AND OTHER VISCERA.
ALL inflammations of the bowels are dangerous, and require the most speedy assistance; as they frequently end in a suppuration, and sometimes in a mortification, which is certain death.
CAUSES. - An inflammation of the stomach may proceed from any of the causes which produce an inflammatory fever; as cold liquor drank while the body is warm, obstructed perspiration, or the sudden striking in of any eruption. It may likewise proceed from the acrimony of the bile, or from acrid and stimulating substances taken into the stomach; as strong vomits or purges, corrosive poisons, and such like.
WHEN the gout has been repelled from the extremities, either by cold or improper applications, it often occasions an inflammation of the stomach. Hard or indigestible substances taken into the stomach, as bones, the stones of fruit, &c. may likewise have that effect.
SYMPTOMS - It is attended with a fixed and burning heat in the stomach; great restlessness and anxiety; a small, quick, and hard pulse; vomiting, or at at least, a nausea and sickness; excessive thirst; coldness of the extremities, difficulty of breathing; cold clammy sweats; and sometimes convulsions and fainting fits. The stomach is swelled and often feels hard to the touch. One of the most certain signs of this disease is the sense of pain, which the patient feels upon taking any kind of food or drink, especially if it be either too hot or too cold.
WHEN the patient vomits every thing he eats or drinks, is extremely restless, has a hiccup, with an intermitting pulse, and frequent fainting fits, the danger is very great.
REGIMEN. - All acrimonious, heating, and irritating food and drink are carefully to be avoided. The weakness of the patient may deceive the by-standers, and induce them to give him wines, spirits, or other cordials; but these never fail to increase the disease, and often occasion sudden death. The inclination to vomit may likewise impose on the attendants, and make them think a vomit necessary, but that too is almost certain death.
THE food must be given in small quantities, and should neither be quite cold, nor too hot. Thin gruel made of barley or oatmeal, light toasted bread dissolved in boiling water, or very weak chicken broth, are the most proper. The drink should be clear whey, barley-water, water in which toasted bread has been boiled, or decoctions of emollient vegetables; as liquorice and marsh-mallow roots, sarsaparilla, &c.
MEDICINE. - Bleeding in this disease is absolutely necessary, and is almost the only thing that can be depended on. When the disease proves obstinate, it will often be proper to repeat this operation several times, nor must the low state of the pulse deter us from doing so. The pulse indeed generally rises upon bleeding, and as long as that is the case, the operation is safe.
FREQUENT fomentations with lukewarm water, or a decoction of emollient vegetables, are likewise beneficial. Flannel cloths dipped in these must be applied to the region of the stomach, and removed as they grow cool. They must neither be applied too warm, nor be suffered to continue till they become quite cold, as either of these extremities would aggravate the disease.
THE feet and legs ought likewise to be frequently bathed in lukewarm water, and warm bricks or poultices may be applied to the soles of the feet. The warm bath, if it can be conveniently used, will be of great service.
IN this, and all other inflammations of the bowels, an epispastic, or blistering-plaster, applied over the part affected, is one of the best remedies I know. I have often used it, and do not recollect one instance wherein it did not give relief to the patient.
THE only internal medicines which we shall venture to recommend in this disease, are mild clysters. These may be made of warm water, or thin water-gruel; and if the patient is costive, a little sweet oil, honey, or manna, may be added. Clysters answer the purpose of an internal fomentation, while they keep the body open, and at the same time nourish the patient, who is often, in this disease, unable to retain any food upon his stomach. For these reasons they must not be neglected, as the patient's life may depend on them.
THIS is one of the most painful and dangerous diseases that mankind is liable to. It generally proceeds from the same causes as the inflammation of the stomach; to which may be added costiveness, worms, eating unripe fruits, or great quantities of nuts, drinking hard windy malt liquors, as stale bottled beer or ale, sour wine, cyder, &c. it may likewise be occasioned by a rupture, by scirrhous tumours of the intestines, or by their opposite sides growing together.
THE inflammation of the intestines is denominated Iliac passion, Enteritis, &c. according to the name of the parts affected. The treatment however is nearly the same whatever part of the intestinal canal be the seat of the disease; we shall therefore omit these distinctions, lest they should perplex the reader.
THE symptoms here are nearly the same as in the foregoing disease; only the pain, if posslble, is more acute, and is situated lower. The vomiting is likewise more violent, and sometimes even the excrements, together with the clysters and suppositories, are discharged by the mouth. The patient is continually belching up wind, and has often an obstruction of his urine.
WHILE the pain shifts and the vomiting only returns at certain intervals, and while the clysters pass downwards, there is ground to hope; but when the clysters and faeces are vomited, and the patient is exceeding weak, with a low fluttering pulse, a pale countenance, and a disagreeable or stinking breath, there is great reason to fear that the consequences will prove fatal. Clammy sweats, black foetid stools, with a small intermitting pulse, and a total cessation of pain, are signs of a mortification already begun, and of approaching death.
REGIMEN. - The regimen in this disease is in general the same as in an inflammation of the stomach.The patient must be kept quiet, avoiding cold, and all violent passions of the mind. His food ought to be very light, and given in small quantities; his drink weak and diluting; as clear whey, barley-water, and such like.
MEDICINE. - Bleeding in this, as well as in the inflammation of the stomach, is of the greatest importance. It should be performed as soon as the symptoms appear, and repeated according to the strength of the patient, and the violence of the disease.
A BLISTERING plaster is here likewise to be applied immediateIy over the part where the most violent pain is. This not only relieves pain of the bowels, but even clysters and purgative medicines, which before had no effect, will operate when the blister begins to rise.
FOMENTATIONS and laxative clysters are by no means to be omitted. The patient's feet and legs should frequently be bathed in warm water; and cloths dipped in it applied to his belly. Bladders filled with warm water may likewise be applied to the region of the navel, and warm bricks, or bottles filled with warm water, to the soles of the feet. The clysters may be made of barley-water or thin gruel with salt, and softened with sweet oil or fresh butter. These may be administered every two or three hours, or oftener, if the patient continues costive.
IF the disease does not yield to clysters and fomentations, recourse must be had to pretty strong purgatives; but as these, by irritating the bowels, often increase their contraction, and by that means frustrate their own intention, it will be necessary to join them with opiates, which, by allaying the pain, and relaxing the spasmodic contractions of the guts, greatly assist the operation of purgatives in this case.
WHAT answers the purpose of opening the body very well, is a solution of the bitter purging salts. Two ounces of these may be dissolved in an English pint of warm water, or thin gruel, and a tea-cupful of it taken every half-hour till it operates. At the same time fifteen, twenty, or twenty-five drops of luadanum may be given in a glass of pepper-mint or simple cinnamon-water, to appease the irritation, and prevent the vomiting, &c.
ACIDS have often a very happy effect in staying the vomiting, and appeasing the other violent symptoms of this disease. It will therefore be of use to sharpen the patient's drink with cream of tartar, juice of lemon; or, when these cannot obtained, with vinegar.
BUT it often happens no liquid whatever will stay on the stomach. In this case the patient must take purging pills. I have generally found the following answer very well: Take jalap in powder, and vitriolated tartar, of each haIf a drachm, opium one grain, Castile soap as much as will make the the mass fit for pills. These must be taken at one dose, and if they do not operate in a few hours, the dose may be repeated.
IF a stool cannot be procured by any of the above means, It will be necessary to immerse the patient in warm water up to the breast. I have often seen this succeed when other means had been tried in vain. The patient must continue in the water as long as he can easily bear it without fainting, and if one immersion has not the desired effect, it may be repeated as soon as the patient's strength and spirits are recruited. It is more safe for him to go frequently into the bath than to continue too long at a time; and it is often necessary to repeat it several times before it has the desired effect.
IT has sometimes happened, after all other means of procuring a stool had been tried to no purpose, that this was brought about by immersing the patient's lower extremities in cold water, or making him walk upon a wet pavement, and dashing his legs and thighs with the cold water. This method, when others fail, at least merits a trial. It is indeed attended with some danger; but a doubtful remedy is better than none.
IN desperate cases it is common to give quicksilver. This may be given to the quantity of several ounces, or even a pound, but should not exceed that. When quicksilver is given in too large quantities, it defeats its own intention, as it pulls down the bottom of the stomach, which prevents it getting ever in the Pylorus. In this case the patient should be hung up by the heels, in order that the quicksilver may be discharged by his mouth. When there is reason to suspect a mortification of the guts, this medicine ought not to be tried. In that case it cannot cure the patient, and will only hasten his death. But when the obstruction is occasioned by any cause that can be removed by force, quicksilver is not only a proper medicine, but the best that can be adininistered, as it is the fittest body we know for making its way through the intestinal canal.
IF the disease proceed from a rupture, the patient must be laid with his head very low, and the intestines returned by gentle pressure with the hand. If this, with fomentations and clysters, should not succeed, recourse must be had to a surgical operation, which may give the patient relief.
SUCH as would avoid this excruciating and dangerous disease must take care never to be too long without a stool. Some who have died of it have had several pounds of hard, dry faeces taken out of their guts.
They should likewise beware of eating too freely of sour or unripe fruits, or drinking stale windy liquors, &c. I have known it brought on by living too much on baked fruits, which are seldom good. It likewise proceeds frequently from cold caught by wet clothes, &c. but especially from wet feet.
THE colic has a great resemblance to the two preceeding diseases, both in its symptoms and method of cure. It is generally attended with costiveness and accute pain of the bowels; and requires diluting diet, evacuations, fomentations, &c.
COLICS are variously denominated according to their causes, as the flatulent, the bilious, the hysteric, the nervous, &c. As each of these requires a particular method of treatment, we shall point out their most general symptoms, and the means to be used for their relief.
THE flatulent, or wind-colic, is generally occasioned by an indiscreet use of unripe fruits, meats of hard digestion, windy vegetables, fermenting liquors, and such like. It may likewise proceed from an obstructed perspiration, or catching cold. Delicate people, whose digestive powers are weak, are most liable to this kind of colic.
THE flatulent colic may either affect the stomach or intestines. It is attended with a painful stretching of the affected part. The patient feels a rumbling in his guts, and is generally relieved by a discharge of wind, either upwards or downwards. The pain is seldom confined to any particular part, as the vapour wanders from one division of the bowels to another till it finds a vent.
WHEN the disease proceeds from windy liquor, green fruit, sour herbs, or the like, the best medicine on the first appearance of the symptoms is a dram of brandy, gin or any good spirits. The patient should likewise sit with his feet upon a warm hearth-stone, or apply warm bricks to them; and warm cloths may be applied to his stomach and bowels.
THIS is the only colic wherein ardent spirits, spiceries, or any thing of a hot nature, may be ventured upon. Nor indeed are they to be used here unless at the very beginning, before any symptoms of inflammation appear. We have reason to believe, that a colic occasioned by wind or flatulent food might always be cured by spirits and warm liquors, if they were taken immediately upon perceiving the first uneasiness; but when the pain has continued for a considerable time, and there is reason to fear an inflammation of the bowels is already begun, all hot things are to be avoided as poison, and the patient is to be treated in the same manner as for the inflammation of the intestines.
SEVERAL kinds of food, as honey, eggs, &c. occasion colics in some particular constitutions. I have generally found, the best method of cure for these was to drink plentifully of small diluting liquors, as water-gruel, small posset, water with toasted bread soaked in it, &c.
COLICS which proceed from excess and indigestion generally cure themselves, by occasioning vomiting or purging. These discharges are by no means to be stopped, but promoted by drinking plentifully of warm water, or weak posset. When their violence is over, the patient may take a dose of rhubarb, or any other gentle purge, to carry off the dregs of his debauch.
COLICS which are occasioned by wet feet, or catching cold, may generally be removed at the beginning, by bathing the feet and legs in warm water, and drinking such warm diluting liquors as will promote the perspiration, as weak wine-whey, or water-gruel with a small quantity of spirits in it.
THESE flatulent colics, which prevail so much among country people, might generally be prevented, were they careful to change their cloths when they get wet. They ought likewise to take a dram, or to drink some warm liquor after eating any kind of green trash. We do not mean to recommend the practice of dram-drinking, but in this case ardent spirits prove a real medicine, and indeed the best that can be administered. A glass of good pepper-mint water will have nearly the same effect as a glass of brandy, and in some cases is rather to be preferred.
The bilious colic is attended with very acute pains about the region of the navel. The patient complains of great thirst, and is generally costive. He vomits a hot, bitter, yellow-coulered bile, which being discharged, seems to afford some relief, but is quickly followed by the same violent pain as before. As the distemper advances, the propensity to vomit sometimes increases so as to become almost continual, and the proper motion of the intestines is so far perverted, that there are all the symptoms of an impending iliac passion.
IF the patient be young and strong, and the pulse full and frequent, it will be proper to bleed, after which clysters may be administered. Clear whey or gruel, sharpened with the juice of lemon, or cream of tartar, must be drank freely. Small chicken-broth, with a little manna dissolved in it, or a slight decoction of tamarinds, are likewise very proper, or any other thin, acid, opening liquor.
BESIDES bleeding and plentiful dilution, it will be necessary to foment the belly with cloths dipped in warm water, and if this should not succeed, the patient must be immersed up to the breast in warm water.
IN the bilious colic the vomiting is often very difficult to restrain. When this happens, the patient may drink a decoction of toasted bread, or an infusion of garden-mint in boiling water. Should these not have the desired effect, the saline draught, with a few drops of laudanum in it, may be given, and repeated according to the urgency of the symptoms.
A small quantity of Venice treacle may be spread in form of a cataplasm, and applied to the pit of the stomach. Clysters, with a proper quantity of Venice treacle or liquid laudanum in them, may likewise be frequently administered.
SUCH as are liable to frequent returns of the bilious colic should use flesh sparingly, and live chiefly upon a light vegetable diet. They should likewise take frequently a dose of cream of tartar with tamarinds, or any other cool acid purge.
THE hysteric colic bears a great resemblance to the bilious. It is attended with acute pains about the region of the stomach, vomiting, &c. But what the patient vomits in this case is commonly of a greenish colour. There is a great sinking of the spirits, with dejection of mind and difficulty of breathing, which are the characteristic symptoms of this disorder. Sometimes it is accompanied with the jaundice, but this generally goes off of its own accord in a few days.
IN this colic all evacuations, as bleeding, purging, vomiting, &c. do hurt. Everything that weakens the patient, or sinks the spirits, is to be avoided. If however the vomiting should prove violent, luke-warm water, or small posset, may be drank to cleanse the stomach. Afterwards the patient may take fifteen, twenty, or twenty-five drops of liquid laudanum in a glass of cinnamon-water. This may be repeated every ten or twelve hours till the symptoms abate.
THE patient may likewise take four or five of the foetid pills every six hours, and drink a cup of penny-royal tea after them. If asafoetida should prove disagreeable, which is sometimes the case, a tea-spoonful of the tincture of castor in a cup of pennyroyal tea, or thirty or forty drops of the balsam of Peru dropped upon a bit of loaf-sugar, may be taken in its stead. The anti-hysteric plaster may also be used, which has often a good effect. See Appendix, Anti-hysteric plaster.
THE nervous colic prevails among miners, smelters of lead, plumbers, the manufacturers of white lead, &c. It is very common in the cyder counties of England, and is supposed to be occasioned by the leaden vessels used in preparing that liquor. it is likewise a frequent disease in the West Indies, where it is termed the dry belly-ache.
NO disease of the bowels is attended with more excruciating pain than this. Nor is it soon at an end. I have known it continue eight or ten days with very little intermission, the body all the while continuing bound in spite of medicine, yet at length yield, and the patient recover. It generally however leaves the patient weak, and often ends in a palsy.
AS the smoke of tobacco thrown into the bowels will often procure a stool when all other means have failed, an apparatus for this purpose ought to be kept by every surgeon. It may be purchased at a small expence, and will be of service in several other cases, as the recovery of drowned persons, &c.
THE general treatment of this disease is so nearly the same with that of the iliac passion, or inflammation of the guts, that we shall not insist upon it. The body is to be opened by mild purgatives given in small doses, and frequently repeated, and their operation must be assisted by soft oily clysters, fomentations, &c. The castor oil is reckoned peculiarly proper in this disease. It may both be mixed with the clysters and given by the mouth.
THE Barbadoes tar is said to be an efficacious medicine in this complaint. It may be taken to the quantity of two drachms three times a-day, or oftener if the stomach will bear it. This tar, mixed with an equal quantity of strong rum, is likewise proper for rubbing the spine, in case any tingling, or other symptoms of a palsy are felt. When the tar cannot be obtained, the back may be rubbed with strong spirits, or a little oil of nutmegs or of rosemary.
IF the patient remains weak and languid after this disease, he must take exercise on horseback, and use an infusion of the Peruvian bark in wine. When the disease ends in a palsy, the Bath-waters are found to be extremely proper.
TO avoid this kind of colic, people must shun all sour fruits, acids, and austere liquors, &c. Those who work in lead ought never to go to their buriness fasting, and their food should be oily or fat. They may take a glass of sallad oil, with a little brandy or rum, every morning, but should never take spirits alone. Liquid aliment is best for them; as fat broths, &c. but low living is bad. They should frequently go a little out of the tainted air; and should never suffer themselves to be costive. In the West-Indies, and on the coast of Guinea, it has been found of great use, for preventing this colic, to wear a piece of flannel round the waist, and to drink an infusion of ginger by way of tea.
SUNDRY other kinds of this disease might be mentioned, but too many distinctions would tend only to perplex the reader. These already mentioned are the most material, and should indeed be attended to, as their treatment is very different. But even persons who are not in a condition to distinguish very accurately in these matters, may nevertheless be of great service to patients in colics of every kind, by only observing the following general rules, viz. To bathe the feet and legs in warm water; to apply bladders filled with warm water, or cloths dipped in it, to the stomach and bowels; to make the patient drink freely of diluting mucilaginous liquors and to give him an emollient clyster every two or three hours. Should these not succeed, the patient ought to be immersed in warm water.
CAUSES. - This disease may proceed from any of those causes which produce an inflammatory fever. It may likewise be occasioned by wounds or bruises of the the kidneys; small stones or gravel lodging within them; by strong diuretic medicines; as spirits of turpentine, tincture of cantharides &c. Violent motion, as hard riding or walking, especially in hot weather, or whatever drives the blood too forcibly into the kidneys, may occasion this malady. It may likewise proceed from lying too soft, too much on the back, involuntary contractions, or spasms, in the urinary vessels, &c.
SYMPTOMS. - There is a sharp pain about the region of the kidneys, with some degree of fever, and a stupor or dull pain in the thigh of the affected side. The urine is at first clear, and afterwards of a reddish colour; but in the worst kind of the disease it generally continues pale, is passed with difficulty, and commonly in small quantities at a time. The patient feels great uneasiness when he endeavours to walk or sit upright. He lies with most ease on the affected side and has generally a nausea or vomiting resembling that which happens in the colic.
THIS disease however may be distinguished from the colic by the pain being seated farther back, and by the difficulty of passing urine with which it is constantly attended.
REGIMEN. - Every thing of a heating or stimulating nature is to be avoided. The food must be thin and light; as panado, small broths with mild vegetables, and the like. Emollient and thin liquors must be plentifully drank; as clear whey, or balm-tea sweetened with honey, decoctions of marsh-mallow roots, with barley and liquorice, &c. The patient, notwithstanding the vomiting, must constantIy keep sipping small quantities of these or other diluting liquors. Nothing so safely and certainly abates the inflammation, and expels the obstructing cause, as copious dilution. The patient must be kept easy, quiet, and free from cold, as long as any symptoms of inflammation remain.
MEDICINE. - Bleeding is generally necessary, especially at the beginning. Ten or twelve ounces may be let from the arm or foot with a lancet, and if the pain and inflammation continue, the operation may be repeated in twenty-four hours, especially if the patient be of a full habit. Leeches may likewise be applied to the haemorrhoidal veins, as a discharge from these will greatly relieve the patient.
CLOTHS dipped in warm water, or bladders filled with it, must be applied as near as possible to the part affected, and renewed as they grow cool. If the bladders be filled with a decoction of mallows and camomile flowers, to which a little saffron is added, mixed with about a third part of new milk, it will be still more beneficial.
EMOLLIENT clysters ought frequently to be administered; and if these do not open the body, a little salt and honey or manna may be added to them.
THE same course is to be followed where gravel or a stone is lodged in the kidney, but when the gravel or stone is separated from the kidney, and lodges in the Ureter - The Ureters are two long and small canaIs, one on each side, which carry the urine from the bason of the kidneys to the bladder. They are sometimes obstructed by small stones or gravel falling down from the kidneys, and lodging in them - it will be proper, besides the fomentations, to rub the small of the back with sweet oil, and to give gentle diuretics: as juniper-water sweetened with the syrup of marsh-mallows; a tea-spoonful of the sweet spirits of nitre, with a few drops of laudanum, may now and then be put in a cup of the patient's drink. He ought likewise to take exercise on horseback, or in a carraige, if he be able to bear it.
WHEN the disease is protracted beyond the seventh or eighth day, and the patient complains of a stupor and heaviness of the part, has frequent returns of chillness, shivering, &c. there is reason to suspect that matter is forming in the kidney, and that an abcess will ensue.
WHEN matter in the urine shews that an ulcer is already formed in the kidney, the patient must be careful to abstain from all acrid, sour, and salted provisions; and to live chiefly upon mild mucilaginous herbs and fruits, together with the broth of young animals, made with barley and common pot-herbs, &c. His drink may be whey, and butter-milk that is not sour. The latter is by some reckoned a specific remedy in ulcers of the kidneys. To answer this character, however, it must be drank for a considerable time. Chalybeate waters have likewise been found beneficial in this disease. This medicine is easily obtained, as it is found in every part of Great-Britain. It must likewise be used for a considerable time, in order to produce any salutary effects.
THOSE who are liable to frequent returns of inflammation, or obstruction of the kidneys, must abstain from wines, especially such as abound with tartar; and their food ought to be light, and of easy digestion. They should use moderate exercise, and should not lie too hot, nor too much on ther back.
THE inflammation of the bladder proceeds, in a great measure, from the same causes as that of the kidneys. It is known by an acute pain towards the bottom of the belly, and difficulty of passing urine, with some degree of fever, a constant inclination to go to stool, and a perpetual desire to make water.
THIS disease must be treated on the same principles as the one immediately preceding. The diet must be light and thin, and the drink of a cooling nature. Bleeding is very proper at the beginning, and in robust constitutions it will often be necessary to repeat it. The lower part of the belly should be fomented with water, or a decoction of mild vegetables; and emollient clysters ought frequently to be administered, &c.
THE patient should abstain from every thing that is of a hot, acrid, and stimulating quality, and should live entirely upon small broths, gruels, or mild vegetables.
A STOPPAGE of urine may proceed from other causes besides an inflammation of the bladder; as a swelling of the haemorrhoidal veins, hard faeces lodged in the rectum; a stone in the bladder, excrescences in the urinary passages, a palsy in the bladder, hysteric affections, &c. Each of these requires a particular treatment, which does not fall under our present consideration. We shall only observe, that in all of them, mild and gentle applications are the safest, as strong diuretic medicines, or things of an irritating nature, generally increase the danger. I have known some persons kill themselves by introducing probes into the urinary passages, to remove, as they thought, somewhat that obstructed the discharge of urine, and others bring on a violent inflammation of the bladder, by using strong diuretics, as oil of turpentine, &c. for that purpose.
THE liver is less subject to inflammation than most of the other viscera, as in it the circulation is slower; but when an inflammation does happen, it is with difficulty removed, and often ends in a suppuration or scirrhus.
CAUSES. - Besides the common causes of inflammation, we may here reckon the following, viz. excessive fatness, a scirrhus of the liver itself, violent shocks from strong vomits when the liver was before unsound, an adust or atrabiliarian state of the blood, any thing that suddenly cools the liver after it has been greatly heated, stones obstructing the course of the bile, drinking strong wines and spirituous liquors, using hot spicy aliment, obstinate hypochondriacal affections, &c.
SYMPTOMS. - This disease is known by a painful tension of the right side under the false ribs, attended with some degree of fever, a sense of weight, or fulness of the part, difficulty of breathing, loathing of food, great thirst, with a pale or yellowish colour of the skin and eyes.
THE symptoms here are various, according to the degree of inflammation, and likewise according to the particular part of the liver where the inflammation happens. Sometimes the pain is so inconsiderable, that an inflammation is not so much as suspected; but when it happens in the upper or convex part of the liver, the pain is more acute, the pulse quicker, and the patient is often troubled with a dry cough, a hiccup, and a pain extending to the shoulder, with difficulty of lying on the left side, &c.
THIS disease may be distinguished from the pleurisy by the pain being less violent, seated under the false ribs, the pulse not so hard, and by the difficulty of lying on the left side. It may be distinguished from the hysteric and hypochondriac disorders by the degree of fever with which it is always attended.
THIS disease, if properly treated, is seldom mortal. A constant hiccuping, violent fever, and excessive thirst, are bad symptoms. If it ends in a suppuration, and the matter cannot be discharged outwardly, the danger is great. When the scirrhus of the liver ensues, the patient, if he observes a proper regimen, may nevertheless live a number of years tolerably easy; but if he indulge in animal food and strong liquors, or take medicines of an acrid or irritating nature, the scirrhus will be converted into a cancer, which must infallibly prove fatal.
REGIMEN. - The same regimen is to be observed in this as in other inflammatory disorders. All hot things are to be carefully avoided, and cool diluting liquors, as whey, barley-water, &.c, drank freely. The food must be light and thin, and the body, as well as the mind, kept easy and quiet.
MEDICINE - Bleeding is proper at the beginning of this disease, and it will often be necessary, even though the pulse should not feel hard, to repeat it. All violent purgatives are to be avoided; the body, however, must be kept gently open. A decoction of tamarinds, with a little honey or manna, will answer this purpose very well. The side affected must be fomented in the manner directed in the foregoing diseases. Mild laxative clysters should be frequently administered; and, if the pain should notwithstanding continue violent, a blistering-plaster may be applied over the part affected.
MEDICINES which promote the secretion of urine have a very good effect here. For this purpose half a drachm of purified nitre, or a tea-spoonful of the sweet spirits of nitre, may be taken in a cup of the patient's drink three or four times a-day.
WHEN there is an inclination to sweat, it ought to be promoted, but not by warm sudorifics. The only thing to be used for that purpose is plenty of diluting liquors drank about the warmth of the human blood. Indeed the patient in this case, as well as in all other topical inflammations, ought to drink nothing that is colder than the blood.
IF the stools should be loose, and even streaked with blood, no means must be used to stop them, unless they be so frequent as to weaken the patient. Loose stools often prove critical, and carry off the disease.
IF an abcess or imposthume is formed in the liver, all methods should be tried to make it break and discharge itself outwardly, as fomentations, the application of poultices, ripening cataplasms, &c. Sometimes indeed the matter or an abcess comes away in the urine, and sometimes it is discharged by stool, but these are efforts of Nature which no means can promote. When the abcess bursts into the cavity of the abdomen at large, death must ensue; nor will the event be more favourable when the abscess is opened by an incision, unless in cases where the liver adheres to the peritonaeum, so as to form a bag for the matter, and prevent it from falling into the cavity of the abdomen; in which case opening the abscess by a sufficiently large incision will probably save the patient's life. I know a gentleman who has had several abscesses of the liver opened, and is now a strong and healthy man, though above eighty years of age.
IF the disorder, in spite of all endeavours to the contrary, should end in a scirrhus, the patient must be careful to regulate his diet, &c. in such a manner as not to aggravate the disease. He must not indulge in flesh, fish, strong liquors, or any highly seasoned or salted provisions; but should, for the most part, live on mild vegetables, as fruits and roots; taking gentle exercise, and drinking whey, barley-water, or butter-milk. If he takes any thing stronger, it should be fine mild ale, which is less heating than wines or spirits.
WE shall take no notice of inflammations of the other viscera. They must in general be treated upon the same principles as those already mentioned. The chief rule with respect to all of them, is to let blood, to avoid every thing that is strong, or of a heating nature, to apply warm fomentations to the part affected, and to cause the patient to drink a sufficient quantity of warm diluting liquors.