Chapter X: Part 10

Sec. 276. This Distemper often shifts its Situation; it sometimes retires suddenly; but the Patient is uneasy and disordered; he has a Propensity to vomit, with a sensible Anxiety and Heat: the _Erisipelas_ appears again in a different Part, and he feels himself quite relieved from the preceding Symptoms. But if instead of re-appearing on some other Part of the Surface, the Humour is thrown upon the Brain, or the Breast, he dies within a few Hours; and these fatal Changes and Translations sometimes occur, without the least Reason or Colour for ascribing them either to any Error of the Patient, or of his Physician.

If the Humour has been transferred to the Brain, the Patient immediately becomes delirious, with a highly flushed Visage, and very quick sparkling Eyes: very soon after he proves downright frantic, and goes off in a Lethargy.

If the Lungs are attacked, the Oppression, Anxiety, and Heat are inexpressible.

Sec. 277. There are some Constitutions subject to a very frequent, and, as it were, to an habitual _Erisipelas_. If it often affects the Face, it is generally repeated on the same Side of it, and that Eye is, at length, considerably weakened by it.

Sec. 278. This Distemper results from two Causes; the one, an acrid sharp Humour, which is commonly bilious, diffused through the Mass of Blood; the other consists in that Humour's not being sufficiently discharged by Perspiration.

Sec. 279. When this Disease is of a gentle Nature, such as it is described Sec. 273, it will be sufficient to keep up a very free Perspiration, but without heating the Patient; and the best Method to answer this Purpose is putting him upon the Regimen so often already referred to, with a plentiful Use of Nitre in Elder Tea. Flesh, Eggs and Wine are prohibited of Course, allowing the Patient a little Pulse and ripe Fruits. He should drink Elder Flower Tea abundantly, and take half a Drachm of Nitre every three Hours; or, which amounts to the same Thing, let three Drachms of Nitre be dissolved in as much Infusion of Elder Flowers, as he can drink in twenty-four Hours. Nitre may be given too in a Bolus with Conserve of Elder-berries. These Medicines keep the Body open, and increase Urine and Perspiration.

Sec. 280. When the Distemper prevails in a severer Degree, if the Fever is very high, and the Pulse, at the same Time, strong or hard, it may be necessary to bleed once: but this should never be permitted in a large Quantity at a Time in this Disease; it being more adviseable, if a sufficient Quantity has not been taken at once, to bleed a second Time, and even a third, if the Fever should prove very high, as it often does, and that sometimes in so violent a Degree, as to render it extremely dangerous: and in some such Cases Nature has sometimes saved the Patients by effecting a large Hemorrhage, or Bleeding, to the Quantity of four or five Pounds. This Conduct a very intelligent and prudent Physician may presume to imitate; but I dare not advise the same Conduct to that Class of Physicians, for which only I write: it being safer for them to use repeated Bleedings in such Cases, than one in an excessive Quantity. These erisipelatous Fevers are often excited by a Person's being too long over-heated.

After Bleeding the Patient is to be restrained to his Regimen; Glysters are to be given until there is a sensible Abatement of the Fever; and he should drink the Barley Water freely, No. 3.

When the Fever is somewhat diminished, either the Purge No. 23 should be given, or a few Doses every Morning of Cream of Tartar No. 24. Purging is absolutely necessary to carry off the stagnant Bile, which is generally the first Cause of the violent Degrees of this Distemper. It may sometimes be really necessary too, if the Disease is very tedious; if the Loathing and Sickness at Stomach is obstinate; the Mouth ill-favoured, and the Tongue foul, (provided there be only a slight Fever, and no Fear of an Inflammation) to give the Medicines No. 34 or 35, which, in Consequence of the Agitation, the Shaking they occasion, remove these Impediments still better than Purges.

It commonly happens that this Disease is more favourable after these Evacuations; nevertheless it is sometimes necessary to repeat them the next Day, or the next but one; especially if the Malady affects the Head. Purging is the true Evacuation for curing it, whenever it attacks this Part. By carrying off the Cause of the Disease, they diminish it, and prevent its worst Effects.

Whenever, even after these Evacuations, the Fever still continues to be very severe, the Patient should take every two Hours, or occasionally, oftner, two Spoonfuls of the Prescription No. 10, added to a Glass of Ptisan.

It will be very useful, when this Disease is seated in the Head or Face, to bathe the Legs frequently in warm Water; and where it is violent there, also to apply Sinapisms to the Soles of the Feet. I have seen this Application, in about four Hours attract, or draw down an _Erisipelas_ to the Legs, which had spread over the Nose, and both the Eyes. When the Distemper once begins to go off by Sweating, this should be promoted by Elder-flower Tea and Nitre (See Sec. 279) and the Sweating may be encouraged to Advantage for some Hours.

Sec. 281. The best Applications that can be made to the affected Part are 1st, The Herb Robert, a Kind of _Geranium_, or Crane's-Bill; or Chervil, or Parsley, or Elder Flowers: and if the Complaint be of a very mild Disposition, it may be sufficient to apply a very soft smooth Linen over it, which some People dust over with a little dry Meal.

2, If there is a very considerable Inflammation, and the Patient is so circumstanced as to be very tractable and regularly attended, Flanels wrung out of a strong Decoction of Elder-flowers and applied warm, afford him the speediest Ease and Relief. By this simple Application I have appeased the most violent Pains of a St. Anthony's Fire, which is the most cruel Species of an Erisipelas, and has some peculiar Marks or Symptoms extraordinary.

3, The Plaister of Smalt, and Smalt itself No. 46, are also very successfully employed in this Disease. This Powder, the farinaceous, or mealy ones, or others cried up for it, agree best when a thin watery Humour distills or weeps from the little Vesications attending it, which it is convenient to absorb by such Applications; without which Precaution it might gall, or even ulcerate the Part.

All other Plaisters, which are partly compounded of greasy, or of resinous Substances, are very dangerous: they often repel, or strike in the _Erisipelas_, occasioning it to ulcerate, or even to gangrene. If People who are naturally subject to this Disease should apply any such Plaister to their Skin, even in its soundest State, an _Erisipelas_ is the speedy Consequence.

Sec. 282. Whenever the Humour occasioning the Distemper is repelled, and thrown upon the Brain, the Throat, the Lungs, or any internal Part, the Patient should be bled; Blisters must be applied to the Legs; and Elder Tea, with Nitre dissolved in it, should be plentifully drank.

Sec. 283. People who are liable to frequent Returns of an Erisipelas, should very carefully avoid using Milk, Cream, and all fat and viscid, or clammy Food, Pies, brown Meat, Spices, thick and heady Liquors, a sedentary Life, the more active Passions, especially Rage, and, if possible, all Chagrin too. Their Food should chiefly consist of Herbage, Fruits, of Substances inclining to Acidity, and which tend to keep the Body open; they should drink Water, and some of the light white Wines; by no Means omitting the frequent Use of Cream of Tartar. A careful Conformity to these Regulations is of real Importance, as, besides the Danger of the frequent Visitations of this Disease, they denote some slight Indispositions of the Liver and the Gall-bladder; which, if too little attended to, might in Time prove very troublesome and pernicious.

Such mineral Waters as are gently opening are very proper for these Constitutions, as well as the Juice of Succory, and clarified Whey, of which they should take about three Pints every Morning, during the five or six Summer Months. This becomes still more efficacious, if a little Cream of Tartar and Honey be added to it.

_Of the Stings, or little Wounds, by Animals._

Sec. 284. The Stings or little Bites of Animals, frequently producing a kind of _Erisipelas_, I shall add a very few Words concerning them in this Place.

Of the Serpents in this Country none but the Vipers are poisonous; and none of these are found except at _Baume_, where there is a _Viperary_, if we may be allowed that Word. We have no Scorpions, which are somewhat poisonous; our Toads are not in the least so: whence the only Stings we are exposed to, are those of Bees, Wasps, Hornets, Muskitos or Gnats, and Dragon [71] Flies: all of which are sometimes attended with severe Pain, a Swelling, and a very considerable erisipelatous Redness; which, if it happens in the Face, sometimes entirely closes the Eyes up; occasioning also a Fever, Pains of the Head, Restlessness, and Sickness at Heart; and, when the Pains are in a violent Degree, Faintings and Convulsions, though always without any mortal Consequence. These Symptoms go off naturally within a few Days, without any Assistance: Nevertheless they may either be prevented, diminished in Degree, or shortned in Duration.

[71] These, in some Parts of America, are called Muskito Hawks; but we
do not recollect their biting there. _K._

1, By extracting the Sting of the Animal, if it is left behind.

2, By a continual Application of one of the Remedies directed Sec. 281, Article 1 and 2, particularly the Infusion of Elder-flowers, to which a little Venice Treacle is added; or by covering the Part affected with a Pultice, made of Crum of Bread, Milk, Honey, and a little Venice Treacle. [72]

[72] Pounded Parsley is one of the most availing Applications in such
Accidents. _E.L._

3, By bathing the Legs of the Person stung repeatedly in warm Water.

4, By retrenching a little of their customary Food, especially at Night, and by making them drink an Infusion of Elder-flowers, with the Addition of a little Nitre. Oil, if applied very quickly after the Sting, sometimes prevents the Appearance of any Swelling, and from thence the Pains that attend it.

__Chapter XX.__

_Of spurious, or false Inflammations of the Breast, and of spurious,
bilious, Pleurisies._

__Sect.__ 285.

The Inflammation of the Breast and that Pleurisy, which is called _bilious_, are the same Disease. It is properly a putrid Fever, attended with an Infarction or Stuffing of the Lungs, though without Pain; in which Circumstance it is called a putrid or bilious Peripneumony: but when attended with a Pain of the Side, a Stitch, it is called a spurious or bastard Pleurisy.

Sec. 286. The Signs which distinguish these Diseases from the inflammatory ones of the same Name, described Chap. IV and V, are a less hard and less strong, but a quicker Pulse, though unaccompanied with the same Symptoms which constitute the inflammatory ones (See Sec. 47 and 90). The Mouth is foul, and has a Sensation of Bitterness; the Patient is infested with a sharp and dry Heat; he has a Feeling of Heaviness and Anxiety all about his Stomach, with Loathings: he is less flushed and red in these, than in the inflammatory Diseases, but rather a little yellow. He has a dejected wan Look; his Urine resembles that in putrid Fevers, and not that of inflammatory ones; and he has very often a small bilious Looseness, which is extremely offensive. The Skin is commonly very dry in this Disease; the Humour spit up is less thick, less reddish, and rather more yellow than in the inflammatory Diseases of the same Names.

Sec. 287. They must be treated after the manner of putrid Fevers, as in Sec. 241. Supposing some little Degree of Inflammation to be combined with the Disease, it may be removed by a single Bleeding. After this the Patient is to drink Barley Water No. 3, to make Use of Glysters; and as soon as all Symptoms of any Inflammation wholly disappear, he is to take the vomiting and purging Draught No. 34. But the utmost Caution must be taken not to give it, before every Appearance of any Inflammation is totally removed; as giving it sooner would be certain Death to the Sick: and it is dreadful but to think of agitating, by a Vomit, Lungs that are inflamed, and overloaded with Blood, whose Vessels burst and discharge themselves, only from the Force of Expectoration. After an Interval of some Days, he may be purged again with the Medicine No. 23. The Prescription No. 25 succeeds also very well as a Vomit. If the Fever is violent, he must drink plentifully of the Potion No. 10.

Blisters to the Legs are very serviceable, when the Load and Oppression are not considerably abated after general Evacuations.

Sec. 288. The false Inflammation of the Breast is an Overfulness or Obstruction in the Lungs, accompanied with a Fever; and it is caused by extremely thick and tenacious Humours; and not by a really inflammatory Blood, or by any putrid or bilious Humour.

Sec. 289. This Distemper happens more frequently in the Spring, than in any other Season. Old Men, puny, ill-constitutioned Children, languid Women, feeble young Men, and particularly such as have worn their Constitutions out by drinking, are the Subjects most frequently attacked by it; especially if they have used but little Exercise throughout the Winter: if they have fed on viscid, mealy and fat Aliments, as Pastry, Chesnuts, thick Milk or Pap, and Cheese. All their Humours have contracted a thick glutinous Quality; they are circulated with Difficulty, and when Heat or Exercise in the Spring increases their Motion at once, the Humours, already stuffing up the Lungs, still more augment that Plenitude, whence these vital Organs are fatally extended, and the Patient dies.

Sec. 290. This Distemper is known to exist,

1, By the previous Existence of the Causes already mentioned.

2, By the Symptoms which precede and usher it in. For Example, the Patient many Days before-hand has a slight Cough; a small Oppression when he moves about; a little Restlessness, and is sometimes a little choleric or fretful. His Countenance is higher coloured than in Health; he has a Propensity to sleep, but attended with Confusion and without Refreshment, and has sometimes an extraordinary Appetite.

3, When this State has continued for some Days, there comes on a cold Shivering, though more considerable for its Duration than its Violence; it is succeeded by a moderate Degree of Heat, but that attended with much Inquietude and Oppression. The sick Person cannot confine himself to the Bed; but walks to and fro in his Chamber, and is greatly dejected. The Pulse is weak and pretty quick; the Urine is sometimes but little changed from that in Health; at other Times it is discharged but in a small Quantity, and is higher coloured: he coughs but moderately, and does not expectorate, or cough up, but with Difficulty. The Visage becomes very red, and even almost livid; he can neither keep awake, nor sleep well; he raves for some Moments, and then his Head grows clear again. Sometimes it happens, especially to Persons of advanced Age, that this State suddenly terminates in a mortal Swoon or Fainting: at other Times and in other Cases, the Oppression and Anguish increase; the Patient cannot breathe but when sitting up, and that with great Difficulty and Agony: the Brain is utterly disturbed and embarrassed; this State lasts for some Hours, and then terminates of a sudden.

Sec. 291. This is a very dangerous Distemper; because, in the first Place, it chiefly attacks those Persons whose Temperament and Constitution are deprived of the ordinary Resources for Health and Recovery: in the second Place, because it is of a precipitate Nature, the Patient sometimes dying on the third Day, and but seldom surviving the seventh; while the Cause of it requires a more considerable Term for its Removal or Mitigation. Besides which, if some Indications present for the Employment of a Remedy, there are frequently others which forbid it; and all that seems to be done is, as follows;

1, If the Patient has still a pretty good Share of Health; if he is not of too advanced an Age; if the Pulse has a perceivable Hardness, and yet at the same Time some Strength; if the Weather is dry, and the Wind blows from the North, he should be bled once, to a moderate Quantity. But if the greater Part of these Circumstances are wanting, Bleeding would be very prejudicial. Were we obliged to establish some general and positive Rule in this Case, it were better to exclude Bleeding, than to admit it.

2, The Stomach and the Bowels should be unloaded from their viscid glutinous Contents; and the Medicines which succeed the best in this Respect are No. 35, when the Symptoms shew there is a great Necessity for vomiting, and there is no Inflammation; or the Prescription No. 25, which after vomiting, purges by Stool, promotes Urine, breaks down and divides the viscid Humours that occasion the Disease, and increase Perspiration. When we are afraid of hazarding the Agitation of a Vomit and its Consequences, the Potion, No. 11 may be given; but we must be very cautious, in Regard to old Men, even with this; as such may expire during the Operation of it.

3, They should, from the Beginning of the Disease, drink plentifully of the Ptisan No. 26, which is the best Drink in this Disease; or that of No. 12, adding half a Dram of Nitre to every Pint of it.

4, A Cup of the Mixture No. 8 must be taken every two Hours.

5. Blisters are to be applied to the Insides of the Legs.

When the Case is very doubtful and perplexing, it were best to confine ourselves to the three last-mentioned Remedies, which have often been successful in severe Degrees of this Disease; and which can occasion no ill Consequence.

Sec. 292. When this Malady invades old People, though they partly recover, they never recover perfectly, entirely, from it: and if due Precaution is not taken, they are very liable to fall into a Dropsy of the Breast after it.

Sec. 293. The spurious or false Pleurisy is a Distemper that does not affect the Lungs, but only the Teguments, the Skin, and the Muscles which cover the Ribs. It is the Effect of a rheumatic Humour thrown upon these Parts, in which, as it produces very sharp Pains resembling that which is called a _Stitch_, it has from this Circumstance, been termed a Pleurisy.

It is generally supposed by the meer Multitude, and even by some of a different Rank, that a false Pleurisy is more dangerous than a genuine, a true one; but this is a Mistake. It is often ushered in by a Shivering, and almost ever attended with a little Fever, a small Cough, and a slight Difficulty of breathing; which, as well as the Cough, is occasioned from the Circumstance of a Patient's (who feels Pain in Respiration, or Breathing) checking Breathing as much as he can; this accumulates a little too much Blood in the Lungs; but yet he has no Anguish, nor the other Symptoms of acute true Pleurisies. In some Patients this Pain is extended, almost over the whole Breast, and to the Nape of the Neck. The sick Person cannot repose himself on the Side affected.

This Disorder is not more dangerous than a Rheumatism, except in two Cases; 1, When the Pain is so very severe, that the Patient strongly endeavours not to breathe at all, which brings on a great Infarction or Stoppage in the Lungs. 2, When this Humour, like any other rheumatic one, is transferred to some internal Part.

Sec. 294. It must be treated exactly like a Rheumatism. See Sec. 168 and 169.

After bleeding once or more, a Blister applied to the affected Part is often attended with a very good Effect: This being indeed the Kind of [73] Pleurisy, in which it particularly agrees.

[73] The Seneka Rattle-Snake root, already recommended in true
Pleurisies, will, with the greatest Probability, be found not less
effectual in these false ones, in which the Inflammation of the
Blood is less. The Method of giving it may be seen P. 118,
N. ([26].) By Dr. _Tissot's_ having never mentioned this valuable
Simple throughout his Work, it may be presumed, that when he wrote
it, this Remedy had not been admitted into the Apothecaries Shops
in _Swisserland_. _K._

Sec. 295. This Malady sometimes gives Way to the first Bleeding; often terminating on the third, fourth or fifth Day, by a very plentiful Sweat, and rarely lasting beyond the seventh. Sometimes it attacks a Person very suddenly, after a Stoppage of Perspiration; and then, if at once before the Fever commences, and has had Time to inflame the Blood, the Patient takes some _Faltrank_, it effects a speedy Cure by restoring Perspiration. They are such Cases as these, or that mentioned Sec. 96, which have given this Composition the Reputation it has obtained in this Disease: a Reputation nevertheless, which has every Year proved tragical in its Consequences to many Peasants, who being deceived by some misleading Resemblances in this Distemper, have rashly and ignorantly made Use of it in true inflammatory Pleurisies.

__Chapter XXI.__

_Of the Cholic and its different Kinds._

__Sect.__ 296.

The Appellation of a Cholic is commonly given to all Pains of the Belly indiscriminately; but I apply it in this Place only to such as attack the Stomach, or the Intestines, the Guts.

Cholics may and do result from very many Causes; and the greater Number of Cholics are chronical or tedious Complaints, being more common among the inactive Inhabitants of Cities, and Workmen in sedentary Trades, than among Country People. Hence I shall treat here only of the small Variety of Cholics, which happen the most usually in Villages. I have already proved that the fatal Events of some Distempers were occasioned by endeavouring to force the Patients into Sweats; and the same unhappy Consequences have attended Cholics, from accustoming the Subjects of this Disease to Drams, and hot inflaming spirituous Liquors, with an Intention to expel the Wind.

_Of the inflammatory Cholic._

Sec. 297. The most violent and dangerous kind of Cholic is that, which arises from an Inflammation of the Stomach, or of the Intestines. It begins most commonly without any Shivering, by a vehement Pain in the Belly, which gradually becomes still more so. The Pulse grows quick and hard; a burning Pain is felt through the whole Region of the Belly; sometimes there is a watery _Diarrhoea_, or Purging; at other Times the Belly is rather costive, which is attended with Vomiting, a very embarrassing and dangerous Symptom: the Countenance becomes highly flushed; the Belly tense and hard; neither can it be touched scarcely without a cruel Augmentation of the Patient's Pain, who is also afflicted with extreme Restlessness; his Thirst is very great, being unquenchable by Drink; the Pain often extends to the Loins, where it proves very sharp, and severe; little Urine is made, and that very red, and with a kind of burning Heat. The tormented Patient has not a Moment's Rest, and now and then raves a little. If the Disease is not removed or moderated, before the Pains rise to their utmost Height and Violence, the Patient begins at length to complain less; the Pulse becomes less strong and less hard than before, but quicker: his Face first abates of its Flush and Redness, and soon after looks pale; the Parts under the Eyes become livid; the Patient sinks into a low stupid Kind of _Delirium_, or Raving; his Strength entirely deserts him; the Face, Hands, Feet, and the whole Body, the Belly only excepted, become cold: the Surface of the Belly appears bluish; extreme Weakness follows, and the Patient dies. There frequently occurs, just a Moment before he expires, an abundant Discharge of excessively foetid Matter by Stool; and during this Evacuation he dies with his Intestines quite gangrened, or mortified.

When the Distemper assaults the Stomach, the Symptoms are the very same, but the Pain is felt higher up, at the Pit of the Stomach. Almost every thing that is swallowed is cast up again; the Anguish of the tortured Patient is terrible, and the Raving comes on very speedily. This Disease proves mortal in a few Hours.

Sec. 298. The only Method of succeeding in the Cure of it is as follows:

1, Take a very large Quantity of Blood from the Arm; this almost immediately diminishes the Violence of the Pains, and allays the Vomiting: besides its contributing to the greater Success of the other Remedies. It is often necessary to repeat this Bleeding within the Space of two Hours.

2, Whether the Patient has a Looseness, or has not, a Glyster of a Decoction of Mallows, or of Barley Water and Oil, should be given every two Hours.

3, The Patient should drink very plentifully of Almond Milk No. 4; or a Ptisan of Mallow Flowers, or of Barley, all which should be warm.

4, Flanels dipt in hot, or very warm Water should be continually applied over the Belly, shifting them every Hour, or rather oftner; for in this Case they very quickly grow dry.

5, If the Disease, notwithstanding all this, continues very obstinate and violent, the Patient should be put into a warm Water Bath, the extraordinary Success of which I have observed.

When the Distemper is over, that is to say, when the Pains have terminated, and the Fever has ceased, so that the Patient recovers a little Strength, and gets a little Sleep, it will be proper to give him a Purge, but a very gentle one. Two Ounces of Manna, and a Quarter of an Ounce of Sedlitz [74] Salt dissolved in a Glass of clear Whey is generally sufficient, at this Period, to purge the most robust and hardy Bodies. Manna alone may suffice for more delicate Constitutions: as all acrid sharp Purges would be highly dangerous, with Regard to the great Sensibility and tender Condition of the Stomach, and of the Intestines after this Disease.

[74] Glauber or Epsom Salt may be substituted, where the other is not to
be readily procured. _K._

Sec. 299. It is sometimes the Effect of a general Inflammation of the Blood; and is produced, like other inflammatory Diseases, by extraordinary Labour, very great Heat, heating Meats or Drinks, _&c._ It is often the Consequence of other Cholics which have been injudiciously treated, and which otherwise would not have degenerated into inflammatory ones; as I have many Times seen these Cholics introduced after the Use of heating Medicines; one Instance of which may be seen Sec. 164.

Sec. 300. Ten Days after I had recovered a Woman out of a severe Cholic, the Pains returned violently in the Night. She, supposing them to arise only from Wind, hoped to appease them by drinking a deal of distilled Walnut Water; which, far from producing any such Effect, rendered them more outrageous. They soon were heightened to a surprising Degree, which might reasonably be expected. Being sent for very early in the Morning, I found her Pulse hard, quick, short; her Belly was tense and hard; she complained greatly of her Loins: her Urine was almost entirely stopt. She past but a few Drops, which felt as it were scalding hot, and these with excessive Pain. She went very frequently to the Close-stool, with scarcely any Effect; her Anguish, Heat, Thirst, and the Dryness of her Tongue were even terrifying: and her wretched State, the Effect of the strong hot Liquor she had taken, made me very apprehensive for her. One Bleeding, to the Quantity of fourteen Ounces, somewhat abated all the Pains; she took several Glysters, and drank off a few Pots of _Orgeat_ in a few Hours. By these Means the Disease was a little mitigated; by continuing the same Drink and the Glysters the Looseness abated; the Pain of the Loins went off, and she passed a considerable Quantity of Urine, which proved turbid, and then let fall a Sediment, and the Patient recovered. Nevertheless I verily believe, if the Bleeding had been delayed two Hours longer, this spirituous Walnut Water would have been the Death of her. During the Progress of this violent Disease, no Food is to be allowed; and we should never be too inattentive to such Degrees of Pain, as sometimes remain after their Severity is over; lest a _Scirrhus_, an inward hard Tumour, should be generated, which may occasion the most inveterate and tedious Maladies.

Sec. 301. An Inflammation of the Intestines, and one of the Stomach, may also terminate in an Abscess, like an Inflammation of any other Part; and it may be apprehended that one is forming, when, though the Violence of the Pains abates, there still remains a slow, obtuse, heavy Pain, with general Inquietude, little Appetite, frequent Shiverings; the Patient at the same Time not recovering any Strength. In such Cases the Patient should be allowed no other Drinks, but what are already directed in this Chapter, and some Soops made of Pulse, or other farinaceous Food.

The Breaking of the Abscess may sometimes be discovered by a slight Swoon or fainting Fit; attended with a perceivable Cessation of a Weight or Heaviness in the Part, where it was lately felt: and when the _Pus_, or ripe Matter, is effused into the Gut, the Patient sometimes has Reachings to vomit, a _Vertigo_, or Swimming in the Head, and the Matter appears in the next Stools. In this Case there remains an Ulcer within the Gut, which, if either neglected, or improperly treated, may pave the Way to a slow wasting Fever, and even to Death. Yet this I have cured by making the Patient live solely upon skimmed Milk, diluted with one third Part Water, and by giving every other Day a Glyster, consisting of equal Parts of Milk and Water, with the Addition of a little Honey.

When the Abscess breaks on the Outside of the Gut, and discharges its Contents into the Cavity of the Belly, it becomes a very miserable Case, and demands such further Assistance as cannot be particularized here.

_Of the bilious Cholic._

Sec. 302. The bilious Cholic discovers itself by very acute Pains, but is seldom accompanied with a Fever; at least not until it has lasted a Day or two. And even if there should be some Degree of a Fever, yet the Pulse, though quick, is neither strong nor hard: the Belly is neither tense or stretched as it were, nor burning hot, as in the former Cholic: the Urine comes away with more Ease, and is less high-coloured: Nevertheless the inward Heat and Thirst are considerable; the Mouth is bitter; the Vomiting or Purging, when either of them attend it, discharge a yellowish Humour or Excrement; and the Patient's Head is often vertiginous or dizzy.

Sec. 303. The Method of curing this is,

1, By injecting Glysters of Whey and Honey; or, if Whey is not readily procurable, by repeating the Glyster, No. 5.

2, By making the Sick drink considerably of the same Whey, or of a Ptisan made of the Root of Dog's-Grass (the common Grass) and a little Juice of Lemon, for want of which, a little Vinegar and Honey may be substituted instead of it. [75]

[75] Pullet, or rather Chicken Water, but very weak, may often do
instead of Ptisan, or serve for a little Variety of Drink to some
Patients. _E. L._--K.

3, By giving every Hour one Cup of the Medicine No. 32; or where this is not to be had, half a Drachm of Cream of Tartar at the same short Intervals.

4, Fomentations of warm Water and Half-baths are also very proper.

5, If the Pains are sharp and violent, in a robust strong Person, and the Pulse is strong and tense, Bleeding should be used to prevent an Inflammation.

6, No other Nourishment should be given, except some maigre Soops, made from Vegetables, and particularly of Sorrel.

7, After plentiful Dilution with the proper Drink, if no Fever supervenes; if the Pains still continue, and the Patient discharges but little by Stool, he should take a moderate Purge. That directed No. 47 is a very proper one.

Sec. 304. This bilious Cholic is habitual to many Persons; and may be prevented or greatly mitigated by an habitual Use of the Powder No. 24; by submitting to a moderate Retrenchment in the Article of Flesh-meat; and by avoiding heating and greasy Food, and the Use of Milk.

_Of Cholics from Indigestions, and of Indigestion._

Sec. 305. Under this Appellation I comprehend all those Cholics, which are either owing to any overloading Quantity of Food taken at once; or to a Mass or Accumulation of Aliments formed by Degrees in such Stomachs, as digest but very imperfectly; or which result from noxious Mixtures of Aliment in the Stomach, such as that of Milk and Acids; or from Food either not wholesome in its self, or degenerated into an unwholesome Condition.

This kind of Cholic may be known from any of these Causes having preceded it; by its Pains, which are accompanied with great Restlessness, and come on by Degrees, being less fixed than in the Cholics before treated of. These Cholics are also without any Fever, Heat or Thirst, but accompanied with a Giddiness of the Head, and Efforts to vomit, and rather with a pale, than a high-coloured Visage.

Sec. 306. These Disorders, from these last Causes, are scarcely ever dangerous in themselves; but may be made such by injudicious Management, and doing more than is necessary or proper: as the only Thing to be done is to promote the Discharges by warm Drinks. There are a considerable Variety of them, which seem equally good, such as warm Water, or even cold Water with a Toast, with the Addition either of a little Sugar, or a little Salt: a light Infusion of Chamomile, or of Elder-flowers, common Tea, or Baum, it imports little which, provided the Patient drink plentifully of them: in Consequence of which the offending Matter is discharged, either by vomiting, or a considerable purging; and the speedier and more in Quantity these Discharges are, the sooner the Patient is relieved.

If the Belly is remarkably full and costive, Glysters of warm Water and Salt should be injected.

The Expulsion of the obstructing Matter is also facilitated, by rubbing the Belly heartily with hot Cloths.

Sometimes the Humours, or other retained Contents of the Belly, are more pernicious from their Quality, than their Quantity; and then the Malady may be dissipated without the former Discharges, by the irritating sharp Humour being diluted, or even drowned, as it were, in the Abundance of small watery Drinks. When the Pains invade first in the Stomach, they become less sharp, and the Patient feels less Inquietude, as soon as the Cause of the Pain has descended out of the Stomach into the Intestines, whose Sensations are something less acute than, or somewhat different from, those of the Stomach.

It is often found that after these plentiful Discharges, and when the Pains are over, there remains a very disagreeable Taste in the Mouth, resembling the Savour of rotten Eggs. This may be removed by giving some Doses of the Powder No. 24, and drinking largely of good Water:

It is an essential Point in these Cases, to take no Food before a perfect Recovery.

Sec. 307. Some have been absurd enough in them, to fly at once to some heating Cordial Confection, to Venice Treacle, Aniseed Water, Geneva, or red Wine to stop these Evacuations; but there cannot be a more fatal Practice: since these Evacuations are the only Thing which can cure the Complaint, and to stop them is to deprive the Person, who was in Danger of drowning, of the Plank which might save him. Nay should this Endeavour of stopping them unhappily succeed, the Patient is either thrown into a putrid Fever, or some chronical tedious Malady; unless Nature, much wiser than such a miserable Assistant, should prevail over the Obstacles opposed to her Recovery, and restore the obstructed Evacuations by her own Oeconomy, in the Space of a few Days.

Sec. 308. Sometimes an Indigestion happens, with very little Pain or Cholic, but with violent Reachings to vomit, inexpressible Anguish, Faintings, and cold Sweats: and not seldom also the Malady begins, only with a very sudden and unexpected Fainting: the Patient immediately loses all his Senses, his Face is pale and wan: he has some Hickups rather than Reachings to vomit, which joined to the Smallness of his Pulse, to the Easiness of his respiring, or breathing, and to the Circumstance of his being attacked immediately, or very soon, after a Meal, makes this Disorder distinguishable from a real Apoplexy. Nevertheless, when it rises to this Height, with these terrible Symptoms, it sometimes kills in a few Hours. The first thing to be done is to throw up a sharp Glyster, in which Salt and Soap are to be dissolved; next to get down as much Salt and Water as he can swallow; and if that is ineffectual, the Powder No. 34 is to be dissolved in three Cups of Water; one half of which is to be given directly; and, if it does not operate in a Quarter of an Hour, the other half. Generally speaking the Patient's Sense begins to return, as soon as he begins to vomit.

_Of the flatulent or windy Cholic._

Sec. 309. Every Particular which constitutes our Food, whether solid or liquid, contains much Air, but some of them more than others. If they do not digest soon enough, or but badly, which occasions a sensible Escape of such Air; if they are such as contain an extraordinary Quantity of Air; or if the Guts being straitened or compressed any where in the Course of their Extent, prevent that Air from being equally diffused (which must occasion a greater Proportion of it in some Places) then the Stomach and the Guts are distended by this Wind; and this Distention occasions these Pains, which are called flatulent, or windy.

This Sort of Cholic rarely appears alone and simple; but is often complicated with, or added, as it were, to the other Sorts, of which it is a Consequence; and is more especially joined with the Cholic from Indigestions, whose Symptoms it multiplies and heightens. It may be known, like that, by the Causes which have preceded it, by its not being accompanied either with Fever, Heat, or Thirst; the Belly's being large and full, though without Hardness, being unequal in its Largeness, which prevails more in one Part of it than in another, forming something like Pockets of Wind, sometimes in one Part, sometimes in another; and by the Patient's feeling some Ease merely from the rubbing of his Belly, as it moves the Wind about; which escaping either upwards or downwards affords him still a greater Relief.

Sec. 310. When it is combined with any different Species of the Cholic, it requires no distinct Treatment from that Species; and it is removed or dissipated by the Medicines which cure the principal Disease.

Sometimes however it does happen to exist alone, and then it depends on the Windiness of the solid and liquid Food of the Person affected with it, such as the _Must_ or new Wine, Beer, especially very new Beer, certain Fruits and Garden-stuff. It may be cured by a Glyster; by chaffing the Belly with hot Cloths; by the Use of Drink moderately spiced; and especially by Camomile Tea, to which a little cordial Confection, or even Venice Treacle, may be added. When the Pains are almost entirely vanished, and there is no Fever, nor any unhealthy Degree of Heat; and if the Patient is sensible of a Weakness at Stomach, he may take a little aromatic, or spiced Wine, or even a small cordial stomachic Dram. It should be observed, that these are not to be allowed in any other Kind of Cholic.

Sec. 311. When any Person is frequently subject to cholic-like Pains, it is a Proof that the digestive Faculty is impaired; the restoring of which should be carefully attended to; without which the Health of the Patient must suffer considerably, and he must be very likely to contract many tedious and troublesome Disorders.

_Of Cholics from Cold._

Sec. 312. When any Person has been very cold, and especially in his Feet, it is not uncommon for him to be attacked, within a few Hours after it, with violent Cholic Pains, in which heating and spirituous Medicines are very pernicious: but which are easily cured by rubbing the Legs well with hot Cloths; and keeping them afterwards for a considerable Time in warm Water; advising them at the same Time to drink freely of a light Infusion of Chamomile or Elder-flowers.

The Cure will be effected the sooner, if the Patient is put to Bed and sweats a little, especially in the Legs and Feet.

A Woman who had put her Legs into a pretty cool Spring, after travelling in the Height of Summer, was very quickly after attacked with a most violent Cholic. She took different hot Medicines; she became still worse; she was purged, but the Distemper was still further aggravated. I was called in on the third Day, a few Hours before her Decease.

In such Cases, if the Pain be excessive, it may be necessary to bleed; [76] to give a Glyster of warm Water; to keep the Legs several Hours over the Steam of hot Water, and afterwards in the Water; to drink plentifully of an Infusion of the Flowers of the Lime-tree, with a little Milk; and if the Distemper is not subdued by these Means, Blisters should be applied to the Legs, which I have known to be highly efficacious.

[76] Bleeding should not be determined on too hastily in this Sort of
Cholic, but rather be omitted, or deferred at least, till there be
an evident Tendency to an Inflammation. _E. L._

The Propriety or Impropriety of Bleeding in a Cholic from this
Cause should be determined, I think, from the State of the Person
it happens to: So that Bleeding a strong Person with a firm Fibre,
and a hard Pulse, may be very prudent and precautionary: But if it
be a weakly lax Subject with a soft and low Pulse, there may be
Room either for omitting, or for suspending it. _K._

Sec. 313. It appears, through the Course of this Chapter, that it is necessary to be extremely on our Guard, against permitting the Use of heating and spirituous Medicines in Cholics, as they may not only aggravate, but even render them mortal. In short they should never be given, and when it is difficult to discover the real Cause of the Cholic, I advise Country People to confine themselves to the three following Remedies, which cannot be hurtful in any Sort of Cholic, and may remove as many as are not of a violent Nature. First then, let Glysters be frequently repeated. 2, Let the Patient drink warm Water plentifully, or Elder Tea. 3, Let the Belly be often fomented in pretty warm Water, which is the most preferable Fomentation of any.

Sec. 314 I have said nothing here of the Use of any Oils in this Disease, as they agree but in very few Species of Cholics, and not at all in those of which I have been treating. For this Reason I advise a total Disuse of them, since they may be of bad Consequence in many Respects.

Sec. 315. Chronical Diseases not coming within the Plan of this Work, I purposely forbear treating of any Kind of those tedious Cholics, which afflict some People for many Years: but I think it my Duty to admonish such, that their Torments being very generally occasioned by Obstructions in the _Viscera_, or different Bowels of the Belly, or by some other Fault, and more particularly in those Organs, which are intended to prepare the Bile, they should, 1, avoid with the greatest Care, the Use of sharp, hot, violent Medicines, Vomits, strong Purges, Elixirs, _&c._ 2, They should be thoroughly on their Guard against all those, who promise them a very speedy Cure, by the Assistance of some specific Remedy; and ought to look upon them as Mountebanks, into whose Hands it is highly dangerous to trust themselves. 3, They should be persuaded, or rather convinced, that they can entertain no reasonable Hope of being cured, without an exact Conformity to a proper and judicious Regimen, and a long Perseverance in a Course of mild and safe Remedies. 4, They should continually reflect with themselves, that there is little Difficulty in doing them great Mischief; and that their Complaints are of that Sort, which require the greatest Knowledge and Prudence in those Persons, to whom the Treatment and Cure of them are confided.

__Chapter XXII.__

_Of the Iliac Passion, and of the Cholera-morbus._

__Sect.__ 316.

These violent Diseases are fatal to many Country People, while their Neighbours are frequently so ignorant of the Cause of their Death, that Superstition has ascribed it to Poison, or to Witchcraft.

Sec. 317. The first of these, the _Miserere_, or Iliac Passion, is one of the most excruciating Distempers. If any Part of the Intestines, the Cavity of the Guts is closed up, whatever may have occasioned it, the Course or Descent of the Food they contain is necessarily stopped; in which Case it frequently happens, that that continual Motion observed in the Guts of a living Animal dissected, and which was intended to detrude, or force their Contents downwards, is propagated in a directly contrary Manner, from the Guts towards the Mouth.

This Disease sometimes begins after a Constipation, or Costiveness, of some Days; at other Times without that Costiveness having been preceded by Pains in any Part of the Belly, especially around the Navel; but which Pains, gradually increasing after their Commencement, at length become extremely violent, and throw the Patient into excessive Anguish. In some of these Cases a hard Tumour may be felt, which surrounds the Belly like a Cord. The Flatulences within become very audible, some of them are discharged upwards; in a little Time after, Vomitings come on, which increase till the Patient has thrown up all he had taken in, with a still further Augmentation of the excessive Pain. With the first of his Vomitings he only brings up the last Food he had taken, with his Drink and some yellowish Humour: but what comes up afterwards proves stinking; and when the Disease is greatly heightened, they have what is called the Smell of Excrement or Dung; but which rather resembles that of a putrid dead Body. It happens too sometimes, that if the Sick have taken Glysters composed of Materials of a strong Smell, the same Smell is discernible in the Matter they vomit up. I confess however I never saw either real Excrements, or the Substance of their Glysters, brought up, much less the Suppositories that were introduced into the Fundament: and were it credible that Instances of this Kind had occurred, they must be allowed very difficult to account for. Throughout this whole Term of the Disease, the Patient has not a single Discharge by Stool; the Belly is greatly distended; the Urine not seldom suppressed, and at other Times thick and foetid. The Pulse, which at first was pretty hard, becomes quick and small; the Strength entirely vanishes; a Raving comes on; a Hiccup almost constantly supervenes, and sometimes general Convulsions; the Extremities grow cold, the Pulse scarcely perceivable; the Pain and the Vomiting cease, and the Patient dies very quickly after.

Sec. 318. As this Disease is highly dangerous, the Moment it is strongly apprehended, it is necessary to oppose it by proper Means and Remedies: the smallest Error may be of fatal Consequence, and hot inflaming Liquids have been known to kill the Patient in a few Hours. I was called in the second Day of the Disease to a young Person, who had taken a good deal of Venice Treacle: Nothing could afford her any Relief, and she died early on the third Day.

This Disease should be treated precisely in the same Manner as an inflammatory Cholic; the principal Difference being, that in the former there are no Stools, but continual Vomitings.

1, First of all then the Patient should be plentifully bled, if the Physician has been called in early enough, and before the Sick has lost his Strength.

2, He should receive opening Glysters made of a Decoction of Barley Water, with five or six Ounces of Oil in each.

3, We should endeavour to allay the violent Efforts to vomit, by giving every two Hours a Spoonful of the Mixture No. 48.

4, The Sick should drink plentifully, in very small Quantities, very often repeated, of an appeasing, diluting, refreshing Drink, which tends at the same Time to promote both Stools and Urine. Nothing is preferable to the Whey No. 49, if it can be had immediately: if not, give simple clear Whey sweetened with Honey, and the Drinks prescribed Sec. 298, Art. 3.

5, The Patient is to be put into a warm Bath, and kept as long as he can bear it, repeating it as often daily too, as his Strength will permit.

6, After Bleeding, warm Bathing, repeated Glysters and Fomentations, if each and all of these have availed nothing; the Fume or Smoak of Tobacco may be introduced in the Manner of a Glyster, of which I shall speak further, in the Chapter on Persons drowned.

I cured a Person of this Disease, by conveying him into a Bath, immediately after bleeding him, and giving him a Purge on his going into the Bath.

Sec. 319. If the Pain abates before the Patient has quite lost his Strength; if the Pulse improves at the same Time; if the Vomitings are less in Number, and in the Quantity of the Matter brought up; if that Matter seems in a less putrid offensive State; if he feels some Commotion and Rumbling in his Bowels; if he has some little Discharge by Stool; and if at the same Time he feels himself a little stronger than before, his Cure may reasonably be expected; but if he is otherwise circumstanced he will soon depart. It frequently happens, a single Hour before Death, that the Pain seems to vanish, and a surprising Quantity of extremely foetid Matter is discharged by Stool: the Patient is suddenly seized with a great Weakness and Sinking, falls into a cold Sweat, and immediately expires.

Sec. 320. This is the Disease which the common People attribute to, and term, the _Twisting of the Guts_; and in which they make the Patients swallow Bullets, or large Quantities of Quick-silver. This twisting, tangling, or Knoting of the Guts is an utter, an impossible Chimera; for how can they admit of such a Circumstance, as one of their Extremities, their Ends, is connected to the Stomach, and the other irremoveably fastened to the Skin of the Fork or Cleft of the Buttocks? In Fact this Disease results from a Variety of Causes, which have been discovered on a Dissection of those who have died of it. It were to be wished indeed this prudent Custom, so extremely conducive to enrich, and to perfect, the Art of Physick, were to prevail more generally; and which we ought rather to consider as a Duty to comply with, than a Difficulty to submit to; as it is our Duty to contribute to the Perfection of a Science, on which the Happiness of Mankind so considerably depends. I shall not enter into a Detail of these Causes; but whatever they are, the Practice of swallowing Bullets in the Disease is always pernicious, and the like Use of Mercury must be often so. Each of these pretended Remedies may aggravate the Disease, and contribute an insurmountable Obstacle to the Cure--Of that Iliac Passion, which is sometimes a Consequence of Ruptures, I shall treat in another Place.

_Of the Cholera-morbus._

Sec. 321. This Disease is a sudden, abundant, and painful Evacuation by vomiting and by Stool.