Chapter XXXII.Of Medicines taken by Way of Precaution, or Prevention.Sect.538.IHave pointed out, in some Parts of this Work, the Means of preventing the bad Effects of several Causes of Diseases; and of prohibiting the Return of some habitual Disorders. In the present Chapter I shall adjoin some Observations, on the Use of the principal Remedies, which are employed as general Preservatives; pretty regularly too at certain stated Times, and almost always from meer Custom only, without knowing, and often with very little Consideration, whether they are rightor wrong.Nevertheless, the Use, the Habit of taking Medicines, is certainly no indifferent Matter: it is ridiculous, dangerous, and even criminal to omit them, when they are necessary, but not less so to take them when they are not wanted. Agood Medicine taken seasonably, when there is some Disorder, someDisarrangementin the Body, which would in a short time occasion a Distemper, has often prevented it. But yet the very same Medicine, if given to a Person in perfect Health, if it does not directly make him sick, leaves him at the best in a greater Propensity to the Impressions of Diseases: and there are but too many Examples of People, who having very unhappily contracted a Habit, a Disposition to take Physick, have really injured their Health, and impaired their Constitution, however naturally strong, by an Abuse of those Materials which Providence has given for the Recovery and Re-establishment of it; an Abuse which, though it should not injure the Health of the Person, would occasion those Remedies, when he should be really sick, to be less efficacious and serviceable to him, from their having been familiar to his Constitution; and thus he becomes deprived of the Assistance he would have received from them, if taken only in those Times and Circumstances, in which they were necessary for him.Of Bleeding.§ 539. Bleeding is necessary only in these four Cases. 1, When there is too great a Quantity of Blood in the Body. 2, When there is any Inflammation, or an inflammatory Disease. 3, When some Cause supervenes, or is about tosupervene, in the Constitution, which would speedily produce an Inflammation, or some other dangerous Symptom, if the Vessels were not relaxed by Bleeding. It is upon this Principle that Patients are bled after Wounds, and after Bruises; that Bleeding is directed for a pregnant Woman, if she has a violent Cough; and that Bleeding is performed, by Way of Precaution, in several other Cases. 4, We also advise Bleeding sometimes to asswage an excessive Pain, though such Pain is not owing to Excess of Blood, norarisesfrom an inflamed Blood; but in Order to appease and moderate the Pain by Bleeding; and thereby to obtain Time for destroying the Cause of it by other Remedies. But as these two last Reasons are in Effect involved or implied in the two first; it may be very generally concluded, that an Excess of Blood, and an inflamed State of it, are the only two necessary Motives for Bleeding.§ 540. An Inflammation of the Blood is known by the Symptoms accompanying those Diseases, which that Cause produces. Of these I have already spoken, and I have at the same time regulated the Practice of Bleeding in such Cases. Here I shall point out those Symptoms and Circumstances, which manifest an Excess of Blood.The first, then, is the general Course and Manner of the Patient's living, while in Health. If he is a great Eater, and indulges in juicy nutritious Food, and especially on much Flesh-meat;if he drinks rich and nourishing Wine, or other strong Drink, and at the same time enjoys a good Digestion; if he takes but little Exercise, sleeps much, and has not been subject to any very considerable Evacuation, he may well be supposed to abound in Blood. It is very obvious that all these Causes rarely occur in Country People; if we except only the Abatement of their Exercise, during some Weeks in Winter, which indeed may contribute to their generating more Blood than they commonly do.The labouring Country-man, for much the greater part of his Time, lives only on Bread, Water and Vegetables; Materials but very moderately nourishing, as one Pound of Bread probably does not make, in the same Body, more Blood than one Ounce of Flesh; though a general Prejudice seems to have established a contrary Opinion. 2, The total Stopping or long Interruption of some involuntary Bleeding or Hæmorrhage, to which he had been accustomed. 3, A full and strong Pulse, and Veins visibly filled with Blood, in a Body that is not lean and thin, and when he is not heated. 4, A florid lively Ruddiness. 5, A considerable and unusual Numbness; Sleep more profound, of more Duration, and yet less tranquil and calm, than at other times; a greater Propensity than ordinary to be fatigued after moderate Exercise or Work; and a little Oppression and Heaviness from walking. 6, Palpitations, accompanied sometimes with very great Dejection, and even with a slight fainting Fit; especially onbeing in any hot Place, or after moving about considerably. 7, Vertigos, or Swimmings of the Head, especially on bowing down and raising it up at once, and after sleeping. 8, Frequent Pains of the Head, to which the Person was not formerly subject; and which seem not to arise from any Defect in the Digestions. 9, An evident Sensation of Heat, pretty generally diffused over the whole Body. 10, A smarting Sort of Itching all over, from a very little more Heat than usual. And lastly, frequent Hæmorrhages, and these attended with manifest Relief, and more Vivacity.People should, notwithstanding, be cautious of supposing an unhealthy Excess of Blood, from any one of these Symptoms only. Many of them must concur; and they should endeavour to be certain that even such a Concurrence of them does not result from a very different Cause, and wholly opposite in Effect to that of an Excess of Blood.But when it is certain, from the whole Appearance, that such an Excess doth really exist, then a single, or even a second Bleeding is attended with very good Effects. Nor is it material, in such Cases, from what Part the Blood is taken.§ 541. On the other Hand, when these Circumstances do not exist, Bleeding is in no wise necessary: nor should it ever be practised in these following Conditions and Circumstances; except for some particular and very strong Reasons; ofthe due Force of which none but Physicians can judge.First, when the Person is in a very advanced Age, or in very early Infancy. 2, When he is either naturally of a weakly Constitution, or it has been rendered such by Sickness, or by some other Accident. 3, When the Pulse is small, soft, feeble, and intermits, and the Skin is manifestly pale. 4, When the Limbs, the Extremities of the Body, are often cold, puffed up and soft. 5, When their Appetite has been very small for a long time; their Food but little nourishing, and their Perspiration too plentiful, from great Exercise. 6, When the Stomach has long been disordered, and the Digestion bad, whence very little Blood could be generated. 7, When the Patient has been considerably emptied, whether by Hæmorrhages, a Looseness, profuse Urine or Sweat: or when theCrisisof some Distemper has been effected by any one of these Evacuations. 8, When the Patient has long been afflicted with some depressing Disease; and troubled with many such Obstructions as prevent the Formation of Blood. 9, Whenever a Person is exhausted, from whatever Cause. 10, When the Blood is in a thin, pale, and dissolved State.§ 542, In all these Cases, and in some others less frequent, a single Bleeding often precipitates the Patient into an absolutely incurable State, an irreparable Train of Evils. Many dismal Examples of it are but too obvious.Whatever, therefore, be the Situation of the Patient, and however naturally robust, that Bleeding, which is unnecessary, is noxious. Repeated, re-iterated Bleedings, weaken and enervate, hasten old Age, diminish the Force of the Circulation, thence fatten and puff up the Body; and next by weakening, and lastly by destroying, the Digestions, they lead to a fatal Dropsy. They disorder the Perspiration by the Skin, and leave the Patient liable to Colds and Defluxions: They weaken the nervous System, and render them subject to Vapours, to the hypochondriac Disorders, and to all nervous Maladies.The ill Consequence of a single, though erroneous Bleeding is not immediately discernible: on the contrary, when it was not performed in such a Quantity, as to weaken the Patient perceivably, it appears to have been rather beneficial. Yet I still here insist upon it, that it is not the less true that, when unnecessary, it is prejudicial; and that People should never bleed, as sometimes has been done, for meer Whim, or, as it were, for Diversion. It avails nothing to affirm, that within a few Days after it, they have got more Blood than they had before it, that is, that they weigh more than at first, whence they infer the Loss of Blood very speedily repaired. The Fact of their augmented Weight is admitted; but this very Fact testifies against the real Benefit of that Bleeding; hence it is a Proof, that the natural Evacuations of the Body are lesscompleatly made; and that Humours, which ought to be expelled, are retained in it. There remains the same Quantity of Blood, and perhaps a little more; but it is not a Blood so well made, so perfectly elaborated; and this is so very true, that if the thing were otherwise; if some Days after the Bleeding they had a greater Quantity of the same Kind of Blood, it would amount to a Demonstration, that more re-iterated Bleedings must necessarily have brought on an inflammatory Disease, in a Man of a robust Habit of Body.§ 543. The Quantity of Blood, which a grown Man may Part with, by Way of Precaution, is about ten Ounces.§ 544. Persons so constituted as to breed much Blood, should carefully avoid all those Causes which tend to augment it, (See§ 540, Nº. 1) and when they are sensible of the Quantity augmented, they should confine themselves to a light frugal Diet, on Pulse, Fruits, Bread and Water; they should often bathe their Feet in warm Water, taking Night and Morning thePowderNº. 20; drink of the PtisanNº. 1; sleep but very moderately, and take much Exercise. By using these Precautions they may either prevent any Occasion for Bleeding, or should they really be obliged to admit of it, they would increase and prolong its good Effects. These are also the very Means, which may remove all the Danger that might ensue from a Person's omitting to bleed, at the usual Season or Interval,when the Habit, the Fashion of Bleeding had been inveterately established in him.§ 545. We learn with Horror and Astonishment, that some have been bled eighteen, twenty and even twenty-four times in two Days; and some others, some112hundred times, in the Course of some Months. Such Instances irrefragably demonstrate the continual Ignorance of their Physician or Surgeon; and should the Patient escape, we ought to admire the inexhaustible Resources of Nature, that survived so many murderous Incisions.§ 546. The People entertain a common Notion, which is, that the first Time of bleeding certainly saves the Life of the Patient; but to convince them of the Falsity of this silly Notion, they need only open their Eyes, and see the very contrary Fact to this occur but too unhappily every Day; many People dying soon after their first Bleeding. Were their Opinion right, it would be impossible that any Person should die of the first Disease that seized him, which yet daily happens. Now the Extirpation of this absurd Opinion is really become important, as theContinuance of it is attended with some unhappy Consequences: their Faith in, their great Dependance on, the extraordinary Virtue of this first Bleeding makes them willing to omit it, that is, to treasure it up against a Distemper, from which they shall be in the greatest Danger; and thus it is deferred as long as the Patient is not extremely bad, in Hopes that if they can do without it then, they shall keep it for another and more pressing Occasion. Their present Disease in the mean time rises to a violent Height; and then they bleed, but when it is too late, and I have seen Instances of many Patients, who were permitted to die, that the first Bleeding might be reserved for a more important Occasion. The only Difference between the first Bleeding, and any subsequent one is, that the first commonly gives the Patient an Emotion, that is rather hurtful than salutary.Of Purges.§ 547. The Stomach and Bowels are emptied either by Vomiting, or by Stools, the latter Discharge being much more natural than the first, which is not effected without a violent Motion, and one indeed to which Nature is repugnant. Nevertheless, there are some Cases, which really require this artificial Vomiting; but these excepted (some of which I have already pointed out) we should rather prefer those Remedies, which empty the Belly by Stool.§ 548. The Signs, which indicate a Necessity for Purging, are, 1, a disagreeable Tast or Savour of the Mouth in a Morning, and especially a bitter Tast; a foul, furred Tongue and Teeth, disagreable Eructations or Belchings, Windiness and Distension.2, A Want of Appetite which increases very gradually, without any Fever, which degenerates into a Disgust or total Aversion to Food; and sometimes communicates a bad Tast to the very little such Persons do eat.3, Reachings to vomit in a Morning fasting, and sometimes throughout the Day; supposing such not to depend on a Woman's Pregnancy, or some other Disorder, in which Purges would be either useless or hurtful.4, A vomiting up of bitter, or corrupted, Humours.5, A manifest Sensation of a Weight, or Heaviness in the Stomach, the Loins, or the Knees.6, A Want of Strength sometimes attended with Restlessness, ill Humour, or Peevishness, and Melancholy.7, Pains of the Stomach, frequent Pains of the Head, or Vertigos; sometimes a Drowsiness, which increases after Meals.8, Some Species of Cholics; irregular Stools which are sometimes very great in Quantity, and too liquid for many Days together; after which an obstinate Costiveness ensues.9, A Pulse less regular, and less strong, than what is natural to the Patient, and which sometimes intermits.§ 549. When these Symptoms, or some of them, ascertain the Necessity of purging a Person, not then attacked by any manifest Disease (for I am not speaking here of Purges in such Cases) a proper purging Medicine may be given him. The bad Tast in his Mouth; the continual Belchings; the frequent Reachings to vomit; the actual Vomitings and Melancholy discover, that the Cause of his Disorder resides in the Stomach, and shew that a Vomit will be of Service to him. But when such Signs or Symptoms are not evident, the Patient should take such purging or opening Remedies, as are particularly indicated by the Pains, whether of the Loins; from the Cholic; or by a Sensation of Weight or Heaviness in the Knees.§ 550. But we should abstain from either vomiting or purging, 1, Whenever the Complaints of thePatientsare founded in their Weakness, and their being already exhausted, 2, When there is a general Dryness of the Habit, a very considerable Degree of Heat, some Inflammation, or a strong Fever. 3, Whenever Nature is exerting herself in some other salutary Evacuation; whence purging must never be attempted in critical Sweats, during the monthly Discharges, nor during a Fit of the Gout. 4, Nor in such inveterate Obstructions as Purges cannot remove, and really do augment. 5, Neitherwhen the nervous System is considerably weakened.§ 551. There are other Cases again, in which it may be proper to purge, but not to give a Vomit. These Cases are, 1, When the Patient abounds too much with Blood, (See§ 540) since the Efforts which attend vomiting, greatly augment the Force of the Circulation; whence the Blood-vessels of the Head and of the Breast, being extremely distended with Blood, might burst, which must prove fatal on the Spot, and has repeatedly proved so. 2, For the same Reason they should not be given to Persons, who are subject to frequent Bleeding from the Nose, or to coughing up or vomiting of Blood; to Women who are subject to excessive or unseasonable Discharges of Blood,&c.from theVagina, the Neck of the Womb; nor to those who are with Child. 3, Vomits are improper for ruptured Persons.§ 552. When any Person has taken too acrid, too sharp, a Vomit, or a Purge, which operates with excessive Violence; whether this consists in the most vehement Efforts and Agitations, the Pains, Convulsions, or Swoonings, which are their frequent Consequences; or whether that prodigious Evacuation and Emptiness their Operation causes, (which is commonly termed aSuper-purgation) and which may hurry the Patient off; Instances of which are but too common among the lower Class of the People, who much too frequently confide themselves to the Conductof ignorant Men-slayers: In all such unhappy Accidents, I say, we should treat these unfortunate Persons, as if they had been actually poisoned, by violent corroding Poisons, (See§ 533) that is, we should fill them, as it were, with Draughts of warm Water, Milk, Oil, Barley-water, Almond Milk, emollient Glysters with Milk, and the Yolks of Eggs; and also bleed them plentifully, if their Pains are excessive, and their Pulses strong and feverish.The Super-purgation, the excessive Discharge, is to be stopt, after having plied the Patient plentifully with diluting Drinks, by giving the calming Anodyne Medicines directed in the Removal of acute Pains,§ 536, Nº. 6.Flanels dipt in hot Water, in which someVeniceTreacle is dissolved, are very serviceable: and should the Evacuations by Stool be excessive, and the Patient has not a high Fever, and a parching Kind of Heat, a Morsel of the same Treacle, as large as a Nutmeg, may be dissolved in his Glyster.But should the Vomiting solely be excessive, without any Purging, the Number of the emollient Glysters with Oil and the Yolk of an Egg must be increased; and the Patient should be placed in a warm Bath.§ 553. Purges frequently repeated, without just and necessary Indications, are attended with much the same ill Effects as frequent Bleedings. They destroy the Digestions; the Stomach no longer, or very languidly, exerts its Functions;the Intestines prove inactive; the Patient becomes liable to very severe Cholics; the Plight of the Body, deprived of its salutary Nutrition, falls off; Perspiration is disordered; Defluxions ensue; nervous Maladies come on, with a general Languor; and the Patient proves old, long before the Number of his Years have made him so.Much irreparable Mischief has been done to the Health of Children, by Purges injudiciously given and repeated. They prevent them from attaining their utmost natural Strength, and frequently contract their due Growth. They ruin their Teeth; dispose young Girls to future Obstructions; and when they have been already affected by them, they render them still more obstinate.It is a Prejudice too generally received, that Persons who have little or no Appetite need purging; since this is often very false, and most of those Causes, which lessen or destroy the Appetite, cannot be removed by purging; though many of them may be increased by it.Persons whose Stomachs contain much glairy viscid Matter suppose, they may be cured by Purges, which seem indeed at first to relieve them: but this proves a very slight and deceitful Relief. These Humours are owing to that Weakness and Laxity of the Stomach, which Purges augment; since notwithstanding they carry off Part of these viscid Humours generated in it, at the Expiration of a few Days there is a greater Accumulation of them than before; andthus, by a Re-iteration of purging Medicines, the Malady soon becomes incurable, and Health irrecoverably lost. The real Cure of such Cases is effected by directly opposite Medicines. Those referred to, or mentioned,§ 272, are highly conducive to it.§ 554. The Custom of taking stomachic Medicines infused in Brandy, Spirit of Wine, Cherry Water,&c.is always dangerous; for notwithstanding the present immediate Relief such Infusions afford in some Disorders of the Stomach, they really by slow Degrees impair and ruin that Organ; and it may be observed, that as many as accustom themselves to Drams, go off, just like excessive Drinkers, in Consequence of their having no Digestion; whence they sink into a State of Depression and Languor, and die dropsical.§ 555. Either Vomits or Purges may be often beneficially omitted, even when they have some Appearance of seeming necessary, by abating one Meal a Day for some time; by abstaining from the most nourishing Sorts of Food; and especially from those which are fat; by drinking freely of cool Water, and taking extraordinary Exercise. The same Regimen also serves to subdue, without the Use of Purges, the various Complaints which often invade those, who omit taking purging Medicines, at those Seasons and Intervals, in which they have made it a Custom to take them.§ 556. The Medicines,Nº. 34and35, are the most certain Vomits. The Powder,Nº. 21, is a good Purge, when the Patient is in no wise feverish.The Doses recommended in the Table of Remedies are those, which are proper for a grown Man, of a vigorous Constitution. Nevertheless there are some few, for whom they may be too weak: in such Circumstances they may be increased by the Addition of a third or fourth Part of the Dose prescribed. But should they not operate in that Quantity, we must be careful not to double the Dose, much less to give a three-fold Quantity, which has sometimes been done, and that even without its Operation, and at the Risque of killing the Patient, which has not seldom been the Consequence. In Case of such purging not ensuing, we should rather give large Draughts of Whey sweetened with Honey, or of warm Water, in a Pot of which an Ounce, or an Ounce and a half of common Salt must be dissolved; and this Quantity is to be taken from time to time in small Cups, moving about with it.The Fibres of Country People who inhabit the Mountains, and live almost solely on Milk, are so little susceptible of Sensation, that they must take such large Doses to purge them, as would kill all the Peasantry in the Vallies. In the Mountains ofValaisthere are Men who take twenty, and even twenty-four Grains of Glass ofAntimony for a single Dose; a Grain or two of which were sufficient to poison ordinary Men.§ 557. Notwithstanding our Cautions on this important Head, whenever an urgent Necessity commands it, Purging must be recurred to at all Times and Seasons: but when the Season may be safely selected, it were right to decline Purging in the Extremities of either Heat or Cold; and to take the Purge early in the Morning, that the Medicines may find less Obstruction or Embarrassment from the Contents of the Stomach. Every other Consideration, with Relation to the Stars and the Moon, is ridiculous, and void of any Foundation. The People are particularly averse to purging in the Dog-days; and if this were only on Account of the great Heat, it would be very pardonable: but it is from an astrological Prejudice, which is so much the more absurd, as the real Dog-days are at thirty-six Days Distance from those commonly reckoned such; and it is a melancholy Reflection, that the Ignorance of the People should be so gross, in this Respect, in our enlightened Age; and that they should still imagine the Virtue and Efficacy of Medicines to depend on what Sign of the Zodiac the Sun is in, or in any particular Quarter of the Moon. Yet it is certain in this Point, they are so inveterately attached to this Prejudice, that it is but too common to see Country-People die, in waiting for the Sign or Quarter most favourable to the Operation and Effect of a Medicine, which was truly necessary five or six Days before either of them.Sometimes too that particular Medicine is given, to which a certain Day is supposed to be auspicious and favourable, in Preference to that which is most prevalent against the Disease. And thus it is, than an ignorant Almanack Maker determines on the Lives of the human Race; and contracts the Duration of them with Impunity.§ 558. When a Vomit or a Purge is to be taken, the Patient's Body should be prepared for the Reception of it twenty-four Hours beforehand; by taking very little Food, and drinking some Glasses of warm Water, or of a light Tea of some Herbs.He should not drink after a Vomit, until it begins to work; but then he should drink very plentifully of warm Water, or a light Infusion of Chamomile Flowers, which is preferable.It is usual, after Purges, to take some thin Broth or Soup during their Operation; but warm Water sweetened with Sugar or Honey, or an Infusion of Succory Flowers, would sometimes be more suitable.§ 559. As the Stomach suffers, in some Degree, as often as either a Vomit, or a Purge, is taken, the Patient should be careful how he lives and orders himself for some Days after taking them, as well in Regard to the Quantity as Quality of his Food.§ 560. I shall say nothing of other Articles taken by Way of Precaution, such as Soups, Whey, Waters,&c.which are but little used among the People; but confine myself to thisgeneral Remark, that when they take any of these precautionary Things, they should enter on a Regimen or Way of living, that may co-operate with them, and contribute to the same Purpose. Whey is commonly taken to refresh and cool the Body; and while they drink it, they deny themselves Pulse, Fruits, and Sallads. They eat nothing then, but the best and heartiest Flesh-meats they can come at; such Vegetables as are used in good Soups, Eggs, and good Wine; notwithstanding this is to destroy, by high and heating Aliments, all the attemperating cooling Effects expected from the Whey.Some Persons propose to cool and attemperate their Blood by Soups and a thin Diet, into which they cram Craw-fish, that heat considerably, orNasturtium, Cresses which also heat, and thus defeat their own Purpose. Happily, in such a Case, the Error in one Respect often cures that in the other; and these Kinds of Soup, which are in no wise cooling, prove very serviceable, in Consequence of the Cause of the Symptoms, which they were intended to remove, not requiring any Coolers at all.The general physical Practice of the Community, which unhappily is but too much in Fashion, abounds with similar Errors. I will just cite one, because I have seen its dismal Effects. Many People suppose Pepper cooling, though their Smell, Taste, and common Sense concur to inform them of the contrary. It is the very hottest of Spices.§ 561. The most certain Preservative, and the most attainable too by every Man, is to avoid all Excess, and especially Excess in eating and in drinking. People generally eat more than thoroughly consists with Health, or permits them to attain the utmost Vigour, of which their natural Constitutions are capable. The Custom is established, and it is difficult to eradicate it: notwithstanding we should at least resolve not to eat, but through Hunger, and always under a Subjection to Reason; because, except in a very few Cases, Reason constantly suggests to us not to eat, when the Stomach has an Aversion to Food. A sober moderate Person is capable of Labour, I may say, even of excessive Labour of some Kinds; of which greater Eaters are absolutely incapable. Sobriety of itself cures such Maladies as are otherwise incurable, and may recover the most shattered and unhealthy Persons.
Chapter XXXII.Of Medicines taken by Way of Precaution, or Prevention.Sect.538.IHave pointed out, in some Parts of this Work, the Means of preventing the bad Effects of several Causes of Diseases; and of prohibiting the Return of some habitual Disorders. In the present Chapter I shall adjoin some Observations, on the Use of the principal Remedies, which are employed as general Preservatives; pretty regularly too at certain stated Times, and almost always from meer Custom only, without knowing, and often with very little Consideration, whether they are rightor wrong.Nevertheless, the Use, the Habit of taking Medicines, is certainly no indifferent Matter: it is ridiculous, dangerous, and even criminal to omit them, when they are necessary, but not less so to take them when they are not wanted. Agood Medicine taken seasonably, when there is some Disorder, someDisarrangementin the Body, which would in a short time occasion a Distemper, has often prevented it. But yet the very same Medicine, if given to a Person in perfect Health, if it does not directly make him sick, leaves him at the best in a greater Propensity to the Impressions of Diseases: and there are but too many Examples of People, who having very unhappily contracted a Habit, a Disposition to take Physick, have really injured their Health, and impaired their Constitution, however naturally strong, by an Abuse of those Materials which Providence has given for the Recovery and Re-establishment of it; an Abuse which, though it should not injure the Health of the Person, would occasion those Remedies, when he should be really sick, to be less efficacious and serviceable to him, from their having been familiar to his Constitution; and thus he becomes deprived of the Assistance he would have received from them, if taken only in those Times and Circumstances, in which they were necessary for him.Of Bleeding.§ 539. Bleeding is necessary only in these four Cases. 1, When there is too great a Quantity of Blood in the Body. 2, When there is any Inflammation, or an inflammatory Disease. 3, When some Cause supervenes, or is about tosupervene, in the Constitution, which would speedily produce an Inflammation, or some other dangerous Symptom, if the Vessels were not relaxed by Bleeding. It is upon this Principle that Patients are bled after Wounds, and after Bruises; that Bleeding is directed for a pregnant Woman, if she has a violent Cough; and that Bleeding is performed, by Way of Precaution, in several other Cases. 4, We also advise Bleeding sometimes to asswage an excessive Pain, though such Pain is not owing to Excess of Blood, norarisesfrom an inflamed Blood; but in Order to appease and moderate the Pain by Bleeding; and thereby to obtain Time for destroying the Cause of it by other Remedies. But as these two last Reasons are in Effect involved or implied in the two first; it may be very generally concluded, that an Excess of Blood, and an inflamed State of it, are the only two necessary Motives for Bleeding.§ 540. An Inflammation of the Blood is known by the Symptoms accompanying those Diseases, which that Cause produces. Of these I have already spoken, and I have at the same time regulated the Practice of Bleeding in such Cases. Here I shall point out those Symptoms and Circumstances, which manifest an Excess of Blood.The first, then, is the general Course and Manner of the Patient's living, while in Health. If he is a great Eater, and indulges in juicy nutritious Food, and especially on much Flesh-meat;if he drinks rich and nourishing Wine, or other strong Drink, and at the same time enjoys a good Digestion; if he takes but little Exercise, sleeps much, and has not been subject to any very considerable Evacuation, he may well be supposed to abound in Blood. It is very obvious that all these Causes rarely occur in Country People; if we except only the Abatement of their Exercise, during some Weeks in Winter, which indeed may contribute to their generating more Blood than they commonly do.The labouring Country-man, for much the greater part of his Time, lives only on Bread, Water and Vegetables; Materials but very moderately nourishing, as one Pound of Bread probably does not make, in the same Body, more Blood than one Ounce of Flesh; though a general Prejudice seems to have established a contrary Opinion. 2, The total Stopping or long Interruption of some involuntary Bleeding or Hæmorrhage, to which he had been accustomed. 3, A full and strong Pulse, and Veins visibly filled with Blood, in a Body that is not lean and thin, and when he is not heated. 4, A florid lively Ruddiness. 5, A considerable and unusual Numbness; Sleep more profound, of more Duration, and yet less tranquil and calm, than at other times; a greater Propensity than ordinary to be fatigued after moderate Exercise or Work; and a little Oppression and Heaviness from walking. 6, Palpitations, accompanied sometimes with very great Dejection, and even with a slight fainting Fit; especially onbeing in any hot Place, or after moving about considerably. 7, Vertigos, or Swimmings of the Head, especially on bowing down and raising it up at once, and after sleeping. 8, Frequent Pains of the Head, to which the Person was not formerly subject; and which seem not to arise from any Defect in the Digestions. 9, An evident Sensation of Heat, pretty generally diffused over the whole Body. 10, A smarting Sort of Itching all over, from a very little more Heat than usual. And lastly, frequent Hæmorrhages, and these attended with manifest Relief, and more Vivacity.People should, notwithstanding, be cautious of supposing an unhealthy Excess of Blood, from any one of these Symptoms only. Many of them must concur; and they should endeavour to be certain that even such a Concurrence of them does not result from a very different Cause, and wholly opposite in Effect to that of an Excess of Blood.But when it is certain, from the whole Appearance, that such an Excess doth really exist, then a single, or even a second Bleeding is attended with very good Effects. Nor is it material, in such Cases, from what Part the Blood is taken.§ 541. On the other Hand, when these Circumstances do not exist, Bleeding is in no wise necessary: nor should it ever be practised in these following Conditions and Circumstances; except for some particular and very strong Reasons; ofthe due Force of which none but Physicians can judge.First, when the Person is in a very advanced Age, or in very early Infancy. 2, When he is either naturally of a weakly Constitution, or it has been rendered such by Sickness, or by some other Accident. 3, When the Pulse is small, soft, feeble, and intermits, and the Skin is manifestly pale. 4, When the Limbs, the Extremities of the Body, are often cold, puffed up and soft. 5, When their Appetite has been very small for a long time; their Food but little nourishing, and their Perspiration too plentiful, from great Exercise. 6, When the Stomach has long been disordered, and the Digestion bad, whence very little Blood could be generated. 7, When the Patient has been considerably emptied, whether by Hæmorrhages, a Looseness, profuse Urine or Sweat: or when theCrisisof some Distemper has been effected by any one of these Evacuations. 8, When the Patient has long been afflicted with some depressing Disease; and troubled with many such Obstructions as prevent the Formation of Blood. 9, Whenever a Person is exhausted, from whatever Cause. 10, When the Blood is in a thin, pale, and dissolved State.§ 542, In all these Cases, and in some others less frequent, a single Bleeding often precipitates the Patient into an absolutely incurable State, an irreparable Train of Evils. Many dismal Examples of it are but too obvious.Whatever, therefore, be the Situation of the Patient, and however naturally robust, that Bleeding, which is unnecessary, is noxious. Repeated, re-iterated Bleedings, weaken and enervate, hasten old Age, diminish the Force of the Circulation, thence fatten and puff up the Body; and next by weakening, and lastly by destroying, the Digestions, they lead to a fatal Dropsy. They disorder the Perspiration by the Skin, and leave the Patient liable to Colds and Defluxions: They weaken the nervous System, and render them subject to Vapours, to the hypochondriac Disorders, and to all nervous Maladies.The ill Consequence of a single, though erroneous Bleeding is not immediately discernible: on the contrary, when it was not performed in such a Quantity, as to weaken the Patient perceivably, it appears to have been rather beneficial. Yet I still here insist upon it, that it is not the less true that, when unnecessary, it is prejudicial; and that People should never bleed, as sometimes has been done, for meer Whim, or, as it were, for Diversion. It avails nothing to affirm, that within a few Days after it, they have got more Blood than they had before it, that is, that they weigh more than at first, whence they infer the Loss of Blood very speedily repaired. The Fact of their augmented Weight is admitted; but this very Fact testifies against the real Benefit of that Bleeding; hence it is a Proof, that the natural Evacuations of the Body are lesscompleatly made; and that Humours, which ought to be expelled, are retained in it. There remains the same Quantity of Blood, and perhaps a little more; but it is not a Blood so well made, so perfectly elaborated; and this is so very true, that if the thing were otherwise; if some Days after the Bleeding they had a greater Quantity of the same Kind of Blood, it would amount to a Demonstration, that more re-iterated Bleedings must necessarily have brought on an inflammatory Disease, in a Man of a robust Habit of Body.§ 543. The Quantity of Blood, which a grown Man may Part with, by Way of Precaution, is about ten Ounces.§ 544. Persons so constituted as to breed much Blood, should carefully avoid all those Causes which tend to augment it, (See§ 540, Nº. 1) and when they are sensible of the Quantity augmented, they should confine themselves to a light frugal Diet, on Pulse, Fruits, Bread and Water; they should often bathe their Feet in warm Water, taking Night and Morning thePowderNº. 20; drink of the PtisanNº. 1; sleep but very moderately, and take much Exercise. By using these Precautions they may either prevent any Occasion for Bleeding, or should they really be obliged to admit of it, they would increase and prolong its good Effects. These are also the very Means, which may remove all the Danger that might ensue from a Person's omitting to bleed, at the usual Season or Interval,when the Habit, the Fashion of Bleeding had been inveterately established in him.§ 545. We learn with Horror and Astonishment, that some have been bled eighteen, twenty and even twenty-four times in two Days; and some others, some112hundred times, in the Course of some Months. Such Instances irrefragably demonstrate the continual Ignorance of their Physician or Surgeon; and should the Patient escape, we ought to admire the inexhaustible Resources of Nature, that survived so many murderous Incisions.§ 546. The People entertain a common Notion, which is, that the first Time of bleeding certainly saves the Life of the Patient; but to convince them of the Falsity of this silly Notion, they need only open their Eyes, and see the very contrary Fact to this occur but too unhappily every Day; many People dying soon after their first Bleeding. Were their Opinion right, it would be impossible that any Person should die of the first Disease that seized him, which yet daily happens. Now the Extirpation of this absurd Opinion is really become important, as theContinuance of it is attended with some unhappy Consequences: their Faith in, their great Dependance on, the extraordinary Virtue of this first Bleeding makes them willing to omit it, that is, to treasure it up against a Distemper, from which they shall be in the greatest Danger; and thus it is deferred as long as the Patient is not extremely bad, in Hopes that if they can do without it then, they shall keep it for another and more pressing Occasion. Their present Disease in the mean time rises to a violent Height; and then they bleed, but when it is too late, and I have seen Instances of many Patients, who were permitted to die, that the first Bleeding might be reserved for a more important Occasion. The only Difference between the first Bleeding, and any subsequent one is, that the first commonly gives the Patient an Emotion, that is rather hurtful than salutary.Of Purges.§ 547. The Stomach and Bowels are emptied either by Vomiting, or by Stools, the latter Discharge being much more natural than the first, which is not effected without a violent Motion, and one indeed to which Nature is repugnant. Nevertheless, there are some Cases, which really require this artificial Vomiting; but these excepted (some of which I have already pointed out) we should rather prefer those Remedies, which empty the Belly by Stool.§ 548. The Signs, which indicate a Necessity for Purging, are, 1, a disagreeable Tast or Savour of the Mouth in a Morning, and especially a bitter Tast; a foul, furred Tongue and Teeth, disagreable Eructations or Belchings, Windiness and Distension.2, A Want of Appetite which increases very gradually, without any Fever, which degenerates into a Disgust or total Aversion to Food; and sometimes communicates a bad Tast to the very little such Persons do eat.3, Reachings to vomit in a Morning fasting, and sometimes throughout the Day; supposing such not to depend on a Woman's Pregnancy, or some other Disorder, in which Purges would be either useless or hurtful.4, A vomiting up of bitter, or corrupted, Humours.5, A manifest Sensation of a Weight, or Heaviness in the Stomach, the Loins, or the Knees.6, A Want of Strength sometimes attended with Restlessness, ill Humour, or Peevishness, and Melancholy.7, Pains of the Stomach, frequent Pains of the Head, or Vertigos; sometimes a Drowsiness, which increases after Meals.8, Some Species of Cholics; irregular Stools which are sometimes very great in Quantity, and too liquid for many Days together; after which an obstinate Costiveness ensues.9, A Pulse less regular, and less strong, than what is natural to the Patient, and which sometimes intermits.§ 549. When these Symptoms, or some of them, ascertain the Necessity of purging a Person, not then attacked by any manifest Disease (for I am not speaking here of Purges in such Cases) a proper purging Medicine may be given him. The bad Tast in his Mouth; the continual Belchings; the frequent Reachings to vomit; the actual Vomitings and Melancholy discover, that the Cause of his Disorder resides in the Stomach, and shew that a Vomit will be of Service to him. But when such Signs or Symptoms are not evident, the Patient should take such purging or opening Remedies, as are particularly indicated by the Pains, whether of the Loins; from the Cholic; or by a Sensation of Weight or Heaviness in the Knees.§ 550. But we should abstain from either vomiting or purging, 1, Whenever the Complaints of thePatientsare founded in their Weakness, and their being already exhausted, 2, When there is a general Dryness of the Habit, a very considerable Degree of Heat, some Inflammation, or a strong Fever. 3, Whenever Nature is exerting herself in some other salutary Evacuation; whence purging must never be attempted in critical Sweats, during the monthly Discharges, nor during a Fit of the Gout. 4, Nor in such inveterate Obstructions as Purges cannot remove, and really do augment. 5, Neitherwhen the nervous System is considerably weakened.§ 551. There are other Cases again, in which it may be proper to purge, but not to give a Vomit. These Cases are, 1, When the Patient abounds too much with Blood, (See§ 540) since the Efforts which attend vomiting, greatly augment the Force of the Circulation; whence the Blood-vessels of the Head and of the Breast, being extremely distended with Blood, might burst, which must prove fatal on the Spot, and has repeatedly proved so. 2, For the same Reason they should not be given to Persons, who are subject to frequent Bleeding from the Nose, or to coughing up or vomiting of Blood; to Women who are subject to excessive or unseasonable Discharges of Blood,&c.from theVagina, the Neck of the Womb; nor to those who are with Child. 3, Vomits are improper for ruptured Persons.§ 552. When any Person has taken too acrid, too sharp, a Vomit, or a Purge, which operates with excessive Violence; whether this consists in the most vehement Efforts and Agitations, the Pains, Convulsions, or Swoonings, which are their frequent Consequences; or whether that prodigious Evacuation and Emptiness their Operation causes, (which is commonly termed aSuper-purgation) and which may hurry the Patient off; Instances of which are but too common among the lower Class of the People, who much too frequently confide themselves to the Conductof ignorant Men-slayers: In all such unhappy Accidents, I say, we should treat these unfortunate Persons, as if they had been actually poisoned, by violent corroding Poisons, (See§ 533) that is, we should fill them, as it were, with Draughts of warm Water, Milk, Oil, Barley-water, Almond Milk, emollient Glysters with Milk, and the Yolks of Eggs; and also bleed them plentifully, if their Pains are excessive, and their Pulses strong and feverish.The Super-purgation, the excessive Discharge, is to be stopt, after having plied the Patient plentifully with diluting Drinks, by giving the calming Anodyne Medicines directed in the Removal of acute Pains,§ 536, Nº. 6.Flanels dipt in hot Water, in which someVeniceTreacle is dissolved, are very serviceable: and should the Evacuations by Stool be excessive, and the Patient has not a high Fever, and a parching Kind of Heat, a Morsel of the same Treacle, as large as a Nutmeg, may be dissolved in his Glyster.But should the Vomiting solely be excessive, without any Purging, the Number of the emollient Glysters with Oil and the Yolk of an Egg must be increased; and the Patient should be placed in a warm Bath.§ 553. Purges frequently repeated, without just and necessary Indications, are attended with much the same ill Effects as frequent Bleedings. They destroy the Digestions; the Stomach no longer, or very languidly, exerts its Functions;the Intestines prove inactive; the Patient becomes liable to very severe Cholics; the Plight of the Body, deprived of its salutary Nutrition, falls off; Perspiration is disordered; Defluxions ensue; nervous Maladies come on, with a general Languor; and the Patient proves old, long before the Number of his Years have made him so.Much irreparable Mischief has been done to the Health of Children, by Purges injudiciously given and repeated. They prevent them from attaining their utmost natural Strength, and frequently contract their due Growth. They ruin their Teeth; dispose young Girls to future Obstructions; and when they have been already affected by them, they render them still more obstinate.It is a Prejudice too generally received, that Persons who have little or no Appetite need purging; since this is often very false, and most of those Causes, which lessen or destroy the Appetite, cannot be removed by purging; though many of them may be increased by it.Persons whose Stomachs contain much glairy viscid Matter suppose, they may be cured by Purges, which seem indeed at first to relieve them: but this proves a very slight and deceitful Relief. These Humours are owing to that Weakness and Laxity of the Stomach, which Purges augment; since notwithstanding they carry off Part of these viscid Humours generated in it, at the Expiration of a few Days there is a greater Accumulation of them than before; andthus, by a Re-iteration of purging Medicines, the Malady soon becomes incurable, and Health irrecoverably lost. The real Cure of such Cases is effected by directly opposite Medicines. Those referred to, or mentioned,§ 272, are highly conducive to it.§ 554. The Custom of taking stomachic Medicines infused in Brandy, Spirit of Wine, Cherry Water,&c.is always dangerous; for notwithstanding the present immediate Relief such Infusions afford in some Disorders of the Stomach, they really by slow Degrees impair and ruin that Organ; and it may be observed, that as many as accustom themselves to Drams, go off, just like excessive Drinkers, in Consequence of their having no Digestion; whence they sink into a State of Depression and Languor, and die dropsical.§ 555. Either Vomits or Purges may be often beneficially omitted, even when they have some Appearance of seeming necessary, by abating one Meal a Day for some time; by abstaining from the most nourishing Sorts of Food; and especially from those which are fat; by drinking freely of cool Water, and taking extraordinary Exercise. The same Regimen also serves to subdue, without the Use of Purges, the various Complaints which often invade those, who omit taking purging Medicines, at those Seasons and Intervals, in which they have made it a Custom to take them.§ 556. The Medicines,Nº. 34and35, are the most certain Vomits. The Powder,Nº. 21, is a good Purge, when the Patient is in no wise feverish.The Doses recommended in the Table of Remedies are those, which are proper for a grown Man, of a vigorous Constitution. Nevertheless there are some few, for whom they may be too weak: in such Circumstances they may be increased by the Addition of a third or fourth Part of the Dose prescribed. But should they not operate in that Quantity, we must be careful not to double the Dose, much less to give a three-fold Quantity, which has sometimes been done, and that even without its Operation, and at the Risque of killing the Patient, which has not seldom been the Consequence. In Case of such purging not ensuing, we should rather give large Draughts of Whey sweetened with Honey, or of warm Water, in a Pot of which an Ounce, or an Ounce and a half of common Salt must be dissolved; and this Quantity is to be taken from time to time in small Cups, moving about with it.The Fibres of Country People who inhabit the Mountains, and live almost solely on Milk, are so little susceptible of Sensation, that they must take such large Doses to purge them, as would kill all the Peasantry in the Vallies. In the Mountains ofValaisthere are Men who take twenty, and even twenty-four Grains of Glass ofAntimony for a single Dose; a Grain or two of which were sufficient to poison ordinary Men.§ 557. Notwithstanding our Cautions on this important Head, whenever an urgent Necessity commands it, Purging must be recurred to at all Times and Seasons: but when the Season may be safely selected, it were right to decline Purging in the Extremities of either Heat or Cold; and to take the Purge early in the Morning, that the Medicines may find less Obstruction or Embarrassment from the Contents of the Stomach. Every other Consideration, with Relation to the Stars and the Moon, is ridiculous, and void of any Foundation. The People are particularly averse to purging in the Dog-days; and if this were only on Account of the great Heat, it would be very pardonable: but it is from an astrological Prejudice, which is so much the more absurd, as the real Dog-days are at thirty-six Days Distance from those commonly reckoned such; and it is a melancholy Reflection, that the Ignorance of the People should be so gross, in this Respect, in our enlightened Age; and that they should still imagine the Virtue and Efficacy of Medicines to depend on what Sign of the Zodiac the Sun is in, or in any particular Quarter of the Moon. Yet it is certain in this Point, they are so inveterately attached to this Prejudice, that it is but too common to see Country-People die, in waiting for the Sign or Quarter most favourable to the Operation and Effect of a Medicine, which was truly necessary five or six Days before either of them.Sometimes too that particular Medicine is given, to which a certain Day is supposed to be auspicious and favourable, in Preference to that which is most prevalent against the Disease. And thus it is, than an ignorant Almanack Maker determines on the Lives of the human Race; and contracts the Duration of them with Impunity.§ 558. When a Vomit or a Purge is to be taken, the Patient's Body should be prepared for the Reception of it twenty-four Hours beforehand; by taking very little Food, and drinking some Glasses of warm Water, or of a light Tea of some Herbs.He should not drink after a Vomit, until it begins to work; but then he should drink very plentifully of warm Water, or a light Infusion of Chamomile Flowers, which is preferable.It is usual, after Purges, to take some thin Broth or Soup during their Operation; but warm Water sweetened with Sugar or Honey, or an Infusion of Succory Flowers, would sometimes be more suitable.§ 559. As the Stomach suffers, in some Degree, as often as either a Vomit, or a Purge, is taken, the Patient should be careful how he lives and orders himself for some Days after taking them, as well in Regard to the Quantity as Quality of his Food.§ 560. I shall say nothing of other Articles taken by Way of Precaution, such as Soups, Whey, Waters,&c.which are but little used among the People; but confine myself to thisgeneral Remark, that when they take any of these precautionary Things, they should enter on a Regimen or Way of living, that may co-operate with them, and contribute to the same Purpose. Whey is commonly taken to refresh and cool the Body; and while they drink it, they deny themselves Pulse, Fruits, and Sallads. They eat nothing then, but the best and heartiest Flesh-meats they can come at; such Vegetables as are used in good Soups, Eggs, and good Wine; notwithstanding this is to destroy, by high and heating Aliments, all the attemperating cooling Effects expected from the Whey.Some Persons propose to cool and attemperate their Blood by Soups and a thin Diet, into which they cram Craw-fish, that heat considerably, orNasturtium, Cresses which also heat, and thus defeat their own Purpose. Happily, in such a Case, the Error in one Respect often cures that in the other; and these Kinds of Soup, which are in no wise cooling, prove very serviceable, in Consequence of the Cause of the Symptoms, which they were intended to remove, not requiring any Coolers at all.The general physical Practice of the Community, which unhappily is but too much in Fashion, abounds with similar Errors. I will just cite one, because I have seen its dismal Effects. Many People suppose Pepper cooling, though their Smell, Taste, and common Sense concur to inform them of the contrary. It is the very hottest of Spices.§ 561. The most certain Preservative, and the most attainable too by every Man, is to avoid all Excess, and especially Excess in eating and in drinking. People generally eat more than thoroughly consists with Health, or permits them to attain the utmost Vigour, of which their natural Constitutions are capable. The Custom is established, and it is difficult to eradicate it: notwithstanding we should at least resolve not to eat, but through Hunger, and always under a Subjection to Reason; because, except in a very few Cases, Reason constantly suggests to us not to eat, when the Stomach has an Aversion to Food. A sober moderate Person is capable of Labour, I may say, even of excessive Labour of some Kinds; of which greater Eaters are absolutely incapable. Sobriety of itself cures such Maladies as are otherwise incurable, and may recover the most shattered and unhealthy Persons.
Of Medicines taken by Way of Precaution, or Prevention.Sect.538.IHave pointed out, in some Parts of this Work, the Means of preventing the bad Effects of several Causes of Diseases; and of prohibiting the Return of some habitual Disorders. In the present Chapter I shall adjoin some Observations, on the Use of the principal Remedies, which are employed as general Preservatives; pretty regularly too at certain stated Times, and almost always from meer Custom only, without knowing, and often with very little Consideration, whether they are rightor wrong.Nevertheless, the Use, the Habit of taking Medicines, is certainly no indifferent Matter: it is ridiculous, dangerous, and even criminal to omit them, when they are necessary, but not less so to take them when they are not wanted. Agood Medicine taken seasonably, when there is some Disorder, someDisarrangementin the Body, which would in a short time occasion a Distemper, has often prevented it. But yet the very same Medicine, if given to a Person in perfect Health, if it does not directly make him sick, leaves him at the best in a greater Propensity to the Impressions of Diseases: and there are but too many Examples of People, who having very unhappily contracted a Habit, a Disposition to take Physick, have really injured their Health, and impaired their Constitution, however naturally strong, by an Abuse of those Materials which Providence has given for the Recovery and Re-establishment of it; an Abuse which, though it should not injure the Health of the Person, would occasion those Remedies, when he should be really sick, to be less efficacious and serviceable to him, from their having been familiar to his Constitution; and thus he becomes deprived of the Assistance he would have received from them, if taken only in those Times and Circumstances, in which they were necessary for him.
Sect.538.
Sect.538.
IHave pointed out, in some Parts of this Work, the Means of preventing the bad Effects of several Causes of Diseases; and of prohibiting the Return of some habitual Disorders. In the present Chapter I shall adjoin some Observations, on the Use of the principal Remedies, which are employed as general Preservatives; pretty regularly too at certain stated Times, and almost always from meer Custom only, without knowing, and often with very little Consideration, whether they are rightor wrong.
Nevertheless, the Use, the Habit of taking Medicines, is certainly no indifferent Matter: it is ridiculous, dangerous, and even criminal to omit them, when they are necessary, but not less so to take them when they are not wanted. Agood Medicine taken seasonably, when there is some Disorder, someDisarrangementin the Body, which would in a short time occasion a Distemper, has often prevented it. But yet the very same Medicine, if given to a Person in perfect Health, if it does not directly make him sick, leaves him at the best in a greater Propensity to the Impressions of Diseases: and there are but too many Examples of People, who having very unhappily contracted a Habit, a Disposition to take Physick, have really injured their Health, and impaired their Constitution, however naturally strong, by an Abuse of those Materials which Providence has given for the Recovery and Re-establishment of it; an Abuse which, though it should not injure the Health of the Person, would occasion those Remedies, when he should be really sick, to be less efficacious and serviceable to him, from their having been familiar to his Constitution; and thus he becomes deprived of the Assistance he would have received from them, if taken only in those Times and Circumstances, in which they were necessary for him.
Of Bleeding.§ 539. Bleeding is necessary only in these four Cases. 1, When there is too great a Quantity of Blood in the Body. 2, When there is any Inflammation, or an inflammatory Disease. 3, When some Cause supervenes, or is about tosupervene, in the Constitution, which would speedily produce an Inflammation, or some other dangerous Symptom, if the Vessels were not relaxed by Bleeding. It is upon this Principle that Patients are bled after Wounds, and after Bruises; that Bleeding is directed for a pregnant Woman, if she has a violent Cough; and that Bleeding is performed, by Way of Precaution, in several other Cases. 4, We also advise Bleeding sometimes to asswage an excessive Pain, though such Pain is not owing to Excess of Blood, norarisesfrom an inflamed Blood; but in Order to appease and moderate the Pain by Bleeding; and thereby to obtain Time for destroying the Cause of it by other Remedies. But as these two last Reasons are in Effect involved or implied in the two first; it may be very generally concluded, that an Excess of Blood, and an inflamed State of it, are the only two necessary Motives for Bleeding.§ 540. An Inflammation of the Blood is known by the Symptoms accompanying those Diseases, which that Cause produces. Of these I have already spoken, and I have at the same time regulated the Practice of Bleeding in such Cases. Here I shall point out those Symptoms and Circumstances, which manifest an Excess of Blood.The first, then, is the general Course and Manner of the Patient's living, while in Health. If he is a great Eater, and indulges in juicy nutritious Food, and especially on much Flesh-meat;if he drinks rich and nourishing Wine, or other strong Drink, and at the same time enjoys a good Digestion; if he takes but little Exercise, sleeps much, and has not been subject to any very considerable Evacuation, he may well be supposed to abound in Blood. It is very obvious that all these Causes rarely occur in Country People; if we except only the Abatement of their Exercise, during some Weeks in Winter, which indeed may contribute to their generating more Blood than they commonly do.The labouring Country-man, for much the greater part of his Time, lives only on Bread, Water and Vegetables; Materials but very moderately nourishing, as one Pound of Bread probably does not make, in the same Body, more Blood than one Ounce of Flesh; though a general Prejudice seems to have established a contrary Opinion. 2, The total Stopping or long Interruption of some involuntary Bleeding or Hæmorrhage, to which he had been accustomed. 3, A full and strong Pulse, and Veins visibly filled with Blood, in a Body that is not lean and thin, and when he is not heated. 4, A florid lively Ruddiness. 5, A considerable and unusual Numbness; Sleep more profound, of more Duration, and yet less tranquil and calm, than at other times; a greater Propensity than ordinary to be fatigued after moderate Exercise or Work; and a little Oppression and Heaviness from walking. 6, Palpitations, accompanied sometimes with very great Dejection, and even with a slight fainting Fit; especially onbeing in any hot Place, or after moving about considerably. 7, Vertigos, or Swimmings of the Head, especially on bowing down and raising it up at once, and after sleeping. 8, Frequent Pains of the Head, to which the Person was not formerly subject; and which seem not to arise from any Defect in the Digestions. 9, An evident Sensation of Heat, pretty generally diffused over the whole Body. 10, A smarting Sort of Itching all over, from a very little more Heat than usual. And lastly, frequent Hæmorrhages, and these attended with manifest Relief, and more Vivacity.People should, notwithstanding, be cautious of supposing an unhealthy Excess of Blood, from any one of these Symptoms only. Many of them must concur; and they should endeavour to be certain that even such a Concurrence of them does not result from a very different Cause, and wholly opposite in Effect to that of an Excess of Blood.But when it is certain, from the whole Appearance, that such an Excess doth really exist, then a single, or even a second Bleeding is attended with very good Effects. Nor is it material, in such Cases, from what Part the Blood is taken.§ 541. On the other Hand, when these Circumstances do not exist, Bleeding is in no wise necessary: nor should it ever be practised in these following Conditions and Circumstances; except for some particular and very strong Reasons; ofthe due Force of which none but Physicians can judge.First, when the Person is in a very advanced Age, or in very early Infancy. 2, When he is either naturally of a weakly Constitution, or it has been rendered such by Sickness, or by some other Accident. 3, When the Pulse is small, soft, feeble, and intermits, and the Skin is manifestly pale. 4, When the Limbs, the Extremities of the Body, are often cold, puffed up and soft. 5, When their Appetite has been very small for a long time; their Food but little nourishing, and their Perspiration too plentiful, from great Exercise. 6, When the Stomach has long been disordered, and the Digestion bad, whence very little Blood could be generated. 7, When the Patient has been considerably emptied, whether by Hæmorrhages, a Looseness, profuse Urine or Sweat: or when theCrisisof some Distemper has been effected by any one of these Evacuations. 8, When the Patient has long been afflicted with some depressing Disease; and troubled with many such Obstructions as prevent the Formation of Blood. 9, Whenever a Person is exhausted, from whatever Cause. 10, When the Blood is in a thin, pale, and dissolved State.§ 542, In all these Cases, and in some others less frequent, a single Bleeding often precipitates the Patient into an absolutely incurable State, an irreparable Train of Evils. Many dismal Examples of it are but too obvious.Whatever, therefore, be the Situation of the Patient, and however naturally robust, that Bleeding, which is unnecessary, is noxious. Repeated, re-iterated Bleedings, weaken and enervate, hasten old Age, diminish the Force of the Circulation, thence fatten and puff up the Body; and next by weakening, and lastly by destroying, the Digestions, they lead to a fatal Dropsy. They disorder the Perspiration by the Skin, and leave the Patient liable to Colds and Defluxions: They weaken the nervous System, and render them subject to Vapours, to the hypochondriac Disorders, and to all nervous Maladies.The ill Consequence of a single, though erroneous Bleeding is not immediately discernible: on the contrary, when it was not performed in such a Quantity, as to weaken the Patient perceivably, it appears to have been rather beneficial. Yet I still here insist upon it, that it is not the less true that, when unnecessary, it is prejudicial; and that People should never bleed, as sometimes has been done, for meer Whim, or, as it were, for Diversion. It avails nothing to affirm, that within a few Days after it, they have got more Blood than they had before it, that is, that they weigh more than at first, whence they infer the Loss of Blood very speedily repaired. The Fact of their augmented Weight is admitted; but this very Fact testifies against the real Benefit of that Bleeding; hence it is a Proof, that the natural Evacuations of the Body are lesscompleatly made; and that Humours, which ought to be expelled, are retained in it. There remains the same Quantity of Blood, and perhaps a little more; but it is not a Blood so well made, so perfectly elaborated; and this is so very true, that if the thing were otherwise; if some Days after the Bleeding they had a greater Quantity of the same Kind of Blood, it would amount to a Demonstration, that more re-iterated Bleedings must necessarily have brought on an inflammatory Disease, in a Man of a robust Habit of Body.§ 543. The Quantity of Blood, which a grown Man may Part with, by Way of Precaution, is about ten Ounces.§ 544. Persons so constituted as to breed much Blood, should carefully avoid all those Causes which tend to augment it, (See§ 540, Nº. 1) and when they are sensible of the Quantity augmented, they should confine themselves to a light frugal Diet, on Pulse, Fruits, Bread and Water; they should often bathe their Feet in warm Water, taking Night and Morning thePowderNº. 20; drink of the PtisanNº. 1; sleep but very moderately, and take much Exercise. By using these Precautions they may either prevent any Occasion for Bleeding, or should they really be obliged to admit of it, they would increase and prolong its good Effects. These are also the very Means, which may remove all the Danger that might ensue from a Person's omitting to bleed, at the usual Season or Interval,when the Habit, the Fashion of Bleeding had been inveterately established in him.§ 545. We learn with Horror and Astonishment, that some have been bled eighteen, twenty and even twenty-four times in two Days; and some others, some112hundred times, in the Course of some Months. Such Instances irrefragably demonstrate the continual Ignorance of their Physician or Surgeon; and should the Patient escape, we ought to admire the inexhaustible Resources of Nature, that survived so many murderous Incisions.§ 546. The People entertain a common Notion, which is, that the first Time of bleeding certainly saves the Life of the Patient; but to convince them of the Falsity of this silly Notion, they need only open their Eyes, and see the very contrary Fact to this occur but too unhappily every Day; many People dying soon after their first Bleeding. Were their Opinion right, it would be impossible that any Person should die of the first Disease that seized him, which yet daily happens. Now the Extirpation of this absurd Opinion is really become important, as theContinuance of it is attended with some unhappy Consequences: their Faith in, their great Dependance on, the extraordinary Virtue of this first Bleeding makes them willing to omit it, that is, to treasure it up against a Distemper, from which they shall be in the greatest Danger; and thus it is deferred as long as the Patient is not extremely bad, in Hopes that if they can do without it then, they shall keep it for another and more pressing Occasion. Their present Disease in the mean time rises to a violent Height; and then they bleed, but when it is too late, and I have seen Instances of many Patients, who were permitted to die, that the first Bleeding might be reserved for a more important Occasion. The only Difference between the first Bleeding, and any subsequent one is, that the first commonly gives the Patient an Emotion, that is rather hurtful than salutary.
§ 539. Bleeding is necessary only in these four Cases. 1, When there is too great a Quantity of Blood in the Body. 2, When there is any Inflammation, or an inflammatory Disease. 3, When some Cause supervenes, or is about tosupervene, in the Constitution, which would speedily produce an Inflammation, or some other dangerous Symptom, if the Vessels were not relaxed by Bleeding. It is upon this Principle that Patients are bled after Wounds, and after Bruises; that Bleeding is directed for a pregnant Woman, if she has a violent Cough; and that Bleeding is performed, by Way of Precaution, in several other Cases. 4, We also advise Bleeding sometimes to asswage an excessive Pain, though such Pain is not owing to Excess of Blood, norarisesfrom an inflamed Blood; but in Order to appease and moderate the Pain by Bleeding; and thereby to obtain Time for destroying the Cause of it by other Remedies. But as these two last Reasons are in Effect involved or implied in the two first; it may be very generally concluded, that an Excess of Blood, and an inflamed State of it, are the only two necessary Motives for Bleeding.
§ 540. An Inflammation of the Blood is known by the Symptoms accompanying those Diseases, which that Cause produces. Of these I have already spoken, and I have at the same time regulated the Practice of Bleeding in such Cases. Here I shall point out those Symptoms and Circumstances, which manifest an Excess of Blood.
The first, then, is the general Course and Manner of the Patient's living, while in Health. If he is a great Eater, and indulges in juicy nutritious Food, and especially on much Flesh-meat;if he drinks rich and nourishing Wine, or other strong Drink, and at the same time enjoys a good Digestion; if he takes but little Exercise, sleeps much, and has not been subject to any very considerable Evacuation, he may well be supposed to abound in Blood. It is very obvious that all these Causes rarely occur in Country People; if we except only the Abatement of their Exercise, during some Weeks in Winter, which indeed may contribute to their generating more Blood than they commonly do.
The labouring Country-man, for much the greater part of his Time, lives only on Bread, Water and Vegetables; Materials but very moderately nourishing, as one Pound of Bread probably does not make, in the same Body, more Blood than one Ounce of Flesh; though a general Prejudice seems to have established a contrary Opinion. 2, The total Stopping or long Interruption of some involuntary Bleeding or Hæmorrhage, to which he had been accustomed. 3, A full and strong Pulse, and Veins visibly filled with Blood, in a Body that is not lean and thin, and when he is not heated. 4, A florid lively Ruddiness. 5, A considerable and unusual Numbness; Sleep more profound, of more Duration, and yet less tranquil and calm, than at other times; a greater Propensity than ordinary to be fatigued after moderate Exercise or Work; and a little Oppression and Heaviness from walking. 6, Palpitations, accompanied sometimes with very great Dejection, and even with a slight fainting Fit; especially onbeing in any hot Place, or after moving about considerably. 7, Vertigos, or Swimmings of the Head, especially on bowing down and raising it up at once, and after sleeping. 8, Frequent Pains of the Head, to which the Person was not formerly subject; and which seem not to arise from any Defect in the Digestions. 9, An evident Sensation of Heat, pretty generally diffused over the whole Body. 10, A smarting Sort of Itching all over, from a very little more Heat than usual. And lastly, frequent Hæmorrhages, and these attended with manifest Relief, and more Vivacity.
People should, notwithstanding, be cautious of supposing an unhealthy Excess of Blood, from any one of these Symptoms only. Many of them must concur; and they should endeavour to be certain that even such a Concurrence of them does not result from a very different Cause, and wholly opposite in Effect to that of an Excess of Blood.
But when it is certain, from the whole Appearance, that such an Excess doth really exist, then a single, or even a second Bleeding is attended with very good Effects. Nor is it material, in such Cases, from what Part the Blood is taken.
§ 541. On the other Hand, when these Circumstances do not exist, Bleeding is in no wise necessary: nor should it ever be practised in these following Conditions and Circumstances; except for some particular and very strong Reasons; ofthe due Force of which none but Physicians can judge.
First, when the Person is in a very advanced Age, or in very early Infancy. 2, When he is either naturally of a weakly Constitution, or it has been rendered such by Sickness, or by some other Accident. 3, When the Pulse is small, soft, feeble, and intermits, and the Skin is manifestly pale. 4, When the Limbs, the Extremities of the Body, are often cold, puffed up and soft. 5, When their Appetite has been very small for a long time; their Food but little nourishing, and their Perspiration too plentiful, from great Exercise. 6, When the Stomach has long been disordered, and the Digestion bad, whence very little Blood could be generated. 7, When the Patient has been considerably emptied, whether by Hæmorrhages, a Looseness, profuse Urine or Sweat: or when theCrisisof some Distemper has been effected by any one of these Evacuations. 8, When the Patient has long been afflicted with some depressing Disease; and troubled with many such Obstructions as prevent the Formation of Blood. 9, Whenever a Person is exhausted, from whatever Cause. 10, When the Blood is in a thin, pale, and dissolved State.
§ 542, In all these Cases, and in some others less frequent, a single Bleeding often precipitates the Patient into an absolutely incurable State, an irreparable Train of Evils. Many dismal Examples of it are but too obvious.
Whatever, therefore, be the Situation of the Patient, and however naturally robust, that Bleeding, which is unnecessary, is noxious. Repeated, re-iterated Bleedings, weaken and enervate, hasten old Age, diminish the Force of the Circulation, thence fatten and puff up the Body; and next by weakening, and lastly by destroying, the Digestions, they lead to a fatal Dropsy. They disorder the Perspiration by the Skin, and leave the Patient liable to Colds and Defluxions: They weaken the nervous System, and render them subject to Vapours, to the hypochondriac Disorders, and to all nervous Maladies.
The ill Consequence of a single, though erroneous Bleeding is not immediately discernible: on the contrary, when it was not performed in such a Quantity, as to weaken the Patient perceivably, it appears to have been rather beneficial. Yet I still here insist upon it, that it is not the less true that, when unnecessary, it is prejudicial; and that People should never bleed, as sometimes has been done, for meer Whim, or, as it were, for Diversion. It avails nothing to affirm, that within a few Days after it, they have got more Blood than they had before it, that is, that they weigh more than at first, whence they infer the Loss of Blood very speedily repaired. The Fact of their augmented Weight is admitted; but this very Fact testifies against the real Benefit of that Bleeding; hence it is a Proof, that the natural Evacuations of the Body are lesscompleatly made; and that Humours, which ought to be expelled, are retained in it. There remains the same Quantity of Blood, and perhaps a little more; but it is not a Blood so well made, so perfectly elaborated; and this is so very true, that if the thing were otherwise; if some Days after the Bleeding they had a greater Quantity of the same Kind of Blood, it would amount to a Demonstration, that more re-iterated Bleedings must necessarily have brought on an inflammatory Disease, in a Man of a robust Habit of Body.
§ 543. The Quantity of Blood, which a grown Man may Part with, by Way of Precaution, is about ten Ounces.
§ 544. Persons so constituted as to breed much Blood, should carefully avoid all those Causes which tend to augment it, (See§ 540, Nº. 1) and when they are sensible of the Quantity augmented, they should confine themselves to a light frugal Diet, on Pulse, Fruits, Bread and Water; they should often bathe their Feet in warm Water, taking Night and Morning thePowderNº. 20; drink of the PtisanNº. 1; sleep but very moderately, and take much Exercise. By using these Precautions they may either prevent any Occasion for Bleeding, or should they really be obliged to admit of it, they would increase and prolong its good Effects. These are also the very Means, which may remove all the Danger that might ensue from a Person's omitting to bleed, at the usual Season or Interval,when the Habit, the Fashion of Bleeding had been inveterately established in him.
§ 545. We learn with Horror and Astonishment, that some have been bled eighteen, twenty and even twenty-four times in two Days; and some others, some112hundred times, in the Course of some Months. Such Instances irrefragably demonstrate the continual Ignorance of their Physician or Surgeon; and should the Patient escape, we ought to admire the inexhaustible Resources of Nature, that survived so many murderous Incisions.
§ 546. The People entertain a common Notion, which is, that the first Time of bleeding certainly saves the Life of the Patient; but to convince them of the Falsity of this silly Notion, they need only open their Eyes, and see the very contrary Fact to this occur but too unhappily every Day; many People dying soon after their first Bleeding. Were their Opinion right, it would be impossible that any Person should die of the first Disease that seized him, which yet daily happens. Now the Extirpation of this absurd Opinion is really become important, as theContinuance of it is attended with some unhappy Consequences: their Faith in, their great Dependance on, the extraordinary Virtue of this first Bleeding makes them willing to omit it, that is, to treasure it up against a Distemper, from which they shall be in the greatest Danger; and thus it is deferred as long as the Patient is not extremely bad, in Hopes that if they can do without it then, they shall keep it for another and more pressing Occasion. Their present Disease in the mean time rises to a violent Height; and then they bleed, but when it is too late, and I have seen Instances of many Patients, who were permitted to die, that the first Bleeding might be reserved for a more important Occasion. The only Difference between the first Bleeding, and any subsequent one is, that the first commonly gives the Patient an Emotion, that is rather hurtful than salutary.
Of Purges.§ 547. The Stomach and Bowels are emptied either by Vomiting, or by Stools, the latter Discharge being much more natural than the first, which is not effected without a violent Motion, and one indeed to which Nature is repugnant. Nevertheless, there are some Cases, which really require this artificial Vomiting; but these excepted (some of which I have already pointed out) we should rather prefer those Remedies, which empty the Belly by Stool.§ 548. The Signs, which indicate a Necessity for Purging, are, 1, a disagreeable Tast or Savour of the Mouth in a Morning, and especially a bitter Tast; a foul, furred Tongue and Teeth, disagreable Eructations or Belchings, Windiness and Distension.2, A Want of Appetite which increases very gradually, without any Fever, which degenerates into a Disgust or total Aversion to Food; and sometimes communicates a bad Tast to the very little such Persons do eat.3, Reachings to vomit in a Morning fasting, and sometimes throughout the Day; supposing such not to depend on a Woman's Pregnancy, or some other Disorder, in which Purges would be either useless or hurtful.4, A vomiting up of bitter, or corrupted, Humours.5, A manifest Sensation of a Weight, or Heaviness in the Stomach, the Loins, or the Knees.6, A Want of Strength sometimes attended with Restlessness, ill Humour, or Peevishness, and Melancholy.7, Pains of the Stomach, frequent Pains of the Head, or Vertigos; sometimes a Drowsiness, which increases after Meals.8, Some Species of Cholics; irregular Stools which are sometimes very great in Quantity, and too liquid for many Days together; after which an obstinate Costiveness ensues.9, A Pulse less regular, and less strong, than what is natural to the Patient, and which sometimes intermits.§ 549. When these Symptoms, or some of them, ascertain the Necessity of purging a Person, not then attacked by any manifest Disease (for I am not speaking here of Purges in such Cases) a proper purging Medicine may be given him. The bad Tast in his Mouth; the continual Belchings; the frequent Reachings to vomit; the actual Vomitings and Melancholy discover, that the Cause of his Disorder resides in the Stomach, and shew that a Vomit will be of Service to him. But when such Signs or Symptoms are not evident, the Patient should take such purging or opening Remedies, as are particularly indicated by the Pains, whether of the Loins; from the Cholic; or by a Sensation of Weight or Heaviness in the Knees.§ 550. But we should abstain from either vomiting or purging, 1, Whenever the Complaints of thePatientsare founded in their Weakness, and their being already exhausted, 2, When there is a general Dryness of the Habit, a very considerable Degree of Heat, some Inflammation, or a strong Fever. 3, Whenever Nature is exerting herself in some other salutary Evacuation; whence purging must never be attempted in critical Sweats, during the monthly Discharges, nor during a Fit of the Gout. 4, Nor in such inveterate Obstructions as Purges cannot remove, and really do augment. 5, Neitherwhen the nervous System is considerably weakened.§ 551. There are other Cases again, in which it may be proper to purge, but not to give a Vomit. These Cases are, 1, When the Patient abounds too much with Blood, (See§ 540) since the Efforts which attend vomiting, greatly augment the Force of the Circulation; whence the Blood-vessels of the Head and of the Breast, being extremely distended with Blood, might burst, which must prove fatal on the Spot, and has repeatedly proved so. 2, For the same Reason they should not be given to Persons, who are subject to frequent Bleeding from the Nose, or to coughing up or vomiting of Blood; to Women who are subject to excessive or unseasonable Discharges of Blood,&c.from theVagina, the Neck of the Womb; nor to those who are with Child. 3, Vomits are improper for ruptured Persons.§ 552. When any Person has taken too acrid, too sharp, a Vomit, or a Purge, which operates with excessive Violence; whether this consists in the most vehement Efforts and Agitations, the Pains, Convulsions, or Swoonings, which are their frequent Consequences; or whether that prodigious Evacuation and Emptiness their Operation causes, (which is commonly termed aSuper-purgation) and which may hurry the Patient off; Instances of which are but too common among the lower Class of the People, who much too frequently confide themselves to the Conductof ignorant Men-slayers: In all such unhappy Accidents, I say, we should treat these unfortunate Persons, as if they had been actually poisoned, by violent corroding Poisons, (See§ 533) that is, we should fill them, as it were, with Draughts of warm Water, Milk, Oil, Barley-water, Almond Milk, emollient Glysters with Milk, and the Yolks of Eggs; and also bleed them plentifully, if their Pains are excessive, and their Pulses strong and feverish.The Super-purgation, the excessive Discharge, is to be stopt, after having plied the Patient plentifully with diluting Drinks, by giving the calming Anodyne Medicines directed in the Removal of acute Pains,§ 536, Nº. 6.Flanels dipt in hot Water, in which someVeniceTreacle is dissolved, are very serviceable: and should the Evacuations by Stool be excessive, and the Patient has not a high Fever, and a parching Kind of Heat, a Morsel of the same Treacle, as large as a Nutmeg, may be dissolved in his Glyster.But should the Vomiting solely be excessive, without any Purging, the Number of the emollient Glysters with Oil and the Yolk of an Egg must be increased; and the Patient should be placed in a warm Bath.§ 553. Purges frequently repeated, without just and necessary Indications, are attended with much the same ill Effects as frequent Bleedings. They destroy the Digestions; the Stomach no longer, or very languidly, exerts its Functions;the Intestines prove inactive; the Patient becomes liable to very severe Cholics; the Plight of the Body, deprived of its salutary Nutrition, falls off; Perspiration is disordered; Defluxions ensue; nervous Maladies come on, with a general Languor; and the Patient proves old, long before the Number of his Years have made him so.Much irreparable Mischief has been done to the Health of Children, by Purges injudiciously given and repeated. They prevent them from attaining their utmost natural Strength, and frequently contract their due Growth. They ruin their Teeth; dispose young Girls to future Obstructions; and when they have been already affected by them, they render them still more obstinate.It is a Prejudice too generally received, that Persons who have little or no Appetite need purging; since this is often very false, and most of those Causes, which lessen or destroy the Appetite, cannot be removed by purging; though many of them may be increased by it.Persons whose Stomachs contain much glairy viscid Matter suppose, they may be cured by Purges, which seem indeed at first to relieve them: but this proves a very slight and deceitful Relief. These Humours are owing to that Weakness and Laxity of the Stomach, which Purges augment; since notwithstanding they carry off Part of these viscid Humours generated in it, at the Expiration of a few Days there is a greater Accumulation of them than before; andthus, by a Re-iteration of purging Medicines, the Malady soon becomes incurable, and Health irrecoverably lost. The real Cure of such Cases is effected by directly opposite Medicines. Those referred to, or mentioned,§ 272, are highly conducive to it.§ 554. The Custom of taking stomachic Medicines infused in Brandy, Spirit of Wine, Cherry Water,&c.is always dangerous; for notwithstanding the present immediate Relief such Infusions afford in some Disorders of the Stomach, they really by slow Degrees impair and ruin that Organ; and it may be observed, that as many as accustom themselves to Drams, go off, just like excessive Drinkers, in Consequence of their having no Digestion; whence they sink into a State of Depression and Languor, and die dropsical.§ 555. Either Vomits or Purges may be often beneficially omitted, even when they have some Appearance of seeming necessary, by abating one Meal a Day for some time; by abstaining from the most nourishing Sorts of Food; and especially from those which are fat; by drinking freely of cool Water, and taking extraordinary Exercise. The same Regimen also serves to subdue, without the Use of Purges, the various Complaints which often invade those, who omit taking purging Medicines, at those Seasons and Intervals, in which they have made it a Custom to take them.§ 556. The Medicines,Nº. 34and35, are the most certain Vomits. The Powder,Nº. 21, is a good Purge, when the Patient is in no wise feverish.The Doses recommended in the Table of Remedies are those, which are proper for a grown Man, of a vigorous Constitution. Nevertheless there are some few, for whom they may be too weak: in such Circumstances they may be increased by the Addition of a third or fourth Part of the Dose prescribed. But should they not operate in that Quantity, we must be careful not to double the Dose, much less to give a three-fold Quantity, which has sometimes been done, and that even without its Operation, and at the Risque of killing the Patient, which has not seldom been the Consequence. In Case of such purging not ensuing, we should rather give large Draughts of Whey sweetened with Honey, or of warm Water, in a Pot of which an Ounce, or an Ounce and a half of common Salt must be dissolved; and this Quantity is to be taken from time to time in small Cups, moving about with it.The Fibres of Country People who inhabit the Mountains, and live almost solely on Milk, are so little susceptible of Sensation, that they must take such large Doses to purge them, as would kill all the Peasantry in the Vallies. In the Mountains ofValaisthere are Men who take twenty, and even twenty-four Grains of Glass ofAntimony for a single Dose; a Grain or two of which were sufficient to poison ordinary Men.§ 557. Notwithstanding our Cautions on this important Head, whenever an urgent Necessity commands it, Purging must be recurred to at all Times and Seasons: but when the Season may be safely selected, it were right to decline Purging in the Extremities of either Heat or Cold; and to take the Purge early in the Morning, that the Medicines may find less Obstruction or Embarrassment from the Contents of the Stomach. Every other Consideration, with Relation to the Stars and the Moon, is ridiculous, and void of any Foundation. The People are particularly averse to purging in the Dog-days; and if this were only on Account of the great Heat, it would be very pardonable: but it is from an astrological Prejudice, which is so much the more absurd, as the real Dog-days are at thirty-six Days Distance from those commonly reckoned such; and it is a melancholy Reflection, that the Ignorance of the People should be so gross, in this Respect, in our enlightened Age; and that they should still imagine the Virtue and Efficacy of Medicines to depend on what Sign of the Zodiac the Sun is in, or in any particular Quarter of the Moon. Yet it is certain in this Point, they are so inveterately attached to this Prejudice, that it is but too common to see Country-People die, in waiting for the Sign or Quarter most favourable to the Operation and Effect of a Medicine, which was truly necessary five or six Days before either of them.Sometimes too that particular Medicine is given, to which a certain Day is supposed to be auspicious and favourable, in Preference to that which is most prevalent against the Disease. And thus it is, than an ignorant Almanack Maker determines on the Lives of the human Race; and contracts the Duration of them with Impunity.§ 558. When a Vomit or a Purge is to be taken, the Patient's Body should be prepared for the Reception of it twenty-four Hours beforehand; by taking very little Food, and drinking some Glasses of warm Water, or of a light Tea of some Herbs.He should not drink after a Vomit, until it begins to work; but then he should drink very plentifully of warm Water, or a light Infusion of Chamomile Flowers, which is preferable.It is usual, after Purges, to take some thin Broth or Soup during their Operation; but warm Water sweetened with Sugar or Honey, or an Infusion of Succory Flowers, would sometimes be more suitable.§ 559. As the Stomach suffers, in some Degree, as often as either a Vomit, or a Purge, is taken, the Patient should be careful how he lives and orders himself for some Days after taking them, as well in Regard to the Quantity as Quality of his Food.§ 560. I shall say nothing of other Articles taken by Way of Precaution, such as Soups, Whey, Waters,&c.which are but little used among the People; but confine myself to thisgeneral Remark, that when they take any of these precautionary Things, they should enter on a Regimen or Way of living, that may co-operate with them, and contribute to the same Purpose. Whey is commonly taken to refresh and cool the Body; and while they drink it, they deny themselves Pulse, Fruits, and Sallads. They eat nothing then, but the best and heartiest Flesh-meats they can come at; such Vegetables as are used in good Soups, Eggs, and good Wine; notwithstanding this is to destroy, by high and heating Aliments, all the attemperating cooling Effects expected from the Whey.Some Persons propose to cool and attemperate their Blood by Soups and a thin Diet, into which they cram Craw-fish, that heat considerably, orNasturtium, Cresses which also heat, and thus defeat their own Purpose. Happily, in such a Case, the Error in one Respect often cures that in the other; and these Kinds of Soup, which are in no wise cooling, prove very serviceable, in Consequence of the Cause of the Symptoms, which they were intended to remove, not requiring any Coolers at all.The general physical Practice of the Community, which unhappily is but too much in Fashion, abounds with similar Errors. I will just cite one, because I have seen its dismal Effects. Many People suppose Pepper cooling, though their Smell, Taste, and common Sense concur to inform them of the contrary. It is the very hottest of Spices.§ 561. The most certain Preservative, and the most attainable too by every Man, is to avoid all Excess, and especially Excess in eating and in drinking. People generally eat more than thoroughly consists with Health, or permits them to attain the utmost Vigour, of which their natural Constitutions are capable. The Custom is established, and it is difficult to eradicate it: notwithstanding we should at least resolve not to eat, but through Hunger, and always under a Subjection to Reason; because, except in a very few Cases, Reason constantly suggests to us not to eat, when the Stomach has an Aversion to Food. A sober moderate Person is capable of Labour, I may say, even of excessive Labour of some Kinds; of which greater Eaters are absolutely incapable. Sobriety of itself cures such Maladies as are otherwise incurable, and may recover the most shattered and unhealthy Persons.
§ 547. The Stomach and Bowels are emptied either by Vomiting, or by Stools, the latter Discharge being much more natural than the first, which is not effected without a violent Motion, and one indeed to which Nature is repugnant. Nevertheless, there are some Cases, which really require this artificial Vomiting; but these excepted (some of which I have already pointed out) we should rather prefer those Remedies, which empty the Belly by Stool.
§ 548. The Signs, which indicate a Necessity for Purging, are, 1, a disagreeable Tast or Savour of the Mouth in a Morning, and especially a bitter Tast; a foul, furred Tongue and Teeth, disagreable Eructations or Belchings, Windiness and Distension.
2, A Want of Appetite which increases very gradually, without any Fever, which degenerates into a Disgust or total Aversion to Food; and sometimes communicates a bad Tast to the very little such Persons do eat.
3, Reachings to vomit in a Morning fasting, and sometimes throughout the Day; supposing such not to depend on a Woman's Pregnancy, or some other Disorder, in which Purges would be either useless or hurtful.
4, A vomiting up of bitter, or corrupted, Humours.
5, A manifest Sensation of a Weight, or Heaviness in the Stomach, the Loins, or the Knees.
6, A Want of Strength sometimes attended with Restlessness, ill Humour, or Peevishness, and Melancholy.
7, Pains of the Stomach, frequent Pains of the Head, or Vertigos; sometimes a Drowsiness, which increases after Meals.
8, Some Species of Cholics; irregular Stools which are sometimes very great in Quantity, and too liquid for many Days together; after which an obstinate Costiveness ensues.
9, A Pulse less regular, and less strong, than what is natural to the Patient, and which sometimes intermits.
§ 549. When these Symptoms, or some of them, ascertain the Necessity of purging a Person, not then attacked by any manifest Disease (for I am not speaking here of Purges in such Cases) a proper purging Medicine may be given him. The bad Tast in his Mouth; the continual Belchings; the frequent Reachings to vomit; the actual Vomitings and Melancholy discover, that the Cause of his Disorder resides in the Stomach, and shew that a Vomit will be of Service to him. But when such Signs or Symptoms are not evident, the Patient should take such purging or opening Remedies, as are particularly indicated by the Pains, whether of the Loins; from the Cholic; or by a Sensation of Weight or Heaviness in the Knees.
§ 550. But we should abstain from either vomiting or purging, 1, Whenever the Complaints of thePatientsare founded in their Weakness, and their being already exhausted, 2, When there is a general Dryness of the Habit, a very considerable Degree of Heat, some Inflammation, or a strong Fever. 3, Whenever Nature is exerting herself in some other salutary Evacuation; whence purging must never be attempted in critical Sweats, during the monthly Discharges, nor during a Fit of the Gout. 4, Nor in such inveterate Obstructions as Purges cannot remove, and really do augment. 5, Neitherwhen the nervous System is considerably weakened.
§ 551. There are other Cases again, in which it may be proper to purge, but not to give a Vomit. These Cases are, 1, When the Patient abounds too much with Blood, (See§ 540) since the Efforts which attend vomiting, greatly augment the Force of the Circulation; whence the Blood-vessels of the Head and of the Breast, being extremely distended with Blood, might burst, which must prove fatal on the Spot, and has repeatedly proved so. 2, For the same Reason they should not be given to Persons, who are subject to frequent Bleeding from the Nose, or to coughing up or vomiting of Blood; to Women who are subject to excessive or unseasonable Discharges of Blood,&c.from theVagina, the Neck of the Womb; nor to those who are with Child. 3, Vomits are improper for ruptured Persons.
§ 552. When any Person has taken too acrid, too sharp, a Vomit, or a Purge, which operates with excessive Violence; whether this consists in the most vehement Efforts and Agitations, the Pains, Convulsions, or Swoonings, which are their frequent Consequences; or whether that prodigious Evacuation and Emptiness their Operation causes, (which is commonly termed aSuper-purgation) and which may hurry the Patient off; Instances of which are but too common among the lower Class of the People, who much too frequently confide themselves to the Conductof ignorant Men-slayers: In all such unhappy Accidents, I say, we should treat these unfortunate Persons, as if they had been actually poisoned, by violent corroding Poisons, (See§ 533) that is, we should fill them, as it were, with Draughts of warm Water, Milk, Oil, Barley-water, Almond Milk, emollient Glysters with Milk, and the Yolks of Eggs; and also bleed them plentifully, if their Pains are excessive, and their Pulses strong and feverish.
The Super-purgation, the excessive Discharge, is to be stopt, after having plied the Patient plentifully with diluting Drinks, by giving the calming Anodyne Medicines directed in the Removal of acute Pains,§ 536, Nº. 6.
Flanels dipt in hot Water, in which someVeniceTreacle is dissolved, are very serviceable: and should the Evacuations by Stool be excessive, and the Patient has not a high Fever, and a parching Kind of Heat, a Morsel of the same Treacle, as large as a Nutmeg, may be dissolved in his Glyster.
But should the Vomiting solely be excessive, without any Purging, the Number of the emollient Glysters with Oil and the Yolk of an Egg must be increased; and the Patient should be placed in a warm Bath.
§ 553. Purges frequently repeated, without just and necessary Indications, are attended with much the same ill Effects as frequent Bleedings. They destroy the Digestions; the Stomach no longer, or very languidly, exerts its Functions;the Intestines prove inactive; the Patient becomes liable to very severe Cholics; the Plight of the Body, deprived of its salutary Nutrition, falls off; Perspiration is disordered; Defluxions ensue; nervous Maladies come on, with a general Languor; and the Patient proves old, long before the Number of his Years have made him so.
Much irreparable Mischief has been done to the Health of Children, by Purges injudiciously given and repeated. They prevent them from attaining their utmost natural Strength, and frequently contract their due Growth. They ruin their Teeth; dispose young Girls to future Obstructions; and when they have been already affected by them, they render them still more obstinate.
It is a Prejudice too generally received, that Persons who have little or no Appetite need purging; since this is often very false, and most of those Causes, which lessen or destroy the Appetite, cannot be removed by purging; though many of them may be increased by it.
Persons whose Stomachs contain much glairy viscid Matter suppose, they may be cured by Purges, which seem indeed at first to relieve them: but this proves a very slight and deceitful Relief. These Humours are owing to that Weakness and Laxity of the Stomach, which Purges augment; since notwithstanding they carry off Part of these viscid Humours generated in it, at the Expiration of a few Days there is a greater Accumulation of them than before; andthus, by a Re-iteration of purging Medicines, the Malady soon becomes incurable, and Health irrecoverably lost. The real Cure of such Cases is effected by directly opposite Medicines. Those referred to, or mentioned,§ 272, are highly conducive to it.
§ 554. The Custom of taking stomachic Medicines infused in Brandy, Spirit of Wine, Cherry Water,&c.is always dangerous; for notwithstanding the present immediate Relief such Infusions afford in some Disorders of the Stomach, they really by slow Degrees impair and ruin that Organ; and it may be observed, that as many as accustom themselves to Drams, go off, just like excessive Drinkers, in Consequence of their having no Digestion; whence they sink into a State of Depression and Languor, and die dropsical.
§ 555. Either Vomits or Purges may be often beneficially omitted, even when they have some Appearance of seeming necessary, by abating one Meal a Day for some time; by abstaining from the most nourishing Sorts of Food; and especially from those which are fat; by drinking freely of cool Water, and taking extraordinary Exercise. The same Regimen also serves to subdue, without the Use of Purges, the various Complaints which often invade those, who omit taking purging Medicines, at those Seasons and Intervals, in which they have made it a Custom to take them.
§ 556. The Medicines,Nº. 34and35, are the most certain Vomits. The Powder,Nº. 21, is a good Purge, when the Patient is in no wise feverish.
The Doses recommended in the Table of Remedies are those, which are proper for a grown Man, of a vigorous Constitution. Nevertheless there are some few, for whom they may be too weak: in such Circumstances they may be increased by the Addition of a third or fourth Part of the Dose prescribed. But should they not operate in that Quantity, we must be careful not to double the Dose, much less to give a three-fold Quantity, which has sometimes been done, and that even without its Operation, and at the Risque of killing the Patient, which has not seldom been the Consequence. In Case of such purging not ensuing, we should rather give large Draughts of Whey sweetened with Honey, or of warm Water, in a Pot of which an Ounce, or an Ounce and a half of common Salt must be dissolved; and this Quantity is to be taken from time to time in small Cups, moving about with it.
The Fibres of Country People who inhabit the Mountains, and live almost solely on Milk, are so little susceptible of Sensation, that they must take such large Doses to purge them, as would kill all the Peasantry in the Vallies. In the Mountains ofValaisthere are Men who take twenty, and even twenty-four Grains of Glass ofAntimony for a single Dose; a Grain or two of which were sufficient to poison ordinary Men.
§ 557. Notwithstanding our Cautions on this important Head, whenever an urgent Necessity commands it, Purging must be recurred to at all Times and Seasons: but when the Season may be safely selected, it were right to decline Purging in the Extremities of either Heat or Cold; and to take the Purge early in the Morning, that the Medicines may find less Obstruction or Embarrassment from the Contents of the Stomach. Every other Consideration, with Relation to the Stars and the Moon, is ridiculous, and void of any Foundation. The People are particularly averse to purging in the Dog-days; and if this were only on Account of the great Heat, it would be very pardonable: but it is from an astrological Prejudice, which is so much the more absurd, as the real Dog-days are at thirty-six Days Distance from those commonly reckoned such; and it is a melancholy Reflection, that the Ignorance of the People should be so gross, in this Respect, in our enlightened Age; and that they should still imagine the Virtue and Efficacy of Medicines to depend on what Sign of the Zodiac the Sun is in, or in any particular Quarter of the Moon. Yet it is certain in this Point, they are so inveterately attached to this Prejudice, that it is but too common to see Country-People die, in waiting for the Sign or Quarter most favourable to the Operation and Effect of a Medicine, which was truly necessary five or six Days before either of them.Sometimes too that particular Medicine is given, to which a certain Day is supposed to be auspicious and favourable, in Preference to that which is most prevalent against the Disease. And thus it is, than an ignorant Almanack Maker determines on the Lives of the human Race; and contracts the Duration of them with Impunity.
§ 558. When a Vomit or a Purge is to be taken, the Patient's Body should be prepared for the Reception of it twenty-four Hours beforehand; by taking very little Food, and drinking some Glasses of warm Water, or of a light Tea of some Herbs.
He should not drink after a Vomit, until it begins to work; but then he should drink very plentifully of warm Water, or a light Infusion of Chamomile Flowers, which is preferable.
It is usual, after Purges, to take some thin Broth or Soup during their Operation; but warm Water sweetened with Sugar or Honey, or an Infusion of Succory Flowers, would sometimes be more suitable.
§ 559. As the Stomach suffers, in some Degree, as often as either a Vomit, or a Purge, is taken, the Patient should be careful how he lives and orders himself for some Days after taking them, as well in Regard to the Quantity as Quality of his Food.
§ 560. I shall say nothing of other Articles taken by Way of Precaution, such as Soups, Whey, Waters,&c.which are but little used among the People; but confine myself to thisgeneral Remark, that when they take any of these precautionary Things, they should enter on a Regimen or Way of living, that may co-operate with them, and contribute to the same Purpose. Whey is commonly taken to refresh and cool the Body; and while they drink it, they deny themselves Pulse, Fruits, and Sallads. They eat nothing then, but the best and heartiest Flesh-meats they can come at; such Vegetables as are used in good Soups, Eggs, and good Wine; notwithstanding this is to destroy, by high and heating Aliments, all the attemperating cooling Effects expected from the Whey.
Some Persons propose to cool and attemperate their Blood by Soups and a thin Diet, into which they cram Craw-fish, that heat considerably, orNasturtium, Cresses which also heat, and thus defeat their own Purpose. Happily, in such a Case, the Error in one Respect often cures that in the other; and these Kinds of Soup, which are in no wise cooling, prove very serviceable, in Consequence of the Cause of the Symptoms, which they were intended to remove, not requiring any Coolers at all.
The general physical Practice of the Community, which unhappily is but too much in Fashion, abounds with similar Errors. I will just cite one, because I have seen its dismal Effects. Many People suppose Pepper cooling, though their Smell, Taste, and common Sense concur to inform them of the contrary. It is the very hottest of Spices.
§ 561. The most certain Preservative, and the most attainable too by every Man, is to avoid all Excess, and especially Excess in eating and in drinking. People generally eat more than thoroughly consists with Health, or permits them to attain the utmost Vigour, of which their natural Constitutions are capable. The Custom is established, and it is difficult to eradicate it: notwithstanding we should at least resolve not to eat, but through Hunger, and always under a Subjection to Reason; because, except in a very few Cases, Reason constantly suggests to us not to eat, when the Stomach has an Aversion to Food. A sober moderate Person is capable of Labour, I may say, even of excessive Labour of some Kinds; of which greater Eaters are absolutely incapable. Sobriety of itself cures such Maladies as are otherwise incurable, and may recover the most shattered and unhealthy Persons.