Chapter XXII.Of the Iliac Passion, and of the Cholera-morbus.Sect.316.These violent Diseases are fatal to many Country People, while their Neighbours are frequently so ignorant of the Cause of their Death, that Superstition has ascribed it to Poison, or to Witchcraft.§ 317. The first of these, theMiserere, or Iliac Passion, is one of the most excruciating Distempers. If any Part of the Intestines, the Cavity of the Guts is closed up, whatever mayhave occasioned it, the Course or Descent of the Food they contain is necessarily stopped; in which Case it frequently happens, that that continual Motion observed in the Guts of a living Animal dissected, and which was intended to detrude, or force their Contents downwards, is propagated in a directly contrary Manner, from the Guts towards the Mouth.This Disease sometimes begins after a Constipation, or Costiveness, of some Days; at other Times without that Costiveness having been preceded by Pains in any Part of the Belly, especially around the Navel; but which Pains, gradually increasing after their Commencement, at length become extremely violent, and throw the Patient into excessive Anguish. In some of these Cases a hard Tumour may be felt, which surrounds the Belly like a Cord. The Flatulences within become very audible, some of them are discharged upwards; in a little Time after, Vomitings come on, which increase till the Patient has thrown up all he had taken in, with a still further Augmentation of the excessive Pain. With the first of his Vomitings he only brings up the last Food he had taken, with his Drink and some yellowish Humour: but what comes up afterwards proves stinking; and when the Disease is greatly heightened, they have what is called the Smell of Excrement or Dung; but which rather resembles that of a putrid dead Body. It happens too sometimes, that if the Sick have taken Glysters composed of Materialsof a strong Smell, the same Smell is discernible in the Matter they vomit up. I confess however I never saw either real Excrements, or the Substance of their Glysters, brought up, much less the Suppositories that were introduced into the Fundament: and were it credible that Instances of this Kind had occurred, they must be allowed very difficult to account for. Throughout this whole Term of the Disease, the Patient has not a single Discharge by Stool; the Belly is greatly distended; the Urine not seldom suppressed, and at other Times thick and fœtid. The Pulse, which at first was pretty hard, becomes quick and small; the Strength entirely vanishes; a Raving comes on; a Hiccup almost constantly supervenes, and sometimes general Convulsions; the Extremities grow cold, the Pulse scarcely perceivable; the Pain and the Vomiting cease, and the Patient dies very quickly after.§ 318. As this Disease is highly dangerous, the Moment it is strongly apprehended, it is necessary to oppose it by proper Means and Remedies: the smallest Error may be of fatal Consequence, and hot inflaming Liquids have been known to kill the Patient in a few Hours. I was called in the second Day of the Disease to a young Person, who had taken a good deal of Venice Treacle: Nothing could afford her any Relief, and she died early on the third Day.This Disease should be treated precisely in the same Manner as an inflammatory Cholic; the principal Difference being, that in the former there are no Stools, but continual Vomitings.1, First of all then the Patient should be plentifully bled, if the Physician has been called in early enough, and before the Sick has lost his Strength.2, He should receive opening Glysters made of a Decoction of Barley Water, with five or six Ounces of Oil in each.3, We should endeavour to allay the violent Efforts to vomit, by giving every two Hours a Spoonful of the MixtureNº. 48.4, The Sick should drink plentifully, in very small Quantities, very often repeated, of an appeasing, diluting, refreshing Drink, which tends at the same Time to promote both Stools and Urine. Nothing is preferable to the WheyNº. 49, if it can be had immediately: if not, give simple clear Whey sweetened with Honey, and the Drinks prescribed§ 298, Art. 3.5, The Patient is to be put into a warm Bath, and kept as long as he can bear it, repeating it as often daily too, as his Strength will permit.6, After Bleeding, warm Bathing, repeated Glysters and Fomentations, if each and all of these have availed nothing; the Fume or Smoak of Tobacco may be introduced in the Manner of a Glyster, of which I shall speak further, in the Chapter on Persons drowned.I cured a Person of this Disease, by conveying him into a Bath, immediately after bleeding him, and giving him a Purge on his going into the Bath.§ 319. If the Pain abates before the Patient has quite lost his Strength; if the Pulse improves at the same Time; if the Vomitings are less in Number, and in the Quantity of the Matter brought up; if that Matter seems in a less putrid offensive State; if he feels some Commotion and Rumbling in his Bowels; if he has some little Discharge by Stool; and if at the same Time he feels himself a little stronger than before, his Cure may reasonably be expected; but if he is otherwise circumstanced he will soon depart. It frequently happens, a single Hour before Death, that the Pain seems to vanish, and a surprising Quantity of extremely fœtid Matter is discharged by Stool: the Patient is suddenly seized with a great Weakness and Sinking, falls into a cold Sweat, and immediately expires.§ 320. This is the Disease which the common People attribute to, and term, theTwisting of the Guts; and in which they make the Patients swallow Bullets, or large Quantities of Quick-silver. This twisting, tangling, or Knoting of the Guts is an utter, an impossible Chimera; for how can they admit of such a Circumstance, as one of their Extremities, their Ends, is connected to the Stomach, and the other irremoveably fastened to the Skin of the Fork or Cleft of the Buttocks? In Fact this Disease results from a Variety of Causes, which have been discovered on a Dissection of those who have died of it. It were to be wished indeed this prudent Custom, so extremely conducive to enrich, and to perfect,the Art of Physick, were to prevail more generally; and which we ought rather to consider as a Duty to comply with, than a Difficulty to submit to; as it is our Duty to contribute to the Perfection of a Science, on which the Happiness of Mankind so considerably depends. I shall not enter into a Detail of these Causes; but whatever they are, the Practice of swallowing Bullets in the Disease is always pernicious, and the like Use of Mercury must be often so. Each of these pretended Remedies may aggravate the Disease, and contribute an insurmountable Obstacle to the Cure—Of that Iliac Passion, which is sometimes a Consequence of Ruptures, I shall treat in another Place.Of the Cholera-morbus.§ 321. This Disease is a sudden, abundant, and painful Evacuation by vomiting and by Stool.It begins with much Flatulence, or Wind, with Swelling and slight Pains in the Belly, accompanied with great Dejection; and followed with large Evacuations either by Stool or by Vomit at first, but whenever either of them has begun, the other quickly follows. The Matter evacuated is either yellowish, green, brown, whitish, or black; the Pains in the Belly violent; the Pulse, almost constantly feverish, is sometimes strong at first, but soon sinks into Weakness, in Consequence of the prodigious Discharge. Some Patients purge a hundred Times in the Compassof a few Hours: they may even be seen to fall away; and if the Disease exists in a violent Degree, they are scarcely to be known within three or four Hours from the Commencement of these Discharges. After a great Number of them they are afflicted with Spasms, or Cramps, in their Legs, Thighs, and Arms, which torment them as much as the Pains in the Belly. When the Disease rages too highly to be asswaged, Hiccups, Convulsions and a Coldness of the Extremities approach; there is a scarcely intermitting Succession of fainting, or swooning Fits, the Patient dying either in one of them, or in Convulsions.§ 322. This Disease, which constantly depends on a Bile raised to the highest Acrimony, commonly prevails towards the End of July and in August: especially if the Heats have been very violent, and there have been little or no Summer Fruits, which greatly conduce to attempt: and allay the putrescent Acrimony of the Bile.§ 323. Nevertheless, however violent this Distemper may be, it is less dangerous, and also less tormenting than the former, many Persons recovering from it.1, Our first Endeavour should be to dilute, or even to drown this acrid Bile, by Draughts, by Deluges, of the most mitigating Drinks; the irritation being so very great, that every Thing having the least Sharpness is injurious. Wherefore the patient should continually take in, by Drink, and by Way of Glyster, either Barley-Water, Almond-Milk, or pure Water, with one eighthPart Milk, which has succeeded very well in my Practice. Or he may use a very light Decoction, or Ptisan, as it were, of Bread, which is made by gently boiling a Pound of toasted Bread, in three or four Pots of Water for half an Hour. InSwisserlandwe prefer Oat bread. We also successfully use pounded Rye, making a light Ptisan of it.A very light thin Soup made of a Pullet, a Chicken, or of one Pound of lean Veal, in three Pots of Water, is very proper too in this Disease. Whey is also employed to good Purpose; and in those Places, where it can easily be had, Butter-milk is the best Drink of any. But, whichever of these Drinks shall be thought preferable, it is a necessary Point to drink very plentifully of it; and the Glysters should be given every two Hours.2, If the Patient is of a robust Constitution, and sanguine Complexion, with a strong Pulse at the Time of the Attack, and the Pains are very severe, a first, and in some Cases, a second Bleeding, very early in the Invasion, asswages the Violence of the Malady, and allows more Leisure for the Assistance of other Remedies. I have seen the Vomiting cease almost entirely, after the first Bleeding.The Rage of this Disease abates a little after a Duration of five or six Hours: we must not however, during this Remission or Abatement, forbear to throw in proper Remedies; since it returns soon after with great Force,which Return however indicates no Alteration of the Method already entered upon.3, In general the warm Bath refreshes the Patient while he continues in it; but the Pains frequently return soon after he is taken out, which, however, is no Reason for omitting it, since it has frequently been found to give a more durable Relief. The Patient should continue in it a considerable Time, and, during that Time, he should take six or seven Glasses of the PotionNº. 32, which has been very efficacious in this Disease. By these Means the Vomiting has been stopt; and the Patient, upon going out of the Bath, has had several large Stools, which very considerably diminished the Violence of the Disease.4, If the Patient's Attendants are terrified by these great Evacuations, and determine to check them (however prematurely) by Venice Treacle, Mint Water, Syrup of white Poppies, called Diacodium, by Opium or Mithridate, it either happens, that the Disease and all its Symptoms are heightened, to which I have been a Witness; or, if the Evacuations should actually be stopt, the Patient, in Consequence of it, is thrown into a more dangerous Condition. I have been obliged to give a Purge, in order to renew the Discharges, to a Man, who had been thrown into a violent Fever, attended with a ragingDelirium, by a Medicine composed of Venice Treacle, Mithridate and Oil. Such Medicines ought not to be employed, until the Smallness of the Pulse, greatWeakness, violent and almost continual Cramps, and even the Insufficience of the Patient's Efforts to vomit, make us apprehensive of his sinking irrecoverably. In such Circumstances indeed he should take, every Quarter or half Quarter of an Hour, a Spoonful of the MixtureNº. 50, still continuing the diluting Drinks. After the first Hour, they should only be given every Hour, and that only to the Extent of eight Doses. But I desire to insist upon it here, that this Medicine should not be given too early in this Distemper.§ 324. If the Patient is likely to recover, the Pains and the Evacuations gradually abate; the Thirst is less; the Pulse continues very quick, but it becomes regular. There have been Instances of their Propensity to a heavy kind of Drowsiness at this Time; for perfect refreshing Sleep advances but slowly after this Disease. It will still be proper to persevere in the Medicines already directed, though somewhat less frequently. And now we may begin to allow the Patient a few Soups from farinaceous mealy Substances; and as soon as the Evacuations accompanying this Disease are evidently ceased, and the Pains are vanished; though an acute Sensibility and great Weakness continues, beside such Soups, he may be allowed some new-laid Eggs, very lightly boiled, or even raw, for some Days. After this he must be referred to the Regimen so frequently recommended to Persons in a State of Recovery: when the concurring Use of thePowderNº. 24, taken twice a Day, will greatly assist to hasten and to establish his Health.
Chapter XXII.Of the Iliac Passion, and of the Cholera-morbus.Sect.316.These violent Diseases are fatal to many Country People, while their Neighbours are frequently so ignorant of the Cause of their Death, that Superstition has ascribed it to Poison, or to Witchcraft.§ 317. The first of these, theMiserere, or Iliac Passion, is one of the most excruciating Distempers. If any Part of the Intestines, the Cavity of the Guts is closed up, whatever mayhave occasioned it, the Course or Descent of the Food they contain is necessarily stopped; in which Case it frequently happens, that that continual Motion observed in the Guts of a living Animal dissected, and which was intended to detrude, or force their Contents downwards, is propagated in a directly contrary Manner, from the Guts towards the Mouth.This Disease sometimes begins after a Constipation, or Costiveness, of some Days; at other Times without that Costiveness having been preceded by Pains in any Part of the Belly, especially around the Navel; but which Pains, gradually increasing after their Commencement, at length become extremely violent, and throw the Patient into excessive Anguish. In some of these Cases a hard Tumour may be felt, which surrounds the Belly like a Cord. The Flatulences within become very audible, some of them are discharged upwards; in a little Time after, Vomitings come on, which increase till the Patient has thrown up all he had taken in, with a still further Augmentation of the excessive Pain. With the first of his Vomitings he only brings up the last Food he had taken, with his Drink and some yellowish Humour: but what comes up afterwards proves stinking; and when the Disease is greatly heightened, they have what is called the Smell of Excrement or Dung; but which rather resembles that of a putrid dead Body. It happens too sometimes, that if the Sick have taken Glysters composed of Materialsof a strong Smell, the same Smell is discernible in the Matter they vomit up. I confess however I never saw either real Excrements, or the Substance of their Glysters, brought up, much less the Suppositories that were introduced into the Fundament: and were it credible that Instances of this Kind had occurred, they must be allowed very difficult to account for. Throughout this whole Term of the Disease, the Patient has not a single Discharge by Stool; the Belly is greatly distended; the Urine not seldom suppressed, and at other Times thick and fœtid. The Pulse, which at first was pretty hard, becomes quick and small; the Strength entirely vanishes; a Raving comes on; a Hiccup almost constantly supervenes, and sometimes general Convulsions; the Extremities grow cold, the Pulse scarcely perceivable; the Pain and the Vomiting cease, and the Patient dies very quickly after.§ 318. As this Disease is highly dangerous, the Moment it is strongly apprehended, it is necessary to oppose it by proper Means and Remedies: the smallest Error may be of fatal Consequence, and hot inflaming Liquids have been known to kill the Patient in a few Hours. I was called in the second Day of the Disease to a young Person, who had taken a good deal of Venice Treacle: Nothing could afford her any Relief, and she died early on the third Day.This Disease should be treated precisely in the same Manner as an inflammatory Cholic; the principal Difference being, that in the former there are no Stools, but continual Vomitings.1, First of all then the Patient should be plentifully bled, if the Physician has been called in early enough, and before the Sick has lost his Strength.2, He should receive opening Glysters made of a Decoction of Barley Water, with five or six Ounces of Oil in each.3, We should endeavour to allay the violent Efforts to vomit, by giving every two Hours a Spoonful of the MixtureNº. 48.4, The Sick should drink plentifully, in very small Quantities, very often repeated, of an appeasing, diluting, refreshing Drink, which tends at the same Time to promote both Stools and Urine. Nothing is preferable to the WheyNº. 49, if it can be had immediately: if not, give simple clear Whey sweetened with Honey, and the Drinks prescribed§ 298, Art. 3.5, The Patient is to be put into a warm Bath, and kept as long as he can bear it, repeating it as often daily too, as his Strength will permit.6, After Bleeding, warm Bathing, repeated Glysters and Fomentations, if each and all of these have availed nothing; the Fume or Smoak of Tobacco may be introduced in the Manner of a Glyster, of which I shall speak further, in the Chapter on Persons drowned.I cured a Person of this Disease, by conveying him into a Bath, immediately after bleeding him, and giving him a Purge on his going into the Bath.§ 319. If the Pain abates before the Patient has quite lost his Strength; if the Pulse improves at the same Time; if the Vomitings are less in Number, and in the Quantity of the Matter brought up; if that Matter seems in a less putrid offensive State; if he feels some Commotion and Rumbling in his Bowels; if he has some little Discharge by Stool; and if at the same Time he feels himself a little stronger than before, his Cure may reasonably be expected; but if he is otherwise circumstanced he will soon depart. It frequently happens, a single Hour before Death, that the Pain seems to vanish, and a surprising Quantity of extremely fœtid Matter is discharged by Stool: the Patient is suddenly seized with a great Weakness and Sinking, falls into a cold Sweat, and immediately expires.§ 320. This is the Disease which the common People attribute to, and term, theTwisting of the Guts; and in which they make the Patients swallow Bullets, or large Quantities of Quick-silver. This twisting, tangling, or Knoting of the Guts is an utter, an impossible Chimera; for how can they admit of such a Circumstance, as one of their Extremities, their Ends, is connected to the Stomach, and the other irremoveably fastened to the Skin of the Fork or Cleft of the Buttocks? In Fact this Disease results from a Variety of Causes, which have been discovered on a Dissection of those who have died of it. It were to be wished indeed this prudent Custom, so extremely conducive to enrich, and to perfect,the Art of Physick, were to prevail more generally; and which we ought rather to consider as a Duty to comply with, than a Difficulty to submit to; as it is our Duty to contribute to the Perfection of a Science, on which the Happiness of Mankind so considerably depends. I shall not enter into a Detail of these Causes; but whatever they are, the Practice of swallowing Bullets in the Disease is always pernicious, and the like Use of Mercury must be often so. Each of these pretended Remedies may aggravate the Disease, and contribute an insurmountable Obstacle to the Cure—Of that Iliac Passion, which is sometimes a Consequence of Ruptures, I shall treat in another Place.Of the Cholera-morbus.§ 321. This Disease is a sudden, abundant, and painful Evacuation by vomiting and by Stool.It begins with much Flatulence, or Wind, with Swelling and slight Pains in the Belly, accompanied with great Dejection; and followed with large Evacuations either by Stool or by Vomit at first, but whenever either of them has begun, the other quickly follows. The Matter evacuated is either yellowish, green, brown, whitish, or black; the Pains in the Belly violent; the Pulse, almost constantly feverish, is sometimes strong at first, but soon sinks into Weakness, in Consequence of the prodigious Discharge. Some Patients purge a hundred Times in the Compassof a few Hours: they may even be seen to fall away; and if the Disease exists in a violent Degree, they are scarcely to be known within three or four Hours from the Commencement of these Discharges. After a great Number of them they are afflicted with Spasms, or Cramps, in their Legs, Thighs, and Arms, which torment them as much as the Pains in the Belly. When the Disease rages too highly to be asswaged, Hiccups, Convulsions and a Coldness of the Extremities approach; there is a scarcely intermitting Succession of fainting, or swooning Fits, the Patient dying either in one of them, or in Convulsions.§ 322. This Disease, which constantly depends on a Bile raised to the highest Acrimony, commonly prevails towards the End of July and in August: especially if the Heats have been very violent, and there have been little or no Summer Fruits, which greatly conduce to attempt: and allay the putrescent Acrimony of the Bile.§ 323. Nevertheless, however violent this Distemper may be, it is less dangerous, and also less tormenting than the former, many Persons recovering from it.1, Our first Endeavour should be to dilute, or even to drown this acrid Bile, by Draughts, by Deluges, of the most mitigating Drinks; the irritation being so very great, that every Thing having the least Sharpness is injurious. Wherefore the patient should continually take in, by Drink, and by Way of Glyster, either Barley-Water, Almond-Milk, or pure Water, with one eighthPart Milk, which has succeeded very well in my Practice. Or he may use a very light Decoction, or Ptisan, as it were, of Bread, which is made by gently boiling a Pound of toasted Bread, in three or four Pots of Water for half an Hour. InSwisserlandwe prefer Oat bread. We also successfully use pounded Rye, making a light Ptisan of it.A very light thin Soup made of a Pullet, a Chicken, or of one Pound of lean Veal, in three Pots of Water, is very proper too in this Disease. Whey is also employed to good Purpose; and in those Places, where it can easily be had, Butter-milk is the best Drink of any. But, whichever of these Drinks shall be thought preferable, it is a necessary Point to drink very plentifully of it; and the Glysters should be given every two Hours.2, If the Patient is of a robust Constitution, and sanguine Complexion, with a strong Pulse at the Time of the Attack, and the Pains are very severe, a first, and in some Cases, a second Bleeding, very early in the Invasion, asswages the Violence of the Malady, and allows more Leisure for the Assistance of other Remedies. I have seen the Vomiting cease almost entirely, after the first Bleeding.The Rage of this Disease abates a little after a Duration of five or six Hours: we must not however, during this Remission or Abatement, forbear to throw in proper Remedies; since it returns soon after with great Force,which Return however indicates no Alteration of the Method already entered upon.3, In general the warm Bath refreshes the Patient while he continues in it; but the Pains frequently return soon after he is taken out, which, however, is no Reason for omitting it, since it has frequently been found to give a more durable Relief. The Patient should continue in it a considerable Time, and, during that Time, he should take six or seven Glasses of the PotionNº. 32, which has been very efficacious in this Disease. By these Means the Vomiting has been stopt; and the Patient, upon going out of the Bath, has had several large Stools, which very considerably diminished the Violence of the Disease.4, If the Patient's Attendants are terrified by these great Evacuations, and determine to check them (however prematurely) by Venice Treacle, Mint Water, Syrup of white Poppies, called Diacodium, by Opium or Mithridate, it either happens, that the Disease and all its Symptoms are heightened, to which I have been a Witness; or, if the Evacuations should actually be stopt, the Patient, in Consequence of it, is thrown into a more dangerous Condition. I have been obliged to give a Purge, in order to renew the Discharges, to a Man, who had been thrown into a violent Fever, attended with a ragingDelirium, by a Medicine composed of Venice Treacle, Mithridate and Oil. Such Medicines ought not to be employed, until the Smallness of the Pulse, greatWeakness, violent and almost continual Cramps, and even the Insufficience of the Patient's Efforts to vomit, make us apprehensive of his sinking irrecoverably. In such Circumstances indeed he should take, every Quarter or half Quarter of an Hour, a Spoonful of the MixtureNº. 50, still continuing the diluting Drinks. After the first Hour, they should only be given every Hour, and that only to the Extent of eight Doses. But I desire to insist upon it here, that this Medicine should not be given too early in this Distemper.§ 324. If the Patient is likely to recover, the Pains and the Evacuations gradually abate; the Thirst is less; the Pulse continues very quick, but it becomes regular. There have been Instances of their Propensity to a heavy kind of Drowsiness at this Time; for perfect refreshing Sleep advances but slowly after this Disease. It will still be proper to persevere in the Medicines already directed, though somewhat less frequently. And now we may begin to allow the Patient a few Soups from farinaceous mealy Substances; and as soon as the Evacuations accompanying this Disease are evidently ceased, and the Pains are vanished; though an acute Sensibility and great Weakness continues, beside such Soups, he may be allowed some new-laid Eggs, very lightly boiled, or even raw, for some Days. After this he must be referred to the Regimen so frequently recommended to Persons in a State of Recovery: when the concurring Use of thePowderNº. 24, taken twice a Day, will greatly assist to hasten and to establish his Health.
Of the Iliac Passion, and of the Cholera-morbus.Sect.316.These violent Diseases are fatal to many Country People, while their Neighbours are frequently so ignorant of the Cause of their Death, that Superstition has ascribed it to Poison, or to Witchcraft.§ 317. The first of these, theMiserere, or Iliac Passion, is one of the most excruciating Distempers. If any Part of the Intestines, the Cavity of the Guts is closed up, whatever mayhave occasioned it, the Course or Descent of the Food they contain is necessarily stopped; in which Case it frequently happens, that that continual Motion observed in the Guts of a living Animal dissected, and which was intended to detrude, or force their Contents downwards, is propagated in a directly contrary Manner, from the Guts towards the Mouth.This Disease sometimes begins after a Constipation, or Costiveness, of some Days; at other Times without that Costiveness having been preceded by Pains in any Part of the Belly, especially around the Navel; but which Pains, gradually increasing after their Commencement, at length become extremely violent, and throw the Patient into excessive Anguish. In some of these Cases a hard Tumour may be felt, which surrounds the Belly like a Cord. The Flatulences within become very audible, some of them are discharged upwards; in a little Time after, Vomitings come on, which increase till the Patient has thrown up all he had taken in, with a still further Augmentation of the excessive Pain. With the first of his Vomitings he only brings up the last Food he had taken, with his Drink and some yellowish Humour: but what comes up afterwards proves stinking; and when the Disease is greatly heightened, they have what is called the Smell of Excrement or Dung; but which rather resembles that of a putrid dead Body. It happens too sometimes, that if the Sick have taken Glysters composed of Materialsof a strong Smell, the same Smell is discernible in the Matter they vomit up. I confess however I never saw either real Excrements, or the Substance of their Glysters, brought up, much less the Suppositories that were introduced into the Fundament: and were it credible that Instances of this Kind had occurred, they must be allowed very difficult to account for. Throughout this whole Term of the Disease, the Patient has not a single Discharge by Stool; the Belly is greatly distended; the Urine not seldom suppressed, and at other Times thick and fœtid. The Pulse, which at first was pretty hard, becomes quick and small; the Strength entirely vanishes; a Raving comes on; a Hiccup almost constantly supervenes, and sometimes general Convulsions; the Extremities grow cold, the Pulse scarcely perceivable; the Pain and the Vomiting cease, and the Patient dies very quickly after.§ 318. As this Disease is highly dangerous, the Moment it is strongly apprehended, it is necessary to oppose it by proper Means and Remedies: the smallest Error may be of fatal Consequence, and hot inflaming Liquids have been known to kill the Patient in a few Hours. I was called in the second Day of the Disease to a young Person, who had taken a good deal of Venice Treacle: Nothing could afford her any Relief, and she died early on the third Day.This Disease should be treated precisely in the same Manner as an inflammatory Cholic; the principal Difference being, that in the former there are no Stools, but continual Vomitings.1, First of all then the Patient should be plentifully bled, if the Physician has been called in early enough, and before the Sick has lost his Strength.2, He should receive opening Glysters made of a Decoction of Barley Water, with five or six Ounces of Oil in each.3, We should endeavour to allay the violent Efforts to vomit, by giving every two Hours a Spoonful of the MixtureNº. 48.4, The Sick should drink plentifully, in very small Quantities, very often repeated, of an appeasing, diluting, refreshing Drink, which tends at the same Time to promote both Stools and Urine. Nothing is preferable to the WheyNº. 49, if it can be had immediately: if not, give simple clear Whey sweetened with Honey, and the Drinks prescribed§ 298, Art. 3.5, The Patient is to be put into a warm Bath, and kept as long as he can bear it, repeating it as often daily too, as his Strength will permit.6, After Bleeding, warm Bathing, repeated Glysters and Fomentations, if each and all of these have availed nothing; the Fume or Smoak of Tobacco may be introduced in the Manner of a Glyster, of which I shall speak further, in the Chapter on Persons drowned.I cured a Person of this Disease, by conveying him into a Bath, immediately after bleeding him, and giving him a Purge on his going into the Bath.§ 319. If the Pain abates before the Patient has quite lost his Strength; if the Pulse improves at the same Time; if the Vomitings are less in Number, and in the Quantity of the Matter brought up; if that Matter seems in a less putrid offensive State; if he feels some Commotion and Rumbling in his Bowels; if he has some little Discharge by Stool; and if at the same Time he feels himself a little stronger than before, his Cure may reasonably be expected; but if he is otherwise circumstanced he will soon depart. It frequently happens, a single Hour before Death, that the Pain seems to vanish, and a surprising Quantity of extremely fœtid Matter is discharged by Stool: the Patient is suddenly seized with a great Weakness and Sinking, falls into a cold Sweat, and immediately expires.§ 320. This is the Disease which the common People attribute to, and term, theTwisting of the Guts; and in which they make the Patients swallow Bullets, or large Quantities of Quick-silver. This twisting, tangling, or Knoting of the Guts is an utter, an impossible Chimera; for how can they admit of such a Circumstance, as one of their Extremities, their Ends, is connected to the Stomach, and the other irremoveably fastened to the Skin of the Fork or Cleft of the Buttocks? In Fact this Disease results from a Variety of Causes, which have been discovered on a Dissection of those who have died of it. It were to be wished indeed this prudent Custom, so extremely conducive to enrich, and to perfect,the Art of Physick, were to prevail more generally; and which we ought rather to consider as a Duty to comply with, than a Difficulty to submit to; as it is our Duty to contribute to the Perfection of a Science, on which the Happiness of Mankind so considerably depends. I shall not enter into a Detail of these Causes; but whatever they are, the Practice of swallowing Bullets in the Disease is always pernicious, and the like Use of Mercury must be often so. Each of these pretended Remedies may aggravate the Disease, and contribute an insurmountable Obstacle to the Cure—Of that Iliac Passion, which is sometimes a Consequence of Ruptures, I shall treat in another Place.
Sect.316.
Sect.316.
These violent Diseases are fatal to many Country People, while their Neighbours are frequently so ignorant of the Cause of their Death, that Superstition has ascribed it to Poison, or to Witchcraft.
§ 317. The first of these, theMiserere, or Iliac Passion, is one of the most excruciating Distempers. If any Part of the Intestines, the Cavity of the Guts is closed up, whatever mayhave occasioned it, the Course or Descent of the Food they contain is necessarily stopped; in which Case it frequently happens, that that continual Motion observed in the Guts of a living Animal dissected, and which was intended to detrude, or force their Contents downwards, is propagated in a directly contrary Manner, from the Guts towards the Mouth.
This Disease sometimes begins after a Constipation, or Costiveness, of some Days; at other Times without that Costiveness having been preceded by Pains in any Part of the Belly, especially around the Navel; but which Pains, gradually increasing after their Commencement, at length become extremely violent, and throw the Patient into excessive Anguish. In some of these Cases a hard Tumour may be felt, which surrounds the Belly like a Cord. The Flatulences within become very audible, some of them are discharged upwards; in a little Time after, Vomitings come on, which increase till the Patient has thrown up all he had taken in, with a still further Augmentation of the excessive Pain. With the first of his Vomitings he only brings up the last Food he had taken, with his Drink and some yellowish Humour: but what comes up afterwards proves stinking; and when the Disease is greatly heightened, they have what is called the Smell of Excrement or Dung; but which rather resembles that of a putrid dead Body. It happens too sometimes, that if the Sick have taken Glysters composed of Materialsof a strong Smell, the same Smell is discernible in the Matter they vomit up. I confess however I never saw either real Excrements, or the Substance of their Glysters, brought up, much less the Suppositories that were introduced into the Fundament: and were it credible that Instances of this Kind had occurred, they must be allowed very difficult to account for. Throughout this whole Term of the Disease, the Patient has not a single Discharge by Stool; the Belly is greatly distended; the Urine not seldom suppressed, and at other Times thick and fœtid. The Pulse, which at first was pretty hard, becomes quick and small; the Strength entirely vanishes; a Raving comes on; a Hiccup almost constantly supervenes, and sometimes general Convulsions; the Extremities grow cold, the Pulse scarcely perceivable; the Pain and the Vomiting cease, and the Patient dies very quickly after.
§ 318. As this Disease is highly dangerous, the Moment it is strongly apprehended, it is necessary to oppose it by proper Means and Remedies: the smallest Error may be of fatal Consequence, and hot inflaming Liquids have been known to kill the Patient in a few Hours. I was called in the second Day of the Disease to a young Person, who had taken a good deal of Venice Treacle: Nothing could afford her any Relief, and she died early on the third Day.
This Disease should be treated precisely in the same Manner as an inflammatory Cholic; the principal Difference being, that in the former there are no Stools, but continual Vomitings.
1, First of all then the Patient should be plentifully bled, if the Physician has been called in early enough, and before the Sick has lost his Strength.
2, He should receive opening Glysters made of a Decoction of Barley Water, with five or six Ounces of Oil in each.
3, We should endeavour to allay the violent Efforts to vomit, by giving every two Hours a Spoonful of the MixtureNº. 48.
4, The Sick should drink plentifully, in very small Quantities, very often repeated, of an appeasing, diluting, refreshing Drink, which tends at the same Time to promote both Stools and Urine. Nothing is preferable to the WheyNº. 49, if it can be had immediately: if not, give simple clear Whey sweetened with Honey, and the Drinks prescribed§ 298, Art. 3.
5, The Patient is to be put into a warm Bath, and kept as long as he can bear it, repeating it as often daily too, as his Strength will permit.
6, After Bleeding, warm Bathing, repeated Glysters and Fomentations, if each and all of these have availed nothing; the Fume or Smoak of Tobacco may be introduced in the Manner of a Glyster, of which I shall speak further, in the Chapter on Persons drowned.
I cured a Person of this Disease, by conveying him into a Bath, immediately after bleeding him, and giving him a Purge on his going into the Bath.
§ 319. If the Pain abates before the Patient has quite lost his Strength; if the Pulse improves at the same Time; if the Vomitings are less in Number, and in the Quantity of the Matter brought up; if that Matter seems in a less putrid offensive State; if he feels some Commotion and Rumbling in his Bowels; if he has some little Discharge by Stool; and if at the same Time he feels himself a little stronger than before, his Cure may reasonably be expected; but if he is otherwise circumstanced he will soon depart. It frequently happens, a single Hour before Death, that the Pain seems to vanish, and a surprising Quantity of extremely fœtid Matter is discharged by Stool: the Patient is suddenly seized with a great Weakness and Sinking, falls into a cold Sweat, and immediately expires.
§ 320. This is the Disease which the common People attribute to, and term, theTwisting of the Guts; and in which they make the Patients swallow Bullets, or large Quantities of Quick-silver. This twisting, tangling, or Knoting of the Guts is an utter, an impossible Chimera; for how can they admit of such a Circumstance, as one of their Extremities, their Ends, is connected to the Stomach, and the other irremoveably fastened to the Skin of the Fork or Cleft of the Buttocks? In Fact this Disease results from a Variety of Causes, which have been discovered on a Dissection of those who have died of it. It were to be wished indeed this prudent Custom, so extremely conducive to enrich, and to perfect,the Art of Physick, were to prevail more generally; and which we ought rather to consider as a Duty to comply with, than a Difficulty to submit to; as it is our Duty to contribute to the Perfection of a Science, on which the Happiness of Mankind so considerably depends. I shall not enter into a Detail of these Causes; but whatever they are, the Practice of swallowing Bullets in the Disease is always pernicious, and the like Use of Mercury must be often so. Each of these pretended Remedies may aggravate the Disease, and contribute an insurmountable Obstacle to the Cure—Of that Iliac Passion, which is sometimes a Consequence of Ruptures, I shall treat in another Place.
Of the Cholera-morbus.§ 321. This Disease is a sudden, abundant, and painful Evacuation by vomiting and by Stool.It begins with much Flatulence, or Wind, with Swelling and slight Pains in the Belly, accompanied with great Dejection; and followed with large Evacuations either by Stool or by Vomit at first, but whenever either of them has begun, the other quickly follows. The Matter evacuated is either yellowish, green, brown, whitish, or black; the Pains in the Belly violent; the Pulse, almost constantly feverish, is sometimes strong at first, but soon sinks into Weakness, in Consequence of the prodigious Discharge. Some Patients purge a hundred Times in the Compassof a few Hours: they may even be seen to fall away; and if the Disease exists in a violent Degree, they are scarcely to be known within three or four Hours from the Commencement of these Discharges. After a great Number of them they are afflicted with Spasms, or Cramps, in their Legs, Thighs, and Arms, which torment them as much as the Pains in the Belly. When the Disease rages too highly to be asswaged, Hiccups, Convulsions and a Coldness of the Extremities approach; there is a scarcely intermitting Succession of fainting, or swooning Fits, the Patient dying either in one of them, or in Convulsions.§ 322. This Disease, which constantly depends on a Bile raised to the highest Acrimony, commonly prevails towards the End of July and in August: especially if the Heats have been very violent, and there have been little or no Summer Fruits, which greatly conduce to attempt: and allay the putrescent Acrimony of the Bile.§ 323. Nevertheless, however violent this Distemper may be, it is less dangerous, and also less tormenting than the former, many Persons recovering from it.1, Our first Endeavour should be to dilute, or even to drown this acrid Bile, by Draughts, by Deluges, of the most mitigating Drinks; the irritation being so very great, that every Thing having the least Sharpness is injurious. Wherefore the patient should continually take in, by Drink, and by Way of Glyster, either Barley-Water, Almond-Milk, or pure Water, with one eighthPart Milk, which has succeeded very well in my Practice. Or he may use a very light Decoction, or Ptisan, as it were, of Bread, which is made by gently boiling a Pound of toasted Bread, in three or four Pots of Water for half an Hour. InSwisserlandwe prefer Oat bread. We also successfully use pounded Rye, making a light Ptisan of it.A very light thin Soup made of a Pullet, a Chicken, or of one Pound of lean Veal, in three Pots of Water, is very proper too in this Disease. Whey is also employed to good Purpose; and in those Places, where it can easily be had, Butter-milk is the best Drink of any. But, whichever of these Drinks shall be thought preferable, it is a necessary Point to drink very plentifully of it; and the Glysters should be given every two Hours.2, If the Patient is of a robust Constitution, and sanguine Complexion, with a strong Pulse at the Time of the Attack, and the Pains are very severe, a first, and in some Cases, a second Bleeding, very early in the Invasion, asswages the Violence of the Malady, and allows more Leisure for the Assistance of other Remedies. I have seen the Vomiting cease almost entirely, after the first Bleeding.The Rage of this Disease abates a little after a Duration of five or six Hours: we must not however, during this Remission or Abatement, forbear to throw in proper Remedies; since it returns soon after with great Force,which Return however indicates no Alteration of the Method already entered upon.3, In general the warm Bath refreshes the Patient while he continues in it; but the Pains frequently return soon after he is taken out, which, however, is no Reason for omitting it, since it has frequently been found to give a more durable Relief. The Patient should continue in it a considerable Time, and, during that Time, he should take six or seven Glasses of the PotionNº. 32, which has been very efficacious in this Disease. By these Means the Vomiting has been stopt; and the Patient, upon going out of the Bath, has had several large Stools, which very considerably diminished the Violence of the Disease.4, If the Patient's Attendants are terrified by these great Evacuations, and determine to check them (however prematurely) by Venice Treacle, Mint Water, Syrup of white Poppies, called Diacodium, by Opium or Mithridate, it either happens, that the Disease and all its Symptoms are heightened, to which I have been a Witness; or, if the Evacuations should actually be stopt, the Patient, in Consequence of it, is thrown into a more dangerous Condition. I have been obliged to give a Purge, in order to renew the Discharges, to a Man, who had been thrown into a violent Fever, attended with a ragingDelirium, by a Medicine composed of Venice Treacle, Mithridate and Oil. Such Medicines ought not to be employed, until the Smallness of the Pulse, greatWeakness, violent and almost continual Cramps, and even the Insufficience of the Patient's Efforts to vomit, make us apprehensive of his sinking irrecoverably. In such Circumstances indeed he should take, every Quarter or half Quarter of an Hour, a Spoonful of the MixtureNº. 50, still continuing the diluting Drinks. After the first Hour, they should only be given every Hour, and that only to the Extent of eight Doses. But I desire to insist upon it here, that this Medicine should not be given too early in this Distemper.§ 324. If the Patient is likely to recover, the Pains and the Evacuations gradually abate; the Thirst is less; the Pulse continues very quick, but it becomes regular. There have been Instances of their Propensity to a heavy kind of Drowsiness at this Time; for perfect refreshing Sleep advances but slowly after this Disease. It will still be proper to persevere in the Medicines already directed, though somewhat less frequently. And now we may begin to allow the Patient a few Soups from farinaceous mealy Substances; and as soon as the Evacuations accompanying this Disease are evidently ceased, and the Pains are vanished; though an acute Sensibility and great Weakness continues, beside such Soups, he may be allowed some new-laid Eggs, very lightly boiled, or even raw, for some Days. After this he must be referred to the Regimen so frequently recommended to Persons in a State of Recovery: when the concurring Use of thePowderNº. 24, taken twice a Day, will greatly assist to hasten and to establish his Health.
§ 321. This Disease is a sudden, abundant, and painful Evacuation by vomiting and by Stool.
It begins with much Flatulence, or Wind, with Swelling and slight Pains in the Belly, accompanied with great Dejection; and followed with large Evacuations either by Stool or by Vomit at first, but whenever either of them has begun, the other quickly follows. The Matter evacuated is either yellowish, green, brown, whitish, or black; the Pains in the Belly violent; the Pulse, almost constantly feverish, is sometimes strong at first, but soon sinks into Weakness, in Consequence of the prodigious Discharge. Some Patients purge a hundred Times in the Compassof a few Hours: they may even be seen to fall away; and if the Disease exists in a violent Degree, they are scarcely to be known within three or four Hours from the Commencement of these Discharges. After a great Number of them they are afflicted with Spasms, or Cramps, in their Legs, Thighs, and Arms, which torment them as much as the Pains in the Belly. When the Disease rages too highly to be asswaged, Hiccups, Convulsions and a Coldness of the Extremities approach; there is a scarcely intermitting Succession of fainting, or swooning Fits, the Patient dying either in one of them, or in Convulsions.
§ 322. This Disease, which constantly depends on a Bile raised to the highest Acrimony, commonly prevails towards the End of July and in August: especially if the Heats have been very violent, and there have been little or no Summer Fruits, which greatly conduce to attempt: and allay the putrescent Acrimony of the Bile.
§ 323. Nevertheless, however violent this Distemper may be, it is less dangerous, and also less tormenting than the former, many Persons recovering from it.
1, Our first Endeavour should be to dilute, or even to drown this acrid Bile, by Draughts, by Deluges, of the most mitigating Drinks; the irritation being so very great, that every Thing having the least Sharpness is injurious. Wherefore the patient should continually take in, by Drink, and by Way of Glyster, either Barley-Water, Almond-Milk, or pure Water, with one eighthPart Milk, which has succeeded very well in my Practice. Or he may use a very light Decoction, or Ptisan, as it were, of Bread, which is made by gently boiling a Pound of toasted Bread, in three or four Pots of Water for half an Hour. InSwisserlandwe prefer Oat bread. We also successfully use pounded Rye, making a light Ptisan of it.
A very light thin Soup made of a Pullet, a Chicken, or of one Pound of lean Veal, in three Pots of Water, is very proper too in this Disease. Whey is also employed to good Purpose; and in those Places, where it can easily be had, Butter-milk is the best Drink of any. But, whichever of these Drinks shall be thought preferable, it is a necessary Point to drink very plentifully of it; and the Glysters should be given every two Hours.
2, If the Patient is of a robust Constitution, and sanguine Complexion, with a strong Pulse at the Time of the Attack, and the Pains are very severe, a first, and in some Cases, a second Bleeding, very early in the Invasion, asswages the Violence of the Malady, and allows more Leisure for the Assistance of other Remedies. I have seen the Vomiting cease almost entirely, after the first Bleeding.
The Rage of this Disease abates a little after a Duration of five or six Hours: we must not however, during this Remission or Abatement, forbear to throw in proper Remedies; since it returns soon after with great Force,which Return however indicates no Alteration of the Method already entered upon.
3, In general the warm Bath refreshes the Patient while he continues in it; but the Pains frequently return soon after he is taken out, which, however, is no Reason for omitting it, since it has frequently been found to give a more durable Relief. The Patient should continue in it a considerable Time, and, during that Time, he should take six or seven Glasses of the PotionNº. 32, which has been very efficacious in this Disease. By these Means the Vomiting has been stopt; and the Patient, upon going out of the Bath, has had several large Stools, which very considerably diminished the Violence of the Disease.
4, If the Patient's Attendants are terrified by these great Evacuations, and determine to check them (however prematurely) by Venice Treacle, Mint Water, Syrup of white Poppies, called Diacodium, by Opium or Mithridate, it either happens, that the Disease and all its Symptoms are heightened, to which I have been a Witness; or, if the Evacuations should actually be stopt, the Patient, in Consequence of it, is thrown into a more dangerous Condition. I have been obliged to give a Purge, in order to renew the Discharges, to a Man, who had been thrown into a violent Fever, attended with a ragingDelirium, by a Medicine composed of Venice Treacle, Mithridate and Oil. Such Medicines ought not to be employed, until the Smallness of the Pulse, greatWeakness, violent and almost continual Cramps, and even the Insufficience of the Patient's Efforts to vomit, make us apprehensive of his sinking irrecoverably. In such Circumstances indeed he should take, every Quarter or half Quarter of an Hour, a Spoonful of the MixtureNº. 50, still continuing the diluting Drinks. After the first Hour, they should only be given every Hour, and that only to the Extent of eight Doses. But I desire to insist upon it here, that this Medicine should not be given too early in this Distemper.
§ 324. If the Patient is likely to recover, the Pains and the Evacuations gradually abate; the Thirst is less; the Pulse continues very quick, but it becomes regular. There have been Instances of their Propensity to a heavy kind of Drowsiness at this Time; for perfect refreshing Sleep advances but slowly after this Disease. It will still be proper to persevere in the Medicines already directed, though somewhat less frequently. And now we may begin to allow the Patient a few Soups from farinaceous mealy Substances; and as soon as the Evacuations accompanying this Disease are evidently ceased, and the Pains are vanished; though an acute Sensibility and great Weakness continues, beside such Soups, he may be allowed some new-laid Eggs, very lightly boiled, or even raw, for some Days. After this he must be referred to the Regimen so frequently recommended to Persons in a State of Recovery: when the concurring Use of thePowderNº. 24, taken twice a Day, will greatly assist to hasten and to establish his Health.