a proper purging Medicine may be given him. The bad Tast in his Mouth; the continual Belchings; the frequent Reachings to vomit; the actual Vomitings and Melancholy discover, that the Cause of his Disorder resides in the Stomach, and shew that a Vomit will be of Service to him. But when such Signs or Symptoms are not evident, the Patient should take such purging or opening Remedies, as are particularly indicated by the Pains, whether of the Loins; from the Cholic; or by a Sensation of Weight or Heaviness in the Knees.

Sec. 550. But we should abstain from either vomiting or purging, 1, Whenever the Complaints of the Patients are founded in their Weakness, and their being already exhausted, 2, When there is a general Dryness of the Habit, a very considerable Degree of Heat, some Inflammation, or a strong Fever. 3, Whenever Nature is exerting herself in some other salutary Evacuation; whence purging must never be attempted in critical Sweats, during the monthly Discharges, nor during a Fit of the Gout. 4, Nor in such inveterate Obstructions as Purges cannot remove, and really do augment. 5, Neither when the nervous System is considerably weakened.

Sec. 551. There are other Cases again, in which it may be proper to purge, but not to give a Vomit. These Cases are, 1, When the Patient abounds too much with Blood, (See Sec. 540) since the Efforts which attend vomiting, greatly augment the Force of the Circulation; whence the Blood-vessels of the Head and of the Breast, being extremely distended with Blood, might burst, which must prove fatal on the Spot, and has repeatedly proved so. 2, For the same Reason they should not be given to Persons, who are subject to frequent Bleeding from the Nose, or to coughing up or vomiting of Blood; to Women who are subject to excessive or unseasonable Discharges of Blood, &c. from the Vagina, the Neck of the Womb; nor to those who are with Child. 3, Vomits are improper for ruptured Persons.

Sec. 552. When any Person has taken too acrid, too sharp, a Vomit, or a Purge, which operates with excessive Violence; whether this consists in the most vehement Efforts and Agitations, the Pains, Convulsions, or Swoonings, which are their frequent Consequences; or whether that prodigious Evacuation and Emptiness their Operation causes, (which is commonly termed a Super-purgation) and which may hurry the Patient off; Instances of which are but too common among the lower Class of the People, who much too frequently confide themselves to the Conduct of ignorant Men-slayers: In all such unhappy Accidents, I say, we should treat these unfortunate Persons, as if they had been actually poisoned, by violent corroding Poisons, (See Sec. 533) that is, we should fill them, as it were, with Draughts of warm Water, Milk, Oil, Barley-water, Almond Milk, emollient Glysters with Milk, and the Yolks of Eggs; and also bleed them plentifully, if their Pains are excessive, and their Pulses strong and feverish.

The Super-purgation, the excessive Discharge, is to be stopt, after having plied the Patient plentifully with diluting Drinks, by giving the calming Anodyne Medicines directed in the Removal of acute Pains, Sec. 536, No. 6.

Flanels dipt in hot Water, in which some Venice Treacle is dissolved, are very serviceable: and should the Evacuations by Stool be excessive, and the Patient has not a high Fever, and a parching Kind of Heat, a Morsel of the same Treacle, as large as a Nutmeg, may be dissolved in his Glyster.

But should the Vomiting solely be excessive, without any Purging, the Number of the emollient Glysters with Oil and the Yolk of an Egg must be increased; and the Patient should be placed in a warm Bath.

Sec. 553. Purges frequently repeated, without just and necessary Indications, are attended with much the same ill Effects as frequent Bleedings. They destroy the Digestions; the Stomach no longer, or very languidly, exerts its Functions; the Intestines prove inactive; the Patient becomes liable to very severe Cholics; the Plight of the Body, deprived of its salutary Nutrition, falls off; Perspiration is disordered; Defluxions ensue; nervous Maladies come on, with a general Languor; and the Patient proves old, long before the Number of his Years have made him so.

Much irreparable Mischief has been done to the Health of Children, by Purges injudiciously given and repeated. They prevent them from attaining their utmost natural Strength, and frequently contract their due Growth. They ruin their Teeth; dispose young Girls to future Obstructions; and when they have been already affected by them, they render them still more obstinate.

It is a Prejudice too generally received, that Persons who have little or no Appetite need purging; since this is often very false, and most of those Causes, which lessen or destroy the Appetite, cannot be removed by purging; though many of them may be increased by it.

Persons whose Stomachs contain much glairy viscid Matter suppose, they may be cured by Purges, which seem indeed at first to relieve them: but this proves a very slight and deceitful Relief. These Humours are owing to that Weakness and Laxity of the Stomach, which Purges augment; since notwithstanding they carry off Part of these viscid Humours generated in it, at the Expiration of a few Days there is a greater Accumulation of them than before; and thus, by a Re-iteration of purging Medicines, the Malady soon becomes incurable, and Health irrecoverably lost. The real Cure of such Cases is effected by directly opposite Medicines. Those referred to, or mentioned, Sec. 272, are highly conducive to it.

Sec. 554. The Custom of taking stomachic Medicines infused in Brandy, Spirit of Wine, Cherry Water, &c. is always dangerous; for notwithstanding the present immediate Relief such Infusions afford in some Disorders of the Stomach, they really by slow Degrees impair and ruin that Organ; and it may be observed, that as many as accustom themselves to Drams, go off, just like excessive Drinkers, in Consequence of their having no Digestion; whence they sink into a State of Depression and Languor, and die dropsical.

Sec. 555. Either Vomits or Purges may be often beneficially omitted, even when they have some Appearance of seeming necessary, by abating one Meal a Day for some time; by abstaining from the most nourishing Sorts of Food; and especially from those which are fat; by drinking freely of cool Water, and taking extraordinary Exercise. The same Regimen also serves to subdue, without the Use of Purges, the various Complaints which often invade those, who omit taking purging Medicines, at those Seasons and Intervals, in which they have made it a Custom to take them.

Sec. 556. The Medicines, No. 34 and 35, are the most certain Vomits. The Powder, No. 21, is a good Purge, when the Patient is in no wise feverish.

The Doses recommended in the Table of Remedies are those, which are proper for a grown Man, of a vigorous Constitution. Nevertheless there are some few, for whom they may be too weak: in such Circumstances they may be increased by the Addition of a third or fourth Part of the Dose prescribed. But should they not operate in that Quantity, we must be careful not to double the Dose, much less to give a three-fold Quantity, which has sometimes been done, and that even without its Operation, and at the Risque of killing the Patient, which has not seldom been the Consequence. In Case of such purging not ensuing, we should rather give large Draughts of Whey sweetened with Honey, or of warm Water, in a Pot of which an Ounce, or an Ounce and a half of common Salt must be dissolved; and this Quantity is to be taken from time to time in small Cups, moving about with it.

The Fibres of Country People who inhabit the Mountains, and live almost solely on Milk, are so little susceptible of Sensation, that they must take such large Doses to purge them, as would kill all the Peasantry in the Vallies. In the Mountains of Valais there are Men who take twenty, and even twenty-four Grains of Glass of Antimony for a single Dose; a Grain or two of which were sufficient to poison ordinary Men.

Sec. 557. Notwithstanding our Cautions on this important Head, whenever an urgent Necessity commands it, Purging must be recurred to at all Times and Seasons: but when the Season may be safely selected, it were right to decline Purging in the Extremities of either Heat or Cold; and to take the Purge early in the Morning, that the Medicines may find less Obstruction or Embarrassment from the Contents of the Stomach. Every other Consideration, with Relation to the Stars and the Moon, is ridiculous, and void of any Foundation. The People are particularly averse to purging in the Dog-days; and if this were only on Account of the great Heat, it would be very pardonable: but it is from an astrological Prejudice, which is so much the more absurd, as the real Dog-days are at thirty-six Days Distance from those commonly reckoned such; and it is a melancholy Reflection, that the Ignorance of the People should be so gross, in this Respect, in our enlightened Age; and that they should still imagine the Virtue and Efficacy of Medicines to depend on what Sign of the Zodiac the Sun is in, or in any particular Quarter of the Moon. Yet it is certain in this Point, they are so inveterately attached to this Prejudice, that it is but too common to see Country-People die, in waiting for the Sign or Quarter most favourable to the Operation and Effect of a Medicine, which was truly necessary five or six Days before either of them. Sometimes too that particular Medicine is given, to which a certain Day is supposed to be auspicious and favourable, in Preference to that which is most prevalent against the Disease. And thus it is, than an ignorant Almanack Maker determines on the Lives of the human Race; and contracts the Duration of them with Impunity.

Sec. 558. When a Vomit or a Purge is to be taken, the Patient's Body should be prepared for the Reception of it twenty-four Hours beforehand; by taking very little Food, and drinking some Glasses of warm Water, or of a light Tea of some Herbs.

He should not drink after a Vomit, until it begins to work; but then he should drink very plentifully of warm Water, or a light Infusion of Chamomile Flowers, which is preferable.

It is usual, after Purges, to take some thin Broth or Soup during their Operation; but warm Water sweetened with Sugar or Honey, or an Infusion of Succory Flowers, would sometimes be more suitable.

Sec. 559. As the Stomach suffers, in some Degree, as often as either a Vomit, or a Purge, is taken, the Patient should be careful how he lives and orders himself for some Days after taking them, as well in Regard to the Quantity as Quality of his Food.

Sec. 560. I shall say nothing of other Articles taken by Way of Precaution, such as Soups, Whey, Waters, &c. which are but little used among the People; but confine myself to this general Remark, that when they take any of these precautionary Things, they should enter on a Regimen or Way of living, that may co-operate with them, and contribute to the same Purpose. Whey is commonly taken to refresh and cool the Body; and while they drink it, they deny themselves Pulse, Fruits, and Sallads. They eat nothing then, but the best and heartiest Flesh-meats they can come at; such Vegetables as are used in good Soups, Eggs, and good Wine; notwithstanding this is to destroy, by high and heating Aliments, all the attemperating cooling Effects expected from the Whey.

Some Persons propose to cool and attemperate their Blood by Soups and a thin Diet, into which they cram Craw-fish, that heat considerably, or Nasturtium, Cresses which also heat, and thus defeat their own Purpose. Happily, in such a Case, the Error in one Respect often cures that in the other; and these Kinds of Soup, which are in no wise cooling, prove very serviceable, in Consequence of the Cause of the Symptoms, which they were intended to remove, not requiring any Coolers at all.

The general physical Practice of the Community, which unhappily is but too much in Fashion, abounds with similar Errors. I will just cite one, because I have seen its dismal Effects. Many People suppose Pepper cooling, though their Smell, Taste, and common Sense concur to inform them of the contrary. It is the very hottest of Spices.