Chapter XVII: Part II: Of Diseases (7)

CAUSES.——The stone and gravel may be occasioned by high living; the use of strong astringent wines; a sedentary life; lying too hot, soft, or too much on the back; the constant use of water impregnated with earthy or stony particles; aliments of an astringent or windy nature, &c. It may likewise proceed from an hereditary disposition. Persons in the decline of life, and those who have been much afflicted with the gout or rheumatism, are most liable to it.

SYMPTOMS.——Small stones or gravel in the kidneys occasion pain in the loins; sickness; vomiting; and sometimes bloody urine. When the stone descends into the _ureter_, and is too large to pass along with ease, all the above symptoms are increased; the pain extends towards the bladder; the thigh and leg of the affected side are benumbed; the testicles are drawn upwards, and the urine is obstructed.

A stone in the bladder is known from a pain, at the time, as well as before and after making water; from the urine coming away by drops, or stopping suddenly when it was running in a full stream; by a violent pain in the neck of the bladder upon motion, especially on horseback, or in a carriage on a rough road; from a white, thick, copious, stinking, mucous sediment in the urine; from an itching in the top of the _penis_; from bloody urine; from an inclination to go to stool during the discharge of urine; from the patient’s passing his urine more easily when lying than in an erect posture; from a kind of convulsive motion occasioned by the sharp pain in discharging the last drops of the urine; and lastly, from sounding or searching with the catheter.

REGIMEN.——Persons afflicted with the gravel or stone should avoid aliments of a windy or heating nature, as salt meats, sour fruits, &c. Their diet ought chiefly to consist of such things as tend to promote the secretion of urine, and to keep the body open. Artichokes, asparagus, spinnage, lettuce, parsley, succory, purslane, turnips, potatoes, carrots, and radishes, may be safely eaten. Onions, leeks, and celery are, in this case, reckoned medicinal. The most proper drinks are whey, butter-milk, milk and water, barley-water; decoctions or infusions of the roots of marsh-mallows, parsley, liquorice, or of other mild mucilaginous vegetables, as linseed, lime-tree buds or leaves, &c. If the patient has been accustomed to generous liquors, he may drink small gin-punch.

Gentle exercise is proper; but violent motion is apt to occasion bloody urine. We would therefore advise that it should be taken in moderation. Persons afflicted with gravel often pass a great number of stones after riding on horseback, or in a carriage; but those who have a stone in the bladder are seldom able to bear these kinds of exercise. Where there is a hereditary tendency to this disease, a sedentary life ought never to be indulged. Were people careful, upon the first symptoms of gravel, to observe a proper regimen of diet, and to take sufficient exercise, it might often be carried off, or at least prevented from increasing; but if the same course which occasioned the disease is persisted in, it must be aggravated.

MEDICINE.——In what is called a fit of the gravel, which is commonly occasioned by a stone sticking in the _ureter_ or some part of the urinary passages, the patient must be bled, warm fomentations should likewise be applied to the part affected, emollient clysters administered, and diluting mucilaginous liquors drank, &c. The treatment of this case has been fully pointed out under the articles, _inflammation of the kidneys and bladder_, to which we refer.

Dr. Whytt advises patients who are subject to frequent fits of gravel in the kidneys, but have no stone in the bladder, to drink every morning, two or three hours before breakfast, an English pint of oyster or cockle-shell lime-water. The Doctor very justly observes, that though this quantity might be too small to have any sensible effect in dissolving a stone in the bladder, yet it may very probably prevent its growth.

When a stone is formed in the bladder, the Doctor recommends Alicant soap, and oyster or cockle-shell lime-water[124], to be taken in the following manner: The patient must swallow every day, in any form that is least disagreeable, an ounce of the internal part of Alicant soap, and drink three or four English pints of oyster or cockle shell lime-water. The soap is to be divided into three doses; the largest to be taken fasting in the morning early; the second at noon; and the third at seven in the evening; drinking above each dose a large draught of the lime-water; the remainder of which he may take any time betwixt dinner and supper, instead of other liquors.

The patient should begin with a smaller quantity of the lime-water and soap than that mentioned above; at first an English pint of the former, and three drachms of the latter, may be taken daily. This quantity, however, he may increase by degrees, and ought to persevere in the use of these medicines, especially if he finds any abatement of his complaints, for several months; nay, if the stone be very large, for years. It may likewise be proper for the patient, if he be severely pained, not only to begin with the soap and lime-water in small quantities, but to take the second or third lime-water instead of the first. However, after he has been for some time accustomed to these medicines, he may not only take the first water, but, if he finds he can easily bear it, heighten its dissolving power still more by pouring it a second time on fresh calcined shells.

The caustic alkali, or soap-lees, is the medicine chiefly in vogue at present for the stone. It is of a very acrid nature, and ought therefore to be given in some gelatinous or mucilaginous liquor; as veal-broth, new milk, linseed-tea, a solution of gum-arabic, or a decoction of marsh-mallow roots. The patient must begin with small doses of the lees, as thirty or forty drops, and increase by degrees, as far as the stomach can bear it[125].

Though the soap-lees and lime-water are the most powerful medicines which have hitherto been discovered for the stone; yet there are some things of a more simple nature, which in certain cases are found to be beneficial, and therefore deserve a trial. An infusion of the seeds of _daucus sylvestris_, or wild carrot, sweetened with honey, has been found to give considerable ease in cases where the stomach could not bear any thing of an acrid nature. A decoction of raw coffee berries taken morning and evening, to the quantity of eight or ten ounces, with ten drops of sweet spirit of nitre, has likewise been found very efficacious in bringing away large quantities of earthy matter in flakes. Honey is likewise found to be of considerable service, and may be taken in gruel, or in any other form that is more agreeable.

The only other medicine which we shall mention is the _uva ursi_. It has been greatly extolled of late both for the gravel and stone. It seems however to be in all respects inferior to the soap and lime-water; but it is less disagreeable, and has frequently, to my knowledge, relieved gravelly complaints. It is generally taken in powder from half a drachm to a whole drachm, two or three times a day. It may however be taken to the quantity of seven or eight drachms a day, with great safety and good effect.

CHAP. XXXIII.
OF INVOLUNTARY DISCHARGES OF BLOOD.

Spontaneous or involuntary discharges of blood, often happen from various parts of the body. These however are so far from being always dangerous, that they often prove salutary. When such discharges are critical, which is frequently the case in fevers, they ought not to be stopped. Nor indeed is it proper at any time to stop them, unless they be so great as to endanger the patient’s life. Most people, afraid of the smallest discharge of blood from any part of the body, fly immediately to the use of styptic and astringent medicines, by which means an inflammation of the brain, or some other fatal disease, is occasioned, which, had the discharge been allowed to go on, might have been prevented.

Periodical discharges of blood, from whatever part of the body they proceed, must not be stopped. They are always the efforts of Nature to relieve herself; and fatal diseases have often been the consequence of obstructing them. It may indeed be sometimes necessary to check the violence of such discharges; but even this requires the greatest caution. Instances might be given where the stopping of a small periodical flux of blood, from one of the fingers, has proved fatal.

In the early period of life, bleeding at the nose is very common. Those who are farther advanced in years are more liable to hæmoptoe, or discharge of blood from the lungs. After the middle period of life, hæmorrhoidal fluxes are most common; and in the decline of life, discharges of blood from the urinary passages.

Involuntary fluxes of blood may proceed from very different, and often from quite opposite causes. Sometimes they are owing to a particular construction of the body, as a sanguine temperament, a laxity of the vessels, a plethoric habit, &c. At other times they proceed from a determination of the blood towards one particular part, as the head, the hæmorrhoidal veins, &c. They may likewise proceed from an inflammatory disposition of the blood, in which case there is generally some degree of fever: this likewise happens when the flux is occasioned by an obstructed perspiration, or a stricture upon the skin, the bowels, or any particular part of the system.

But a dissolved state of the blood will likewise occasion hæmorrhages. Thus, in putrid fevers, the dysentery, the scurvy, the malignant small-pox, &c. there are often very great discharges of blood from different parts of the body. They may likewise be brought on by too liberal an use of medicines which tend to dissolve the blood, as cantharides, the volatile alkaline salts, &c. Food of an acrid or irritating quality may likewise occasion hæmorrhages; as also strong purges and vomits, or any thing that greatly stimulates the bowels.

Violent passions or agitations of the mind will likewise have this effect. These often cause bleeding at the nose, and I have known them sometimes occasion an hæmorrhage in the brain. Violent efforts of the body, by overstraining or hurting the vessels, may have the same effect, especially when the body is long kept in an unnatural posture, as hanging the head very low, &c.

The cure of an hæmorrhage must be adapted to its cause. When it proceeds from too much blood, or a tendency to inflammation, bleeding, with gentle purges, and other evacuations, will be necessary. It will likewise be proper for the patient in this case to live chiefly upon a vegetable diet, to avoid all strong liquors, and food that is of an acrid, hot, or stimulating quality. The body should be kept cool, and the mind easy.

When an hæmorrhage is owing to a putrid or dissolved state of the blood, the patient ought to live chiefly upon acid fruits with milk, and vegetables of a nourishing nature, as sago, salop, &c. His drink may be wine diluted with water, and sharpened with the juice of lemon, vinegar, or spirits of vitriol. The best medicine in this case is the Peruvian bark, which may be taken according to the urgency of the symptoms.

When a flux of blood is the effect of acrid food, or of strong stimulating medicines, the cure is to be effected by soft and mucilaginous diet. The patient may likewise take frequently about the bulk of a nutmeg of Locatelli’s balsam, or the same quantity of sperma-ceti.

When an obstructed perspiration, or a stricture upon any part of the system, is the cause of an hæmorrhage, it may be removed by drinking warm diluting liquors, lying a-bed, bathing the extremities in warm water, &c.

OF BLEEDING AT THE NOSE.

Bleeding at the nose is commonly preceded by some degree of quickness of the pulse, flushing in the face, pulsation of the temporal arteries, heaviness in the head, dimness of the sight, heat and itching of the nostrils, &c.

To persons who abound with blood this discharge is very salutary. It often cures a vertigo, the head-ach, a phrenzy, and even an epilepsy. In fevers, where there is a great determination of blood towards the head, it is of the utmost service. It is likewise beneficial in inflammations of the liver and spleen, and often in the gout and rheumatism. In all diseases where bleeding is necessary, a spontaneous discharge of blood from the nose is of much more service than the same quantity let with a lancet.

In a discharge of blood from the nose, the great point is to determine whether it ought to be stopped or not. It is a common practice to stop the bleeding, without considering whether it be a disease, or the cure of a disease. This conduct proceeds from fear; but it has often bad, and sometimes fatal consequences.

When a discharge of blood from the nose happens in an inflammatory disease, there is always reason to believe that it may prove salutary; and therefore it should be suffered to go on, at least as long as the patient is not weakened by it.

When it happens to persons in perfect health, who are full of blood, it ought not to be suddenly stopped, especially if the symptoms of plethora, mentioned above, have preceded it. In this case it cannot be stopped without risking the patient’s life.

In fine, whenever bleeding at the nose relieves any bad symptom, and does not proceed so far as to endanger the patient’s life, it ought not to be stopped. But when it returns frequently, or continues till the pulse becomes low, the extremities begin to grow cold, the lips pale, or the patient complains of being sick or faint, it must immediately be stopped.

For this purpose the patient should be set nearly upright, with his head reclining a little, and his legs immersed in water about the warmth of new milk. His hands ought likewise to be put in lukewarm water, and his garters may be tied a little tighter than usual. Ligatures may be applied to the arms, about the place where they are usually made for bleeding, and with nearly the same degree of tightness. These must be gradually slackened as the blood begins to stop, and removed entirely as soon as it gives over.

Sometimes dry lint put up the nostrils will stop the bleeding. When this does not succeed, dossils of lint dipped in strong spirits of wine, may be put up the nostrils, or if that cannot be had, they may be dipped in brandy. Blue vitriol dissolved in water may likewise be used for this purpose, or a tent dipped in the white of an egg beat up, may be rolled in a powder made of equal parts of white sugar, burnt allum, and white vitriol, and put up the nostril from whence the blood issues.

Internal medicines can hardly be of use here, as they have seldom time to operate. It may not however be amiss to give the patient half an ounce of Glauber’s salt, and the same quantity of manna, dissolved in four or five ounces of barley-water. This may be taken at a draught, and repeated, if it does not operate, in a few hours. Ten or twelve grains of nitre may be taken in a glass of cold water and vinegar every hour, or oftner, if the stomach will bear it. If a stronger medicine be necessary, a tea-cupful of the tincture of roses, with twenty or thirty drops of the weak spirit of vitriol, may be taken every hour. When these things cannot be had, the patient may drink water, with a little common salt in it, or equal parts of water and vinegar.

If the genitals be immersed for some time in cold water, it will generally stop a bleeding at the nose. I have not known this fail.

Sometimes, when the bleeding is stopped outwardly, it continues inwardly. This is very troublesome, and requires particular attention, as the patient is apt to be suffocated with the blood, especially if he falls asleep, which he is very ready to do after losing a great quantity of blood.

When the patient is in danger of suffocation from the blood getting into his throat, the passages may be stopped by drawing threads up the nostrils, and bringing them out at the mouth, then fastening pieces of spunge, or small rolls of linen cloth to their extremities; afterwards drawing them back, and tying them on the outside with a sufficient degree of tightness.

After the bleeding is stopped, the patient ought to be kept as easy and quiet as possible. He should not pick his nose, nor take away the tents or clotted blood, till they fall off of their own accord, and should not lie with his head low.

Those who are affected with frequent bleeding at the nose ought to bathe their feet often in warm water, and to keep them warm and dry. They ought to wear nothing tight about their necks, to keep their body as much in an erect posture as possible, and never to view any object obliquely. If they have too much blood, a vegetable diet, with now and then a cooling purge, is the safest way to lessen it.

But when the disease proceeds from a thin dissolved flare of the blood, the diet should be rich and nourishing; as strong broths and jellies, sago-gruel with wine and sugar, &c. Infusions of the Peruvian bark in wine ought likewise to be taken and persisted in for a considerable time.

OF THE BLEEDING AND BLIND PILES.

A discharge of blood from the hæmorrhoidal vessels is called the _bleeding piles_. When the vessels only swell, and discharge no blood, but are exceeding painful, the disease is called the _blind piles_.

Persons of a loose spungy fibre, of a bulky size, who live high, and lead a sedentary inactive life, are most subject to this disease. It is often owing to a hereditary disposition. Where this is the case, it attacks persons more early in life than when it is accidental. Men are more liable to it than women, especially those of a sanguine, plethoric, or a scorbutic habit, or of a melancholy disposition.

The piles may be occasioned by an excess of blood, by strong aloetic purges, high-seasoned food, drinking great quantities of sweet wines, the neglect of bleeding, or other customary evacuations, much riding, great costiveness, or any thing that occasions hard or difficult stools. Anger, grief, or other violent passions, will likewise occasion the piles. I have often known them brought on by sitting on the damp ground. A pair of thin breeches will excite the disorder in a person who is subject to it, and sometimes even in those who never had it before. Pregnant women are often afflicted with the piles.

A flux of blood from the _anus_ is not always to be treated as a disease. It is even more salutary than bleeding at the nose, and often prevents or carries off diseases. It is peculiarly beneficial in the gout, rheumatism, asthma, and hypochondriacal complaints, and often proves critical in colics, and inflammatory fevers.

In the management of the patient, regard must be had to his habit of body, his age, strength, and manner of living. A discharge which might be excessive and prove hurtful to one, may be very moderate, and even salutary to another. That only is to be esteemed dangerous which continues too long, and is in such quantity as to waste the patient’s strength, hurt the digestion, nutrition, and other functions necessary to life.

When this is the case, the discharge must be checked by a proper regimen, and astringent medicines. The DIET must be cool but nourishing, consisting chiefly of bread, milk, cooling vegetables and broths. The drink may be chalybeate water, orange-whey, decoctions or infusions of the astringent and mucilaginous plants, as the tormentil root, bistort, the marsh-mallow-roots, &c.

Old conserve of red roses is a very good medicine in this case. It may be mixed with new milk, and taken in the quantity of an ounce three or four times a-day. This medicine is in no great repute, owing to its being seldom taken in such quantity as to produce any effects; but when taken as here directed, and duly persisted in, I have known it perform very extraordinary cures in violent hæmorrhages, especially when assisted by the tincture of roses; a tea-cupful of which may be taken about an hour after every dose of the conserve.

The Peruvian bark is likewise proper in this case, both as a strengthener and astringent. Half a drachm of it may be taken in a glass of red-wine, sharpened with a few drops of the elixir of vitriol, three or four times a-day.

The bleeding piles are sometimes periodical, and return regularly once a month, or once in three weeks. In this case they are always to be considered as a salutary discharge, and by no means to be stopped. Some have entirely ruined their health by stopping a periodical discharge of blood from the hæmorrhoidal veins.

In the _blind piles_ bleeding is generally of use. The diet must be light and thin, and the drink cool and diluting. It is likewise necessary that the body be kept gently open. This may be done by small doses of the flowers of brimstone and cream of tartar. These may be mixed in equal quantities, and a tea-spoonful taken two or three times a-day, or oftner if necessary. Or an ounce of the flowers of brimstone and half an ounce of purified nitre may be mixed with three or four ounces of the lenitive electuary, and a tea-spoonful of it taken three or four times a-day.

Emollient clysters are here likewise beneficial; but there is sometimes such an astriction of the _anus_, that they cannot be thrown up. In this case I have known a vomit have a very good effect.

When the piles are exceeding painful and swelled, but discharge nothing, the patient must sit over the steams of warm water. He may likewise apply a linen cloth dipped in warm spirits of wine to the part, or poultices made of bread and milk, or of leeks fried with butter. If these do not produce a discharge, and the piles appear large, leeches must be applied as near them as possible, or, if they will fix upon the piles themselves, so much the better. When leeches will not fix, the piles may be opened with a lancet. The operation is very easy, and is attended with no danger.

Various ointments, and other external applications, are recommended in the piles; but I do not remember to have seen any effects from these worth mentioning. Their principal use is to keep the part moist, which may be done as well by a soft poultice, or an emollient cataplasm. When the pain however is very great, a liniment made of two ounces of emollient ointment, and half an ounce of liquid laudanum, beat up with the yolk of an egg, may be applied.

SPITTING OF BLOOD.

We mean here to treat of that discharge of blood from the lungs only which is called an _hæmoptoe_, or _spitting of blood_. Persons of a slender make, and a lax fibre, who have long necks and strait breasts, are most liable to this disease. It is most common in the spring, and generally attacks people before they arrive at the prime or middle period of life. It is a common observation, that those who have been subject to bleeding at the nose when young, are afterwards most liable to an hæmoptoe.

CAUSES.——An hæmoptoe may proceed from excess of blood, from a peculiar weakness of the lungs, or a bad conformation of the breast. It is often occasioned by excessive drinking, running, wrestling, singing, or speaking aloud. Such as have weak lungs ought to avoid all violent exertions of that organ, as they value life. They should likewise guard against violent passions, excessive drinking, and every thing that occasions a rapid circulation of the blood.

This disease may likewise proceed from wounds of the lungs. These may either be received from without, or they may be occasioned by hard bodies getting into the wind-pipe, and so falling down upon the lungs, and hurting that tender organ. The obstruction of any customary evacuation may occasion a spitting of blood; as neglect of bleeding or purging at the usual seasons, the stoppage of the bleeding piles in men, or the menses in women, &c. It may likewise proceed from a polypus, scirrhous concretions, or any thing that obstructs the circulation of the blood in the lungs. It is often the effect of a long and violent cough; in which case it is generally the forerunner of a consumption. A violent degree of cold suddenly applied to the external parts of the body will occasion an hæmoptoe. It may likewise be occasioned by breathing air which is too much rarified to be able properly to expand the lungs. This is often the case with those who work in hot places, as furnaces, glasshouses, or the like. It is likewise said to happen to such as ascend to the top of very high mountains, as the Peak of Teneriff, &c.

Spitting of blood is not always to be considered as a primary disease. It is often only a symptom, and in some diseases not an unfavourable one. This is the case in pleurisies, peripneumonies, and sundry other fevers. In a dropsy, scurvy, or consumption, it is a bad symptom, and shews that the lungs are ulcerated.

SYMPTOMS.——Spitting of blood is generally preceded by a sense of weight, and oppression of the breast, a dry tickling cough, hoarseness, and a difficulty of breathing. Sometimes it is ushered in with shivering coldness of the extremities, costiveness, great lassitude, flatulence, pain of the back and loins, &c. As these shew a general stricture upon the vessels, and a tendency of the blood to inflammation, they are commonly the forerunners of a very copious discharge. The above symptoms do not attend a discharge of blood from the gums or fauces, by which means these may always be distinguished from an hæmoptoe. Sometimes the blood that is spit up is thin, and of a florid red colour; and at other times it is thick, and of a dark or blackish colour; nothing however can be inferred from this circumstance, but that the blood has lain a longer or shorter time in the breast before it was discharged.

Spitting of blood, in a strong healthy person, of a sound constitution, is not very dangerous; but when it attacks the tender and delicate, or persons of a weak lax fibre, it is with difficulty removed. When it proceeds from a scirrhus or polypus of the lungs, it is bad. The danger is greater when the discharge proceeds from the rupture of a large vessel than of a small one. When the extravasated blood is not spit up, but lodges in the breast, it corrupts, and greatly increases the danger. When the blood proceeds from an ulcer in the lungs, it is generally fatal.

REGIMEN.——The patient ought to be kept cool and easy. Every thing that heats the body or quickens the circulation, increases the danger. The mind ought likewise to be soothed, and every occasion of exciting the passions avoided. The diet should be soft, cooling, and slender; as rice boiled with milk, small broths, barley-gruels, panado, &c. The diet, in this case, can scarce be too low. Even water-gruel is sufficient to support the patient for some days. All strong liquors must be avoided. The patient may drink milk and water, barley-water, whey, butter-milk, and such like. Every thing however should be drank cold, and in small quantities at a time. He should observe the strictest silence, or at least speak with a very low voice.

MEDICINE.——This, like the other involuntary discharges of blood, ought not to be suddenly stopped by astringent medicines. More mischief is often done by these than if it were suffered to go on. It may however proceed so far as to weaken the patient, and even endanger his life; in which case proper means must be used for restraining it.

The body should be kept gently open by laxative diet; as roasted apples, stewed prunes, and such like. If these should not have the desired effect, a tea-spoonful of the lenitive electuary may be taken twice or thrice a-day, as is found necessary. If the bleeding proves violent, ligatures may be applied to the extremities, as directed for a bleeding at the nose.

If the patient be hot or feverish, bleeding and small doses of nitre will be of use; a scruple or half a drachm of nitre may be taken in a cup of his ordinary drink twice or thrice a-day. His drink may likewise be sharpened with acids, as juice of lemon, or a few drops of the spirit of vitriol; or he may take frequently a cup of the tincture of roses.

Bathing the feet and legs in lukewarm water has likewise a very good effect in this disease. Opiates too are sometimes beneficial; but these must be administered with caution. Ten or twelve drops of laudanum may be given in a cup of barley-water twice a-day, and continued for some time, provided they be found beneficial.

The conserve of roses is likewise a very good medicine in this case, provided it be taken in sufficient quantity, and long enough persisted in. It may be taken to the quantity of three or four ounces a-day; and, if the patient be troubled with a cough, it should be made into an electuary with balsamic syrup, and a little of the syrup of poppies.

If stronger astringents be necessary, fifteen or twenty drops of the elixir of vitriol may be given in a glass of water three or four times a-day.

Those who are subject to frequent returns of this disease should avoid all excess. Their diet should be light and cool, consisting chiefly of milk and vegetables. Above all, let them beware of vigorous efforts of the body, and violent agitations of the mind.

VOMITING OF BLOOD.

This is not so common as the other discharges of blood which have already been mentioned; but it is very dangerous, and requires particular attention.

Vomiting of blood is generally preceded by pain of the stomach, sickness, and nausea; and is accompanied with great anxiety, and frequent fainting fits.

This disease is sometimes periodical; in which case it is less dangerous. It often proceeds from an obstruction of the menses in women; and sometimes from the stopping of the hæmorrhoidal flux in men. It may be occasioned by any thing that greatly stimulates or wounds the stomach, as strong vomits or purges, acrid poisons, sharp or hard substances taken into the stomach, &c. It is often the effect of obstructions in the liver, the spleen, or some of the other viscera. It may likewise proceed from external violence, as blows or bruises, or from any of the causes which produce inflammation. In hysteric women, vomiting of blood is a very common, but by no means a dangerous symptom.

A great part of the danger in this disease arises from the extravasated blood lodging in the bowels, and becoming putrid, by which means a dysentery or putrid fever may be occasioned. The best way of preventing this, is to keep the body gently open, by frequently exhibiting emollient clysters. Purges must not be given till the discharge is stopt, otherwise they will irritate the stomach, and increase the disorder. All the food and drink must be of a mild cooling nature, and taken in small quantities. Even drinking cold water has sometimes proved a remedy, but it will succeed better when sharpened with the weak spirits of vitriol. When there are signs of an inflammation, bleeding may be necessary; but the patient’s weakness will seldom permit it. Opiates may be of use; but they must be given in very small doses, as four or five drops of liquid laudanum twice or thrice a-day.

After the discharge is over, as the patient is generally troubled with gripes, occasioned by the acrimony of the blood lodged in the intestines, gentle purges will be necessary.

OF BLOODY URINE.

This is a discharge of blood from the vessels of the kidneys or bladder, occasioned by their being either enlarged, broken, or eroded. It is more or less dangerous according to the different circumstances which attend it.

When pure blood is voided suddenly without interruption and without pain, it proceeds from the kidneys; but if the blood be in small quantity, of a dark colour, and emitted with heat and pain about the bottom of the belly, it proceeds from the bladder. When bloody urine is occasioned by a rough stone descending from the kidneys to the bladder, which wounds the _ureters_, it is attended with a sharp pain in the back, and difficulty of making water. If the coats of the bladder are hurt by a stone, and the bloody urine follows, it is attended with the most acute pain, and a previous stoppage of urine.

Bloody urine may likewise be occasioned by falls, blows, the lifting or carrying of heavy burdens, hard riding, or any violent motion. It may also proceed from ulcers of the bladder, from a stone lodged in the kidneys, or from violent purges, or sharp diuretic medicines, especially cantharides.

Bloody urine is always attended with some degree of danger: but it is peculiarly so when mixed with purulent matter, as this shews an ulcer somewhere in the urinary passages. Sometimes this discharge proceeds from excess of blood, in which case it is rather to be considered as a salutary evacuation than a disease. If the discharge however be very great, it may waste the patient’s strength, and occasion an ill habit of body, a dropsy, or a consumption.

The treatment of this disorder must be varied according to the different causes from which it proceeds.

When it is owing to a stone in the bladder, the cure depends upon an operation; a description of which would be foreign to our purpose.

If it be attended with a plethora, and symptoms of inflammation, bleeding will be necessary. The body must likewise be kept open by emollient clysters, or cooling purgative medicines; as cream of tartar, rhubarb, manna, or small doses of lenitive electuary.

When bloody urine proceeds from a dissolved state of the blood, it is commonly the symptom of some malignant disease; as the small-pox, a putrid fever, or the like. In this case the patient’s life depends on the liberal use of the Peruvian bark and acids, as has already been shewn.

When there is reason to suspect an ulcer in the kidneys or bladder, the patient’s diet must be cool, and his drink of a soft, healing, balsamic quality, as decoctions of marsh-mallow roots with liquorice, solutions of gum-arabic, &c. Three ounces of marsh-mallow roots, and half an ounce of liquorice, may be boiled in two English quarts of water to one; two ounces of gum-arabic, and half an ounce of purified nitre, may be dissolved in the strained liquor, and a tea-cupful of it taken four or five times a-day.

The early use of astringents in this disease has often bad consequences. When the flux is stopped too soon, the grumous blood, by being confined in the vessels, may produce inflammations, abscess, and ulcers. If however the case be urgent, or the patient seems to suffer from the loss of blood, gentle astringents may be necessary. In this case the patient may take three or four ounces of lime-water, with half an ounce of the tincture of Peruvian bark, three times a-day.

OF THE DYSENTERY, OR BLOODY FLUX.

This disease prevails in the spring and autumn. It is most common in marshy countries, where, after hot and dry summers, it is apt to become epidemic. Persons are most liable to it who are much exposed to the night-air, or who live in places where the air is confined and unwholesome. Hence it often proves fatal in camps, on shipboard, in jails, hospitals, and such like places.

CAUSES.——The dysentery may be occasioned by any thing that obstructs the perforation, or renders the humours putrid; as damp beds, wet clothes, unwholesome diet, air, &c. But it is most frequently communicated by infection. This ought to make people extremely cautious in going near such persons as labour under the disease. Even the smell of the patient’s excrements has been known to communicate the infection.

SYMPTOMS.——It is known by a flux of the belly, attended with violent pain of the bowels, a constant inclination to go to stool, and generally more or less blood in the stools. It begins, like other fevers, with chillness, loss of strength, a quick pulse, great thirst, and an inclination to vomit. The stools are at first greasy and frothy, afterwards they are streaked with blood, and at last have frequently the appearance of pure blood, mixed with small filaments resembling bits of skin. Worms are sometimes passed both upwards and downwards through the whole course of the disease. When the patient goes to stool, he feels a bearing down, as if the whole bowels were falling out, and sometimes a part of the intestine is actually protruded, which proves exceeding troublesome, especially in children. Flatulency is likewise a troublesome symptom, especially towards the end of the disease.

This disease may be distinguished from a diarrhœa or looseness, by the acute pain of the bowels, and the blood which generally appears in the stools. It may be distinguished from the _cholera morbus_ by its not being attended with such violent and frequent fits of vomiting, &c.

When the dysentery attacks the old, the delicate, or such as have been wasted by the gout, the scurvy, or other lingering diseases, it generally proves fatal. Vomiting and hiccuping are bad signs, as they shew an inflammation of the stomach. When the stools are green, black, or have an exceeding disagreeable cadaverous smell, the danger is very great, as it shows the disease to be of the putrid kind. It is an unfavourable symptom when clysters are immediately returned; but still more so, when the passage is so obstinately shut, that they cannot be injected. A feeble pulse, coldness of the extremities, with difficulty of swallowing, and convulsions, are signs of approaching death.

REGIMEN.——Nothing is of more importance in this disease than cleanliness. It contributes greatly to the recovery of the patient, and no less to the safety of such as attend him. In all contagious diseases the danger is increased, and the infection spread, by the neglect of cleanliness, but in no one more than this. Every thing about the patient should be frequently changed. The excrements should never be suffered to continue in his chamber, but removed immediately, and buried under ground. A constant stream of fresh air should be admitted into the chamber; and it ought frequently to be sprinkled with vinegar, juice of lemon, or some other strong acid.

The patient must not be discouraged, but his spirits kept up in hopes of a cure. Nothing tends more to render any putrid disease mortal, than the fears and apprehensions of the sick. All diseases of this nature have a tendency to sink and depress the spirits, and when that is increased by fears and alarms from those whom the patient believes to be persons of skill, it cannot fail to have the worst effects.

A flannel waistcoat worn next the skin has often a very good effect in the dysentery. This promotes the perspiration without overheating the body. Great caution however is necessary in leaving it off. I have often known a dysentery brought on by imprudently throwing off a flannel waistcoat before the season was sufficiently warm. For whatever purpose this piece of dress is worn, it should never be left off but in a warm season.

In this disease the greatest attention must be paid to the patient’s diet. Flesh, fish, and every thing that has a tendency to turn putrid or rancid on the stomach, must be abstained from. Apples boiled in milk, water-pap, and plain light pudding, with broth made of the gelatinous parts of animals, may constitute the principal part of the patient’s food. Gelatinous broth not only answers the purpose of food, but likewise of medicine. I have often known dysenteries, which were not of a putrid nature, cured by it after pompous medicines had proved ineffectual[126].

Another kind of food very proper in the dysentery, which may be used by such as cannot take the broth mentioned above, is made by boiling a few handfuls of fine flour, tied in a cloth, for six or seven hours, till it becomes as hard as starch. Two or three table-spoonfuls of this may be grated down, and boiled in such a quantity of new milk and water as to be of the thickness of pap. This may be sweetened to the patient’s taste, and taken for his ordinary food[127].

In a _putrid dysentery_ the patient may be allowed to eat freely of most kinds of good ripe fruit; as apples, grapes, gooseberries, currant-berries, strawberries, &c. These may either be eaten raw or boiled, with or without milk, as the patient chuses. The prejudice against fruit in this disease is so great, that many believe it to be the common cause of dysenteries. This however is an egregious mistake. Both reason and experience shew, that good fruit is one of the best medicines, both for the prevention and cure of the dysentery. Good fruit is in every respect calculated to counteract that tendency to putrefaction, from whence the most dangerous kind of dysentery proceeds. The patient in such a case ought therefore be allowed to eat as much fruit as he pleases, provided it be ripe[128].

The most proper drink in this disorder is whey. The dysentery has often been cured by the use of clear whey alone. It may be taken both for drink and in form of clyster. When whey cannot be had, barley-water sharpened with cream of tartar may be drank, or a decoction of barley and tamarinds; two ounces of the former and one of the latter may be boiled in two English quarts of water to one. Warm water, water-gruel, or water wherein hot iron has been frequently quenched, are all very proper, and may be drank in turns. Camomile-tea, if the stomach will bear it, is an exceeding proper drink. It both strengthens the stomach, and by its antiseptic quality tends to prevent a mortification of the bowels.

MEDICINE.——At the beginning of this disease it is always necessary to cleanse the first passages. For this purpose a vomit of ipecacuanha must be given, and wrought off with weak camomile-tea. Strong vomits are seldom necessary here. A scruple, or at most half a drachm of ipecacuanha, is generally sufficient for an adult, and sometimes a very few grains will suffice. The day after the vomit, half a drachm, or two scruples of rhubarb, must be taken; or, what will answer the purpose rather better, an ounce or an ounce and a half of Epsom salts. This dose may be repeated every other day for two or three times. Afterwards small doles of ipecacuanha may be taken for some time. Two or three grains of the powder may be mixed in a table-spoonful of the syrup of poppies, and taken three times a day.

These evacuations, and the regimen prescribed above, will often be sufficient to effect a cure. Should it however happen otherwise, the following astringent medicines may be used.

A clyster of starch or fat mutton-broth, with thirty or forty drops of liquid laudanum in it, may be administered twice a-day. At the same time an ounce of gum-arabic, and half an ounce of gum-tragacanth, may be dissolved in an English pint of barley-water, over a slow fire, and a table-spoonful of it taken every hour.

If these have not the desired effect, the patient may take, four times a-day, about the bulk of a nutmeg of the _Japonic confection_, drinking after it a tea-cupful of the decoction of logwood[129].

Persons who have been cured of this disease are very liable to suffer a relapse; to prevent which, great circumspection with respect to diet is necessary. The patient must abstain from all fermented liquors, except now and then a glass of good wine; but he must drink no kind of malt-liquor. He should likewise abstain from animal food, as fish and flesh, and live principally on milk and vegetables.

Gentle exercise and wholesome air are likewise of importance. The patient should go to the country as soon as his strength will permit, and should take exercise daily on horseback, or in a carriage. He may likewise use bitters infused in wine or brandy, and may drink twice a-day a gill of lime-water mixed with an equal quantity of new milk.

When dysenteries prevail, we would recommend a strict attention to cleanliness, a spare use of animal food, and the free use of sound ripe fruits, and other vegetables. The night air is to be carefully avoided, and all communication with the sick. Bad smells are likewise to be shunned, especially those which arise from putrid animal substances. The necessaries where the sick go are carefully to be avoided.

When the first symptoms of the dysentery appear, the patient ought immediately to take a vomit, to go to bed, and drink plentifully of weak warm liquor, to promote a sweat. This, with a dose or two of rhubarb at the beginning, would often carry off the disease. In countries where dysenteries prevail, we would advise such as are liable to them, to take either a vomit or a purge every spring or autumn, as a preventive.

There are sundry other fluxes of the belly, as the LIENTERY and CŒLIAC PASSION, which, though less dangerous than the dysentery, yet merit consideration. These diseases generally proceed from a relaxed state of the stomach and intestines, which is sometimes so great, that the food passes through them without almost any sensible alterations; and the patient dies merely from the want of nourishment.

When the lientery or cœliac passion succeeds to a dysentery, the case is bad. They are always dangerous in old age, especially when the constitution has been broken by excess or acute diseases. If the stools be very frequent, and quite crude, the thirst great, with little urine, the mouth ulcerated, and the face marked with spots of different colours, the danger is very great.

The treatment of the patient is in general the same as in the dysentery. In all obstinate fluxes of the belly, the cure must be attempted, by first cleansing the stomach and bowels with gentle vomits and purges; afterwards such a diet as has a tendency to heal and strengthen the bowels, with opiates and astringent medicines, will generally perfect the cure.

The same observation holds with respect to a TENESMUS, or frequent desire of going to stool. This disease resembles the dysentery so much, both in its symptoms and method of cure, that we think it needless to insist upon it.

CHAP. XXXIV.
OF THE HEAD-ACH.

Aches and pains proceed from very different causes, and may affect any part of the body; but we shall point out those only which occur most frequently, and are attended with the greatest danger.

When the head-ach is slight, and affects a particular part of the head only, it is called _cephalalgia_; when the whole head is affected, _cephalæa_; and when on one side only, _hemicrania_. A fixed pain in the forehead, which may be covered with the end of the thumb, is called the _clavis hystericus_.

There are also other distinctions. Sometimes the pain is internal, sometimes external; sometimes it is an original disease, and at other times only symptomatic. When the head-ach proceeds from a hot bilious habit, the pain is very acute and throbbing, with a considerable heat of the part affected. When from a cold phlegmatic habit, the patient complains of a dull heavy pain, and has a sense of coldness in the part. This kind of head-ach is sometimes attended with a degree of stupidity or folly.

Whatever obstructs the free circulation of the blood through the vessels of the head, may occasion a head-ach. In persons of a full habit, who abound with blood, or other humours, the head-ach often proceeds from the suppression of customary evacuations; as bleeding at the nose, sweating of the feet, &c. It may likewise proceed from any cause that determines a great flux of blood towards the head; as coldness of the extremities, or hanging down the head for a long time. Whatever prevents the return of the blood from the head will likewise occasion a head-ach; as looking long obliquely at any object, wearing any thing tight about the neck, or the like.

When a head-ach proceeds from the stoppage of a running at the nose, there is a heavy, obtuse, pressing pain in the fore-part of the head, in which there seems to be such a weight, that the patient can scarce hold it up. When it is occasioned by the caustic matter of the venereal disease, it generally affects the skull, and often produces a _caries_ of the bones.

Sometimes the head-ach proceeds from the repulsion or retrocession of the gout, the erysipelas, the small-pox, measles, itch, or other eruptive diseases. What is called a _hemicrania_ generally proceeds from crudities or indigestion. Inanition, or emptiness, will often also occasion head-achs. I have often seen instances of this in nurses who gave suck too long, or who did not take a sufficient quantity of solid food.

There is likewise a most violent, fixed, constant, and almost intolerable head-ach, which occasions great debility both of body and mind, prevents sleep, destroys the appetite, causes a _vertigo_, dimness of sight, a noise in the ears, convulsions, epileptic fits, and sometimes vomiting, costiveness, coldness of the extremities, &c.

The head-ach is often symptomatic in continual and intermitting fevers, especially quartans. It is likewise a very common symptom in hysteric and hypochondriac complaints.

When a head-ach attends an acute fever, with pale urine, it is an unfavourable symptom. In excessive head-achs, coldness of the extremities is a bad sign.

When the disease continues long, and is very violent, it often terminates in blindness, an apoplexy, deafness, a _vertigo_, the palsy, epilepsy, &c.

In this disease the cool regimen in general is to be observed. The diet ought to consist of such emollient substances as will correct the acrimony of the humours, and keep the body open; as apples boiled in milk, spinage, turnips, and such like. The drink ought to be diluting; as barley-water, infusions of mild mucilaginous vegetables, decoctions of the sudorific woods, &c. The feet and legs ought to be kept warm, and frequently bathed in lukewarm water; the head should be shaved, and bathed with water and vinegar. The patient ought as much as possible to keep in an erect posture, and not to lie with his head too low.

When the head-ach is owing to excess of blood, or an hot bilious constitution, bleeding is necessary. The patient may be bled in the jugular vein, and the operation repeated if there be occasion. Cupping also, or the application of leeches to the temples, and behind the ears, will be of service. Afterwards a blistering-plaster may be applied to the neck behind the ears, or to any part of the head that is most affected. In some cases it will be proper to blister the whole head. In persons of a gross habit, issues or perpetual blisters will be of service. The body ought likewise to be kept open by gentle laxatives.

But when the head-ach proceeds from a copious vitiated _serum_ stagnating in the membranes, either within or without the skull, with a dull, heavy, continual pain, which will neither yield to bleeding nor gentle laxatives, then more powerful purgatives are necessary, as pills made of aloes, resin of jalap, or the like. It will also be necessary in this case to blister the whole head, and to keep the back part of the neck open for a considerable time by a perpetual blister.

When the head-ach is occasioned by the stoppage of a running at the nose, the patient should frequently smell to a bottle of volatile salts; he may likewise take snuff, or any thing that will irritate the nose, so as to promote a discharge from it; as the herb mastich, ground-ivy, &c.

A _hemicrania_, especially a periodical one, is generally owing to a foulness of the stomach, for which gentle vomits must be administered, as also purges of rhubarb. After the bowels have been sufficiently cleared, chalybeate waters, and such bitters as strengthen the stomach, will be necessary. A periodical head-ach has been cured by wearing a piece of flannel over the forehead during the night.