PART II. OF DISEASES. (continued 8)

533If she be able to bear it, she should lose at least half a pound of blood from the arm. Her drink ought to be barley-water sharpened with juice of lemon; or she may take half a drachm of powdered nitre, in a cup of water-gruel, every five or six hours. If the woman be seized with a violent looseness, she ought to drink the decoction of calcined hartshorn prepared. If she be affected with vomiting, let her take frequently two table-spoonfuls of the saline mixture. In general, opiates are of service; but they should always be given with caution.

Sanguine robust women, who are liable to miscarry at a certain time of pregnancy, ought always to be bled a few days before that period arrives. By this means, and observing the regimen above prescribed, they might often escape that misfortune.

Though we recommend due care for preventing abortion, we would not be understood as restraining pregnant women from their usual exercises. This would generally operate the quite contrary way. Want of exercise not only relaxes the body, but induces a plethora, or too great a fulness of the vessels, which are the two principal causes of abortion. There are, however, some women of so delicate a texture, that it is necessary for them to avoid almost every kind of exercise during the whole period of pregnancy.

OF CHILD-BIRTH.

Many diseases proceed from the want of due care in child-bed; and the more hardy part of the sex are most apt to despise the necessary precautions in this state. This is peculiarly the case with young wives. They think, when the labour-pains are 534ended, the danger is over; but in truth it may only then be said to be begun. Nature, if left to herself, will seldom fail to expel the fœtus; but proper care and management are certainly necessary for the recovery of the mother. No doubt mischief may be done by too much as well as by too little care. Hence females who have the greatest number of attendants in child-bed generally recover worst. But this is not peculiar to the state of child-bed. Excessive care always defeats its own intention, and is generally more dangerous than none at all^[181].

During actual labour, nothing of a heating nature ought to be given. The woman may now and then take a little panado, and her drink ought to be toast and water, or thin groat-gruel. Spirits, wines, cordial waters, and other things which are given with a view to strengthen the mother, and promote the birth, for the most part tend only to increase the fever, inflame the womb, and retard the labour. Besides, they endanger the woman afterwards, as they often occasion violent and 535mortal hæmorrhages, or dispose her to eruptive and other fevers.

When the labour proves tedious and difficult, to prevent inflammations, it will be proper to bleed. An emollient clyster ought likewise frequently to be administered; and the patient should sit over the steams of warm water. The passage ought to be gently rubbed with a little soft pomatum or fresh butter, and cloths wrung out of warm water applied over the belly. If nature seems to sink, and the woman is greatly exhausted with fatigue, a draught of generous wine, or some other cordial, may be given, but not otherwise. These directions are sufficient in natural labours; and in all preternatural cases, a skilful surgeon, or man-midwife, ought to be called as soon as possible.

After delivery, the woman ought to be kept as quiet and easy as possible^[182]. Her food should be light and thin, as gruel, panado, &c. and her drink weak and diluting. To this rule, however, there are many exceptions. I have known several women, whose spirits could not be supported in child-bed without solid food and generous liquors; to such, a glass of wine and a bit of chicken must be allowed.

Sometimes an excessive hæmorrhage or flooding happens after delivery. In this case the patient should be laid with her head low, kept cool, and be in all respects treated as for an excessive flux of the menses. If the flooding proves violent, linen cloths, which have been wrung out of a mixture of 536equal parts of vinegar and water, or red wine, should be applied to the belly, the loins, and the thighs: these must be changed as they grow dry; and may be discontinued as soon as the flooding abates^[183].

If there be violent pains after delivery, the patient ought to drink plentifully of warm diluting liquors, as groat-gruel, or tea with a little saffron in it; and to take small broths, with carrawayseeds, or a bit of orange-peel in them; an ounce of the oil of sweet almonds may likewise be frequently taken in a cup of any of the above liquors; and if the patient be restless, a spoonful of the syrup of poppies may now and then be mixed with a cup of her drink. If she be hot or feverish, one of the following powders may be taken in a cup of her usual drink every five or six hours^[184].

An inflammation of the womb is a dangerous and not unfrequent disease after delivery. It is known by pains in the lower part of the belly, which are greatly increased upon touching; by the tension or tightness of the parts; great weakness; change of countenance; a constant fever, with a weak and hard pulse; a slight delirium or raving; sometimes incessant vomiting; a hiccup; a discharge of reddish, stinking, sharp water from the womb; an inclination to go frequently to stool; a heat, and sometimes total suppression of urine.

537This must be treated like other inflammatory disorders, by bleeding and plentiful dilution. The drink may be thin gruel or barley-water; in a cup of which half a drachm of nitre may be dissolved, and taken three or four times a-day. Clysters of warm milk and water must be frequently administered; and the belly should be fomented by cloths wrung out of warm water, or by applying bladders filled with warm milk and water to it.

A suppression of the lochia, or usual discharges after delivery, and the milk-fever, must be treated nearly in the same manner as an inflammation of the womb. In all these cases, the safest course is plentiful dilution, gentle evacuations, and fomentations of the parts affected. In the milk-fever, the breads may be embrocated with a little warm linseed oil, or the leaves of red cabbage may be applied to them. The child should be often put to the breast, or it should be drawn by some other person.

Nothing would tend more to prevent the milk-fever than putting the child early to the breast. The custom of not allowing children to suck for the first two or three days, is contrary to Nature and common sense, and is very hurtful both to the mother and child.

Every mother who has milk in her breasts, ought either to suckle her own child, or to have her breasts frequently drawn, at least for the first month. This would prevent many of the diseases which prove fatal to women in child-bed.

When an inflammation happens in the breast, attended with redness, hardness, and other symptoms of suppuration, the safest application is a poultice of bread and milk, softened with oil or fresh butter. This may be renewed twice a-day, till the tumour be either discussed or brought to suppuration. The use of repellents, in this case, is very 538dangerous; they often occasion fevers, and sometimes cancers; whereas a suppuration is seldom attended with any danger, and has often the most salutary effects.

When the nipples are fretted or chapt, they may be anointed with a mixture of oil and beeswax, or a little powdered gum-arabic may be sprinkled on them. I have seen Hungary water applied to the nipples have a very good effect. Should the complaint prove obstinate, a cooling purge may be given, which generally removes it.

The miliary fever is a disease incident to women in child-bed; but as it has been treated of already, we shall take no further notice of it. The celebrated Hoffman observes, That this fever of child-bed women might generally be prevented, if they, during their pregnancy, were regular in their diet, used moderate exercise, took now and then a gentle laxative of manna, rhubarb, or cream of tartar; not forgetting to bleed in the first months, and avoid all sharp air. When the labour is coming on, it is not to be hastened with forcing medicines, which inflame the blood and humours, or put them into unnatural commotions. Care should be taken, after the birth, that the natural excretions proceed regularly; and if the pulse be quick, a little nitrous powder, or some other cooling medicines, should be administered.

The most fatal disorder consequent upon delivery is the puerperal, or child-bed fever. It generally makes its attack upon the second or third day after delivery. Sometimes indeed it comes on sooner, and at other times, though rarely, it does not appear before the fifth or sixth day.

It begins, like most other fevers, with a cold or shivering fit, which is succeeded by restlessness, pain of the head, great sickness at stomach, and bilious 539vomiting. The pulse is generally quick, the tongue dry, and there is a remarkable depression of spirits and loss of strength. A great pain is usually felt in the back, hips, and region of the womb; a sudden change in the quantity or quality of the lochia also takes place; and the patient is frequently troubled with a tenesmus, or constant inclination to go to stool. The urine, which is very high-coloured, is discharged in small quantity, and generally with pain. The belly sometimes swells to a considerable bulk, and becomes susceptible of pain from the slightest touch. When the fever has continued for a few days, the symptoms of inflammation usually subside, and the disease acquires a more putrid form. At this period, if not sooner, a bilious or putrid looseness, of an obstinate and dangerous nature, comes on, and accompanies the disease through all its future progress.

There is not any disease that requires to be treated with more skill and attention than this; consequently the best assistance ought always to be obtained as soon as possible. In women of plethoric constitutions, bleeding will generally be proper at the beginning; it ought however to be used with caution, and not to be repeated unless where the signs of inflammation rise high; in which case it will also be necessary to apply a blistering-plaster to the region of the womb.

During the rigour, or cold fit, proper means should be used to abate its violence, and shorten its duration. For this purpose the patient may drink freely of warm diluting liquors, and, if low, may take now and then a cup of whine-whey; warm applications to the extremities, as heated bricks, bottles or bladders filled with warm water, and such like, may also be used with advantage.

Emollient clysters of milk and water, or of chicken water, ought to be frequently administered 540through the course of the disease. These prove beneficial by promoting a discharge from the intestines, and also by acting as a kindly fomentation to the womb and parts adjacent. Great care however is requisite in giving them, on account of the tenderness of the parts in the pelvis at this time.

To evacuate the offending bile from the stomach, a vomit is generally given. But as this is apt to increase the irritability of the stomach, already too great, it will be safer to omit it, and to give in its stead a gentle laxative, which will both tend to cool the body, and to procure a free discharge of the bile^[185].

The medicine which I have always found to succeed best in this disease is the saline draught. This, if frequently repeated, will often put a stop to the vomiting, and at the same time lessen the violence of the fever. If it runs off by stool, or if the patient be restless, a few drops of laudanum, or some syrup of poppies, may occasionally be added.

If the stools should prove so frequent as to weaken and exhaust the patient, a starch clyster, with thirty or forty drops of laudanum in it, may be administered as occasion shall require; and the drink may be rice-water, in every English pint of which half an ounce of gum-arabic has been dissolved. Should these fail, recourse must be had to Columbo-root, or some other strong astringent.

Though in general the food ought to be light, and the drink diluting, yet when the disease has been long protracted, and the patient is greatly 541spent by evacuations, it will be necessary to support her with nourishing diet and generous cordials.

It was observed that this fever, after continuing for some time, often acquires a putrid form. In this case the Peruvian bark must be given, either by itself, or joined with cordials, as circumstances may require. As the bark in substance will be apt to purge, it may be given in decoction or infusion mixed with the tincture of roses, or other gentle astringents; or, a scruple of the extract of bark with half an ounce of spirituous cinnamon-water, two ounces of common water, and ten drops of laudanum, may be made into a draught, and given every second, third, or fourth hour, as shall be found necessary.

When the stomach will not bear any kind of nourishment, the patient may be supported for some time by clysters of beef tea, or chicken water.

To avoid this fever, every woman in child-bed ought to be kept perfectly easy; her food should be light and simple, and her bed-chamber cool, and properly ventilated. There is not any thing more hurtful to a woman in this situation than being kept too warm. She ought not to have her body bound too tight, nor to rise too soon from bed, after delivery; catching cold is also to be avoided; and a proper attention should be paid to cleanliness.

To prevent the milk-fever, the breast ought to be frequently drawn; and if they are filled previous to the onset of a fever, they should, upon its first appearance, be drawn, to prevent the milk from becoming acrid, and its being absorbed in this state. Costiveness is likewise to be avoided. This will be best effected by the use of mild clysters and a laxative diet.

542We shall conclude our observations on child-bed women by recommending it to them, above all things, to beware of cold. Poor women, whose circumstances oblige them to quit their bed too soon, often contract diseases from cold, of which they never recover. It is pity the poor are not better taken care of in this situation.

But the better sort of women run the greatest hazard from too much heat. They are generally kept in a sort of bagnio for the first eight or ten days, and then dressed out to see company. The danger of this conduct must be obvious to every one.

The superstitious custom of obliging women to keep the house till they go to church, is likewise a very common cause of catching cold. All churches are damp, and most of them cold; consequently they are the very word places to which a woman can go to make her first visit, after having been confined in a warm room for a month.

OF BARRENNESS.

Barrenness may be very properly reckoned among the diseases of females, as few married women who have not children enjoy a good state of health. It may proceed from various causes, as high living, grief, relaxation, &c. but it is chiefly owing to an obstruction or irregularity of the menstrual flux.

It is very certain that high living vitiates the humours, and prevents fecundity. We seldom find a barren woman among the labouring poor, while nothing is more common among the rich and affluent. The inhabitants of every country are prolific in proportion to their poverty; and it would be an easy matter to adduce many instances of women, 543who, by being reduced to live entirely upon a milk and vegetable diet, have conceived and brought forth children, though they never had any before. Would the rich use the same sort of food and exercise as the better sort of peasants, they would seldom have cause to envy their poor vassals and dependants the blessing of a numerous and healthy offspring, while they pine in sorrow for the want of even a single heir to their extensive domains.

Affluence begets indolence, which not only vitiates the humours, but induces a general relaxation of the solids; a state, highly unfavourable to procreation. To remove this, we would recommend the following course: First, sufficient exercise in the open air; secondly, a diet consisting chiefly of milk and vegetables^[186]; thirdly, the use of astringent medicines, as steel, allum, dragon’s blood, elixir of vitriol, the Spaw or Tunbridge waters, Peruvian bark, &c.; and lastly, above all, the cold bath.

Barrenness is often the consequence of grief, sudden fear, anxiety, or any of the passions which tend to obstruct the menstrual flux. When barrenness is suspected to proceed from affections of the mind, the person ought to be kept as easy and cheerful as possible; all disagreeable objects are to be avoided, and every method taken to amuse and entertain the fancy.

544

CHAP. XLIX. DISEASES OF CHILDREN.

Miserable indeed is the lot of man in the state of infancy! He comes into the world more helpless than any other animal, and stands much longer in need of the protection and care of his parents; but, alas! this care is not always bestowed upon him; and when it is, he often suffers as much from improper management as he would have done from neglect. Hence the officious care of parents, nurses, and midwives, becomes one of the most fruitful sources of the disorders of infants^[187].

It must be obvious to every attentive person, that the first diseases of infants arise chiefly from their bowels. Nor is this in the least to be wondered at, as they are in a manner poisoned with indigestible drugs and improper diet as soon as they come into the world. Every thing that the stomach cannot digest may be Considered as a poison; and unless it can be thrown up, or voided by stool, it must occasion sickness, gripes, spasmodic 545affections of the bowels, or what the good women call inward fits, and at last convulsions and death.

As these symptoms evidently arise from somewhat that irritates the intestines, doubtless the proper method of cure must be to expel it as soon as possible. The most safe and effectual method of doing this is by gentle vomits. Five or six grains of the powder of ipecacuanha may be mixed in two table-spoonfuls of water, and sweetened with a little sugar. A tea-spoonful of this may be given to the infant every quarter of an hour till it operates; or, what will more certainly answer the purpose, a grain of emetic tartar may be dissolved in three ounces of water, sweetened with a little syrup, and given as above. Those who are unwilling to use the emetic tartar, may give six or seven drops of the antimonial wine, in a tea-spoonful of water or thin gruel. Small doses of the ipecacuanha wine will be found more gentle than any of the above, and ought to be preferred.

These medicines will not only cleanse the stomach, but will generally likewise open the body. Should this however not happen, and if the child be costive, some gentle purge will be necessary: for this purpose, some manna and pulp of cassia may be dissolved in boiling water, and given in small quantities till it operates; or, what will answer rather better, a few grains of magnesia alba may be mixed in any kind of food that is given to the child, and continued till it has the desired effect. If these medicines be properly administered, and the child’s belly and limbs frequently rubbed with a warm hand before the fire, they will seldom fail to relieve those affections of the stomach and bowels from which infants suffer so much.

These general directions include most of what can be done for relieving the internal disorders of 546infants. They will likewise go a considerable way in alleviating those which appear externally, as the rash, gum, or fellon, &c. These, as was formerly observed, are principally owing to too hot a regimen, and consequently will be most effectually relieved by gentle evacuations. Indeed, evacuations of one kind or other constitute a principal part of the medicine of infants, and will seldom, if administered with prudence, in any of their diseases, fail to give relief.

OF THE MECONIUM.

The stomach and bowels of a new-born infant are filled with a blackish-coloured matter of the consistence of syrup, commonly called the meconium. This is generally passed soon after the birth, by the mere effort of Nature; in which case it is not necessary to give the infant any kind of medicine. But if it should be retained, or not sufficiently carried off, a little manna or magnesia alba may be given, as mentioned above; or, if these should not be at hand, a common spoonful of whey, sweetened with a little honey, or raw sugar, will answer the purpose.

The most proper medicine for expelling the meconium is the mother’s milk, which is always at first of a purgative quality. Were children allowed to suck as soon as they shew an inclination for the breast, they would seldom have occasion for medicines to discharge the meconium; but even where this is not allowed, they ought never to have daubs of syrup, oils, and other indigestible stuff, crammed down their throats.

547

THE APHTHÆ OR THRUSH.

The aphthæ are little whitish ulcers affecting the whole inside of the mouth, tongue, throat, and stomach of infants. Sometimes they reach through the whole intestinal canal; in which case they are very dangerous, and often put an end to the infant’s life.

If the aphthæ are of a pale colour, pellucid, few in number, soft, superficial, and fall easily off, they are not dangerous; but if opake, yellow, brown, black, thick, or running together, they ought to be dreaded.

It is generally thought that the aphthæ owe their origin to acid humours; we have reason however to believe, they are more frequently owing to too hot a regimen both of the mother and child. It is a rare thing to find a child who is not dosed with wine, punch, cinnamon-waters, or some other hot and inflaming liquors, almost as soon as it is born. It is well known that these will occasion inflammatory disorders even in adults; is it any wonder then that they should heat and inflame the tender bodies of infants, and set as it were the whole constitution on a blaze?

The most proper medicines for the aphthæ are vomits, such as have been already recommended, and gentle laxatives. Five grains of rhubarb and half a drachm of magnesia alba may be rubbed together, and divided into six doses, one of which may be given to the infant every four or five hours till they operate. These powders may either be given in the child’s food, or a little of the syrup of pale roses, and may be repeated as often as is found necessary to keep the body open. It is common 548in this case to administer calomel; but as that medicine sometimes occasions gripes, it ought always to be given to infants with caution.

Many things have been recommended for gargling the mouth and throat in this disease; but it is not easy to apply these in very young infants; we would therefore recommend it to the nurse to rub the child’s mouth frequently with a little borax and honey; or with the following mixture: Take fine honey an ounce, borax a drachm, burnt alum half a drachm, rose-water two drachms; mix them together. A very proper application in this case, is a solution of ten or twelve grains of white vitriol in eight ounces of barley-water. These may be applied with the finger, or by means of a bit of soft rag tied to the end of a probe.

OF ACIDITIES.

The food of children being for the most part of an acescent nature, it readily turns sour upon the stomach, especially if the body be any way disordered. Hence most diseases of children are accompanied with evident signs of acidity, as green stools, gripes, &c. These appearances have induced many to believe, that all the diseases of children were owing to an acid abounding in the stomach and bowels; but whoever considers the matter attentively, will find that these symptoms of acidity are oftner the effect than the cause of their diseases.

Nature evidently intended, that the food of children should be acescent; and unless the body be disordered, or the digestion hurt, from some other cause, we will venture to say, that the acescent quality of their food is seldom injurious to them. 549Acidity, however, is often a symptom of disorders in children, and, as it is sometimes a troublesome one, we shall point out the method of relieving it.

When green stools, gripes, purgings, sour smells, &c. shew that the bowels abound with an acid, the child should have a little small broth, with light white bread in it; and should have sufficient exercise in order to promote the digestion. It has been customary in this case to give the pearl-julep, chalk, crabs eyes, and other testaceous powders. These, indeed, by their absorbent quality, may correct the acidity; but they are attended with this inconvenience, that they are apt to lodge in the bowels, and occasion costiveness, which may prove very hurtful to the infant. For this reason they should never be given unless mixed with purgative medicines; as rhubarb, manna, or such like.

The best medicine which we know, in all cases of acidity, is that fine insipid powder called magnesia alba. It purges, and at the same time corrects the acidity: by which means it not only removes the disease, but carries off its cause. It may be given in any kind of food, or in a mixture, as recommended in the Appendix^[188].

When an infant is troubled with gripes, it ought not at first to be dosed with brandy, spiceries, and other hot things, but should have its body opened with an emollient clyster, or the medicine mentioned above; and at the same time a little brandy may be rubbed on its belly with a warm hand before the fire. I have seldom seen this fail to ease the gripes of infants. If it should happen, however, not to succeed, a little brandy or other spirits may be mixed with thrice the quantity of warm water, and a tea-spoonful of it given frequently till 550the infant be easier. Sometimes a little peppermint-water will answer this purpose very well.

GALLING AND EXCORIATION.

These are very troublesome to children. They happen chiefly about the groin and wrinkles of the neck, under the arms, behind the ears, and in other parts that are moistened by the sweat or urine.

As these complaints are, in a great measure, owing to want of cleanliness, the most effectual means of preventing them are, to wash the parts frequently with cold water, to change the linen often, and, in a word, to keep the child in all respects thoroughly clean. When this is not sufficient, the excoriated parts may be sprinkled with absorbent or drying powders; as burnt hartshorn, tutty, chalk, crabs claws prepared, and the like. When the parts affected are very sore, and tend to a real ulceration, it will be proper to add a little sugar of lead to the powders; or to anoint the place with the camphorated ointment. If the parts be washed with spring water, in which a little white vitriol has been dissolved, it will dry and heal them very powerfully. One of the best applications for this purpose, is to dissolve some fuller’s earth in a sufficient quantity of hot water; and after it has stood till it is cold, to rub it gently upon the galled parts once or twice a-day.

STOPPAGE OF THE NOSE.

The nostrils of infants are often plugged up with a gross mucus, which prevents their breathing 551freely, and likewise renders it difficult for them to suck or swallow.

Some in this case order, after a suitable purge, two or three grains of white vitriol dissolved in half an ounce of marjoram-water, and filtered, to be applied now and then to the nostrils with a linen rag. Wedelius says, If two grains of white vitriol, and the same quantity of elaterium, be dissolved in half an ounce of marjoram-water, and applied to the nose, as above directed, that it brings away the mucus without sneezing.

In obstinate cases these medicines may be tried; but I have never found any thing necessary, besides rubbing the nose at bed-time with a little sweet oil, or fresh butter. This resolves the filth, and renders the breathing more free^[189].

OF VOMITING.

From the delicate state of children, and the great sensibility of their organs, a vomiting or looseness may be induced by any thing that irritates the nerves of the stomach or intestines. Hence these disorders are much more common in childhood than in the more advanced periods of life. They are seldom however dangerous, and ought never to be considered as diseases, unless when they are violent, or continue so long as to exhaust the strength of the patient.

Vomiting may be excited by an over-quantity of food; by food that is of such a nature as to irritate the nerves of the stomach too much; or by the sensibility of the nerves being so much increased as to 552render them unable to bear the stimulus of even the mildest element.

When vomiting is occasioned by too much food, it ought to be promoted, as the cure will depend upon cleansing the stomach. This may be done either by a few grains of ipecacuanha, or a weak solution of emetic tartar, as mentioned before. When it is owing to food of an acrid or irritating quality, the diet ought to be changed, and aliment of a milder nature substituted in its stead.

When vomiting proceeds from an increased degree of sensibility, or too great an irritability of the nerves of the stomach, such medicines as have a tendency to brace and strengthen that organ, and to abate its sensibility, must be used. The first of these intentions may be answered by a slight infusion of the Peruvian bark, with the addition of a little rhubarb and orange-peel; and the second by the saline draughts, to which a few drops of liquid laudanum may be occasionally added.

In obstinate vomitings the operation of internal medicines may be assisted by aromatic fomentations made with wine, applied warm to the pit of the stomach; or the use of the stomach plaster, with the addition of a little Theriaca.

OF A LOOSENESS.

A looseness may generally be reckoned salutary when the stools are sour, slimy, green, or curdled. It is not the discharge, but the production of such stools, which ought to be remedied. Even where the purging is thin and watery, it ought not to be checked too suddenly, as it often proves critical, especially when the child has caught cold, or an eruption on the skin has disappeared. Sometimes an evacuation of this kind succeeds a humid state 553of the atmosphere, in which case it may also prove of advantage, by carrying off a quantity of watery humours, which would otherwise tend to relax the habit.

As the principal intention of the cure of a looseness is to evacuate the offending matter, it is customary to give the patient a gentle vomit of ipecacuanha, and afterwards to exhibit small and frequent doses of rhubarb; interposing absorbent medicines, to mitigate the acrimony of the humours. The best purge, however, in this case, is magnesia alba. It is at the same time absorbent and laxative, and operates without exciting gripes.

The antimonial wine, which acts both as an emetic and purge, is also an excellent medicine in this case. By being diluted with water, it may be proportioned to the weakest constitution; and, not being disagreeable to the palate, it may be repeated as often as occasion requires. Even one dose will frequently mitigate the disease, and pave the way for the use of absorbents. If, however, the patient’s strength will permit, the medicine ought to be repeated every six or eight hours, till the stools begin to assume a more natural appearance; afterwards a longer space may be allowed to intervene between the doses. When it is necessary to repeat the medicine frequently, the dose ought always to be a little increased, as its efficacy is generally diminished by use.

Some, upon the first appearance of a looseness, fly immediately to the use of absorbent medicines and astringents. If these be administered before the offending humours are discharged, though the disease may appear to be mitigated for a little time, it soon afterwards breaks forth with greater violence, and often proves fatal. After proper evacuations, however, these medicines may be administered with considerable advantage.

554Should any gripings or restlessness remain after the stomach and bowels have been cleansed, a tea-spoonful of the syrup of poppies may be given in a little simple cinnamon-water, three or four times a-day till these symptoms have ceased.

OF ERUPTIONS.

Children, while on the breast, are seldom free from eruptions of one kind or other. These, however, are not often dangerous, and ought never to be dried up but with the greatest caution. They tend to free the bodies of infants from hurtful humours, which, if retained, might produce fatal disorders.

The eruptions of children are chiefly owing to improper food and neglect of cleanliness. If a child be stuffed at all hours with food that its stomach is not able to digest, such food, not being properly assimilated, instead of nourishing the body, fills it with gross humours. These must either break out in form of eruptions upon the skin, or remain in the body, and occasion fevers and other internal disorders. That neglect of cleanliness is a very general cause of eruptive disorders, must be obvious to every one. The children of the poor, and of all who despise cleanliness, are almost constantly found to swarm with vermin, and are generally covered with the scab, itch, and other eruptions.

When eruptions are the effect of improper food, or want of cleanliness, a proper attention to these alone will generally be sufficient to remove them. If this should not be the case, some drying medicines will be necessary. When they are applied, the body ought at the same time to be kept open, and cold is carefully to be avoided. We know no 555medicine that is more safe for drying up cutaneous eruptions than sulphur, provided it be prudently used. A little of the flour of sulphur may be mixed with fresh butter, oil, or hog’s lard, and the parts affected frequently touched with it.

The most obstinate of all the eruptions incident to children are, the tinea capitis, or scabbed head, and chilblains. The scabbed head is often exceeding difficult to cure, and sometimes indeed the cure proves worse than the disease. I have frequently known children seized with internal disorders, of which they died soon after their scabbed heads had been healed by the application of drying medicines^[190]. The cure ought always first to be attempted by keeping the head very clean, cutting off the hair, combing and brushing away the scabs, &c. If this is not sufficient, let the head be shaved once a-week, washed daily with soap suds, and gently anointed with a liniment made of train oil eight ounces, red precipitate, in fine powder, one drachm. And if there be proud flesh, it should be touched with a bit of blue vitriol, sprinkled with a little burnt allum. While these things are 556doing, the patient must be confined to a regular light diet, the body should be kept gently open; and cold, as far as possible, ought to be avoided. To prevent any bad consequences from stopping this discharge, it will be proper, especially in children of a gross habit, to make an issue in the neck or arm, which may be kept open till the patient becomes more strong, and the constitution be somewhat mended.

Chilblains commonly attack children in cold weather. They are generally occasioned by the feet or hands being kept long wet or cold, and afterwards suddenly heated. When children are cold, instead of taking exercise to warm themselves gradually, they run to the fire. This occasions a sudden rarefaction of the humours, and an infarction of the vessels; which being often repeated, the vessels are at last over-distended, and forced to give way.

To prevent it, violent cold and sudden heat must be equally avoided. When the parts begin to look red and swell, the patient ought to be purged, and to have the affected parts frequently rubbed with mustard and brandy, or something of a warming nature. They ought likewise to be covered with flannel, and kept warm and dry. Some apply warm ashes between cloths to the swelled parts, which frequently help to reduce them. When there is a sore, it must be dressed with Turner’s cerate, the ointment of tutty, the plaster of cerus, or some other drying ointment. These sores are indeed troublesome, but seldom dangerous. They generally heal as soon as the warm weather sets in.

557

OF THE CROUP.

Children are often seized very suddenly with this disease, which, if not quickly relieved, proves mortal. It is known by various names in different parts of Britain. On the east coast of Scotland it is called the croup. On the west they call it the chock or stuffing. In some parts of England, where I have observed it, the good women call it the rising of the lights. It seems to be a species of asthma, attended with very acute and violent catarrhal symptoms.

This disease generally prevails in cold and wet seasons. It is most common upon the sea-coast, and in low marshy countries. Children of a gross and lax habit are most liable to it. I have sometimes known it hereditary. It generally attacks children in the night, after having been much exposed to damp cold easterly winds through the day. Damp houses, wet feet, thin shoes, wet clothes, or any thing that obstructs the perspiration, may occasion the croup.

It is attended with a frequent pulse, quick and laborious breathing, which is performed with a peculiar kind of croaking noise, that may be heard at a considerable distance. The voice is sharp and shrill, and the face is generally much flushed, though sometimes it is of a livid colour.

When a child is seized with the above symptoms, his feet should immediately be put into warm water. He ought likewise to be bled^[191], and to have a laxative clyster administered as soon as possible. He should be made to breathe over the 558steams of warm water and vinegar; or an emollient decoction, and emollient cataplasms or fomentations may be applied round his neck. If the symptoms do not abate, a blistering plaster must be applied round the neck, or between the shoulders, and the child may take frequently a table-spoonful of the following julep: Take penny-royal water three ounces, syrup of althea and balsamic syrup, each one ounce, mix them together.

Asafœtida is found to have a good effect in this case. It may be both given in form of clyster, and taken by the mouth. Two drachms of asafœtida may be dissolved in one ounce of Mindererus’s spirit, and three ounces of penny-royal water. A table-spoonful of this mixture may be given every hour, or oftner, if the patient’s stomach be able to bear it. If the child cannot be brought to take this medicine, two drachms of the asafœtida may be dissolved in a common clyster, and administered every six or eight hours, till the violence of the disease abates^[192].

To prevent a return of the disorder, all those things which occasion it must be carefully avoided; 559as wet feet, cold, damp, easterly winds, &c. Children who have had frequent returns of this disease, or whose constitutions seem to dispose them to it, ought to have their diet properly regulated; all food that is viscid or hard of digestion, and all crude, raw, trashy fruits, are to be avoided. They ought likewise to have a drain constantly kept open in some part of their body, by means of a seton or issue. I have sometimes known a Burgundy-pitch plaster, worn continually between the shoulders for several years, have a very happy effect in preventing the return of this dreadful disorder.

OF TEETHING.

Dr. Arbuthnot observes, that above a tenth part of infants die in teething, by symptoms proceeding from the irritation of the tender nervous parts of the jaws, occasioning inflammations, fevers, convulsions, gangrenes, &c. These symptoms are in a great measure owing to the great delicacy and exquisite sensibility of the nervous system at this time of life, which is too often increased by an effeminate education. Hence it comes to pass, that children who are delicately brought up, always suffer most in teething, and often fall by convulsive disorders.

About the sixth or seventh month the teeth generally begin to make their appearance; first, the incisores, or fore-teeth; next, the canini, or dogteeth; and, lastly, the molares, or grinders. About the seventh year, there comes a new set; and about the twentieth, the two inner grinders, called dentes sapientiæ, the teeth of wisdom.

Children, about the time of cutting their teeth, slaver much, and have generally a looseness. When the teething is difficult, especially when the dogteeth 560begin to make their way through the gums, the child has startings in his sleep, tumours of the gums, watchings, gripes, green stools, the thrush, fever, difficult breathing, and convulsions.

Difficult teething requires nearly the same treatment as an inflammatory disease. If the body be bound, it must be opened either by emollient clysters or gentle purgatives; as manna, magnesia alba, rhubarb, senna, or the like. The food should be light, and in small quantity; the drink plentiful, but weak and diluting, as infusions of balm, or of the lime-tree flowers; to which about a third or fourth part of milk may be added.

If the fever be high, bleeding will be necessary; but this in very young children ought always to be sparingly performed. It is an evacuation which they bear the worst of any. Purging, vomiting, or sweating, agree much better with them, and are generally more beneficial. Harris, however, observes, that, when an inflammation appears, the physician will labour in vain, if the cure be not begun with applying a leech under each ear. If the child be seized with convulsion-fits, a blistering-plaster may be applied between the shoulders, or one behind each ear.

Sydenham says, that in fevers occasioned by teething, he never found any remedy so effectual as two, three, or four drops of spirits of hartshorn in a spoonful of simple water, or other convenient vehicle, given every four hours. The number of doses may be four, five, or six. I have often prescribed this medicine with success, but always found a larger dose necessary. It may be given from five drops to fifteen or twenty, according to the age of the child, and, when costiveness does not forbid it, three or four drops of laudanum may be added to each dose.

561In Scotland, it is very common, when children are cutting their teeth, to put a small Burgundy-pitch plaster between their shoulders. This generally eases the tickling cough which attends teething, and is by no means an useless application. When the teeth are cut with difficulty, it ought to be kept on during the whole time of teething. It may be enlarged as occasion requires, and ought to be renewed at least once a fortnight.

Several things have been recommended for rubbing the gums, as oils, mucilages, &c.; but from these much is not to be expected. If any thing of this kind is to be used, we would recommend a little fine honey, which may be rubbed on with the finger three or four times a-day. Children are generally at this time disposed to chew whatever they get into their hands. For this reason they ought never to be without somewhat that will yield a little to the pressure of their gums, as a crust of bread, a wax-candle, a bit of liquorice-root, or such like.

With regard to cutting the gums, we have seldom known it of any great benefit. In obstinate cases, however, it ought to be tried. It may be performed by the finger-nail, the edge of a six-penny piece that is worn thin, or any sharp body which can be with safety introduced into the mouth; but the lancet, in a skilful hand, is certainly the most proper.

In order to render the teething less difficult, parents ought to take care that their children’s food be light and wholesome, and that their nerves be braced by sufficient exercise without doors, the use of the cold bath, &c. Were these things duly regarded, they would have a much better effect than teething necklaces, or other nonsensical amulets worn for that purpose.

562

OF THE RICKETS.

This disease generally attacks children between the age of nine months and two years. It appeared first in England about the time when manufactures began to flourish, and still prevails most in towns where the inhabitants follow sedentary employments, by which means they neglect either to take proper exercise themselves, or to give it to their children.

CAUSES.——One cause of the rickets is diseased parents. Mothers of a weak relaxed habit, who neglect exercise, and live upon weak watery diet, can neither be expected to bring forth strong and healthy children, or to be able to nurse them, after they are brought forth. Accordingly we find, that the children of such women generally die of the rickets, the scrophula, consumptions, or such like diseases. Children begotten by men in the decline of life, who are subject to the gout, the gravel, or other chronic diseases, or who have been often affected with the venereal disease in their youth, are likewise very liable to the rickets.

Any disorder that weakens the constitution, or relaxes the habit of children, as the small-pox, measles, teething, the hooping-cough, &c. disposes them to this disease. It may likewise be occasioned by improper diet, as food that is either too weak and watery, or so viscid that the stomach cannot digest it.

Bad nursing is the chief cause of this disease. When the nurse is either diseased, or has not enough of milk to nourish the child, it cannot thrive. But children suffer oftner by want of care in nurses than want of food. Allowing an infant to lie or sit too 563much, or not keeping it thoroughly clean in its clothes, has the most pernicious effects.

The want of free air is likewise very hurtful to children in this respect. When a nurse lives in a close small house, where the air is damp and confined, and is too indolent to carry her child abroad into the open air, it will hardly escape this disease. A healthy child should always be in motion, unless when asleep; if it be suffered to lie, or sit, instead of being tossed and dandled about, it will not thrive.

SYMPTOMS.——At the beginning of this disease the child’s flesh grows soft and flabby; its strength is diminished; it loses its wonted cheerfulness, looks more grave and composed than is natural for its age, and does not chuse to be moved. The head and belly become too large in proportion to the other parts; the face appears full, and the complexion florid. Afterwards the bones begin to be affected, especially in the more soft and spungy parts. Hence the wrists and ancles become thicker than usual; the spine or backbone puts on an unnatural shape; the breast is likewise often deformed; and the bones of the arms and legs grow crooked. All these symptoms vary according to the violence of the disease. The pulse is generally quick, but feeble; the appetite and digestion for the most part bad; the teeth come slowly and with difficulty, and they often rot and fall out afterwards. Ricketty children generally have great acuteness of mind, and an understanding above their years. Whether this is owing to their being more in the company of adults than other children, or to the preternatural enlargement of the brain, is not material.

REGIMEN.——As this disease is always attended with evident signs of weakness and relaxation, our chief aim in the cure must be to brace 564and strengthen the solids, and to promote digestion and the due preparation of the fluids. These important ends will be best answered by wholesome nourishing diet, suited to the age and strength of the patient, open dry air, and sufficient exercise. If the child has a bad nurse, who either neglects her duty, or does not understand it, she should be changed. If the season be cold, the child ought to be kept warm; and when the weather is hot, it ought to be kept cool; as sweating is apt to weaken it, and too great a degree of cold has the same effect. The limbs should be rubbed frequently with a warm hand, and the child kept as cheerful as possible.

The diet ought to be dry and nourishing, as good bread, roasted flesh, &c. Biscuit is generally reckoned the best bread; and pigeons, pullets, veal, rabbits, or mutton roasted or minced, are the most proper flesh. If the child be too young for flesh-meats, he may have rice, millet, or pearl-barley boiled with raisins, to which may be added a little wine and spice. His drink may be good claret, mixed with an equal quantity of water. Those who cannot afford claret, may give the child now and then a wine-glass of mild ale, or good porter.

MEDICINE.——Medicines are here of little avail. The disease may often be cured by the nurse, but seldom by the physician. In children of a gross habit, gentle vomits and repeated purges of rhubarb may sometimes be of use, but they will seldom carry off the disease; that must depend chiefly upon such things as brace and strengthen the system: for which purpose, besides the regimen mentioned above, we would recommend the cold bath, especially in the warm season. It must however be used with prudence, as some ricketty children cannot bear it. The best time for using the 565cold bath is in the morning, and the child should be well rubbed with a dry cloth immediately after he comes out of it. If the child should be weakened by the cold bath, it must be discontinued.

Sometimes issues have been found beneficial in this disease. They are peculiarly necessary for children who abound with gross humours. An infusion of the Peruvian bark in wine or ale would be of service, were it possible to bring children to take it. We might here mention many other medicines which have been recommended for the rickets; but as there is far more danger in trusting to these than in neglecting them altogether, we chuse rather to pass them over, and to recommend a proper regimen as the thing chiefly to be depended on.

OF CONVULSIONS.

Though more children are said to die of convulsions than of any other disease, yet they are for the most part only a symptom of some other malady. Whatever greatly irritates or stimulates the nerves, may occasion convulsions. Hence infants whose nerves are easily affected, are often thrown into convulsions by any thing that irritates the alimentary canal; likewise by teething; strait clothes; the approach of the small-pox, measles, or other eruptive diseases.

When convulsions proceed from an irritation of the stomach or bowels, whatever clears them of their acrid contents, or renders these mild and inoffensive, will generally perform a cure: wherefore, if the child be costive, the best way will be to begin with a clyster, and afterwards to give a gentle vomit, which may be repeated occasionally, and the body in the mean time kept open by gentle 566doses of magnesia alba, or small quantities of rhubarb mixed with the powder of crabs claws.

Convulsions which precede the eruption of the small-pox or measles generally go off upon these making their appearance. The principal danger in this case arises from the fears and apprehensions of those who have the care of the patient. Convulsions are very alarming, and something must be done to appease the affrighted parents, nurses, &c. Hence the unhappy infant often undergoes bleeding, blistering, and several other operations, to the great danger of its life, when a little time, bathing the feet in warm water, and throwing in a mild clyster, would have set all to rights.

When convulsion fits arise from the cutting of teeth, besides gentle evacuations, we would recommend blistering, and the use of antispasmodic medicines, as the tincture of soot, asafœtida, or castor. A few drops of any of these may be mixed in a cup of white-wine whey, and given occasionally.

When convulsions proceed from any external cause, as the pressure occasioned by strait clothes or bandages, &c. these ought immediately to be removed; though in this case taking away the cause will not always remove the effect, yet it ought to be done. It is not likely that the patient will recover, as long as the cause which first gave rise to the disorder continues to act.

When a child is seized with convulsions without having any complaint in the bowels, or symptoms of teething; or any rash or other discharge which has been suddenly dried up; we have reason to conclude that it is a primary disease, and proceeds immediately from the brain. Cases of this kind, however, happen but seldom, which is very fortunate, as little can be done to relieve the unhappy patient. When a disease proceeds from an origial 567fault in the formation or structure of the brain itself, we cannot expect that it should yield to medicine. But as this is not always the cause, even of convulsions which proceed immediately from the brain, some attempts should be made to remove them. The chief intention to be pursued for this purpose, is to make some derivation from the head, by blistering, purging, and the like. Should these fail, issues or setons may be put in the neck, or between the shoulders.

OF WATER IN THE HEAD.

Though water in the head, or a dropsy of the brain, may affect adults as well as children, yet, as the latter are more peculiarly liable to it, we thought it would be most proper to place it among the diseases of infants.

CAUSES.——A dropsy of the brain may proceed from injuries done to the brain itself by falls, blows, or the like; it may likewise proceed from an original laxity or weakness of the brain; from scirrhous tumours or excrescences within the skull; a thin watery state of the blood; a diminished secretion of urine; and, lastly, from tedious and lingering diseases, which waste and consume the patient.

SYMPTOMS.——This disease has at first the appearance of a slow fever; the patient complains of a pain in the crown of his head, or over his eyes; he shuns the light; is sick, and sometimes vomits; his pulse is irregular and generally low: though he seems heavy and dull, yet he does not sleep: he is sometimes delirious, and frequently sees objects double; towards the end of this commonly fatal disease, the pulse becomes more frequent, the pupils 568are generally dilated, the cheeks flushed, the patient becomes comatose, and convulsions ensue.

MEDICINE.——No medicine has hitherto been found sufficient to carry off a dropsy of the brain. It is laudable, however, to make some attempts, as time or chance may bring many things to light, of which at present we have no idea. The medicines generally used are, purges of rhubarb or jalap with calomel, and blistering-plasters applied to the neck or back part of the head. To which we would beg leave to add diuretics, or medicines which promote the secretion of urine, such as are recommended in the common dropsy. A discharge from the nose ought likewise to be promoted by causing the patient to snuff the powder of asarum, white hellebore, or the like.

Some practitioners have of late pretended to cure this disease by the use of mercury. I have not been so happy as to see any instances of a cure being performed in a confirmed dropsy of the brain; but in so desperate a malady every thing deserves a trial^[193].

569

CHAP. L. OF SURGERY.

To describe all the operations of surgery, and to point out the different diseases in which these operations are necessary, would extend this article far beyond the limits allotted to it: we must therefore confine our observations to such cases as most generally occur, and in which proper assistance is either not asked, or not always to be obtained.

Though an acquaintance with the structure of the human body is indispensably necessary to qualify a man for being an expert surgeon; yet many things may be done to save the lives of their fellow-men in emergencies by those who are no adepts in anatomy. It is amazing with what facility the peasants daily perform operations upon brute animals, which are not of a less difficult nature than many of those performed on the human species; yet they seldom fail of success.

Indeed every man is in some measure a surgeon whether he will or not. He feels an inclination to assist his fellow-men in distress, and accidents happen every hour which give occasion to exercise this feeling. The feelings of the heart, however, when not directed by the judgment, are apt to mislead. Thus one, by a rash attempt to save his friend, may sometimes destroy him; while another, for fear of doing amiss, stands still and sees his bosom-friend expire without so much as attempting to relieve him, even when the means are in his power. As every good man would wish to steer a course different from either of these, it will no doubt be 570agreeable to him to know what ought to be done upon such emergencies.

OF BLEEDING.

No operation of surgery is so frequently necessary as bleeding; it ought therefore to be very generally understood. But though practised by midwives, gardeners, blacksmiths, we have reason to believe that very few know when it is proper. Even physicians themselves have been so much the dupes of theory in this article, as to render it the subject of ridicule. It is however an operation of great importance, and must, when seasonably and properly performed, be of singular service to those in distress.

Bleeding is proper at the beginning of all inflammatory fevers, as pleurisies, peripneumonies, &c. It is likewise proper in all topical inflammations, as those of the intestines, womb, bladder, stomach, kidnies, throat, eyes, &c. as also in the asthma, sciatic pains, coughs, head-achs, rheumatisms, the apoplexy, epilepsy, and bloody flux. After falls, blows, bruises, or any violent hurt received either externally or internally, bleeding is necessary. It is likewise necessary for persons who have had the misfortune to be strangled, drowned, suffocated with foul air, the fumes of metal, or the like. In a word, whenever the vital motions have been suddenly stopt from any cause whatever, except in swoonings occasioned by mere weakness or hysteric affections, it is proper to open a vein. But in all disorders proceeding from a relaxation of the solids, and an impoverished state of the blood, as dropsies, cacochymies, &c. bleeding is improper.

571Bleeding for topical inflammations ought always to be performed as near the part affected as possible. When this can be done with a lancet, it is to be preferred to any other method; but where a vein cannot be found, recourse must be had to leeches or cupping.

The quantity of blood to be let must always be regulated by the strength, age, constitution, manner of life, and other circumstances relating to the patient. It would be ridiculous to suppose that a child could bear to lose as much blood as a grown person, or that a delicate lady should be bled to the same extent as a robust man.

From whatever part of the body blood is to be let, a bandage must be applied between that part and the heart. As it is often necessary, in order to raise the vein, to make the bandage pretty tight, it will be proper in such cases, as soon as the blood begins to flow, to slacken it a little. The bandage ought to be applied at least an inch, or an inch and half from the place where the wound is intended to be made.

Persons not skilled in anatomy ought never to bleed in a vein that lies over an artery or a tendon, if they can avoid it. The former may easily be known from its pulsation or beating, and the latter from its feeling hard or tight like a whipcord under the finger.

It was formerly a rule, even among those who had the character of being regular practitioners, to bleed their patients in certain diseases till they fainted. Surely a more ridiculous rule could not be proposed. One person will faint at the very sight of a lancet, while another will lose almost the whole blood of his body before he faints. Swooning depends more upon the state of the mind than of the body; besides, it may often be occasioned 572or prevented by the manner in which the operation is performed.

Children are generally bled with leeches. This, though sometimes necessary, is a very troublesome and uncertain practice. It is impossible to know what quantity of blood is taken away by leeches; besides, the bleeding is often very difficult to stop, and the wounds are not easily healed. Would those who practice bleeding take a little more pains, and accustom themselves to bleed children, they would not find it such a difficult operation as they imagine.

Certain hurtful prejudices with regard to bleeding still prevail among the country people. They talk, for instance, of head-veins, heart-veins, breast-veins, &c. and believe that bleeding in these will certainly cure all diseases of the parts from whence they are supposed to come, without considering that all the blood-vessels arise from the heart, and return to it again; for which reason, unless in topical inflammations, it signifies very little from what part of the body blood is taken. But this, though a foolish prejudice, is not near so hurtful as the vulgar notion that the first bleeding will perform wonders. This belief makes them often postpone the operation when necessary, in order to reserve it for some more important occasion, and, when they think themselves in extreme danger, they fly to it for relief, whether it be proper or not. Bleeding at certain dated periods or seasons has likewise bad effects.

It is a common notion that bleeding in the feet draws the humours downwards, and consequently cures diseases of the head and other superior parts: but we have already observed that, in all topical affections, the blood ought to be drawn as near the part as possible. When it is necessary, however, to bleed in the foot or hand, 573as the veins are small, and the bleeding is apt to stop too soon, the part ought to be immersed in warm water, and kept there till a sufficient quantity of blood be let.

We shall not spend time in describing the manner of performing this operation: that will be better learned by example than precept. Twenty pages of description would not convey so just an idea of the operation as seeing it once performed by an expert hand. Neither is it necessary to point out the different parts of the body from whence blood may be taken, as the arm, foot, forehead, temples, neck, &c. These will readily occur to every intelligent person, and the foregoing observations will be sufficient for determining which of them is most proper upon any particular occasion. In all cases where the intention is merely to lessen the general mass of blood, the arm is the most commodious part of the body in which the operation can be performed.

OF INFLAMMATIONS AND ABSCESSES.

From whatever cause an inflammation proceeds, it must terminate either by dispersion, suppuration, or gangrene. Though it is impossible to foretel with certainty in which of these ways any particular inflammation will terminate, yet a probable conjecture may be formed with regard to the event, from a knowledge of the patient’s age and constitution. Inflammations happening in a slight degree upon colds, and without any previous indisposition, will most probably be dispersed; those which follow close upon a fever, or happen to persons of a gross habit of body, will generally suppurate; and those which attack very old people, or 574persons of a dropsical habit, will have a strong tendency to gangrene.

If the inflammation be slight, and the constitution sound, the dispersion ought always to be attempted. This will be best promoted by a slender diluting diet, plentiful bleeding, and repeated purges. The part itself must be fomented, and, if the skin be very tense, it may be embrocated with a mixture of three-fourths of sweet oil, and one-fourth of vinegar, and afterwards covered with a piece of wax plaster.

If, notwithstanding these applications, the symptomatic fever increases, and the tumour becomes larger, with violent pain and pulsation, it will be proper to promote the suppuration. The best application for this purpose is a soft poultice, which may be renewed twice a day. If the suppuration proceeds but slowly, a raw onion cut small or bruised may be spread upon the poultice. When the abscess is ripe or fit for opening, which may easily be known from the thinness of the skin in the most prominent part of it, a fluctuation of matter which may be felt under the finger, and, generally speaking, an abatement of the pain, it may be opened either with a lancet or by means of caustic.

The last way in which an inflammation terminates, is in a gangrene or mortification, the approach of which may be known by the following symptoms: the inflammation loses its redness, and becomes duskish or livid; the tension of the skin goes off, and it feels flabby; little bladders filled with ichor of different colours spread all over it; the tumour subsides, and from a duskish complexion becomes black; a quick low pulse, with cold clammy sweats, are the immediate forerunners of death.

575When these symptoms first appear, the part ought to be dressed with London treacle, or a cataplasm made of lixivium and bran. Should the symptoms become worse, the part must be scarified, and afterwards dressed with basilicum softened with oil of turpentine. All the dressings must be applied warm. With regard to internal medicines, the patient must be supported with generous cordials, and the Peruvian bark exhibited in as large doses as the stomach will bear it. If the mortified parts should separate, the wound will become a common ulcer, and must be treated accordingly.

This article includes the treatment of all those diseases, which, in different parts of the country, go by the names of biles, imposthumes, whitloes, &c. They are all abscesses in consequence of a previous inflammation, which, if possible, ought to be discussed; but when this cannot be done, the suppuration should be promoted, and the matter discharged by an incision, if necessary; afterwards the sore may be dressed with yellow basilicum, or some other digestive ointment.

OF WOUNDS.

No part of medicine has been more mistaken than the treatment or cure of wounds. Mankind in general believe that certain herbs, ointments, and plasters are possessed of wonderful healing powers, and imagine that no wound can be cured without the application of them. It is however a fact, that no external application whatever contributes towards the cure of a wound, any other way than by keeping the parts soft, clean, and defending them from the external air, which may be as effectually done by dry lint, as by the most pompous 576applications, while it is exempt from many of the bad consequences attending them.

The same observation holds with respect to internal applications. These only promote the cure of wounds as far as they tend to prevent a fever, or to remove any cause that might obstruct or impede the operations of Nature. It is Nature alone that cures wounds. All that Art can do is to remove obstacles, and to put the parts in such a condition as is the most favourable to Nature’s efforts.

With this simple view we shall consider the treatment of wounds, and endeavour to point out such steps as ought to be taken to facilitate their cure.

The first thing to be done when a person has received a wound, is to examine whether any foreign body be lodged in it, as wood, stone, iron, lead, glass, dirt, bits of cloth, or the like. These, if possible, ought to be extracted, and the wound cleaned, before any dressings be applied. When that cannot be effected with safety, on account of the patient’s weakness, or loss of blood, they must be suffered to remain in the wound, and afterwards extracted when he is more able to bear it.

When a wound penetrates into any of the cavities of the body, as the breast, the bowels, &c. or where any considerable blood-vessel is cut, a skilful surgeon ought immediately to be called, otherwise the patient may lose his life. But sometimes the discharge of blood is so great, that if it be not stopt, the patient may die even before a surgeon, though at no great distance, can arrive. In this case, something must be done by those who are present. If the wound be in any of the limbs, the bleeding may generally be stopt by applying a tight ligature or bandage round the member a little above the wound. The best method of doing this 577is to put a strong broad garter round the part, but so slack as easily to admit a small piece of stick to be put under it, which must be twisted, in the same manner as a countryman does a cart-rope to secure his loading, till the bleeding stops. Whenever this is the case, he must take care to twist it no longer, as straining it too much might occasion an inflammation of the parts, and endanger a gangrene.

In parts where this bandage cannot be applied, various other methods may be tried to stop the bleeding, as the application of styptics, astringents, &c. Cloths dipped in a solution of blue vitriol in water, or the styptic water of the Dispensatories, may be applied to the wound. When these cannot be obtained, strong spirits of wine may be used. Some recommend the agaric^[194] of the oak as preferable to any of the other styptics; and indeed it deserves considerable encomiums. It is easily obtained, and ought to be kept in every family, in case of accidents. A piece of it must be laid upon the wound, and covered with a good 578deal of lint, above which a bandage may be applied so tight as to keep it firmly on.

Though spirits, tinctures, and hot balsams may be used, in order to stop the bleeding when it is excessive, they are improper at other times. They do not promote but retard the cure, and often change a simple wound into an ulcer. People imagine, because hot balsams congeal the blood, and seem, as it were, to solder up the wound, that they therefore heal it; but this is only a deception. They may indeed stop the flowing blood, by searing the mouths of the vessels; but, by rendering the parts callous, they obstruct the cure.

In slight wounds, which do not penetrate much deeper than the skin, the best application is a bit of the common black sticking-plaster. This keeps the sides of the wound together, and prevents the air from hurting it, which is all that is necessary. When a wound penetrates deep, it is not safe to keep its lips quite close: this keeps in the matter, and is apt to make the wound fester. In this case the best way is to fill the wound with soft lint, commonly called caddis. It however must not be stuffed in too hard, otherwise it will do hurt. The lint may be covered with a cloth dipped in oil, or spread with the common wax plaster^[195]; and the whole must be kept on by a proper bandage.

We shall not spend time in describing the different bandages that may be proper for wounds in different parts of the body; common sense will generally suggest the most commodious method of applying a bandage; besides, descriptions of this kind are not easily understood or remembered.

The first dressing ought to continue on for at least two days; after which it may be removed, and fresh lint applied as before. If any part of 579the first dressing sticks so close as not to be removed with ease or safety to the patient, it may be allowed to continue, and fresh lint dipped in sweet oil laid over it. This will soften it, so as to make it come off easily at next dressing. Afterwards the wound may be dressed twice a-day in the same manner till it be quite healed. Those who are fond of salves or ointments, may, after the wound is become very superficial, dress it with the yellow basilicum^[196]; and if fungous, or what is called proud flesh, should rise in the wound, it may be checked, by mixing with the ointment a little burnt alum or red precipitate of mercury.

When a wound is greatly inflamed, the most proper application is a poultice of bread and milk, softened with a little sweet oil or fresh butter. This must be applied instead of a plaster, and should be changed twice a-day.

If the wound be large, and there is reason to fear an inflammation, the patient should be kept on a very low diet. He must abstain from flesh, strong liquors, and every thing that is of a heating nature. If he be of a full habit, and has lost but little blood from the wound, he must be bled; and, if the symptoms be urgent, the operation may be repeated. But when the patient has been greatly weakened by loss of blood from the wound, it will be dangerous to bleed him, even though a fever should ensue. Nature should never be too far exhausted. It is always more safe to allow her to struggle with the disease in her own way, than to sink the patient’s strength by excessive evacuations.

Wounded persons ought to be kept perfectly quiet and easy. Every thing that ruffles the mind or moves the passions, as love, anger, fear, excessive 580joy, &c. are very hurtful. They ought above all things to abstain from venery. The body should be kept gently open, either by laxative clysters, or by a cool vegetable diet, as roasted apples, stewed prunes, boiled spinage, and such like.

OF BURNS.

In slight burns which do not break the skin, it is customary to hold the part near the fire for a competent time, to rub it with salt, or to lay a compress upon it dipped in spirits of wine or brandy. But when the burn has penetrated so deep as to blister or break the skin, it must be dressed with some of the liniment for burns mentioned in the Appendix, or with the emollient and gently drying ointment, commonly called Turner’s cerate^[197]. This may be mixed with an equal quantity of fresh olive oil, and spread upon a soft rag, and applied to the part affected. When this ointment cannot be had, an egg may be beat up with about an equal quantity of the sweetest salad-oil. This will serve very well till a proper ointment can be prepared. When the burning is very deep, after the first two or three days, it should be dressed with equal parts of yellow basilicum and Turner’s cerate mixed together.

When the burn is violent, or has occasioned a high degree of inflammation, and there is reason to fear a gangrene or mortification, the same means must be used to prevent it as are recommended in other violent inflammations. The patient, in this case, must live low, and drink freely of weak diluting liquors. He must likewise be bled, and have his body kept open. But if the burnt parts should become livid or black, with other symptoms 581of mortification, it will be necessary to bathe them frequently with warm camphorated spirits of wine, tincture of myrrh, or other antiseptics, mixed with a decoction of the bark. In this case the bark must likewise be taken internally, and the patient’s diet must be more generous.

As example teaches better than precept, I shall relate the treatment of the most dreadful case of this kind that has occurred in my practice. A middle-aged man, of a good constitution, fell into a large vessel full of boiling water, and miserably scalded about one half of his body. As his clothes were on, the burning in some parts was very deep before they could be got off. For the first two days the scalded parts had been frequently anointed with a mixture of lime-water and oil, which is a very proper application for recent burnings. On the third day, when I first saw him, his fever was high, and his body costive, for which he was bled, and had an emollient clyster administered. Poultices of bread and milk, softened with fresh butter, were likewise applied to the affected parts, to abate the heat and inflammation. His fever still continuing high, he was bled a second time, was kept strictly on the cooling regimen, took the saline mixture with small doses of nitre, and had an emollient clyster administered once a-day. When the inflammation began to abate, the parts were dressed with a digestive composed of brown cerate and yellow basilicum. Where any black spots appeared, they were slightly scarified, and touched with the tincture of myrrh; and, to prevent their spreading, the Peruvian bark was administered. By this course, the man was so well in three weeks as to be able to attend his business.

582

OF BRUISES.

Bruises are generally productive of worse consequences than wounds. The danger from them does not appear immediately, by which means it often happens that they are neglected. It is needless to give any definition of a disease so universally known; we shall therefore proceed to point out the method of treating it.

In slight bruises it will be sufficient to bathe the part with warm vinegar, to which a little brandy or rum may occasionally be added, and to keep cloths wet with this mixture constantly applied to it. This is more proper than rubbing it with brandy, spirits of wine, or other ardent spirits, which are commonly used in such cases.

In some parts of the country the peasants apply to a recent bruise a cataplasm of fresh cow-dung. I have often seen this cataplasm applied to violent contusions occasioned by blows, falls, bruises, and such like, and never knew it fail to have a good effect.

When a bruise is very violent, the patient ought immediately to be bled, and put upon a proper regimen. His food should be light and cool, and his drink weak, and of an opening nature; as whey sweetened with honey, decoctions of tamarinds, barley, cream-tartar-whey, and such like. The bruised part must be bathed with vinegar and water, as directed above; and a poultice made by boiling crumb of bread, elder-flowers, and camomile-flowers, in equal quantities of vinegar and water, applied to it. This poultice is peculiarly proper when a wound is joined to the bruise. It may be renewed two or three times a-day.

583As the structure of the vessels is totally destroyed by a violent bruise, there often ensues a great loss of substance, which produces an ulcerous sore very difficult to cure. If the bone be affected, the sore will not heal before an exfoliation takes place; that is, before the diseased part of the bone separates, and comes out through the wound. This is often a very slow operation, and may even require several years to be completed. Hence it happens, that these sores are frequently mistaken for the king’s evil, and treated as such, though in fact they proceed solely from the injury which the solid parts received from the blow.

Patients in this situation are pestered with different advices. Every one who sees them proposes a new remedy, till the sore is so much irritated with various and opposite applications, that it is often at length rendered absolutely incurable. The best method of managing such sores is, to take care that the patient’s constitution does not suffer by confinement, or improper medicine, and to apply nothing to them besides simple ointment spread upon soft lint, over which a poultice of bread and milk, with boiled camomile-flowers, or the like, may be put, to nourish the part, and keep it soft and warm. Nature, thus assisted, will generally in time operate a cure, by throwing off the diseased parts of the bone, after which the sore soon heals.

OF ULCERS.

Ulcers may be the consequence of wounds, bruises, or imposthumes improperly treated; they may likewise proceed from an ill state of the humours, or what may be called a bad habit of body.

584In the latter case, they ought not to be hastily dried up, otherwise it may prove fatal to the patient. Ulcers happen most commonly in the decline of life; and persons who neglect exercise, and live grossly, are most liable to them. They might often be prevented by retrenching some part of the solid food, or by opening artificial drains, as issues, setons, or the like.

An ulcer may be distinguished from a wound by its discharging a thin watery humour, which is often so acrid as to inflame and corrode the skin; by the hardness and perpendicular situation of its sides or edges, by the time of its duration, &c.

It requires considerable skill to be able to judge whether or not an ulcer ought to be dried up. In general, all ulcers which proceed from a bad habit of body, should be suffered to continue open, at least till the constitution has been so far changed by proper regimen, or the use of medicine, that they seem disposed to heal of their own accord. Ulcers which are the effect of malignant fevers, or other acute diseases, may generally be healed with safety after the health has been restored for some time. The cure ought not however to be attempted too soon, nor at any time without the use of purging medicines and a proper regimen. When wounds or bruises have, by wrong treatment, degenerated into ulcers, if the constitution be good, they may generally be healed with safety. When ulcers either accompany chronical diseases, or come in their stead, they must be cautiously healed. If an ulcer conduces to the patient’s health, from whatever cause it proceeds, it ought not to be healed; but if, on the contrary, it wastes the strength, and consumes the patient by a slow fever, it should be healed as soon as possible.

585We would earnestly recommend a strict attention to these particulars, to all who have the misfortune to labour under this disorder, particularly persons in the decline of life; as we have frequently known people throw away their lives by the want of it, while they were extolling and generously rewarding those whom they ought to have looked upon as their executioners.

The most proper regimen for promoting the cure of ulcers, is to avoid all spices, salted and high-seasoned food, all strong liquors, and to lessen the usual quantity of flesh meat. The body ought to be kept gently open by a diet consisting chiefly of cooling laxative vegetables, and by drinking butter-milk, whey sweetened with honey, or the like. The patient ought to be kept cheerful, and should take as much exercise as he can easily bear.

When the bottom and sides of an ulcer seem hard and callous, they may be sprinkled twice a-day with a little red precipitate of mercury, and afterwards dressed with the yellow basilicum ointment. Sometimes it will be necessary to have the edges of the ulcer scarified with the lancet.

Lime-water has frequently been known to have very happy effects in the cure of obstinate ulcers. It may be used in the same manner as directed for the stone and gravel.

My late learned and ingenious friend, Dr. Whytt, strongly recommends the use of the solution of corrosive sublimate of mercury in brandy, for the cure of obstinate ill conditioned ulcers. I have frequently found this medicine, when given according to the Doctor’s directions, prove very successful. The dose is a table-spoonful night and morning; at the same time washing the sore twice or thrice a-day with it. In a letter which I had from the Doctor a little before his death, he informed me, “That he observed washing the sore thrice 586a-day with the solution of a triple strength was very beneficial^[198].”

A fistulous ulcer can seldom be cured without an operation. It must either be laid open so as to have its callous parts destroyed by some corrosive application, or they must be entirely cut away by the knife: but as this operation requires the hand of an expert surgeon, there is no occasion to describe it. Ulcers about the anus are most apt to become fistulous, and are very difficult to cure. Some indeed pretend to have found Ward’s Fistula paste very successful in this complaint. It is not a dangerous medicine, and being easily procured, it may deserve a trial; but as these ulcers generally proceed from an ill habit of body, they will seldom yield to any thing except a long course of regimen, assisted by medicines, which are calculated to correct that particular habit, and to induce an almost total change in the constitution.

CHAP. LI. OF DISLOCATIONS.

When a bone is moved out of its place or articulation, so as to impede its proper functions, it is said to be luxated or dislocated. As this often happens to persons in situations where no medical assistance can be obtained, by which means limbs, and even lives, are frequently lost, we shall endeavour to point out the method of reducing 587the most common luxations, and those which require immediate assistance. Any person of common sense and resolution, who is present when a dislocation happens, may often be of more service to the patient, than the most expert surgeon can after the swelling and inflammation have come on. When these are present, it is difficult to know the state of the joint, and dangerous to attempt a reduction; and by waiting till they are gone off, the muscles become so relaxed, and the cavity filled up, that the bone can never afterwards be retained in its place.

A recent dislocation may generally be reduced by extension alone, which must always be greater or less according to the strength of the muscles which move the joint, the age, robustness, and other circumstances of the patient. When the bone has been out of its place for any considerable time, and a swelling or inflammation has come on, it will be necessary to bleed the patient, and, after fomenting the part, to apply soft poultices with vinegar to it for some time before the reduction is attempted.

All that is necessary after the reduction, is to apply cloths dipt in vinegar or camphorated spirits of wine to the part, and to keep it perfectly easy. Many bad consequences proceed from the neglect of this rule. A dislocation seldom happens without the tendons and ligaments of the joint being stretched and sometimes torn. When these are kept easy till they recover their strength and tone, all goes on very well; but is the injury be increased by too frequent an exertion of the parts, no wonder if they be found weak and diseased ever after.

588

DISLOCATION OF THE JAW.

The lower jaw may be luxated by yawning, blows, falls, chewing hard substances, or the like. It is easily known from the patient’s being unable to shut his mouth, or to eat any thing, as the teeth of the under jaw do not correspond with those of the upper; besides, the chin either hangs down, or is thrown toward one side, and the patient is neither able to speak distinctly, nor to swallow without considerable difficulty.

The usual method of reducing a dislocated jaw, is to set the patient upon a low stool, so as an assistant may hold the head firm by pressing it against his breast. The operator is then to thrust his two thumbs, being first wrapped up with linen cloths that they may not slip, as far back into the patient’s mouth as he can, while his fingers are applied to the jaw externally. After he has got firm hold of the jaw, he is to press it strongly downwards and backwards, by which means the elapsed heads of the jaw may be easily pushed into their former cavities.

The peasants in some parts of the country have a peculiar way of performing this operation. One of them puts a handkerchief under the patient’s chin, then turning his back to that of the patient, pulls him up by the chin so as to suspend him from the ground. This method often succeeds, but we think it a dangerous one, and therefore recommend the former.

589

DISLOCATION OF THE NECK.

The neck may be dislocated by falls, violent blows, or the like. In this case, if the patient receives no assistance, he soon dies, which makes people imagine the neck was broken; it is, however, for the most part only partially dislocated, and may be reduced by almost any person who has resolution enough to attempt it. A complete dislocation of the neck is instantaneous death.

When the neck is dislocated, the patient is immediately deprived of all sense and motion; his neck swells, his countenance appears bloated; his chin lies upon his breast, and his face is generally turned towards one side.

To reduce this dislocation, the unhappy person should immediately be laid upon his back on the ground, and the operator must place himself behind him so as to be able to lay hold of his head with both hands, while he makes a resistance by placing his knees against the patient’s shoulders. In this posture he must pull the head with considerable force, gently twisting it at the same time, if the face be turned to one side, till he perceives that the joint is replaced, which may be known from the noise which the bones generally make when going in, the patient’s beginning to breathe, and the head continuing in its natural posture.

This is one of those operations which it is more easy to perform than describe. I have known instances of its being happily performed even by women, and often by men of no medical education. After the neck is reduced, the patient ought to be bled, and should be suffered to rest for some days, till the parts recover their proper tone.

590

DISLOCATION OF THE RIBS.

As the articulation of the ribs with the backbone is very strong, they are not often dislocated. It does however sometimes happen, which is a sufficient reason for our taking notice of it. When a rib is dislocated either upwards or downwards, in order to replace it, the patient should be laid upon his belly on a table, and the operator must endeavour to push the head of the bone into its proper place. Should this method not succeed, the arm of the disordered side may be suspended over a gate or ladder, and, while the ribs are thus stretched asunder, the heads of such as are out of place may be thrust into their former situation.

Those dislocations wherein the heads of the ribs are forced inwards, are both more dangerous and the most difficult to reduce, as neither the hand nor any instrument can be applied internally to direct the luxated heads of the ribs. Almost the only thing that can be done is, to lay the patient his belly over a cask, or some gibbous body, and to move the fore-part of the rib inward towards the back, sometimes shaking it; by this means the heads of the luxated ribs may slip into their former place.

DISLOCATION OF THE SHOULDER.

The humerus or upper bone of the arm may be dislocated in various directions: it happens however most frequently downwards, but very seldom directly upwards. From the nature of its articulation, as well as from its exposure to external injuries, 591this bone is the most subject to dislocation of any in the body. A dislocation of the humerus may be known by a depression or cavity on the top of the shoulder, and an inability to move the arm. When the dislocation is downward or forward, the arm is elongated, and a ball or lump is perceived under the arm-pit; but when it is backward, there appears a protuberance behind the shoulder, and the arm is thrown forwards toward the breast.

The usual method of reducing dislocations of the shoulder is to seat the patient upon a low stool, and to cause an assistant to hold his body so that it may not give way to the extension, while another lays hold of the arm a little above the elbow, and gradually extends it. The operator then puts a napkin under the patient’s arm, and causes it to be tied behind his own neck: by this, while a sufficient extension is made, he lifts up the head of the bone, and with his hands directs it into its proper place. There are various machines invented for facilitating this operation, but the hand of an expert surgeon is always more safe. In young and delicate patients, I have generally found it a very easy matter to reduce the shoulder, by extending the arm with one hand, and thrusting in the head of the bone with the other. In making the extension, the arm ought always to be a little bent.

DISLOCATION OF THE ELBOW.

The bones of the fore-arm may be dislocated in any direction. When this is the case, a protuberance may be observed on that side of the arm towards which the bone is pushed, from which, and the patient’s inability to bend his arm, a dislocation of this joint may easily be known.