PART II. OF DISEASES. (continued 9)

592Two assistants are generally necessary for reducing a dislocation of the elbow; one of them must lay hold of the arm above, and the other below the joint, and make a pretty strong extension, while the operator returns the bones into their proper place. Afterwards the arm must be bent, and suspended for some time with a sling about the neck.

Luxations of the wrist and fingers are to be reduced in the same manner as those of the elbow, viz. by making an extension in different directions, and thrusting the head of the bone into its place.

DISLOCATION OF THE THIGH.

When the thigh-bone is dislocated forward and downward, the knee and foot are turned out, and the leg is longer than the other; but when it is displaced backward, it is usually pushed upward at the same time, by which means the limb is shortened, and the foot is turned inwards.

When the thigh-bone is displaced forward and downward, the patient, in order to have it reduced, must be laid upon his back, and made fast by bandages, or held by assistants, while by others an extension is made by means of slings fixed about the bottom of the thigh a little above the knee. While the extension is made, the operator must push the head of the bone outward, till it gets into the socket. If the dislocation be outward, the patient must be laid upon his face, and, during the extension, the head of the bone must be pushed inward.

Dislocations of the knees, ancles, and toes, are reduced much in the same manner as those of the upper extremities, viz. by making an extension in opposite directions, while the operator replaces the 593bones. In many cases, however, the extension alone is sufficient, and the bone will slip into its place merely by pulling the limb with sufficient force. It is not hereby meant, that force alone is sufficient for the reduction of dislocations. Skill and address will often succeed better than force. I have known a dislocation of the thigh reduced by one man, after all the force that could be used by six had proved ineffectual.

CHAP. LII. OF BROKEN BONES, &c.

There is, in most country villages, some person who pretends to the art of reducing fractures. Though in general such persons are very ignorant, yet some of them are very successful; which evidently proves, that a small degree of learning, with a sufficient share of common sense and a mechanical head, will enable a man to be useful in this way. We would, however, advise people never to employ such operators, when an expert and skilful surgeon can be had; but when that is impracticable, they must be employed: we shall therefore recommend the following hints to their consideration:

When a large bone is broken, the patient’s diet ought in all respects to be the same as in an inflammatory fever. He should likewise be kept quiet and cool, and his body open by emollient clysters; or, if these cannot be conveniently administered, by food that is. of an opening quality; as stewed prunes, apples boiled in milk, boiled spinage, and the like. It ought however to be here remarked, 594that persons who have been accustomed to live high, are not all of a sudden to be reduced to a very low diet. This might have fatal effects. There is often a necessity for indulging even bad habits, in some measure, where the nature of the disease might require a different treatment.

It will generally be necessary to bleed the patient immediately after a fracture, especially if he be young, of a full habit, or has at the same time received any bruise or contusion. This operation should not only be performed soon after the accident happens, but if the patient be very feverish, it may be repeated next day. When several of the ribs are broken, bleeding is peculiarly necessary.

If any of the large bones which support the body are broken, the patient must keep his bed for several weeks. It is by no means necessary, however, that he should lie all that time, as is customary, upon his back. This situation sinks the spirits, galls and frets the patient’s skin, and renders him very uneasy. After the second week he may be gently raised up, and may sit several hours, supported by a bed-chair, or the like, which will greatly relieve him. Great care, however, must be taken in raising him up, and laying him down, that he make no exertions himself, otherwise the action of the muscles may pull the bone out of its place^[199].

595It is of great importance to keep the patient dry and clean while in this situation. By neglecting this, he is often so galled and excoriated, that he is forced to keep shifting places for ease. I have known a fractured thigh-bone, after it had been kept straight for above a fortnight, displaced by this means, and continue bent for life, in spite of all that could be done.

It has been customary when a bone was broken, to keep the limb for five or six weeks continually upon the stretch. But this is a bad posture. It is both uneasy to the patient, and unfavourable to the cure. The best situation is to keep the limb a little bent. This is the posture into which every animal puts its limbs when it goes to rest, and in which fewest muscles are upon the stretch. It is easily effected, by either laying the patient upon his side, or making the bed so as to favour this position of the limb.

Bone-setters ought carefully to examine whether the bone be not shattered or broken into several pieces. In this case it will sometimes be necessary to have the limb immediately taken off, otherwise a gangrene or mortification may ensue. The horror which attends the very idea of an amputation often occasions its being delayed in such cases till too late. I have known this principle operate so strongly, that a limb, where the bones were shattered into more than twenty pieces, was not amputated before the third day after the accident, when the gangrene had proceeded so far as to render the operation useless.

When a fracture is accompanied with a wound, it must be dressed in all respects as a common wound.

All that art can do towards the cure of a broken bone, is to lay it perfectly straight, and to keep it quite easy. All tight bandages do hurt. 596They had much better be wanting altogether. A great many of the bad consequences which succeed to fractured bones are owing to tight bandages. This is one of the ways in which the excess of art, or rather the abuse of it, does more mischief than would be occasioned by the want of it. Some of the most sudden cures of broken bones which were ever known, happened where no bandages were applied at all. Some method however must be taken to keep the member steady; but this may be done many ways without bracing it with a tight bandage.

The best method of retention is by two or more splints made of leather or pasteboard. These, if moistened before they be applied, soon assume the shape of the included member, and are sufficient, by the assistance of a very slight bandage, for all the purposes of retention. The bandage which we would recommend is that made with twelve or eighteen tails. It is much easier applied and taken off than rollers, and answers all the purposes of retention equally well. The splints should always be as long as the limb, with holes cut for the ancles when the fracture is in the leg.

In fractures of the ribs, where a bandage cannot be properly used, an adhesive plaster may be applied over the part. The patient in this case ought to keep himself quite easy, avoiding every thing that may occasion sneezing, laughing, coughing, or the like. He ought to keep his body in a straight posture, and should take care that his stomach be constantly distended, by taking frequently some light food, and drinking freely of weak watery liquors.

The most proper external application for a fracture is oxycrate, or a mixture of vinegar and water. The bandages should be wet with this at every dressing.

597

OF STRAINS.

Strains are often attended with worse consequences than broken bones. The reason is obvious; they are generally neglected. When a bone is broken, the patient is obliged to keep the member easy, because he cannot make use of it; but when a joint is only strained, the person, finding he can still make a shift to move it, is sorry to lose his time for so trifling an ailment. In this way he deceives himself, and converts into an incurable malady what might have been removed by only keeping the part easy for a few days.

Country people generally immerse a strained limb in cold water. This is very proper, provided it be done immediately, and not kept in too long. But the custom of keeping the part immersed in cold water for a long time is certainly dangerous. It relaxes instead of bracing the part, and is more likely to produce a disease than remove one.

Wrapping a garter, or some other bandage, pretty tight about the strained part, is likewise of use. It helps to restore the proper tone of the vessels, and prevents the action of the parts from increasing the disease. It should not however be applied too tight. I have frequently known bleeding near the affected part have a very good effect: but what we would recommend above all is ease. It is more to be depended on than any medicine, and seldom fails to remove the complaint^[200].

598

OF RUPTURES.

Children and old people are most liable to this disease. In the former it is generally occasioned by excessive crying, coughing, vomiting, or the like. In the latter, it is commonly the effect of blows or violent exertions of the strength, as leaping, carrying great weights, &c. In both, a relaxed habit, indolence, and an oily or very moist diet, dispose the body to this disease.

A rupture sometimes proves fatal before it is discovered. Whenever sickness, vomiting, and obstinate costiveness give reason to suspect an obstruction of the bowels, all those places where ruptures usually happen ought carefully to be examined. The protrusion of a very small part of the gut will occasion all these symptoms; and, if not returned in due time, will prove mortal.

On the first appearance of a rupture in an infant, it ought to be laid upon its back, with its head very low. While in this posture, if the gut does not return of itself, it may easily be put up by gentle pressure. After it is returned, a piece of sticking-plaster may be applied over the part, and a proper truss or bandage must be constantly worn for a considerable time. The method of making and applying these rupture-bandages for children is pretty well known. The child must, as far as possible, be kept from crying, and from all violent exertions, till the rupture is quite healed.

In adults, when the gut has been forced down with great violence, or happens from any cause to be inflamed, there is often great difficulty in returning it, and sometimes the thing is quite impracticable 599without an operation; a description of which is foreign to our purpose. As I have been fortunate enough, however, always to succeed in my attempts to return the gut, without having recourse to any other means than what are in the power of every man, I shall briefly mention the method which I generally pursue.

After the patient has been bled, he must be laid upon his back, with his head very low, and his breech raised high with pillows. In this situation flannel cloths wrung out of a decoction of mallows and camomile-flowers, or, if these are not at hand, of warm water, must be applied for a considerable time. A clyster made of this decoction, with a large spoonful of butter and an ounce or two of salt, may be afterwards thrown up. If these should not prove successful, recourse must be had to pressure. If the tumour be very hard, considerable force will be necessary; but it is not force alone which succeeds here. The operator, at the same time that he makes a pressure with the palms of his hand, must with his fingers artfully conduct the gut in by the same aperture through which it came out. The manner of doing this can be much easier conceived than described. Should these endeavours prove ineffectual, clysters of the smoke of tobacco may be tried. These have been often known to succeed where every other method failed.

There is reason to believe that, by persisting in the use of these, and such other means as the circumstances of the case may suggest, most hernias might be reduced without an operation. Cutting for the hernia is a nice and difficult matter. I would therefore advise surgeons to try every method of returning the gut before they have recourse to the knife. I have once and again succeeded by persevering in my endeavours, after eminent surgeons had 600declared the reduction of the gut impracticable without an operation^[201].

An adult, after the gut has been returned, must wear a steel bandage. It is needless to describe this, as it may always be had ready made from the artists. Such bandages are generally uneasy to the wearer for some time, but by custom they become quite easy. No person who has had a rupture after he arrived at man’s estate should ever be without one of these bandages.

Persons who have a rupture ought carefully to avoid all violent exercise, carrying great weights, leaping, running, and the like. They should likewise avoid windy aliment and strong liquors; and should carefully guard against catching cold.

CHAP. LIII. OF CASUALTIES.

It is certain that life, when to all appearance lost, may often, by due care, be restored. Accidents frequently prove fatal, merely because proper means are not used to counteract their effects, 601No person ought to be looked upon as killed by any accident, unless where the structure of the heart, brain, or some organ necessary to life, is evidently destroyed. The action of these organs may be so far impaired as even to be for some time imperceptible, when life is by no means gone. In this case, however, if the fluids be suffered to grow cold, it will be impossible to put them again in motion, even though the solids should recover their power of acting. Thus, when the motion of the lungs has been stopt by unwholesome vapour, the action of the heart by a stroke on the breast, or the functions of the brain by a blow on the head, if the person be suffered to grow cold, he will in all probability continue so; but, if the body be kept warm, as soon as the injured part has recovered its power of acting, the fluids will again begin to move, and all the vital functions will be restored.

It is a horrid custom immediately to consign over to death every person who has the misfortune, by a fall, a blow, or the like, to be deprived of the appearance of life. The unhappy person, instead of being carried into a warm house, and laid by the fire, or put to a warm bed, is generally hurried away to church, or a barn, or some other cold damp house, where, after a fruitless attempt has been made to bleed him, perhaps by one who knew nothing of the matter, he is given over for dead, and no further notice taken of him. This conduct seems to be the result of ignorance, supported by an ancient superstitious notion, which forbids the body of any person killed by accident to be laid in an house that is inhabited. What the ground of this superstition may be, we shall not pretend to inquire; but surely the conduct founded upon it is contrary to all the principles of reason, humanity, and common sense.

602When a person seems to be suddenly deprived of life, our first business is to inquire into the cause. We ought carefully to observe whether any substance be lodged in the wind-pipe or gullet; and, if that is the case, attempts must be made to remove it. When unwholesome air is the cause, the patient ought immediately to be removed out of it. If the circulation be suddenly stopped, from any cause whatever, except mere weakness, the patient should be bled. If the blood does not flow, he may be immersed in warm water, or rubbed with warm cloths, &c. to promote the circulation. When the cause cannot be suddenly removed, our great aim must be to keep up the vital warmth, by rubbing the patient with hot cloths, or salt, and covering his body with warm sand, ashes, or the like.

I should now proceed to treat more fully of those accidents, which, without immediate assistance, would often prove fatal, and to point out the most likely means for relieving the unhappy sufferers; but as I have been happily anticipated in this part of my subject by the learned and humane Dr. Tissot, I shall content myself with selecting such of his observations as seem to be the most important, and adding such of my own as have occurred in the course of practice.

OF SUBSTANCES STOPT BETWEEN THE MOUTH AND STOMACH.

Though accidents of this kind are very common, and extremely dangerous, yet they are generally the effect of carelessness. Children should be taught to chew their food well, and to put nothing into their mouths which it would be dangerous for 603them to swallow. But children are not the only persons guilty of this piece of imprudence. I know many adults who put pins, nails, and other sharp-pointed substances in their mouths upon every occasion, and some who even sleep with the former there all night. This conduct is exceedingly injudicious, as a fit of coughing, or twenty other accidents, may force over the substance before the person is aware^[202].

When any substance is detained in the gullet, there are two ways of removing it, viz. either by extracting it, or pushing it down. The safest and most certain way is to extract it; but this is pot always the easiest; it may therefore be more eligible sometimes to thrust it down, especially when the obstructing body is of such a nature, that there is no danger from its reception into the stomach. The substances which may be pushed down without danger are, all common nourishing ones, as bread, flesh, fruits, and the like. All indigestible bodies, as cork, wood, bones, pieces of metal, and such like, ought if possible to be extracted, especially if these bodies be sharp pointed, as pins, needles, fish-bones, bits of glass, &c.

When such substances have not passed in too deep, we should endeavour to extract them with our fingers, which method often succeeds. When they are lower, we must make use of nippers, or a small pair of forceps, such as surgeons use. But this attempt to extract rarely succeeds, if the substance be of a flexible nature, and has descended far into the gullet.

If the fingers and nippers fail, or cannot be duly applied, crotchets, a kind of hooks, must be employed. 604These may be made at once, by bending a piece of pretty strong iron wire at one end. It must be introduced in the flat way; and for the better conducing it, there should likewise be a curve or bending at the end it is held by, to serve as a kind of handle to it; which has this further use, that it may be secured by a string tied to it, a circumstance not to be omitted in any instrument employed on such occasions, to avoid such ill accidents as have sometimes ensued from these instruments slipping out of the operator’s hand. After the crotchet has passed below the substance that obstructs the passage, it is drawn up again, and hooks up the body along with it. The crotchet is also very convenient, when a substance somewhat flexible, as a pin or fish-bone, sticks across the gullet, the hook, in such cases, seizing them about their middle part, crooks and thus disengages them; or, if they are very brittle substances, serves to break them.

When the obstructing bodies are small, and only stop up a part of the passage, and which may either easily elude the hook, or straiten it by their resistance, a kind of rings, made either of wire, wool, or silk, may be used. A piece of fine wire of a proper length may be bent into a circle, about the middle, of about an inch diameter, and the long unbent sides brought parallel, and near each other: these are to be held in the hand, and the circular part or ring introduced into the gullet, in order to be conduced about the obstructing body, and so to extract it. More flexible rings may be made of wool, thread, silk, or small pack-thread, which may be waxed for their greater strength and consistence. One of these is to be tied fast to a handle of iron wire, whale-bone, or any kind of flexible wood, and by this means introduced, in order to surround the obstructing substance, and to draw it 605out. Several of these rings passed through one another may be used, the more certainly to lay hold of the obstructing body, which may be involved by one, if another should miss it. These rings have one advantage, which is, that when the substance to be extracted is once laid hold of, it may then, by turning the handle, be retained so strongly in the ring thus twitted, as to be moved every way, which must in many cases be a considerable advantage.

Another material employed on these unhappy occassions is the sponge. Its property of swelling considerably on being wet is the principal foundation of its usefulness here. If any substance is stopt in the gullet, but without filling up the whole passage, a bit of sponge may be introduced into that part which is unstopt, and beyond the substance. The sponge soon dilates, and grows larger in this moist situation; and indeed the enlargement of it may be forwarded by making the patient swallow a few drops of water. Afterwards it is to be drawn back by the handle to which it is fastened; and as it is now too large to return through the small cavity by which it was conveyed in, it draws out the obstructing body along with it.

The compressibility of sponge is another foundation of its usefulness in such cases. A pretty large piece of sponge may be compressed or squeezed into a small size, by winding a string of tape closely about it, which may be easily unwound, and withdrawn, after the sponge has been introduced. A bit of sponge may likewise be, compressed by a piece of whale-bone split at one end; but this can hardly be introduced in such a manner as not to hurt the patient.

I have often known pins and other sharp bodies, which had stuck in the throat, brought up by 606causing the person to swallow a bit of tough meat tied to a thread, and drawing it quickly up again. This is safer than swallowing sponge, and will often answer the purpose equally well.

When all these methods prove unsuccessful, there remains one more, which is, to make the patient vomit: but this can scarcely be of any service, unless when such obstructing bodies are simply engaged in, and not hooked or stuck into the sides of the gullet, as in this case vomiting might sometimes occasion further mischief. If the patient can swallow, vomiting may be excited by taking half a drachm or two scruples of ipecacuanha in powder made into a draught. If he is not able to swallow, an attempt may be made to excite vomiting, by tickling his throat with a feather; and, if that should not succeed, a clyster of tobacco may be administered. It is made by boiling an ounce of tobacco in a sufficient quantity of water: this has often been found to succeed, when other attempts to excite vomiting had failed.

When the obstructing body is of such a nature that it may with safety be pushed downwards, this may be attempted by means of a wax-candle oiled, and a little heated, so as to make it flexible; or a piece of whale-bone, wire, or flexible wood, with a sponge fastened to one end.

Should it be impossible to extract even those bodies which it is dangerous to admit into the stomach, we must then prefer the least of two evils, and rather run the hazard of pushing them down than suffer the patient to perish in a few minutes; and we ought to scruple this resolution the less, as a great many instances have happened, where the swallowing of such hurtful and indigestible substances has been followed by no disorder.

Whenever it is manifest that all endeavours either to extract or push down the substance must 607prove ineffectual, they should be discontinued; because the inflammation occasioned by persisting in them might be as dangerous as the obstruction itself. Some have died in consequence of the inflammation, even after the body which caused the obstruction had been entirely removed.

While the means recommended above are making use of, the patient should often swallow, or, if he cannot, he should frequently receive by injection through a crooked tube or pipe that may reach down to the gullet, some emollient liquor, as warm milk and water, barley-water, or a decoction of mallows. Injections of this kind not only soften and sooth the irritated parts, but, when thrown in with force, are often more successful in loosening the obstruction than all attempts with instruments.

When, after all our endeavours, we are obliged to leave the obstructing body in the part, the patient must be treated as if he had an inflammatory disease. He should be bled, kept upon a low diet, and have his whole neck surrounded with emollient poultices. The like treatment must also be used, if there be any reason to suspect an inflammation of the passages, though the obstructing body be removed.

A proper degree of agitation has sometimes loosened the inhering body more effectually than instruments. Thus, a blow on the back has often forced up a substance which stuck in the gullet; but this is still more proper and efficacious when the substance gets into the wind-pipe. In this case, vomiting and sneezing are likewise to be excited. Pins, which stuck in the gullet, have been frequently discharged by riding on horseback, or in a carriage.

When any indigestible substance has been forced down into the stomach, the patient should use a very 608mild and smooth diet, consisting chiefly of fruits and farinaceous substances, as puddings, pottage, and soups. He should avoid all heating and irritating things, as wine, punch, pepper, and such like; and his drink should be milk and water, barley-water, or whey.

When the gullet is so strongly and fully closed, that the patient can receive no food by the mouth, he must be nourished by clysters of soup, jelly, and the like.

When the patient is in danger of being immediately suffocated, and all hope of freeing the passage is vanished, so that death seems at hand, if respiration be not restored; the operation of bronchotomy, or opening of the wind-pipe, must be directly performed. As this operation is neither difficult to an expert surgeon, nor very painful to the patient, and is often the only method which can be taken to preserve life in these emergencies, we thought proper to mention it, though it should only be attempted by persons skilled in surgery.

OF DROWNED PERSONS.

When a person has remained above a quarter of an hour under water, there can be no considerable hopes of his recovery. But as several circumstances, may happen to have continued life, in such an unfortunate situation, beyond the ordinary term, we should never too soon resign the unhappy object to his fate, but try every method for his relief, as there are many well attested proofs of the recovery of persons to life and health who had been taken out of the water apparently dead, and who remained a considerable time without exhibiting any signs of life.

609The first thing to be done, after the body is taken out of the water, is to convey it as soon as possible to some convenient place where the necessary operations for its recovery may be performed. In doing this, care must be taken not to bruise or injure the body by carrying it in any unnatural posture with the head downwards, or the like. If an adult body, it ought to be laid on a bed, or on straw, with the head a little raised, and carried on a cart or on men’s shoulders, and kept in as natural and easy a position as possible. A small body may be carried in the arms.

In attempting to recover persons apparently drowned, the principal intention to be pursued is, to restore the natural warmth, upon which all the vital functions depend; and to excite these functions by the application of stimulants, not only to the skin, but likewise to the lungs, intestines, &c.

Though cold was by no means the cause of the person’s death, yet it will prove an effectual obstacle to his recovery. For this reason, after stripping him of his wet clothes, his body must be strongly rubbed for a considerable time with coarse linen cloths, as warm as they can be made; and, as soon as a well-heated bed can be got ready, he may be laid in it, and the rubbing should be continued. Warm cloths ought likewise to be frequently applied to the stomach and bowels, and hot bricks, or bottles of warm water, to the soles of his feet, and to the palms of his hands.

Strong volatile spirits should be frequently applied to the nose; and the spine of the back and pit of the stomach may be rubbed with warm brandy or spirit of wine. The temples ought always to be chafed with volatile spirits; and stimulating powders, as that of tobacco or marjoram, may be blown up the nostrils.

610To renew the breathing, a strong person may blow his own breath into the patient’s mouth with all the force he can, holding his nostrils at the same time. When it can be perceived by the rising of the chest or belly that the lungs are filled with air, the person ought to desist from blowing, and should press the breast and belly so as to expel the air again; and this operation may be repeated for some time, alternately inflating and depressing the lungs so as to imitate natural respiration.

If the lungs cannot be inflated in this manner, it may be attempted by blowing through one of the nostrils, and at the same time keeping the other close. Dr. Monro for this purpose recommends a wooden pipe fitted at one end for filling the nostril, and at the other for being blown into by a person’s mouth, or for receiving the pipe of a pair of bellows, to be employed for the same purpose, if necessary.

When air cannot be forced into the chest by the mouth or nose, it may be necessary to make an opening into the wind-pipe for this purpose. It is needless, however, to spend time in describing this operation, as it should not be attempted unless by persons skilled in surgery.

To stimulate the intestines, the fume of tobacco may be thrown up in form of clyster. There are various pieces of apparatus contrived for this purpose, which may be used when at hand; but where these cannot be obtained, the business may be done by a common tobacco-pipe. The bowl of the pipe must be filled with tobacco well kindled, and, after the small tube has been introduced into the fundament, the smoke may be forced up by blowing through a piece of paper full of holes wrapped round the mouth of the pipe, or by blowing through an empty pipe, the mouth of which is 611applied close to that of the other. This may also be done in the following manner: A common clyster-pipe with a bag mounted upon it may be introduced into the fundament, and the mouth of the bag may be applied round the small end of a tobacco-pipe, in the bowl of which tobacco is to be kindled, and the smoke blown up as directed above. Should it be found impracticable to throw up the smoke of tobacco, clysters of warm water, with the addition of a little salt and some wine or spirits, may be frequently administered. This may be done by a common clyster-bag and pipe; but, as it ought to be thrown well up, a pretty large syringe will answer the purpose better.

While these things are doing, some of the attendants ought to be preparing a warm bath, into which the person should be put, if the above endeavours prove ineffectual. Where there are no conveniencies for using the warm bath, the body may be covered with warm salt, sand, ashes, grains, or such like. Tissot mentions an instance of a girl who was restored to life, after she had been taken out of the water, swelled, bloated, and to all appearance dead, by laying her naked body upon hot ashes, covering her with others equally hot, putting a bonnet round her head, and a stocking round her neck stuffed with the same, and heaping coverings over all. After she had remained half an hour in this situation, her pulse returned, she recovered speech, and cried out, I freeze, I freeze; a little cherry-brandy was given her, and she remained buried as it were under the ashes for eight hours; afterwards she was taken out, without any other complaint except that of lassitude or weariness, which went off in a few days. The Doctor mentions likewise an instance of a man who was restored to life, after he had remained six hours under water, by the heat of a dunghill.

612Till the patient shews some signs of life, and is able to swallow, it would be useless and even dangerous to pour liquors into his mouth. His lips, however, and tongue, may be frequently wet with a feather dipt in warm brandy or other strong spirits; and, as soon as he has recovered the power of swallowing, a little warm wine, or some other cordial, ought every now and then to be administered.

Some recommend a vomit after the patient is a little re-animated; but if he can be made to puke without the sickening draught, it will be more safe: this may generally be done by tickling the throat and fauces with an oiled feather, or some other soft substance, which will not injure the parts. Tissot in this case recommends the oxymel of squills, a table-spoonful of which, diluted with water, may be given every quarter of an hour, till the patient has taken five or six doses. Where that medicine is not at hand, a strong infusion of sage, camomile-flowers, or carduus benedictus, sweetened with honey, or some warm water, with the addition of a little salt, may, he says, supply its place. The Doctor does not intend that any of these things should be given in such quantity as to occasion vomiting. He thinks emetics in this situation are not expedient.

We are by no means to discontinue our assistance as soon as the patients discover some tokens of life, since they sometimes expire after these first appearances of recovering. The warm and stimulating applications are still to be continued, and small quantities of some cordial liquor ought frequently to be administered. Lastly, though the person should be manifestly re-animated, there sometimes remain an oppression, a cough, and feverishness, which effectually constitute a disease. In this case it will be necessary to bleed the patient in the arm, and to cause him to drink plentifully 613of barley-water, elder-flower-tea, or any other soft pectoral infusions.

Such persons as have the misfortune to be deprived of the appearances of life, by a fall, a blow, suffocation, or the like, must be treated nearly in the same manner as those who have been for some time under water. I once attended a patient who was so stunned by a fall from a horse, that for above six hours he scarcely exhibited any signs of life; yet this man, by being bled, and proper methods taken to keep up the vital warmth, recovered, and in a few days was perfectly well. Dr. Alexander gives an instance to the same purpose, in the Edinburgh Physical and Literary Essays, of a man who was to all appearance killed by a blow on the breast, but recovered upon being immersed for some time in warm water. These, and other instances of a similar nature, which might be adduced, amount to a full proof of this fact, that many of those unhappy persons who lose their lives by falls, blows, and other accidents, might be saved by the use of proper means duly persisted in.

OF NOXIOUS VAPOURS.

Air may be many ways rendered noxious, or even destructive to animals. This may either happen from its vivifying principle being destroyed, or from subtle exhalations with which it is impregnated. Thus air that has passed through burning fuel is neither capable of supporting fire nor the life of animals. Hence the danger of sleeping in close chambers with charcoal fires. Some indeed suppose the danger here proceeds from the sulphureous oil contained in the charcoal, which is set at liberty and diffused all over the chamber; while 614others imagine it is owing to the air of the room being charged with phlogiston. Be this as it may, it is a situation carefully to be avoided. Indeed, it is dangerous to sleep in a small apartment with a fire of any kind. I lately saw four persons who had been suffocated by sleeping in an apartment where a small fire of coal had been left burning.

The vapour which exhales from wine, cyder, beer, or other liquors, in the state of fermentation, contains something poisonous, which kills in the same manner as the vapour of coal. Hence there is always danger in going into cellars where a large quantity of these liquors is in a state of fermentation, especially if they have been close shut up for some time. There have been many instances of persons struck dead on entering such places, and of others who have with difficulty escaped.

When subterraneous caves, that have been very long shut, are opened, or when deep wells are cleaned, which have not been emptied for several years, the vapours arising from them produce the same effects as those mentioned above. For this reason, no person ought to venture into a well, pit, cellar, or any place that is damp, and has been long shut up, till the air has been sufficiently purified, by burning gunpowder in it. It is easy to know, as has been observed in a former part of this work, when the air of such places is unwholesome, by letting down a lighted candle, throwing in burning fuel, or the like. If these continue to burn, people may safely venture in; but where they are suddenly extinguished, no one ought to enter till the air has been first purified by fire.

The offensive smell of lamps and of candles, especially when their flames are extinguished, operate like other vapours, though with less violence, 615and less suddenly. There have however been instances of people killed by the fumes of lamps which had been extinguished in a close chamber, and persons of weak delicate breasts generally find themselves quickly oppressed in apartments illuminated with many candles.

Such as are sensible of their danger in these situations, and retreat seasonably from it, are generally relieved as soon as they get into the open air, or, if they have any remaining uneasiness, a little water and vinegar, or lemonade, drank hot, affords them relief. But when they are so far poisoned, as to have lost their feeling and understanding, the following means must be used for their recovery:

The patient should be exposed to a very pure, fresh, and open air; and volatile salts, or other stimulating substances, held to his nose. He should next be bled in the arm, or if that does not succeed, in the neck. His legs ought to be put into warm water, and well rubbed. As soon as he can swallow, some lemonade, or water and vinegar, with the addition of a little nitre, may be given him.

Nor are sharp clysters by any means to be neglected; these may be made, by adding to the common clyster, syrup of buckthorn and tincture of senna, of each two ounces; or, in their stead, half an ounce of Venice turpentine dissolved in the yolk of an egg. Should these things not be at hand, two or three large spoonfuls of common salt may be put into the clyster. The same means, if necessary, which were recommended in the former part of this chapter, may be used to restore the circulation, warmth, &c.

Mr. Tossach, surgeon at Alloa, relates the case of a man suffocated by the steam of burning coal, whom he recovered by blowing his breath into the 616patient’s mouth, bleeding him in the arm, and causing him to be well rubbed and tossed about. And Dr. Frewen, of Sussex, mentions the case of a young man who was stupified by the smoke of sea-coal, but was recovered by being plunged into cold water, and afterwards laid in a warm bed.

The practice of plunging persons suffocated by noxious vapours in cold water, would seem to be supported by the common experiment of suffocating dogs in the grotto del cani, and afterwards recovering them, by throwing them into the neighbouring lake.

EFFECTS OF EXTREME COLD.

When cold is extremely severe, and a person is exposed to it for a long time, it proves mortal, in consequence of its stopping the circulation in the extremities, and forcing too great a proportion of blood towards the brain; so that the patient dies of a kind of apoplexy, preceded by great sleepiness. The traveller, in this situation, who finds himself begin to grow drowsy, should redouble his efforts to extricate himself from the imminent danger he is exposed to. This sleep, which he might consider as some alleviation of his sufferings, would, if indulged, prove his last.

Such violent effects of cold are happily not very common in this country; it frequently happens, however, that the hands or feet of travellers are so benumbed or frozen, as to be in danger of a mortification, if proper means are not used to prevent it. The chief danger in this situation arises from the sudden application of heat. It is very common, when the hands or feet are pinched with cold, to hold them to the fire; yet reason and observation shew that this is a most dangerous and imprudent practice.

617Every peasant knows, if frozen meat, fruits, or roots of any kind, be brought near the fire, or put into warm water, they will be destroyed, by rottenness, or a kind of mortification; and that the only way to recover them, is to immerse them for some time in very cold water. The same observation holds with regard to animals in this condition.

When the hands or feet are greatly benumbed with cold, they ought either to be immersed in cold water, or rubbed with snow, till they recover their natural warmth and sensibility: after which the person may be removed into an apartment a little warmer, and may drink some cups of tea, or an infusion of elder flowers sweetened with honey. Every person must have observed, when his hands were even but slightly affected with cold, that the best way to warm them was by washing them in cold water, and continuing to rub them well for some time.

When a person has been so long exposed to the cold, that all appearances of life are gone, it will be necessary to rub him all over with snow or cold water; or, what will answer better, if it can be obtained, to immerse him in a bath of the very coldest water. There is the greatest encouragement to persist in the use of these means, as we are assured that persons who had remained in the snow, or had been exposed to the freezing air during five or six successive days, and who had discovered no marks of life for several hours, have nevertheless been revived.

I have always thought, that the whitloes, kibes, chilblains, and other inflammations of the extremities, which are so common among the peasants in the cold season, were chiefly occasioned by their sudden transitions from cold to heat. After they have been exposed to an extreme degree of cold, 618they immediately apply their hands and feet to the fire, or, if they have occasion, plunge them into warm water, by which means, if a mortification does not happen, an inflammation seldom fails to ensue. Most of the ill consequences from this quarter might be easily avoided, by only observing the precautions mentioned above.

EFFECTS OF EXTREME HEAT.

The effects of extreme heat, though not so common in this country, are no less fatal, and much more sudden than those of cold. In hot countries people frequently drop down dead in the streets, exhausted with heat and fatigue. In this case, if any warm cordial can be poured into the mouth it ought to be done. If this cannot be effected, they may be thrown up in form of a clyster. Volatile spirits, and other things of a stimulating nature, may be applied to the skin, which should be well rubbed with coarse-cloths, whipped with nettles, or other stimulating things. Some of the ancient physicians are said to have restored to life persons apparently dead, by beating them with rods.

CHAP. LIV. OF FAINTING FITS, AND OTHER CASES WHICH REQUIRE IMMEDIATE ASSISTANCE.

Strong and healthy persons, who abound with blood, are often seized with sudden fainting fits, after violent exercise, drinking freely of 619warm or strong liquors, exposure to great heat, intense application to study, or the like.

In such cases the patient should be made to smell to some vinegar. His temples, forehead, and wrists ought at the same time to be bathed with vinegar mixed with an equal quantity of warm water; and two or three spoonfuls of vinegar, with four or five times as much water, may, if he can swallow, be poured into his mouth.

If the fainting proves obstinate, or degenerates into a syncope, that is, an abolition of feeling and understanding, the patient must be bled. After the bleeding, a clyster will be proper, and then he should be kept easy and quiet, only giving him every half hour a cup or two of an infusion of any mild vegetable, with the addition of a little sugar and vinegar.

When swoonings, which arise from this cause, occur frequently in the same person, he should, in order to escape them, confine himself to a light diet, confiding chiefly of bread, fruits, and other vegetables. His drink ought to be water or small beer, and he should deep but moderately, and take much exercise.

But fainting fits proceed much oftner from a defect than an excess of blood. Hence they are very ready to happen after great evacuations of any kind, obstinate watching, want of appetite, or such like. In these an almost directly opposite course to that mentioned above must be pursued.

The patient should be laid in bed, with his head low, and being covered, should have his legs, thighs, arms, and his whole body rubbed strongly with hot flannels. Hungary water, volatile salts, or strong smelling herbs, as rue, mint, or rosemary, may be held to his nose. His mouth may be wet with a little rum or brandy; and, if he can swallow, some hot wine, mixed with sugar and 620cinnamon, which is an excellent cordial, may be poured into his mouth. A compress of flannel dipt in hot wine or brandy must be applied to the pit of his stomach, and warm bricks, or bottles filled with hot water, laid to the feet.

As soon as the patient is recovered a little, he should take some strong soup or broth, or a little bread or biscuit soaked in hot-spiced wine. To prevent the return of the fits, he ought to take often, but in small quantities, some light yet strengthening nourishment, as panado made with soup instead of water, new laid eggs lightly poached, chocolate, light roast meats, jellies, and such like.

Those fainting fits, which are the effect of bleeding, or of the violent operation of purges, belong to this class. Such as happen after artificial bleeding are seldom dangerous, generally terminating as soon as the patient is laid upon the bed; indeed persons subject to this kind should always be bled lying, in order to prevent it. Should the fainting however continue longer than usual, volatile spirits may be held to the nose, and rubbed on the temples, &c.

When fainting is the effect of too strong or acrid purges or vomits, the patient must be treated in all respects as if he had taken poison. He should be made to drink plentifully of milk, warm water, and oil, barley-water, or suck like; emollient clysters will likewise be proper, and the patient’s strength should afterwards be recruited, by giving him generous cordials, and anodyne medicines.

Faintings are often occasioned by indigestion. This may either proceed from the quantity or quality of the food. When the former of these is the cause, the cure will be best performed by vomiting, which may be promoted by causing the patient to drink a weak infusion of camomile-flowers, 621carduus benedictus or the like. When the disorder proceeds from the nature of the food, the patient, as in the case of weakness, must be revived by strong smells, &c. after which he should be made to swallow a large quantity of light warm fluid, which may serve to drown, as it were, the offending matter, to soften its acrimony, and either to effect a discharge of it by vomiting, or force it down into the intestines.

Even disagreeable smells will sometimes occasion swoonings, especially in people of weak nerves. When this happens, the patient should be carried into the open air, have stimulating things held to his nose, and those substances which are disagreeable to him ought immediately to be removed. But we have already taken notice of swoonings which arise from nervous disorders, and shall therefore say no more upon that head.

Fainting fits often happen in the progress of diseases. In the beginning of putrid diseases they generally denote an oppression at stomach, or a mass of corrupted humours, and they cease after evacuations either by vomit or stool. When they occur at the beginning of malignant fevers, they indicate great danger. In each of these cases, vinegar used both externally and internally is the best remedy during the paroxysm, and plenty of lemon-juice and water after it. Swoonings which happen in diseases accompanied with great evacuations, must be treated like those which are owing to weakness, and the evacuations ought to be restrained. When they happen towards the end of a violent fit of an intermitting fever, or at that of each exacerbation of a continual fever, the patient must be supported by small draughts of wine and water.

Delicate and hysteric women are very liable to swooning or fainting fits after delivery. These 622might be often prevented by generous cordials, and the admission of fresh air. When they are occasioned by excessive flooding, it ought by all means to be restrained. They are generally the effect of mere weakness or exhaustion. Dr. Engleman relates the case of a woman “in child-bed, who, after being happily delivered, suddenly fainted, and lay upwards of a quarter of an hour apparently dead. A physician was sent for; her own maid, in the mean while, being out of patience at his delay, attempted to assist her herself, and extending herself upon her mistress, applied her mouth to her’s, blew in as much breath as she possibly could, and in a very short time the exhausted woman awaked as out of a profound sleep; when proper things being given her, she soon recovered.

“The maid being asked how she came to think of this expedient, said she had seen it practised at Altenburgh, by midwives, upon children with the happiest effect.”

We mention this case chiefly that other midwives may be induced to follow so laudable an example. Many children are born without any signs of life, and others expire soon after the birth, who might, without all doubt, by proper care, be restored to life.

From whatever cause fainting fits proceed, fresh air is always of the greatest importance to the patient. By not attending to this circumstance, people often kill their friends while they are endeavouring to save them. Alarmed at the patient’s situation, they call in a crowd of people to his assistance, or perhaps to witness his exit, whose breathing exhausts the air, and increases the danger. There is not the least doubt but this practice, which is very common among the lower sort of people, often proves fatal, especially to the delicate, 623and such persons as fall into fainting fits from mere exhaustion, or the violence of some disease. No more persons ought ever to be admitted into the room where a patient lies in a swoon than are absolutely necessary for his assistance, and the windows of the apartment should always be opened, at least as far as to admit a stream of fresh air.

Persons subject to frequent swoonings, or fainting fits, should neglect no means to remove the cause of them, as their consequences are always injurious to the constitution. Every fainting fit leaves the person in dejection and weakness; the secretions are thereby suspended, the humours disposed to stagnation, coagulations and obstructions are formed, and, if the motion of the blood be totally intercepted, or very considerably checked, polypuses are sometimes formed in the heart or larger vessels. The only kind of swoonings not to be dreaded are those which sometimes mark the crisis in fevers; yet even these ought, as soon as possible, to be removed.

OF INTOXICATION.

The effects of intoxication are often fatal. No kind of poison kills more certainly than an over-dose of ardent spirits. Sometimes, by destroying the nervous energy, they put an end to life at once; but in general their effects are more slow, and in many respects similar to those of opium. Other kinds of intoxicating liquors may prove fatal when taken to excess, as well as ardent spirits; but they may generally be discharged by vomiting, which ought always to be excited when the stomach is overcharged with liquor.

More of those unhappy persons, who die intoxicated, lose their lives from an inability to conduct 624themselves than from the destructive quality of the liquor. Unable to walk, they tumble down, and lie in some awkward posture, which obstructs the circulation or breathing, and often continue in this situation till they die. No drunken person should be left by himself, till his clothes have been loosened, and his body laid in such a posture as is most favourable for continuing the vital motions, discharging the contents of the stomach, &c. The best posture for discharging the contents of the stomach is to lay the person upon his belly; when asleep he may be laid on his side, with his head a little raised, and particular care must be taken that his neck be no way bent, twisted, or have any thing too tight about it.

The excessive degree of thirst occasioned by drinking strong liquors, often induces people to quench it by taking what is hurtful. I have known fatal consequences even from drinking freely of milk after a debauch of wine or sour punch; these acid liquors, together with the heat of the stomach, having coagulated the milk in such a manner that it could never be digested. The safest drink after a debauch is water with a toast, tea, infusions of balm, sage, barley-water, and such like. If the person wants to vomit, he may drink a weak infusion of camomile-flowers, or lukewarm water and oil; but in this condition vomiting may generally be excited by only tickling the throat with the finger or a feather.

Instead of giving a detail of all the different symptoms of intoxication which indicate danger, and proposing a general plan of treatment for persons in this situation, I shall briefly relate the history of a case which lately fell under my own observation, wherein most of those symptoms usually reckoned dangerous concurred, and where the treatment was successful.

625A young man, about fifteen years of age, had, for a hire, drank ten glasses of strong brandy. He soon after fell fast asleep, and continued in that situation for near twelve hours, till at length his uneasy manner of breathing, the coldness of the extremities, and other threatening symptoms, alarmed his friends, and made them send for me. I found him still sleeping, his countenance ghastly, and his skin covered with a cold clammy sweat. Almost the only signs of life remaining were, a deep laborious breathing, and a convulsive motion or agitation of his bowels.

I tried to rouse him, but in vain, by pinching, shaking, applying volatile spirits, and other stimulating things to his nose, &c. A few ounces of blood were likewise taken from his arm, and a mixture of vinegar and water was poured into his mouth; but, as he could not swallow, very little of this got into the stomach. None of these things having the least effect, and the danger seeming to increase, I ordered his legs to be put into warm water, and a sharp clyster to be immediately administered. This gave him a stool, and was the first thing that relieved him. It was afterwards repeated with the same happy effect, and seemed to be the chief cause of his recovery. He then began to shew some signs of life, took drink when it was offered him, and came gradually to his senses. He continued, however, for several days weak and feverish, and complained much of a soreness in his bowels, which gradually went off, by means of a slender diet, and cool mucilaginous liquors.

This young man would probably have been suffered to die, without any assistance being called, had not a neighbour, a few days before, who had been advised to drink a bottle of spirits to cure him of an ague, expired under very similar circumstances.

626

OF SUFFOCATION AND STRANGLING·

These may sometimes proceed from an infarction of the lungs, produced by viscid clammy humours, or a spasmodic affection of the nerves of that organ. Persons who feed grossly, and abound in rich blood, are very liable to suffocating fits from the former of these causes. Such ought, as soon as they are attacked, to be bled, to receive an emollient clyster, and to take frequently a cup of diluting liquor with a little nitre in it. They should likewise receive the steams of hot vinegar into their lungs by breathing.

Nervous and asthmatic persons are most subject to spasmodic affections of the lungs. In this case the patient’s legs should be immersed in warm water, and the steams of vinegar applied as above. Warm diluting liquors should likewise be drank; to a cup of which a tea-spoonful of the parygoric elixir may occasionally be added. Burnt paper, feathers, or leather, may be held to the patient’s nose, and fresh air should be freely admitted to him.

Infants are often suffocated by the carelessness or inattention of their nurses^[203]. An infant when in bed should always be laid so, that it cannot tumble down with its head under the bed-clothes; and when in a cradle, its face ought never to be covered. A small degree of attention to these two 627simple rules would save the lives of many infants, and prevent others from being rendered weak and sickly all their days by the injuries done to their lungs.

Instead of laying down a plan for the recovery of infants who are suffocated, or overlaid, as it is termed by their nurses, I shall give the history of a case related by Monsieur Janin, of the Royal College of Surgery at Paris, as it was attended with success, and contains almost every thing that can be done on such occasions.

A nurse having had the misfortune to over-lay a child, he was called in, and found the infant without any signs of life; no pulsation in the arteries, no respiration, the face livid, the eyes open, dull, and tarnished, the nose full of snivel, the mouth gaping, in short it was almost cold. Whilst some linen clothes and a parcel of ashes were warming, he had the boy unswathed, and laid him in a warm bed, and on the right side. He then was rubbed all over with fine linen, for fear of fretting his tender and delicate skin. As soon as the ashes had received their due degree of heat, Mr. Janin buried him in them, except the face, placed him on the side opposite to that on which he had been at first laid, and covered him with a blanket. He had a bottle of eau de luce in his pocket, which he presented to his nose from time to time; and between whiles some puffs of tobacco were blown up his nostrils: to these succeeded the blowing into his mouth, and squeezing tight his nose. Animal heat began thus to be excited gradually; the pulsations of the temporal artery were soon felt, the breathing became more frequent and free, and the eyes closed and opened alternately. At length the child fetched some cries expressive of his want of the breast, which being applied to his mouth, he catched at it with avidity, and sucked as if nothing had happened 628to him. Though the pulsations of the arteries were by this time very well re-established, and it was hot weather, yet Mr. Janin thought it advisable to leave his little patient three quarters of an hour longer under the ashes. He was afterwards taken out, cleaned and dressed as usual; to which a gentle sleep succeeded, and he continued perfectly well.

Mr. Janin mentions likewise an example of a young man who had hanged himself through despair, to whom he administered help as effectually as in the preceding case.

Mr. Glover, surgeon in Doctors Commons, London, relates the case of a person who was restored to life after twenty-nine minutes hanging, and continued in good health for many years after.

The principal means used to restore this man to life were, opening the temporal artery and the external jugular; rubbing the back, mouth, and neck, with a quantity of volatile spirits and oil; administering the tobacco clyster by means of lighted pipes, and strong frictions of the legs and arms. This course had been continued for about four hours, when an incision was made into the wind-pipe, and air blown strongly through a canula into the lungs. About twenty minutes after this, the blood at the artery began to run down the face, and a slow pulse was just perceptible at the wrist. The frictions were continued for some time longer; his pulse became more frequent, and his mouth and nose being irritated with spirit of sal ammoniac, he opened his eyes. Warm cordials were then administered to him, and in two days he was so well as to be able to walk eight miles.

These cases are sufficient to shew what may be done for the recovery of those unhappy persons who strangle themselves in a fit of despair.

629

OF PERSONS WHO EXPIRE IN CONVULSION FITS.

Convulsion fits often constitute the last scene of acute or chronic disorders. When this is the case, there can remain but small hopes of the patient’s recovery after expiring in a fit. But when a person, who appears to be in perfect health, is suddenly seized with a convulsion fit, and seems to expire, some attempts ought always to be made to restore him to life. Infants are most liable to convulsions, and are often carried off very suddenly by one or more fits about the time of teething. There are many well-authenticated accounts of infants having been restored to life, after they had to all appearance expired in convulsions; but we shall only relate the following instance mentioned by Dr. Johnson in his pamphlet on the practicability of recovering persons visibly dead.

In the parish of St. Clemens in Colchester, a child of six months old, lying upon its mother’s lap, having had the breast, was seized with a strong convulsion fit, which lasted so long, and ended with so total a privation of motion in the body, lungs, and pulse, that it was deemed absolutely dead. It was accordingly stripped, laid out, the passing-bell ordered to be tolled, and a coffin to be made; but a neighbouring gentlewoman who used to admire the child, hearing of its sudden death, hastened to the house, and upon examining the child found it not cold, its joints limber, and fancied that a glass she held to its mouth and nose was a little damped with the breath; upon which she took the child in her lap, sat down before the fire, rubbed it, and kept it in gentle agitation. In a quarter of an hour she felt the heart begin to 630beat faintly; she then put a little of the mother’s milk into its mouth, continued to rub its palms and soles, found the child begin to move, and the milk was swallowed; and in another quarter of an hour she had the satisfaction of restoring to its disconsolate mother the babe quite recovered, eager to lay hold of the breast, and able to suck again. The child throve, had no more fits, is grown up, and at present alive.

These means, which are certainly in the power of every person, were sufficient to restore to life an infant to all appearance dead, and who, in all probability, but for the use of these simple endeavours, would have remained so. There are however many other things which might be done in case the above should not succeed; as rubbing the body with strong spirits, covering it with warm ashes or salt, blowing air into the lungs, throwing up warm stimulating clysters, or the smoke of tobacco, into the intestines, and such like.

When children are dead born, or expire soon after the birth, the same means ought to be used for their recovery, as if they had expired in circumstances similar to those mentioned above.

These directions may likewise be extended to adults, attention being always paid to the age and other circumstances of the patient.

The foregoing cases and observations afford sufficient proof of the success which may attend the endeavours of persons totally ignorant of medicine, in assisting those who are suddenly deprived of life by any accident or disease. Many facts of a similar nature might be adduced, were it necessary; but these, it is hoped, will be sufficient to call up the attention of the public, and to excite the humane and benevolent to exert their utmost endeavours for the preservation of their fellow-men.

631The society for the recovery of drowned persons, instituted at Amsterdam in the year 1767, had the satisfaction to find that not fewer than 150 persons in the space of four years had been saved by the means pointed out by them, many of whom owed their preservation to peasants and people of no medical knowledge. But the means used with so much efficacy in recovering drowned persons are, with equal success, applicable to a number of cases where the powers of life seem in reality to be only suspended, and to remain capable of renewing all their functions, on being put into motion again. It is shocking to reflect, that for want of this consideration many persons have been committed to the grave, in whom the principles of life might have been revived.

The cases wherein such endeavours are most likely to be attended with success, are all those called sudden deaths from an invisible cause, as apoplexies, hysterics, faintings, and many other disorders wherein persons in a moment sink down and expire. The various casualties in which they may be tried are, suffocations, from the sulphureous damps of mines, coal-pits, &c.; the unwholesome air of long unopened wells or caverns; the noxious vapours arising from fermenting liquors; the steams of burning charcoal; sulphureous mineral acids; arsenical effluvia, &c.

The various accidents of drowning, strangling, and apparent deaths, by blows, falls, hunger, cold, &c. likewise furnish opportunities of trying such endeavours. Those perhaps who to appearance are killed by lightning, or by any violent agitation of the passions, as fear, joy, surprise, and such like, might also be frequently recovered by the use of proper means, as blowing strongly into their lungs, &c.

632The means to be used for the recovery of persons suddenly deprived of life are nearly the same in all cases; they are practicable by every one who happens to be present at the accident, and require no great expence, and less skill. The great aim is to restore the warmth and vital motions. This may in general be attempted by means of heat, frictions, bleeding, blowing air into the lungs, administering clysters and generous cordials. These must be varied according to circumstances. Common sense, and the situation of the patient, will suggest the proper manner of conducting them. Above all we would recommend perseverance. People ought never to despair on account of discouraging circumstances, or to leave off their endeavours as long as there is the least hope of success. Where much good and no hurt can be done, no one ought to grudge his labour.

It were greatly to be wished, that an institution, similar to that of Amsterdam, was established, upon a more extensive plan, in Great Britain; and that a reward was allowed to every one who should be instrumental in restoring to life a person seemingly dead^[204]. Men will do much for fame, but still more for money. Should no profit, however, be annexed to those benevolent offices, the heartfelt 633pleasure which a good man must enjoy, on reflecting that he has been the happy instrument of saving one of his fellow-creatures from an untimely grave, is itself a sufficient reward.

CHAP. LV. CAUTIONS CONCERNING COLD BATHING, AND DRINKING THE MINERAL WATERS.

As it is now fashionable for persons of all ranks to plunge into the sea, and drink the mineral waters, I was desirous of rendering this work still more extensively useful, by the addition of some practical remarks on these active and useful medicines. Finding it impossible to bring these observations within so narrow a compass as not to swell the book, already too large, into an enormous size, I resolved to confine myself to a few hints or cautions; which may be of service to persons who bathe, or drink the mineral waters, without being able to put themselves under the care of a physician.

No part of the practice of medicine is of greater importance, or merits more the attention of the physician, as many lives are lost, and numbers ruin their health, by cold bathing, and an imprudent use of the mineral waters. On some future occasion I may probably resume this subject, as I know not any work that contains a sufficient number of practical observations to regulate the patient’s conduct in the use of these active and important medicines.

634We have indeed many books on the mineral waters, and some of them are written with much ingenuity; but they are chiefly employed in ascertaining the contents of the waters by chymical analysis. This no doubt has its use, but it is by no means of such importance as some may imagine. A man may know the chymical analysis of all the articles in the materia medica, without being able properly to apply any one of them in the cure of diseases. One page of practical observations is worth a whole volume of chymical analysis. But where are such observations to be met with? Few physicians are in a situation to make them, and fewer still are qualified for such a task. It can only be accomplished by practitioners who reside at the fountains, and who possessing minds superior to local prejudices, are capable of distinguishing diseases with accuracy, and of forming a sound judgment respecting the genuine effects of medicines.

Without a proper discrimination with regard to the disease and the constitution of the patient, the most powerful medicine is more likely to do harm than good. Every one knows that the same physician who, by cold bathing, cured Augustus, by an imprudent use of the same medicine killed his heir. This induced the Roman senate to make laws for regulating the baths, and preventing the numerous evils which arose from an imprudent and promiscuous use of those elegant and fashionable pieces of luxury. But as no such laws exist in this country, every one does that which is right in his own eyes, and of course many must do wrong.

People are apt to imagine that the simple element of water can do no hurt, and that they may plunge into it at any time with impunity. In this, however, they are much mistaken. I have known apoplexies occasioned by going into the cold bath, 635fevers excited by staying too long in it, and other maladies so much aggravated by its continued use, that they could never be wholly eradicated. Nor are examples wanting, either in ancient or modern times, of the baneful consequences which have arisen also from an injudicious application of the warm bath; but as warm baths are not so common in this country, and are seldom used but under the direction of a physician, I shall not enlarge on that part of the subject.

Immersion in cold water is a custom which lays claim to the most remote antiquity: indeed it must have been coëval with man himself. The necessity of water for the purpose of cleanliness, and the pleasure arising from its application to the body in hot countries, must very early have recommended it to the human species. Even the example of other animals was sufficient to give the hint to man. By instinct many of them are led to apply cold water in this manner; and some, when deprived of its use, have been known to languish, and even to die. But whether the practice of cold bathing arose from necessity, reasoning, or imitation, is an inquiry of no importance; our business is to point out the advantages which may be derived from it, and to guard people against an improper use of it.

The cold bath recommends itself in a variety of cases, and is peculiarly beneficial to the inhabitants of populous cities, who indulge in idleness, and lead sedentary lives. In persons of this description the action of the solids is always too weak, which induces a languid circulation, a crude indigested mass of humours, and obstructions in the capillary vessels and glandular system. Cold water, from its gravity as well as its tonic power, is well calculated either to obviate or remove these symptoms. It accelerates the motion of the blood, 636promotes the different secretions, and gives permanent vigour to the solids. But all these important purposes will be more essentially answered by the application of salt-water. This ought not only to be preferred on account of its superior gravity, but likewise for its greater power of stimulating the skin, which promotes the perspiration, and prevents the patient from catching cold.

It is necessary, however, to observe, that cold bathing is more likely to prevent, than to remove obstructions of the glandular or lymphatic system. Indeed, when these have arrived at a certain pitch, they are not to be removed by any means. In this case the cold bath will only aggravate the symptoms, and hurry the unhappy patient into an untimely grave. It is therefore of the utmost importance, previous to the patient’s entering upon the use of the cold bath, to determine whether or not he labours under any obstinate obstructions of the lungs or other viscera; and where this is the case, cold bathing ought strictly to be prohibited^[205].

In what is called a plethoric state, or too great a fulness of the body, it is likewise dangerous to use the cold bath, without due preparation. In this case there is great danger of bursting a blood-vessel, or occasioning an inflammation of the brain, or some of the viscera. This precaution is the 637more necessary to citizens, as most of them live full, and are of a gross habit. Yet, what is very remarkable, these people resort in crowds every season to the sea-side, and plunge in the water without the least consideration. No doubt they often escape with impunity, but does this give a sanction to the practice? Persons of this description ought by no means to bathe, unless the body has been previously prepared by suitable evacuations.

Another class of patients, who stand peculiarly in need of the bracing qualities of cold water, is the nervous. This includes a great number of the male, and almost all the female inhabitants of great cities. Yet even those persons ought to be cautious in using the cold bath. Nervous people have often weak bowels, and may, as well as others, be subject to congestions and obstructions of the viscera; and in this case they will not be able to bear the effects of the cold water. For them, therefore, and indeed for all delicate people, the best plan would be to accustom themselves to it by the most pleasing and gentle degrees. They ought to begin with the temperate bath, and gradually use it cooler, till at length the coldest proves quite agreeable. Nature revolts against all great transitions; and those who do violence to her dictates, have often cause to repent of their temerity.

Wherever cold bathing is practised, there ought likewise to be tepid baths for the purpose mentioned above. Indeed it is the practice of some countries to throw cold water over the patient as soon as he comes out of the warm bath; but though this may not injure a Russian peasant, we dare not recommend it to the inhabitants of this country. The ancient Greeks and Romans, we are told, when covered with sweat and dust, used to plunge into rivers, without receiving the smallest injury. 638Though they might often escape danger from this imprudent conduct, yet it was certainly contrary to sound reason. I have known many robust men throw away their lives by such an attempt. We would not however advise patients to go into the cold water when the body is chilly; as much exercise, at least, ought to be taken, as may excite a gentle glow all over the body, but by no means so as to overheat it.

To young people, and particularly to children, cold bathing is of the last importance. Their lax fibres render its tonic powers peculiarly proper. It promotes their growth, increases their strength^[206], and prevents a variety of diseases incident to childhood. Were infants early accustomed to the cold bath, it would seldom disagree with them; and we should see fewer instances of the scrofula, rickets, and other diseases, which prove fatal to many, and make others miserable for life. Sometimes, indeed, these disorders render infants incapable of bearing the shock of cold water; but this is owing to their not having been early and regularly accustomed to it. It is however necessary here to caution young men against too frequent bathing; as I have known many fatal consequences result from the daily practice of plunging into rivers, and continuing there too long.

The most proper time of the day for using the cold bath is no doubt the morning, or at least before dinner; and the best mode, that of quick immersion. As cold bathing has a constant tendency 639to propel the blood and other humours towards the head, it ought to be a rule always to wet that part as soon as possible. By due attention to this circumstance, there is reason to believe, that violent head-achs, and other complaints, which frequently proceed from cold bathing, might be often prevented.

The cold bath, when too long-continued in, not only occasions an excessive flux of humours towards the head, but chills the blood, cramps the muscles, relaxes the nerves, and wholly defeats the intention of bathing. Hence, by not adverting to this circumstance, expert swimmers are often injured, and sometimes even lose their lives. All the beneficial purposes of cold bathing are answered by one immersion at a time; and the patient ought to be rubbed dry the moment he comes out of the water, and should continue to take exercise for some time after.

When cold bathing occasions chillness, loss of appetite, listlessness, pain of the breast or bowels, a prostration of strength, or violent head-achs, it ought to be discontinued.

Though these hints are by no means intended to point out all the cases where cold bathing may be hurtful, nor to illustrate its extensive utility as a medicine; yet it is hoped they may serve to guard people against some of those errors into which, from mere inattention, they are apt to fall, and thereby not only endanger their own lives, but bring an excellent medicine into disrepute.

Of drinking the Mineral Waters.

The internal use of water, as a medicine, is no less an object of the physician’s attention than the external. Pure elementary water is indeed the most 640inoffensive of all liquors, and constitutes a principal part of the food of every animal. But this element is often impregnated with substances of a very active and penetrating nature; and of such an insidious quality, that, while they promote certain secretions, and even alleviate some disagreeable symptoms, they weaken the powers of life, undermine the constitution, and lay the foundation of worse diseases than those which they were employed to remove. Of this every practitioner must have seen instances; and physicians of eminence have more than once declared that they have known more diseases occasioned than removed by the use of mineral waters. This doubtless has proceeded from the abuse of these powerful medicines, which evinces the necessity of using them with caution.

By examining the contents of the mineral waters which are most used in this country, we shall be enabled to form an idea of the danger which may arise from an improper application of them either externally or internally, though it is to the latter of these that the present observations are chiefly confined.

The waters most in use for medical purposes in Britain, are those impregnated with salts, sulphur, iron, and mephitic air, either separately, or variously combined. Of these the most powerful is the saline sulphureous water of Harrowgate, of which I have had more occasion to observe the pernicious consequences, when improperly used, than of any other. To this, therefore, the following remarks will more immediately relate, though they will be found applicable to all the purging waters in the kingdom which are strong enough to merit attention^[207].

641The errors which so often defeat the intention of drinking the purgative mineral waters, and which so frequently prove injurious to the patient, proceed from the manner of using them, the quantity taken, the regimen pursued, or using them in cases where they are not proper.

A very hurtful prejudice still prevails in this country, that all diseases must be cured by medicines taken into the stomach, and that the more violently these medicines operate, they are the more likely to have the desired effect. This opinion has proved fatal to thousands, and will, in all probability, destroy many more before it can be wholly eradicated. Purging is often useful in acute diseases, and in chronical cases may pave the way for the operation of other medicines; but it will seldom perform a cure; and by exhausting the strength of the patient, will often leave him in a worse condition than it found him. That this is frequently the case with regard to the more active mineral waters, every person conversant in these matters will readily allow.

Strong stimulants applied to the stomach and bowels for a length of time, must tend to weaken and destroy their energy; and what stimulants are more active than salt and sulphur, especially when these substances are intimately combined, and carried through the system by the penetrating medium 642of water? Those bowels must be strong indeed, which can withstand the daily operation of such active principles for months together, and not be injured. This however is the plan pursued by most of those who drink the purging mineral waters, and whose circumstances will permit them to continue long enough at those fashionable places of resort.

Many people imagine that every thing depends on the quantity of water taken, and that the more they drink they will the sooner get well. This is an egregious error; for, while the unhappy patient thinks he is by this means eradicating his disorder, he is often in fact undermining the powers of life, and ruining his constitution. Indeed nothing can do this so effectually as weakening the powers of digestion by the improper application of strong stimulants. The very essence of health depends on the digestive organs performing their due functions, and the most tedious maladies are all connected with indigestion.

Drinking the water in too great quantity, not only injures the bowels and occasions indigestion, but generally defeats the intention for which it is taken. The diseases for the cure of which mineral waters are chiefly celebrated, are mostly of the chronic kind; and it is well known that such diseases can only be cured by the slow operation of alteratives, or such medicines as act by inducing a gradual change in the habit. This requires length of time, and never can be effected by medicines which run off by stool, and operate chiefly on the first passages.

Those who wish for the cure of any obstinate malady from the mineral waters, ought to take them in such a manner as hardly to produce any effect whatever on the bowels. With this view a 643half-pint glass may be drank at bed-time^[208], and the same quantity an hour before breakfast, dinner, and supper. The dose, however, must vary according to circumstances. Even the quantity mentioned above will purge some persons, while others will drink twice as much without being in the least moved by it. Its operation on the bowels is the only standard for using the water as an alterative. No more ought to be taken than barely to move the body; nor is it always necessary to carry it this length, provided the water goes off by the other emunctories, and does not occasion a chillness, or flatulency in the stomach or bowels. When the water is intended to purge, the quantity mentioned above may be all taken before breakfast.

I would not only caution patients who drink the purging mineral waters over night to avoid heavy suppers, but also from eating heavy meals at any time. The stimulus of water, impregnated with salts, seems to create a false appetite. I have seen a delicate person, after drinking the Harrowgate waters of a morning, eat a breakfast sufficient to have served two ploughmen, devour a plentiful dinner of flesh and fish, and, to crown all, eat such a supper as might have satisfied a hungry porter. All this, indeed, the stomach seemed to crave; but this craving had better remain not quite satisfied, than that the stomach should be loaded with what exceeds its powers. To starve patients was never my plans; but I am clearly of opinion, that, in the 644use of all the purging mineral waters, a light and rather diluting diet is the most proper; and that no person, during such a course, ought to eat to the full extent to what his appetite craves.

To promote the operation of mineral waters, and to carry them through the system, exercise is indispensably necessary. This may be taken in any manner that is most agreeable to the patient; but he ought never to carry it to excess. The best kinds of exercise are those connected with amusement. Every thing that tends to exhilarate the spirits, not only promotes the operation of the waters, but acts as a medicine. All who resort to the mineral waters ought therefore to leave every care behind, to mix with the company, and to make themselves as cheerful and happy as possible. From this conduct, assisted by the free and wholesome air of those fashionable places of resort, and also the regular and early hours which are usually kept, the patient often receives more benefit than from using the waters.

But the greatest errors in drinking the purging mineral waters arise from their being used in cases where they are absolutely improper, and adverse to the nature of the disease. When people hear of a wonderful cure having been performed by some mineral water, they immediately conclude that it will cure every thing, and accordingly swallow it down, when they might as well take poison. Patients ought to be well informed, before they begin to drink the more active kinds of mineral waters, of the propriety of the course, and should never persist in using them when they are found to aggravate the disorder.

In all cases where purging is indicated, the saline mineral waters will be found to fulfil this intention better than any other medicine. Their operation, if 645taken in proper quantity, is generally mild; and they are neither found to irritate the nerves, nor debilitate the patient so much as the other purgatives.

As a purgative, these waters are chiefly recommended in diseases of the first passages, accompanied with, or proceeding from, inactivity of the stomach and bowels, acidity, indigestion, vitiated bile, worms, putrid sordes, the piles, and jaundice. In most cases of this kind they are the best medicines that can be administered. But when used with this view, it is sufficient to take them twice, or at most three times a-week, so as to move the body three or four times; and it will be proper to continue this course for some weeks.

But the operation of the more active mineral waters is not confined to the bowels. They often promote the discharge of urine, and not unfrequently increase the perspiration. This shews that they are capable of penetrating into every part of the body, and of stimulating the whole system. Hence arises their efficacy in removing the most obstinate of all disorders, obstructions of the glandular and lymphatic system. Under this class is comprehended the scrofula or King’s evil, indolent tumours, obstructions of the liver, spleen, kidnies, and mesenteric glands. When these great purposes are to be effected, the waters must be used in the gradual manner mentioned above, and persisted in for a length of time. It will be proper however now and then to discontinue their use for a few days.

The next great class of diseases where mineral waters are found to be beneficial, are those of the skin, as the itch, scab, tetters, ringworms, scaly eruptions, leprosies, blotches, foul ulcers, &c. Though these may seem superficial, yet they are often the most obstinate which the physician has to encounter, and not unfrequently set his skill at 646defiance: but they will sometimes yield to the application of mineral waters for a sufficient length of time, and in most cases of this kind these waters deserve a trial. The saline sulphureous waters, such as those of Moffat in Scotland, and Harrowgate in England, are the most likely to succeed in diseases of the skin; but for this purpose it will be necessary not only to drink the waters, but likewise to use them externally.

To enumerate more particularly the qualities of the different mineral waters, to specify those diseases in which they are respectively indicated, and to point out their proper modes of application, would be an useful, and by no means a disagreeable employment; but as the limits prescribed to these remarks will not allow me to treat the subject at more length, I shall conclude by observing, that whenever the mineral waters are found to exhaust the strength, depress the spirits, take away the appetite, excite fevers, distend the bowels, or occasion a cough, they ought to be discontinued.

⁂ These Cautions having been printed and sold separately for the accommodation of those who had purchased the former editions of this book, has induced some persons to consider them as a Treatise on sea-bathing and drinking the mineral waters; whereas the author’s sole intention was to furnish a few general hints to persons who frequent those fashionable places of resort, without putting themselves under the care of a physician. As he looks upon this subject however to be of the greatest importance to the sick, he pledges himself to treat it at more length on a future occasion.

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