Chapter XIV: Part 14

But, independently of these external Applications, which are the most effectual ones, when they are directly to be had; whenever the Burn has been very violent, is highly inflamed, and we are apprehensive of the Progress and the Consequences of the Inflammation, the same Means and Remedies must be recurred to, which are used in violent Inflammations: the Patient should be bled, and, if it is necessary, it should be repeated more than once, and he should be put into a Regimen; drink nothing but the Ptisans No. 2 and 4, and receive daily two simple Glysters.

If the Ingredients for the Ointment, called _Nutritum_, are not at Hand to make the Pomatum No. 64; one Part of Wax should be melted in eight such Parts of Oil, to two Ounces of which Mixture the Yolk of an Egg should be added. A still more simple and sooner prepared Application, is that of one Egg, both the Yolk and the White, beat up with two common Spoonfuls of the sweetest Oil, without any Rankness. When the Pain of the Burn, and all its other Symptoms have very nearly disappeared, it is sufficient to apply the Sparadrap, or Oil-cloth No. 66.

_Of Wounds._

Sec. 434. If a Wound has penetrated into any of the Cavities, and has wounded any Part contained in the Breast, or in the Belly: Or if, without having entered into one of the Cavities, it has opened some great Blood-vessel; or if it has wounded a considerable Nerve, which occasions Symptoms much more violent, than would otherwise have happened; if it has penetrated even to and injured the Bone: in short, if any great and severe Symptom supervenes, there is an absolute Necessity for calling in a Surgeon. But whenever the Wound is not attended with any of these Circumstances; when it affects only the Skin, the fat Membrane beneath it, the fleshy Parts and the small Vessels, it may be easily and simply dressed without such Assistance; since, in general, all that is truly necessary in such Cases is, to defend the Wound from the Impressions of the Air; and yet not so, as to give any material Obstruction to the Discharge of the Matter, that is to issue from the Wound.

Sec. 435. If the Blood does not particularly flow out of any considerable Vessel, but trickles almost equally from every Spot of the Wound, it may very safely be permitted to bleed, while some Lint is speedily preparing. As soon as the Lint is ready, so much of it may be introduced into the Wound as will nearly fill it, without being forced in; which is highly improper, and would be attended with the same Inconveniences as Tents and Dossils. It should be covered over with a Compress dipt in sweet Oil, or with the Cerecloth No. 65; though I prefer the Compress for the earliest Dressings: and the whole Dressing should be kept on, with a Bandage of two Fingers Breadth, and of a Length proportioned to the Size of the Part it is to surround: This should be rolled on tight enough to secure the Dressings, and yet so moderately, as to bring on no Inflammation.

This Bandage with these Dressings are to remain on twenty-four or forty-eight Hours; Wounds being healed the sooner, for being less frequently drest. At the second Dressing all the Lint must be removed, which can be done with Ease, and with reasonable Speed, to the Wounded; and if any of it should stick close, in Consequence of the clogged and dried Blood, it should be left behind, adding a little fresh Lint to it; this Dressing in other Respects exactly resembling the first.

When, from the Continuance of this simple Dressing, the Wound is become very superficial, it is sufficient to apply the Cerecloth, or Plaister, without any Lint.

Such as have conceived an extraordinary Opinion of any medical Oils, impregnated with the Virtues of particular Plants, may, if that will increase their Satisfaction, make use of the common Oil of Yarrow, of Trefoil, of Lilies, of Chamomile, of Balsamines, or of red Roses; only being very careful, that such Oils are not become stale and rank.

Sec. 436. When the Wound is considerable, it must be expected to inflame before Suppuration (which, in such a Case, advances more slowly) can ensue; which Inflammation will necessarily be attended with Pain, with a Fever, and sometimes with a Raving, or Wandering, too. In such a Situation, a Pultice of Bread and Milk, with the Addition of a little Oil, that it may not stick too close, must be applied instead of the Compress or the Plaister: which Pultice is to be changed, but without uncovering the Wound, thrice and even four times every Day.

Sec. 437. Should some pretty considerable Blood-vessel be opened by the Wound, there must be applied over it, a Piece of Agaric of the Oak, No. 67, with which no Country place ought to be unprovided. It is to be kept on, by applying a good deal of Lint over it; covering the whole with a thick Compress, and then with a Bandage a little tighter than usual. If this should not be sufficient to prevent the Bleeding from the large Vessel, and the Wound be in the Leg or Arm, a strong Ligature must be made above the Wound with a _Turniquet_, which is made in a Moment with a Skain of Thread, or of Hemp, that is passed round the Arm circularly, into the Middle of which is inserted a Piece of Wood or Stick of an Inch Thickness, and four or five Inches long; so that by turning round this Piece of Wood, any Tightness or Compression may be effected at Pleasure; exactly as a Country-man secures a Hogshead, or a Piece of Timber on his Cart, with a Chain and Ring. But Care must be taken, 1, to dispose the Skain in such a Manner, that it must always be two Inches wider than the Part it surrounds: and, 2, not to strain it so tight as to bring on an Inflammation, which might terminate in a Gangrene.

Sec. 438. All the boasted Virtues of a Multitude of Ointments are downright Nonsense or Quackery. Art, strictly considered, does not in the least contribute to the healing of Wounds; the utmost we can do amounting only to our removing those Accidents, which are so many Obstacles to their Re-union. On this Account, if there is any extraneous Body in the Wound, such as Iron, Lead, Wood, Glass, Bits of Cloth or Linen, they must be extracted, if that can be very easily done; but if not, Application must be made to a good Surgeon, who considers what Measures are to be taken, and then dresses the Wound, as I have already advised.

Very far from being useful, there are many Ointments that are pernicious on these Occasions; and the only Cases in which they should be used, are those in which the Wounds are distinguished with some particular Appearances, which ought to be removed by particular Applications: But a simple recent Wound, in a healthy Man, requires no other Treatment but what I have already directed, besides that of the general Regimen.

Spirituous Applications are commonly hurtful, and can be suitable and proper but in a few Cases, which Physicians and Surgeons only can distinguish.

When Wounds occur in the Head, instead of the Compress dipt in Oil, or of the Cerecloth, the Wound should be covered with a Betony Plaister; or, when none is to be had in time, with a Compress squeezed out of hot Wine.

Sec. 439. As the following Symptoms, of which we should be most apprehensive, are such as attend on Inflammations, the Means we ought to have Recourse to are those which are most likely to prevent them; such as Bleeding, the usual Regimen, moderate Coolers and Glysters.

Should the Wound be very inconsiderable in its Degree, and in its Situation, it may be sufficient to avoid taking any Thing heating; and above all Things to retrench the Use of any strong Drink, and of Flesh-meat.

But when it is considerable, and an Inflammation must be expected, there is a Necessity for Bleeding; the Patient should be kept in the most quiet and easy Situation; he should be ordered immediately to a Regimen; and sometimes the Bleeding also must be repeated. Now all these Means are the more indispensably necessary, when the Wound has penetrated to some internal Part; in which Situation, no Remedy is more certain than that of an extremely light Diet. Such wounded Persons as have been supposed incapable of living many Hours, after Wounds in the Breast, in the Belly, or in the Kidnies, have been completely recovered, by living for the Course of several Weeks, on nothing but a Barley, or other farinaceous mealy, Ptisans, without Salt, without Soup, without any Medicine; and especially without the Use of any Ointments.

Sec. 440. In the same Proportion that Bleeding, moderately and judiciously employed, is serviceable, in that very same an Excess of it becomes pernicious. Great Wounds are generally attended with a considerable Loss of Blood, which has already exhausted the wounded Person; and the Fever is often a Consequence of this copious Loss of Blood. Now if under such a Circumstance, Bleeding should be ordered and performed, the Patient's Strength is totally sunk; the Humours stagnate and corrupt; a Gangrene supervenes, and he dies miserably, at the End of two or three Days, of a _Series_ of repeated Bleedings, but not of the Wound. Notwithstanding the Certainty of this, the Surgeon frequently boasts of his ten, twelve, or even his fifteen Bleedings; assuring his Hearers of the insuperable Mortality of the Wound, since the letting out such a Quantity of Blood could not recover the Patient; when it really was that excessive artificial Profusion of it, that downright dispatched him.------The Pleasures of Love are very mortal ones to the Wounded.

Sec. 441. The Balsams and vulnerary Plants, which have often been so highly celebrated for the Cure of Wounds, are very noxious, when taken inwardly; because the Introduction of them gives or heightens the Fever, which ought to have been abated.

_Of Contusions, or Bruises._

Sec. 442. A Contusion, which is commonly called a Bruise, is the Effect of the forcible Impression or Stroke of a Substance not sharp or cutting, on the Body of a Man, or any Animal; whether such an Impression be violently made on the Man, as when he is struck by a Stick, or by a Stone thrown at him; or whether the Man be involuntarily forced against a Post, a Stone, or any hard Substance by a Fall; or whether, in short, he is squeezed and oppressed betwixt two hard Bodies, as when his Finger is squeezed betwixt the Door and the Door-Post, or the whole Body jammed in betwixt any Carriage and the Wall. These Bruises, however, are still more frequent in the Country than Wounds, and commonly more dangerous too; and indeed the more so, as we cannot judge so exactly, and so soon, of the whole Injury that has been incurred; and because all that is immediately visible of it is often but a small Part of the real Damage attending it: since it frequently happens that no Hurt appears for a few successive Days; nor does it become manifest, until it is too late to admit of an effectual Cure.

Sec. 443. It is but a few Weeks since a Cooper came to ask my Advice. His Manner of breathing, his Aspect, the Quickness, Smallness, and Irregularity of his Pulse, made me apprehensive at once, that some Matter was formed within his Breast. Nevertheless he still kept up, and went about, working also at some Part of his Trade. He had fallen in removing some Casks or Hogsheads; and the whole Weight of his Body had been violently impressed upon the right Side of his Breast. Notwithstanding this, he was sensible of no Hurt at first; but some Days afterwards he began to feel a dull heavy Pain in that Part, which continued and brought on a Difficulty of Breathing, Weakness, broken Sleep and Loss of Appetite. I ordered him immediately to Stillness and Repose, and I advised him to drink a Ptisan of Barley sweetened with Honey, in a plentiful Quantity. He regularly obeyed only the latter Part of my Directions: yet on meeting him a few Days after, he told me he was better. The very same Week, however, I was informed he had been found dead in his Bed. The Imposthume had undoubtedly broke, and suffocated him.

Sec. 444. A young Man, run away with by his Horse, was forced with Violence against a Stable-Door, without being sensible of any Damage at the Time. But at the Expiration of twelve Days, he found himself attacked by some such Complaints, as generally occur at the Beginning of a Fever. This Fever was mistaken for a putrid one, and he was very improperly treated, for the Fever it really was, above a Month. In short, it was agreed at a Consultation, that Matter was collected in the Breast. In Consequence of this, he was more properly attended, and at length happily cured by the Operation for an _Empyema_, after languishing a whole Year. I have published these two Instances, to demonstrate the great Danger of neglecting violent Strokes or Bruises; since the first of these Patients might have escaped Death; and the second a tedious and afflicting Disorder, if they had taken, immediately after each Accident, the necessary Precautions against its Consequences.

Sec. 445. Whenever any Part is bruised, one of two Things always ensues, and commonly both happen together; especially if the Contusion is pretty considerable: Either the small Blood-vessels of the contused Part are broken, and the Blood they contained is spread about in the adjoining Parts; or else, without such an Effusion of it, these Vessels have lost their Tone, their active Force, and no longer contributing to the Circulation, their Contents stagnate. In each of these Cases, if Nature, either without or with the Assistance of Art, does not remove the Impediment, an Inflammation comes on, attended with an imperfect, unkindly Suppuration, with Putrefaction and a Gangrene; without mentioning the Symptoms that arise from the Contusion of some particular Substance, as a Nerve, a large Vessel, a Bone, _&c._ Hence we may also conceive the Danger of a Contusion, happening to any inward Part, from which the Blood is either internally effused, or the Circulation wholly obstructed in some vital Organ. This is the Cause of the sudden Death of Persons after a violent Fall; or of those who have received the violent Force of heavy descending Bodies on their Heads; or of some violent Strokes, without any evident external Hurt or Mark.

There have been many Instances of sudden Deaths after one Blow on the Pit of the Stomach, which has occasioned a Rupture of the Spleen.

It is in Consequence of Falls occasioning a general slight Contusion, as well internal as external, that they are sometimes attended with such grievous Consequences, especially in old Men, where Nature, already enfeebled, is less able to redress such Disorders. And thus in Fact has it been, that many such, who had before enjoyed a firm State of Health, have immediately lost it after a Fall (which seemed at first to have affected them little or not at all) and languished soon after to the Moment of their Death, which such Accidents very generally accelerate.

Sec. 446. Different external and internal Remedies are applicable in Contusions. When the Accident has occurred in a slight Degree, and there has been no great nor general Shock, which might produce an internal Soreness or Contusion, external Applications may be sufficient. They should consist of such Things as are adapted, first, to attenuate and resolve the effused and stagnant Blood, which shews itself so apparently; and which, from its manifest Blackness very soon after the Contusion, becomes successively brown, yellow, and greyish, in Proportions as the Magnitude of the Suffusion or Sealing decreases, till at last it disappears entirely, and the Skin recovers its Colour, without the Blood's having been discharged through the external Surface, as it has been insensibly and gradually dissolved, and been taken in again by the Vessels: And secondly, the Medicines should be such as are qualified to restore the Tone, and to recover the Strength of the affected Vessels.

The best Application is Vinegar, diluted, if very sharp, with twice as much warm Water; in which Mixture Folds of Linnen are to be dipt, within which the contused Parts are to be involved; and these Folds are to be remoistened and re-applied every two Hours on the first Day.

Parsley, Chervil, and Houseleek Leaves, lightly pounded, have also been successfully employed; and these Applications are preferable to Vinegar, when a Wound is joined to the Bruise. The Pultices, No. 68, may also be used with Advantage.

Sec. 447. It has been a common Practice immediately to apply spirituous Liquors, such as Brandy, Arquebussade and [97] Alibour Water, and the like; but a long Abuse ought not to be established by Prescription. These Liquids which coagulate the Blood, instead of resolving it, are truly pernicious; notwithstanding they are sometimes employed without any visible Disadvantage on very slight Occasions. Frequently by determining the settled Blood towards the Insterstices of the Muscles, the fleshy Parts; or sometimes even by preventing the Effusion, or visible Settling of the Blood, and fixing it, as it were, within the bruised Vessels, they seem to be well; though this only arises from their concentring and concealing the Evil, which, at the End of a few Months, breaks forth again in a very troublesome Shape. Of this I have seen some miserable Examples, whence it has been abundantly evinced, that Applications of this Sort should never be admitted; and that Vinegar should be used instead of them. At the utmost it should only be allowed, (after there is Reason to suppose all the stagnant Blood resolved and resorbed into the Circulation) to add a third Part of Arquebusade Water to the Vinegar; with an Intention to restore some Strength to the relaxed and weakened Parts.

[97] This, Dr. _Tissot_ informs me, is a Solution of white Vitriol and
some other Drugs in Spirit of Wine, and is never used in regular
Practice now. It has its Name from the Author of the Solution. _K._

Sec. 448. It is still a more pernicious Practice to apply, in Bruises, Plaisters composed of greasy Substances, Rosins, Gums, Earths, _&c._ The most boasted of these is always hurtful, and there have been many Instances of very slight Contusions being aggravated into Gangrenes by such Plaisters ignorantly applied; which Bruises would have been entirely subdued by the Oeconomy of Nature, if left to herself, in the Space of four Days.

Those Sacs or Suffusions of coagulated Blood, which are visible under the Skin, should never be opened, except for some urgent Reason; since however large they may be, they insensibly disappear and dissipate; instead of which Termination, by opening them, they sometimes terminate in a dangerous Ulceration.

Sec. 449. The internal Treatment of Contusions is exactly the same with that of Wounds; only that in these Cases the best Drink is the Prescription, No. 1, to each Pot of which a Drachm of Nitre must be added.

When any Person has got a violent Fall; has lost his Senses, or is become very stupid; when the Blood starts out of his Nostrils, or his Ears; when he is greatly oppressed, or his Belly feels very tight and tense, which import an Effusion of Blood either into the Head, the Breast or the Belly, he must, first of all, be bled upon the Spot, and all the Means must be recurred to, which have been mentioned Sec. 439, giving the wretched Patient the least possible Disturbance or Motion; and by all means avoiding to jog or shake him, with a Design to bring him to his Senses; which would be directly and effectually killing him, by causing a further Effusion of Blood. Instead of this the whole Body should be fomented, with some one of the Decoctions already mentioned: and when the Violence has been chiefly impressed on the Head, Wine and Water should be prefered to Vinegar.

Falls attended with Wounds, and even a Fracture of the Skull, and with the most alarming Symptoms, have been cured by these internal Remedies, and without any other external Assistance, except the Use of the aromatic Fomentation, No. 68.

A Man from _Pully-petit_ came to consult me some Months ago, concerning his Father, who had a high Fall out of a Tree. He had been twenty-four Hours without Feeling or Sense, and without any other Motion than frequent Efforts to vomit; and Blood had issued both from his Nose and Ears. He had no visible outward Hurt neither on his Head, nor any other Part; and, very fortunately for him, they had not as yet exerted the least Effort to relieve him. I immediately directed a plentiful Bleeding in the Arm; and a large Quantity of Whey sweetened with Honey to be drank, and to be also injected by Way of Glyster. This Advice was very punctually observed; and fifteen Days after the Father came to _Lausanne_, which is four Leagues from _Pully-petit_, and told me he was very well. It is proper, in all considerable Bruises, to open the Patient's Belly with a mild cooling Purge, such as No. 11, 23, 32, 49. The Prescription No. 24, and the honyed Whey are excellent Remedies, from the same Reason.

Sec. 450. In these Circumstances, Wine, distiled Spirits, and whatever has been supposed to revive and to rouse, is mortal. For this Reason People should not be too impatient, because the Patients remain some Time without Sense or Feeling. The giving of Turpentine is more likely to do Mischief than Good; and if it has been sometimes serviceable, it must have been in Consequence of its purging the Patient, who probably then needed to be purged. The Fat of a Whale, (_Sperma caeti_) Dragons Blood, Crabs-Eyes, and Ointments of whatsoever Sort are at least useless and dangerous Medicine, if the Case be very hazardous; either by the Mischief they do, or the Good they prevent from being done. The proper Indication is to dilute the Blood, to render it more fluid and disposed to circulate; and the Medicines just mentioned produce a very contrary Effect.

Sec. 451. When an aged Person gets a Fall, which is the more dangerous in Proportion to his Age and Grossness; notwithstanding he should not seem in the least incommoded by it, if he is sanguine and still somewhat vigorous, he should part with three or four Ounces of Blood. He should take immediately a few successive Cups of a lightly aromatic Drink, which should be given him hot; such, for Instance, as an Infusion of Tea sweetened with Honey, and he should be advised to move gently about. He must retrench a little from the usual Quantity of his Food, and accustom himself to very gentle, but very frequent, Exercise.

Sec. 452. Sprains or Wrenches, which very often happen, produce a Kind of Contusion, in the Parts adjoining to the sprained Joint. This Contusion is caused by the violent Friction of the Bone against the neighbouring Parts; and as soon as the Bones are immediately returned into their proper Situation, the Disorder should be treated as a Contusion. Indeed if the Bones should not of themselves return into their proper natural Position, Recourse must be had to the Hand of a Surgeon.

The best Remedy in this Case is absolute Rest and Repose, after applying a Compress moistened in Vinegar and Water, which is to be renewed and continued, till the Marks of the Contusion entirely disappear; and there remains not the smallest Apprehension of an Inflammation. Then indeed, and not before, a little Brandy or Arquebusade Water may be added to the Vinegar; and the Part (which is almost constantly the Foot) should be strengthened and secured for a considerable Time with a Bandage; as it might otherwise be liable to fresh Sprains, which would daily more and more enfeeble it: and if this Evil is overlooked too much in its Infancy, the Part never recovers its full Strength; and a small Swelling often remains to the End of the Patient's Life.

If the Sprain is very slight and moderate, a Plunging of the Part into cold Water is excellent; but if this is not done at once immediately after the Sprain, or if the Contusion is violent, it is even hurtful.

The Custom of rolling the naked Foot upon some round Body is insufficient, when the Bones are not perfectly replaced; and hurtful, when the Sprain is accompanied with a Contusion.

It happens continually almost that Country People, who encounter such Accidents, apply themselves either to ignorant or knavish Imposters, who find, or are determined to find, a Disorder or Dislocation of the Bones, where there is none; and who, by their violent Manner of handling the Parts, or by the Plaisters they surround them with, bring on a dangerous Inflammation, and change the Patient's Dread of a small Disorder, into a very grievous Malady.

These are the very Persons who have created, or indeed rather imagined, some impossible Diseases, such as the Opening, the Splitting of the Stomach, and of the Kidnies. But these big Words terrify the poor Country People, and dispose them to be more easily and effectually duped.

_Of Ulcers._

Sec. 453. Whenever Ulcers arise from a general Fault of the Blood, it is impossible to cure them, without destroying the Cause and Fuel of them. It is in Fact imprudent to attempt to heal them up by outward Remedies; and a real Misfortune to the Patient, if his Assistant effectually heals and closes them.

But, for the greater Part, Ulcers in the Country are the Consequence of some Wound, Bruise, or Tumour improperly treated; and especially of such as have been dressed with too sharp, or too spirituous Applications. Rancid Oils are also one of the Causes, which change the most simple Wounds into obstinate Ulcers, for which Reason they should be avoided; and Apothecaries should be careful, when they compound greasy Ointments, to make but little at a Time, and the oftner, as a very considerable Quantity of any of them becomes rank before it is all sold; notwithstanding sweet fresh Oil may have been employed in preparing them.

Sec. 454. What serves to distinguish Ulcers from Wounds, is the Dryness and Hardness of the Sides or Borders of Ulcers, and the Quality of the Humour discharged from them; which, instead of being ripe consistent Matter, is a Liquid more thin, less white, sometimes yielding a disagreable Scent, and so very sharp, that if it touch the adjoining Skin, it produces Redness, Inflammation, or Pustules there; sometimes a serpiginous, or Ring-worm like Eruption, and even a further Ulceration.

Sec. 455. Such Ulcers as are of a long Duration, which spread wide, and discharge much, prey upon the Patient, and throw him into a slow Fever, which melts and consumes him. Besides, when an Ulcer is of a long Standing, it is dangerous to dry it up; and indeed this never should be done, but by substituting in the Place of one Discharge that is become almost natural, some other Evacuation, such as Purging from Time to Time.

We may daily see sudden Deaths, or very tormenting Diseases, ensue the sudden drying up such Humours and Drains as have been of a long Continuance: and whenever any Quack (and as many as promise the speedy Cure of such, deserve that Title) assures the Patient of his curing an inveterate Ulcer in a few Days, he demonstrates himself to be a very dangerous and ignorant Intermeddler, who must kill the Patient, if he keeps his Word. Some of these impudent Impostors make use of the most corrosive Applications, and even arsenical ones; notwithstanding the most violent Death is generally the Consequence of them.

Sec. 456. The utmost that Art can effect, with Regard to Ulcers, which do not arise from any Fault in the Humours, is to change them into Wounds. To this End, the Hardness and Dryness of the Edges of the Ulcer, and indeed of the whole Ulcer, must be diminished, and its Inflammation removed. But sometimes the Hardness is so obstinate, that this cannot be mollified any other Way, than by scarifying the Edges with a Lancet. But when it may be effected by other Means, let a Pledget spread with the Ointment, No. 69, be applied all over the Ulcer; and this Pledget be covered again with a Compress of several Folds, moistened in the Liquid, No. 70, which should be renewed three times daily; though it is sufficient to apply a fresh Pledget only twice.

As I have already affirmed that Ulcers were often the Consequence of sharp and spirituous Dressings, it is evident such should be abstained from, without which Abstinence they will prove incurable.

To forward the Cure, salted Food, Spices, and strong Drink should be avoided; the Quantity of Flesh-meat should be lessened; and the Body be kept open by a Regimen of Pulse, of Vegetables, and by the habitual Use of Whey sweetened with Honey.

If the Ulcers are in the Legs, a very common Situation of them, it is of great Importance, as well as in Wounds of the same Parts, that the Patient should walk about but little; and yet never stand up without walking. This indeed is one of these Cases, in which those, who have some Credit and Influence in the Estimation of the People, should omit nothing to make them thoroughly comprehend the Necessity of confining themselves, some Days, to undisturbed Tranquillity and Rest; and they should also convince them, that this Term of Rest is so far from being lost Time, that it is likely to prove their most profitable Time of Life. Negligence, in this material Point, changes the slightest Wounds into Ulcers, and the most trifling Ulcers into obstinate and incurable ones: insomuch that there is scarcely any Man, who may not observe some Family in his Neighbourhood, reduced to the Hospital, [98] from their having been too inattentive to the due Care of some Complaint of this Sort.

[98] This seems just the same as _coming on the Parish_, or being
received into an Alms house here; in Consequence of such an
incurable Disability happening to the poor working Father of a
Family. _K._

I conclude this Article on Ulcers with repeating, that those which are owing to some internal Cause; or even such as happen from an external one, in Persons of a bad Habit of Body, frequently require a more particular Treatment.

_Of Frozen Limbs._

Sec. 457. It is but too common, in very rigorous Winters, for some Persons to be pierced with so violent a Degree of Cold, that their Hands or Feet, or sometimes both together are frozen at once, just like a Piece of Flesh-meat exposed to the Air.

If a Person thus pierced with the Cold, dispose himself to walk about, which seems so natural and obvious a Means to get warm; and especially, if he attempts to [99] warm the Parts that have been frozen, his Case proves irrecoverable. Intolerable Pains are the Consequence, which Pains are speedily attended with an incurable Gangrene; and there is no Means left to save the Patient's Life, but by cutting off the gangrened Limbs.

[99] The Reason of the Fatality of Heat, in these Cases, and of the
Success of an opposite Application, (See Sec. 459) seems strictly and
even beautifully analogous to what _Hippocrates_ has observed of
the Danger, and even Fatality, of all great and sudden Changes in
the human Body, whether from the Weather or otherwise. Whence this
truly great Founder of Physick, when he observes elsewhere, that
Diseases are to be cured by something contrary to their Causes,
very consistently advises, not a direct and violent Contrariety,
but a gradual and regulated one, a _Sub-contrariety_. _K._

There was a very late and terrible Example of this, in the Case of an Inhabitant at _Cossonay_, who had both his Hands frozen. Some greasy Ointments were applied hot to them, the Consequence of which was, the Necessity of cutting off six of his Fingers.

Sec. 458. In short, there is but one certain Remedy in such Cases, and this is to convey the Person affected into some Place where it does not freeze, but where, however, it is but very moderately hot, and there continually to apply, to the frozen Parts, Snow, if it be at hand; and if not, to keep washing them incessantly, but very gently (since all Friction would at this Juncture prove dangerous) in Ice-water, as the Ice thaws in the Chamber. By this Application the Patients will be sensible of their Feeling's returning very gradually to the Part, and that they begin to recover their Motion. In this State they may Safely be moved into a Place a little warmer, and drink some Cups of the Potion No. 13, or of another of the like Quality.

Sec. 459. Every Person may be a competent judge of the manifest Danger of attempting to relieve such Parts by heating them, and of the Use of Ice-water, by a common, a daily Experience. Frozen Pears, Apples, and Radishes, being put into Water just about to freeze, recover their former State, and prove quickly eatable. But if they are put into warm Water, or into a hot Place, Rottenness, which is one Sort of Gangrene, is the immediate Effect. The following Case will make this right Method of treating them still more intelligible, and demonstrate its Efficacy.

A Man was travelling to the Distance of six Leagues in very cold Weather; the Road being covered with Snow and Ice. His Shoes, not being very good, failed him on his March, so that he walked the three last Leagues bare-footed; and felt, immediately after the first Half League, sharp Pains in his Legs and Feet, which increased as he proceeded. He arrived at his Journey's End in a Manner nearly deprived of his lower Extremities. They set him before a great Fire, heated a Bed well, and put him into it. His Pains immediately became intolerable: he was incessantly in the most violent Agitations, and cried out in the most piercing and affecting Manner. A Physician, being sent for in the Night, found his Toes of a blackish Colour, and beginning to lose their Feeling. His Legs and the upper Part of his Feet, which were excessively swelled, of a purplish Red, and varied with Spots of a violet Colour, were still sensible of the most excruciating Pains. The Physician ordered in a Pail of Water from the adjoining River, adding more to it, and some Ice withal. In this he obliged the Patient to plunge his Legs; they were kept in near an Hour, and within that Time, the Pains became less violent. After another Hour he ordered a second cold Bath, from which the Patient perceiving still further Relief, prolonged it to the Extent of two Hours. During that Time, some Water was taken out of the Pail, and some Ice and Snow were put into it. Now his Toes, which had been black, grew red; the violet Spots in his Legs disappeared; the Swelling abated; the Pains became moderate, and intermitted. The Bath was nevertheless repeated six times; after which there remained no other Complaint, but that of a great Tenderness or extraordinary Sensibility in the Soles of his Feet, which hindered him from walking. The Parts were afterwards bathed with some aromatic Fomentations; and he drank a Ptisan of Sarsaparilla [one of Elder Flowers would have answered the same Purpose, and have been less expensive.] On the eighth Day from his Seizure he was perfectly recovered, and returned home on Foot on the fifteenth.

Sec. 460. When cold Weather is extremely severe, and a Person is exposed to it for a long Time at once, it proves mortal, in Consequence of its congealing the Blood, and because it forces too great a Proportion of Blood up to the Brain; so that the Patient dies of a Kind of Apoplexy, which is preceded by a Sleepiness. In this Circumstance the Traveller, who finds himself drowsy, should redouble his Efforts to extricate himself from the eminent Danger he is exposed to. This Sleep, which he might consider as some Alleviation of his Sufferings, if indulged, would prove his last.

Sec. 461. The Remedies in such Cases are the same with those directed in frozen Limbs. The Patient must be conducted to an Apartment rather cold than hot, and be rubbed with Snow or with Ice-water. There have been many well attested Instances of this Method; and as such Cases are still more frequent in more northern Climates, a Bath of the very coldest Water has been found the surest Remedy.

Since it is known that many People have been revived, who had remained in the Snow, or had been exposed to the freezing Air during five, or even six successive Days, and who had discovered no one Mark of Life for several Hours, the utmost Endeavours should be used for the Recovery of Persons in the like Circumstances and Situation.

_Of Kibes, or Chilblains._

Sec. 462. These troublesome and smarting Complaints attack the Hands, Feet, Heels, Ears, Nose and Lips, those of Children especially, and mostly in Winter; when these Extremities are exposed to the sudden Changes from hot to cold, and from cold to hot Weather. They begin with an Inflation or kind of Swelling, which, at first, occasions but little Heat, Pain or Itching. Sometimes they do not exceed this first State, and go off spontaneously without any Application: But at other Times (which may be termed the second Degree of the Disorder, whether it happens from their being neglected, or improperly treated) their Heat, Redness, Itching and Pain increase considerably; so that the Patient is often deprived of the free Use of his Fingers by the Pain, Swelling and Numbness: in which Case the Malady is still aggravated, if effectual Means are not used.

Whenever the Inflammation mounts to a still higher Degree, small Vesications or Blisters are formed, which are not long without bursting; when they leave a slight Excoriation, or Rawness, as it were, which speedily ulcerates, and frequently proves a very deep and obstinate Ulcer, discharging a sharp and ill-conditioned Matter.

The last and most virulent Degree of Chilblains, which is not infrequent in the very coldest Countries, though very rare in the temperate ones, is, when the Inflammation degenerates into a Gangrene.

Sec. 463. These Tumours are owing to a Fulness and Obstruction of the Vessels of the Skin, which occurs from this Circumstance, that the Veins, which are more superficial than the Arteries, being proportionably more affected and straitened by the Cold, do not carry off all the Blood communicated to them by the Arteries; and perhaps also the Particles or Atoms of Cold, which are admitted through the Pores of the Skin, may act upon our Fluids, as it does upon Water, and occasion a Congelation of them, or a considerable Approach towards it.

If these Complaints are chiefly felt, which in Fact is the Case, rather on the extreme Parts than on others, it arises from two Causes, the principal one being, that the Circulation's being weaker at the Extremities than elsewhere, the Effect of those Causes, that may impair it, must be more considerably felt there. The second Reason is, because these Parts are more exposed to the Impressions from without than the others.

They occur most frequently to Children, from their Weakness and the greater Tenderness and Sensibility of their Organs, which necessarily increases the Effect of external Impressions. It is the frequent and strong Alteration from Heat to Cold, that seems to contribute the most powerfully to the Production of Chilblains; and this Effect of it is most considerable, when the Heat of the Air is at the same Time blended with Moisture; whence the extreme and superficial Parts pass suddenly as it were, out of a hot, into a cold, Bath. A Man sixty Years of Age, who never before was troubled with Kibes, having worn, for some Hours on a Journey, a Pair of furred Gloves, in which his Hands sweated, felt them very tender, and found them swelled up with Blood: as the common Effect of the warm Bath is to soften and relax, and to draw Blood abundantly to the bathed Parts, whence it renders them more sensible.

This Man, I say, thus circumstanced, was at that Age first attacked with Chilblains, which proved extremely troublesome; and he was every succeeding Winter as certainly infested with them, within Half an Hour after he left off his Gloves, and was exposed to a very cold Air.

It is for this Reason, that several Persons are never infested with Chilblains, but when they use themselves to Muffs, which are scarcely known in hot Countries; nor are they very common among the more northern ones, in which the extraordinary Changes from Cold to Heat are very rare and unusual.

Some People are subject to this troublesome Complaint in the Fall; while others have it only in the Spring. The Child of a labouring Peasant, who has a hard Skin, and one inured to all the Impressions of the Seasons and of the Elements, is, and indeed necessarily must be, less liable to Kibes, than the Child of a rich Citizen, whose Skin is often cherished, at the Expence of his Constitution. But even among Children of the same Rank in Life and Circumstances, who seem pretty much of the same Complexion, and live much in the same Manner; whence they might of Course be supposed equally liable to the same Impressions, and to the like Effects of them, there is, nevertheless, a very great Difference with Respect to their constitutional Propensity to contract Chilblains. Some are very cruelly tormented with them, from the setting in of Autumn, to the very End of the Spring: others have either none at all, or have them but very slightly, and for a very short Time. This Difference undoubtedly arises from the different Quality of their Humours, and the Texture of their whole Surface, but particularly from that of the Skin of their Hands; though we readily confess it is by no Means easy to determine, with Certainty and Precision, in what this Difference essentially consists.

Children of a sanguine Complexion and delicate Skin are pretty generally subject to this Disorder, which is often regarded much too slightly, though it is really severe enough to engage our Attention more; since, even abstracted from the sharp Pains which smart these unhappy Children for several Months; it sometimes gives them a Fever, hinders them from sleeping, and yet confines them to their Bed, which is very prejudicial to their Constitutions. It also breaks in upon the Order of their different Duties and Employments; it interrupts their innocent salutary Pleasures; and sometimes, when they are obliged to earn their daily Bread by doing some Work or other, it sinks them down to Misery. I knew a young Man, who from being rendered incapable by Chilblains, of serving out his Apprenticeship to a Watch-maker, is become a lazy Beggar.

Chilblains which attack the Nose, often leave a Mark that alters the Physiognomy, the Aspect of the Patient, for the Remainder of his Life: and the Hands of such as have suffered from very obstinate ones, are commonly ever sensible of their Consequences.

Sec. 464. With Respect, therefore, to these afflicting Tumours and Ulcerations, we should, in the first Place, do our utmost to prevent them; and next exert our best Endeavours to cure such as we could not prevent.

Sec. 465. Since they manifestly depend on the Sensibility of the Skin, the Nature of the Humours, and the Changes of the Weather from Heat to Cold, in Order to prevent them, in the first Place, the Skin must be rendered firmer or less tender. 2, That vicious Quality of the Temperament, which contributes to their Existence, must be corrected; and, 3, the Persons so liable must guard themselves as well as possible, against these Changes of the Weather.

Now the Skin of the Hands, as well as that of the whole Body, may be strengthened by that Habit of washing or bathing in cold Water, which I have described at large, Sec. 384; and in Fact I have never seen Children, who had been early accustomed and inured to this Habit, as much afflicted with Chilblains as others. But still a more particular Regard should be had to fortify the Skin of the Hands, which are more obnoxious to this Disorder than the Feet, by making Children dip them in cold Water, and keep them for some Moments together in it every Morning, and every Evening too before Supper, from the very Beginning of the Fall. It will give the Children no Sort of Pain, during that Season, to contract this Habit; and when it is once contracted, it will give them no Trouble to continue it throughout the Winter, even when the Water is ready to freeze every where. They may also be habituated to plunge their Feet into cold Water twice or thrice a Week: and this Method, which might be less adapted for grown Persons, who had not been accustomed to it, must be without Objection with Respect to such Children, as have been accustomed to it; to whom all its Consequences must be useful and salutary.

At the same Time Care must be taken not to defeat or lessen the Effect of the cold bathing, by suffering the Bather or Washer, to grow too warm between two Baths or Dippings; which is also avoiding the too speedy Successions of Heat and Cold. For this Purpose, 1, the Children must be taught never to warm their Hands before the Fire at such Times, and still less before the Stoves, which very probably are one of the principal Causes of Chilblains, that are less usual in Countries which use no such Stoves, and among those Individuals who make the least Use of them, where they are. Above all, the Use of _Cavettes_ (that is, of Seats or little Stairs, as it were, contrived between the Stove and the Wall) is prejudicial to Children, and even to grown People, upon several Accounts. 2, They should never accustom themselves to wear Muffs. 3, It would be also proper they should never use Gloves, unless some particular Circumstances require it; and I recommend this Abstinence from Gloves, especially to young Boys: but if any should be allowed them, let the Gloves be thin and smooth.

Sec. 466. When Chilblains seem to be nourished by some Fault in the Temperament or Humours, the Consideration of a Physician becomes necessary, to direct a proper Method of removing or altering it. I have seen Children from the Age of three, to that of twelve or thirteen Years, in whom their Chilblains, raw and flead, as it were, for eight Months of the Year, seemed to be a particular Kind of Issue, by which Nature freed herself of an inconvenient Superfluity of Humours, when the Perspiration was diminished by the Abatement of the violent Heats. In such Cases I have been obliged to carry them through a pretty long Course of Regimen and Remedies; which, however, being necessarily various from a Variety of Circumstances, cannot be detailed here. The milder Preparations of Antimony are often necessary in such Cases; and some Purges conduce in particular ones to allay and to abridge the Disorder.

Sec. 467. The first Degree of this Complaint goes off, as I have already said, without the Aid of Medicine; or should it prove somewhat more obstinate, it may easily be dissipated by some of the following Remedies. But when they rise to the second Degree, they must be treated like other Complaints from Congelation, or Frost-biting (of which they are the first Degree) with cold Water, Ice-water and Snow.

No other Method or Medicine is nearly as efficacious as very cold Water, so as to be ready to freeze, in which the Hands are to be dipt and retained for some Minutes together, and several Times daily. In short it is the only Remedy which ought to be applied, when the Hands are the Parts affected; when the Patient has the Courage to bear this Degree of Cold; and when he is under no Circumstance which may render it prejudicial. It is the only Application I have used for myself, after having been attacked with Chilblains for some Years past, from having accustomed myself to too warm a Muff.

There ensues a slight Degree of Pain for some Moments after plunging the Hand into Water, but it diminishes gradually. On taking the Hand out, the Fingers are numbed with the Cold, but they presently grow warm again; and within a Quarter of an Hour, it is entirely over.

The Hands, on being taken out of the Water, are to be well dried, and put into Skin Gloves; after bathing three or four Times, their Swelling subsides, so that the Skin wrinkles: but by continuing the cold Bathing, it grows tight and smooth again; the Cure is compleated after using it three or four Days; and, in general, the Disorder never returns again the same Winter.

The most troublesome raging Itching is certainly assuaged by plunging the Hands into cold Water.

The Effect of Snow is, perhaps, still more speedy: the Hands are to be gently and often rubbed with it for a considerable Time; they grow hot, and are of a very high Red for some Moments, but entire Ease very quickly succeeds.

Nevertheless, a very small Number of Persons, who must have extremely delicate and sensible Skins, do not experience the Efficacy of this Application. It seems too active for them; it affects the Skin much like a common blistering Plaister; and by bringing on a large flow of Humours there, it increases, instead of lessening the Complaint.

Sec. 468. When this last Reason indeed, or some other Circumstance exists; such as the Child's Want of Courage, or its Affliction; the monthly Discharges in a Woman; a violent Cough; habitual Colics; and some other Maladies, which have been observed to be renewed or aggravated by the Influence of Cold at the Extremities, do really forbid this very cold Application, some others must be substituted.

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. [100]

[100] 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 [101] _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.

[101] 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.