THE STOMACH AND BOWELS.
THE cholera morbus is a violent purging and vomiting, attended with gripes, sickness, and a constant desire to go to stool. It comes on suddenly, and is most common in autumn. There is hardly any disease that kills more quickly than this, when proper means are not used in due time for removing it.
CAUSES. - It is occasioned by a redundancy and putrid acrimony of the bile; cold; food that easily turns rancid or sour on the stomach; as butter, bacon, sweet-meats, cucumbers, melons, cherries, and other cold fruits. I have been twice brought to the gates of death by this disease, and both times it was occasioned by eating rancid bacon. It is sometimes the effect of strong acrid purges or vomits; or of poisonous substances taken into the stomach. It may likewise proceed from violent passions or affections of the mind as fear, anger, &c.
SYMPTOMS. - It is generally preceded by a cardialgia, or heart-burn, sour belchings, and flatulences, with pain of the stomach and intestines. To these succeed excessive vomiting, and purging of green, yellow, or blackish coloured bile, with a distention of the stomach, and violent griping pains. There is likewise a great thirst, with a very quick unequal pulse, and often a fixed acute pain about the region of the navel. As the disease advances, the pulse often sinks so low as to become quite imperceptible, the extremities grow cold, or cramped; and are often covered with a clammy sweat, the urine is obstructed, and there is a palpitation of the heart. Violent hiccuping, fainting, and convulsions, are the signs of approaching death.
MEDICINE. - At the beginning of this disease the efforts of Nature to expel the offending cause should be assisted, by promoting the purging and vomiting. For this pupose the patient must drink freely of diluting liquors; as whey, butter-milk, warm water, thin water gruel, small posset, or, what is perhaps preferable to any of them, very weak chicken broth. This should not only be drank plentifully to promote the vomiting, but a clyster of it given every hour in order to promote the purging.
AFTER these evacuations have been continued for some time, a decoction of toasted oat-bread may be drank to stop the vomiting. The bread should be toasted till it is of a brown colour, and afterwards boiled in spring-water. If oat-bread cannot be had, wheat-bread, or oat-meal well toasted, may be used in its stead. If this does not put a stop to the vomiting, two table-spoonfuls of the saline julep, with ten drops of laudanum, may be taken every hour till it ceases.
THE vomiting and purging however ought never to be stopped too soon. As long as these discharges do not weaken the patient, they are salutary, and may be allowed to go on, or rather ought to be promoted. But when the patient is weakened by the evacuations, which may be known from the sinking of his pulse, &c. recourse must immediately be had to opiates, as recommended above; to which may be added strong wines, with spirituous cinnamon-waters, and other generous cordials. Warm negus, or strong wine-whey, will likewise be necessary to support the patient's spirits, and promote the perspiration. His legs should be bathed in warm water, and afterwards rubbed with flannel cloths, or wrapped in warm blankets, and warm bricks applied to the soles of his feet. Flannels wrung out of warm spiritous fomentations should likewise be applied to the region of the stomach.
WHEN the violence of the disease is over, to prevent a relapse, it will be necessary, for some time, to continue the use of small doses of laudanum. Ten or twelve drops may be taken in a glass of wine, at least twice a-day, for eight or ten days. The patient's food ought to be nourishing, but taken in small quantities, and he should use moderate exercise. As the stomach and intestines are generally much weakened, an infusion of the bark, or other bitters, in small wine, sharpened with the elixir of vitriol, may be drank for some time.
THOUGH physicians are seldom called in due time in this disease, they ought not to despair of relieving the patient even in the most desperate circumstances. Of this I lately saw a very striking proof in an old man and his son, who had been both seized with it about the middle of the night. I did not see them till next morning, when they had much more the appearance of dead than of living men. No pulse could be felt, the extremities were cold and rigid; the countenance was ghastly, and the strength almost quite exhausted. Yet from this deplorable condition they were both recovered by the use of opiates and cordial medicines.
A LOOSENESS, in many cases, is not to be considered as a disease, but rather as a salutary evacuation. It ought therefore never to be stopped unless when it continues too long, or evidently weakens the patient. As this however sometimes happens, we shall point out the most common causes of a looseness, with the proper method of treatment.
WHEN a looseness is occasioned by catching cold, or an obstructed perspiration, the patient ought to keep warm, to drink freely of weak diluting liquors, to bathe his feet and legs frequently in lukewarm water, to wear flannel next his skin, and to take every other method to restore the perspiration.
IN a looseness which proceeds from excess or repletion, a vomit is the proper medicine. Vomits not only cleanse the stomach, but promote all the secretions, which renders them of great importance in carrying off a debauch. Half a drachm of ipecacuanha in powder will answer this purpose very well. A day or two after the vomit, the same quantity of rhubarb may be taken, and repeated two or three times, if the looseness continues. The patient ought to live upon light vegetable food of easy digestion, and to drink whey, thin gruel, or barley-water.
A LOOSENESS, occasioned by the obstruction of any customary evacuation, generally requires bleeding. If that does not succeed, other evacuations may be substituted in the form of those which are obstructed. At the same time, every method is to be taken to restore the usual discharges, as not only the cure of the disease, but the patient's life, may depend on this.
A PERIODICAL looseness ought never to be stopped. It is always an effort of Nature to carry off some offending matter, which, if retained in the body, might have fatal effects. Children are very liable to this kind of looseness, especially while teething. It is however so far from being hurtful to them, that such children generally get their teeth with least trouble. If these loose stools should at any time prove sour or griping, a tea-spoonful of magnesia alba, with four or five grains of rhubarb, may be given to the child in a little panado, or any other food. This, if repeated three or four times, will generally correct the acidity, and carry off the griping stools.
A DIARRHOEA, or looseness, which proceeds from violent passions or affections of the mind, must be treated with the greatest caution. Vomits in this case are highly improper. Nor are purges safe, unless they be very mild, and given in small quantities. Opiates, and other antispasmodic medicines, are most proper. Ten or twelve drops of liquid laudanum maybe taken in a cup of valerian or penny-royal tea, every eight or ten hours, till the symptoms abate. Ease, cheerfulness, and tranquility of mind, are here of the greatest importance.
WHEN a looseness proceeds from acrid or poisonous substances taken into the stomach, the patient must drink large quantities of diluting liquors, with oil or fat broth, to promote vomiting and purging. Afterwards, if there be reason to suspect that the bowels are inflamed, bleeding will be necessary. Small doses of laudanum may Iikewise be taken to remove their irritation.
WHEN the gout, repelled from the extremities, occasions a looseness, it ought to be promoted by gentle doses of rhubarb, or other mild purgatives. The gouty matter is likewise to be solicited towards the extremities by warm fomentations, cataplasms, &c. The perspiration ought at the same time to be promoted by warm diluting liquors; as wine-whey, with spirits of hartshorn, or a few drops of liquid laudanum in it.
WHEN a looseness proceeds from worms, which may be known from the sliminess of the stools, mixed with pieces of decayed worms, &c. medicines must be given to kill and carry off these vermin, as the powder of tin with purges of rhubarb and calomel. Afterwards lime-water, either alone, or with a small quantity of rhubarb infused, will be proper to strengthen the bowels, and prevent the new generation of worms.
A LOOSENESS is often occasioned by drinking bad water. When this is the case, the disease generally proves epidemical. When there is reason to believe that this or any other disease proceeds from the use of unwholesome water, it ought immediately to be changed, or, if that cannot be done, it may be corrected by mixing with it quick-lime, chalk, or the like.
IN people whose stomachs are weak, violent exercise immediately after eating will occasion a looseness. Though the cure of this is obvious, yet it will be proper, besides avoiding violent exercise, to use such medicines as tend to brace and strengthen the stomach, as infusions of the bark, with other bitter and astringent ingredients, in white wine. Such persons ought likewise to take frequently a glass or two of old red port, or good claret.
FROM whatever cause a looseness proceeds, when it is found necessary to check it, the diet ought to consist of rice boiled with milk, and flavoured with cinnamon; rice-jelly; sago, with red port; and the Iighter sorts of flesh-meat roasted. The drink may be thin water-gruel, rice water, or weak broth made from lean veal, or with a sheep's head, as being more gelatinous than mutton, beef, or chicken broth.
PERSONS who, from a peculiar weakness, or too great an irritability of the bowels, are liable to frequent returns of this disease, should live temperately, avoiding crude summer fruits, all unwholesome food, and meats of hard digestion. They ought likewise to beware of cold, moisture, or whatever may obstruct the perspiration, and should wear flannel next their skin. All violent passions, as fear, anger, &c. are likewise carefully to be guarded against.
VOMITING may proceed from various causes; as excess in eating and drinking; foulness of the stomach; the acrimony of the aliments; a translation of the morbific matter of ulcers, of the gout, the erysipelas, or other diseases to the stomach. It may llkewise proceed from a looseness having been too suddenly stopped; from the stoppage of any customary evacuation, as the bleeding piles, the menses, &c. from a weakness of the stomach, the cholic, the iliac passion, a rupture, a fit of the gravel, worms; or from any kind of poison taken into the stomach. It is an usual symptom of injuries done to the brain; as contusions, compressions, &c. It is likewise a symptom of wounds, or inflammations of the diaphragm, intestines, spleen, liver, kidneys, &c.
VOMITING may be occasioned by unusual motions; as falling, being drawn backwards in a cart or coach, &c. It may likewise be excited by violent passions, or by the idea of nauseous or disagreeable objects, especially of such things as have formerly produced vomiting. Sometimes it proceeds from a regurgitation of the bile into the stomach: in this case, what the patient vomits is generally of a yellow or greenish colour, and has a bitter taste. Persons who are subject to nervous affections are often suddenly seized with violent fits of vomiting. Lastly, vomiting is a common symptom of pregnancy. In this case it generally comes on about two weeks after the stoppage of the menses, and continues during the first three or four months.
WHEN vomiting proceeds from a foul stomach or indigestion, it is not to be considered as a disease, but as the cure of a disease. It ought therefore to be promoted by drinking lukewarm water, or thin gruel. If this does not put a stop to the vomiting, a dose of ipecacuanha may be taken, and worked off with weak camomile-tea.
WHEN the retrocession of the gout, or the obstruction of customary evacuations, occasion vomiting, all means must be used to restore these discharges; or if that cannot be effected, their place must be supplied by others, as bleeding, purging, bathing the extremities in warm water, opening issues, setons, perpetual blisters, &c.
WHEN vomiting is the effect of pregnancy, it may generally be mitigated by bleeding, and keeping the body gently open. The bleeding however ought to be in small quantities at a time, and the purgatives should be of the mildest kind, as figs, stewed prunes, manna, or senna. Pregnant women are most apt to vomit in the morning, immediately after getting out of bed, which is owing partly to the change of posture, but more to the emptiness of the stomach. It may generally be prevented by taking a dish of coffee, tea, or some light breakfast in bed. Pregnant women who are afflicted with vomiting ought be kept easy both in body and mind. They should neither allow their stomachs to be quite empty, nor should they eat much at once. Cold water is a very proper drink in this case; if the stomach be weak, a little brandy may be added to it. If the spirits are low, and the person apt to faint, a spoonful of cinnamon-water, with a little marmalade of quinces or oranges, may be taken.
IF vomiting proceeds from weakness of the stomach, bitters will be of service. Peruvian bark infused in wine or brandy, with as much rhubarb as will keep the body gently open, is an excellent medicine in this case. The elixir of vitriol is also a good medicine. It may be taken in the dose of fifteen or twenty drops, twice or thrice a-day, in a glass of wine or water. Habitual vomitings are sometimes alleviated by making oysters a principal part of diet.
A VOMITING, which proceeds from acidities in the stomach, is relieved by alkaline purges. The best medicine of this kind is the magnesia alba, a tea-spoonful of which may be taken in a dish of tea or a little milk, three or four times a-day, or oftener if necessary, to keep the body open.
WHEN vomiting proceeds from violent passions, or affections of the mind, all evacuants must be carefully avoided, especially vomits. These are exceeding dangerous. The patient in this case ought to be kept perfectly easy and quiet, to have the mind soothed, and to take some gentle cordial, as negus, or a little brandy and water, to which a few drops of laudanum may occasionally be added.
WHEN vomiting proceeds from spasmodic affections of the stomach, musk, castor, and other antispasmodic medicines, are of use. Warm and aromatic plasters have likewise a good effect. The stomach-plaster of the London or Edinburgh dispensatory may be applied to the pit of the stomach, or a plaster of theriaca, which will answer rather better. Aromatic medicines may likewise be taken inwardly, as cinnamon or mint tea, wine with spiceries boiled in it, &c. The region of the stomach may be rubbed with aether, or, if that cannot be had, with strong brandy, or other spirits. The belly should be fomented with warm water, or the patient immersed up to the breast in a warm bath.
I HAVE always found the saline draughts taken in the act of effervescence, of singular use in stopping a vomiting, from whatever cause it proceeded. These may be prepared by dissolving a drachm of the salt of tartar, in an ounce and half of fresh lemon juice, and adding to it an ounce of peppermint-water, the same quantity of simple cinnamon-water, and a little white sugar. This draught must be swallowed before the effervescence is quite over, and may be repeated every two hours, or oftener, if the vomiting be violent. A violent vomiting has sometimes been stopped by cupping on the region of the stomach after all other means had failed.
AS the least motion will often bring on the vomiting again, even after it has been stopped, the patient must avoid all manner of action. The diet must be so regulated as to sit easy upon the stomach, and nothing should be taken that is hard of digestion. We do not however mean that the patient should live entirely upon slops. Solid food, in this case, often sits easier on the stomach than liquids.