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DOMESTIC MEDICINE

CHAP. XXXIV.

OF THE HEAD-ACH.

ACHES and pains proceed from very different causes, and may effect any part of the body; but we shall point out those only which occur most frequently, and are attended with the greatest danger.

WHEN the head-ach is slight; and effects a particular part of the head only, it is called cephalalgia; when the whole head is affected, cephalea; and when on one side only, hemicrania. A fixed pain in the forehead, which may be covered with the end of the thum, is called the clavis hystericus.

THERE are also other distinctions. Sometimes the pain is internal, sometimes external, sometimes it is an original disease, and at other times only symptomatic. When the head-ach proceeds from a hot bilious habit, the pain is very acute and throbbing, with a considerable heat of the part affected. When from a cold phlegmatic habit, the patient complains of a dull heavy pain, and has a sense of coldness in the part. This kind of head-ach is sometimes attended with a degree of stupidity or folly.

WHATEVER obstructs the free circulation of the blood through the vessels of the head, may occasion a head-ach. In persons of a full habit, who abound with blood, or other humours, the head-ach often proceeds from the suppression of customary evacuations; as bleeding at the nose, sweating of the feet, &c. It may likewise proceed from any cause that determines a great flux of blood towards the head; as coldness of the extremities, or hanging down the head for a long time. Whatever prevents the return of the blood from the head will likewise occasion a head-ach; as looking long obliquely at any object, wearing any thing tight about the neck, or the like.

WHEN a head-ach proceeds from the stoppage of a running at the nose, there is a heavy, obtuse, pressing pain in the fore-part of the head, in which there seems to be such a weight, that the patient can scarce hold it up. When it is occasioned by the caustic matter of the venereal disease, it generally affects the skull, and often produces a caries of the bones.

SOMETIMES the head-ach proceeds from the repulsion, or retrocession of the gout, the erysipelas, the small-pox, measles, itch, or other eruptive diseases. What is called a hemicrania generally proceeds from crudities or indigestion. Inanition, or emptiness, will also occasion head-achs. I have often seen instances of this in nurses who gave suck too long, or who did not take a sufficient quantity of solid food.

THERE is likewise a most violent, fixed, constant, and almost intolerable head-ach, which occasions great debility both of body and mind, prevents sleep, destroys the appetite, causes a vertigo, dimness of sight, a noise in the ears, convulsions, epileptic fits, and sometimes vomiting, costiveness, coldness of the extremities, &c.

THE head-ach is often symptomatic in continual and intermittting fevers, especially quartans. It is likewise a very common symptom in hysteric and hypochondriac complaints.

WHEN a head-ach attends an acute fever, with pale urine, it is an unfavourable symptom. In excessive head-achs, coldness of the extremities is a bad sign.

WHEN the disease continues long, and is very violent, it often terminates in blindness, an apoplexy, deafness, a vertigo, the palsy, epilepsy, &c.

IN this disease the cool regimen in general is to be observed. The diet ought to consist of such emollient substances as will correct the acrimony of the humours, and keep the body open; as apples boiled in milk, spinage, turnips, and such like. The drink ought to be diluting; as barley-water, infusions of mild mucilaginous vegetables, decoctions of the sudorific woods, &c. The feet and legs ought to be kept warm, and frequently bathed in luke-warm water; the head should be shaved, and bathed with water and vinegar. The patient ought, as much as possible, to keep in an erect posture, and not to lie with his head too low.

WHEN the head-ach is owing to excess of blood, or an hot bilious constitution, bleeding is necessary. The patient may be bled in the jugular vein, and the operation repeated if there be occasion. Cupping also, or the application of leeches to the temples, and behind the ears, will be of service. Afterwards a blistering-plaster may be applied to the neck, behind the ears, or to any part of the head that is most affected. In some cases it will be proper to blister the whole head. In persons of a gross habit, issues or perpetual blisters will be of service. The body ought likewise to be kept open by gentle laxatives.

BUT when the head-ach proceeds from a copious vitiated serum stagnating in the membranes, either within or without the skull, with a dull, heavy, continual pain, which will neither yield to bleeding nor gentle laxatives, then more powerful purgatives are necessary, as pills made of aloes, resin of jalap, or the like. It will also be necessary in this case to blister the whole head, and to keep the back part of the neck open for a considerable time by a perpetual blister.

WHEN the head-ach is occasioned by the stoppage of a running at the nose, the patient should frequently smell to a bottle of volatile salts; he may likewise take snuff, or any thing that will irritate the nose, so as to promote a discharge from it; as the herb mastich, ground-ivy, &c.

A hemicrania, especially a periodical one, is generally owing to a foulness of the stomach, for which gentle vomits must be administered, as also purges of rhubarb. After the bowels have been sufficiently cleared, chalybeate waters, and such bitters as strengthen the stomach, will be necessary.

WHEN the head-ach arises from a vitiated state of the humours, as in the scurvy and venereal disease, the patient, after proper evacuations, must drink freely of the decoction of woods or the decoction of sarsaparilla, with raisins and liquorice. See Appendix, Decoction of Sarsaparilla. These promote perspiration, sweeten the humours, and, if duly persisted in, will produce very happy effects. When a collection of matter is felt under the skin, it must be discharged by an incision, otherwise it will render the bone carious.

WHEN the head-ach is so intolerable as to endanger the patient's life, or is attended with continual watching, delirium, &c. recourse must be had to opiates. These, after proper evacuations by clysters, or mild purgatives, may be applied both externally and internally. The affected part may be rubbed with Bate's anodyne balsam, or a cloth dipped in it may be applied to the part. The patient may, at the, same time, take twenty drops of laudanum, in a cup of valerian or penny-royal tea, twice or thrice a-day. This is only to be done in case of extreme pain. Proper evacuations ought always to accompany and follow the use of opiates. When the pain is very violent, and does not yield to small doses of laudanum, the quantity may be increased. I have known a patient in extreme pain take three hundred drops in twenty-four hours; but such doses ought only to be administered by a person of skill.

WHEN the patient cannot bear the loss of blood, his feet ought frequently to be bathed in luke-warm water, and well rubbed with a coarse cloth. Cataplasms with mustard or horseradish ought likewise to be applied to-them. This course is peculiarly necessary when the pain proceeds from a gouty humour affecting the head.

WHEN the head-ach is occasioned by great heat, hard labour, or violent exercise of any kind, it may be allayed by cooling medicines; as the saline, draughts with nitre, and the like.

A LITTLE of Ward's essence, dropt into the palm of the hand and applied to the forehead, will sometimes remove a violent head-ach; and so will aether, when applied in the same manner.

OF THE TOOTH-ACH.

THIS disease is so well known, that it needs no description. It has great affinity with the rheumatism, and often succeeds pains of the shoulders and other parts of the body.

IT may proceed from obstructed perspiration, or any of the other causes of inflammation. I have often known the tooth-ach occasioned by neglecting some part of the usual coverings of the head, by sitting with the head bare near an open window, or exposing it any how to a draught of cold air. Food or drink taken either too hot or too cold is very hurtful to the teeth. Great quantities of sugar, or other sweet-meats, are likewise hurtful. Nothing is more destructive to the teeth than cracking nuts, or chewing any kind of hard substances. Picking the teeth with pins, needles, or any thing that may hurt the enamel with which they are covered, does great mischief, as the tooth is sure to be spoiled whenever the air gets into it. Breeding women are very subject to the tooth-ach, especially during the first three or four months of pregnancy. The tooth-ach often proceeds from scorbutic humours affecting the gums. In this case the teeth are sometimes wasted, and fall out without any considerable degree of pain. The more immediate cause of the tooth-ach is a rotten or carious tooth.

IN order to relieve the tooth-ach, we must first endeavour to draw off the humours from the part affected. This may be done by mild purgatives, scarifying the gums, or applying leeches to them, and bathing the feet frequently with warm water. The perspiration ought likewise to be promoted, by drinking freely of weak wine-whey, or other diluting liquors, with small doses of nitre. Vomits too have often an exceeding good effect in the tooth-ach. It is seldom safe to administer opiates, or any kind of heating medicines, or even to draw a tooth till proper evacuations have been premised; and these alone will often effect the cure.

IF this fails, and the pain and inflammation still increase, a suppuration may be expected, to promote which a toasted fig should be held between the gum and the cheek; bags filled with boiled camomile flowers, flowers of elder, or the like, may be applied near the part affected, with as great a degree of warmth as the patient can bear, and renewed as they grow cool: the patient may likewise receive the steams of warm water into his mouth, through an inverted funnel, or by holding his head over the mouth of a porringer filled with warm water, & c.

SUCH things as promote the discharge of saliva, or cause the patient to spit, are generally of service. For this purpose, bitter, hot, or pungent vegetables may be chewed; as gentian, calamus aromaticus, or pellitory of Spain. Allen recommends the root of yellow water flower-de-luce in this case. This root may either be rubbed upon the tooth, or a little of it chewed. Brookes says he hardly ever knew it fail to ease the tooth-ach. It ought however to be used with caution.

MANY other herbs, roots, and seeds, are recommended for curing the tooth-ach; as the leaves or roots of millefoil or yarrow chewed, tobacco smoked or chewed, staves-acre, or the seeds of mustard chewed, &c. These bitter, hot, and pungent things, by occasioning a greater flow of saliva, frequently give ease in the tooth-ach.

OPIATES often relieve the tooth-ach. For this purpose a little cotton wet with laudanum may be held between the teeth, or a piece of sticking plaster, about the bigness of a shilling, with a bit of opium in the middle of it, of a size not to prevent the sticking of the other, may be laid on the temporal artery, where the pulsation is most sensible. De la Motte affirms, that there are few cases wherein this will not give reIief. If there be a hollow tooth, a small pill made of equal parts of camphire and opium, put into the hollow, is often beneficial. When this cannot be had, the hollow tooth may be filled with gum mastich, wax, Iead, or any substance that will stick in it, and keep out the external air.

FEW applications give more relief in the tooth-ach than blistering plasters. These may be applied betwixt the shoulders, but they have the best effect when put behind the ears, and made so large as to cover a great part of the lower-jaw.

AFTER all, when a tooth is carious, it is often impossible to remove the pain without extracting it; and, as a spoilt tooth never becomes sound again, it is prudent to draw it soon, lest it should affect the rest. Tooth-drawing, like bleeding, is very much practised by mechanics as well as persons of the medical profession. The operation however is not without danger, and ought always to be performed with care. A person unacquainted with the structure of the parts will be in danger of hurting the jaw-bone or of drawing a sound tooth instead of a rotten one. This may always be prevented by the operator striking upon the teeth with any piece of metal, as this never faiIs to excite the pain in the carious tooth.

WHEN the tooth-ach returns periodically, and the pain chiefly affects the gums, it may be cured by the bark.

SOME pretend to have found great benefit in the tooth-ach, from the application of an artificial magnet to the affected tooth. We shall not attempt to account for its mode of operation, but, if it be found to answer, though only in particular cases, it certainly deserves a trial, as it is attended with no expence, and cannot do any harm. Electricity has likewise been recommended, and particular instruments have been invented for sending a shock through the affected tooth.

PERSONS who have returns of the tooth-ach at certain seasons, as spring and autumn, might often prevent it by taking a purge at these times.

KEEPING the teeth clean has no doubt a tendency to prevent the tooth-ach. The best method of doing this is to wash them daily with salt and water, a decoction of the bark, or with cold water alone. All brushing and scraping of the teeth is dangerous, and, unless it be performed with great care, does mischief.

OF THE EAR-ACH.

THIS disorder chiefly affects the membrane which lines the inner cavity of the ear called the meatus auditorius. It is often so violent as to occasion great restlessness, anxiety, and even delirium. Sometimes epileptic fits, and other convulsive disorders, have been brought on by extreme pain in the ear.

THE ear-ach may proceed from any of the causes which produce inflammation. It often proceeds from a sudden suppression of perspiration, or from the head being exposed to cold when covered with sweat. It may also be occasioned by worms, or other insects getting into the ear, or being bred there; or from any hard body sticking in the ear. Sometimes it proceeds from the translation of morbific matter to the ear. This often happens in the decline of malignant fevers, and occasions deafness which is generally reckoned a favourable symptom.

WHEN the ear-ach proceeds from insects, or any hard body sticking in the ear, every method must be taken to remove them as soon as possible. The membranes may be relaxed by dropping into the ear oil of sweet almonds, or olive oil. Afterwards the patient should be made to sneeze, by taking snuff, or some strong sternutatory. If this should not force out the body, it must be extracted by art. I have seen insects, which had got into the ear, come out of their own accord upon pouring in oil, which is a thing they cannot bear.

WHEN the pain of the ear proceeds from inflammation, it must be treated like other topical inflammations, by a cooling regimen, and opening medicines. Bleeding at the beginning, either in the arm or jugular vein, or cupping in the neck, will be proper. The ear may likewise be fomented with steams of warm water, or flannel bags filled with boiled mallows and camomile flowers may be applied to it warm; or bladders filled with warm milk and water. An exceeding good method of fomenting the ear is to apply it close to the mouth of a jug filled with warm water, or a strong decoction of camomile flowers.

THE patient's feet should be frequently bathed in lukewarm water, and he ought to take small doses of nitre and rhubarb, viz. a scruple of the former, and ten grains of the latter, three times a-day. His drink may be whey, or decoctions of barley and liquorice with figs or raisins. The parts behind the ear ought frequently to be rubbed with camphorated oil, or a little of the volatile liniment.

WHEN the inflammation cannot be discussed, a poultice of bread and milk, or roasted onions, may be applied to the ear, and frequently renewed, till the abscess breaks, or can be opened. Afterwards the humours may be diverted from the part by gentle laxatives, blifters, or issues; but the discharge must not be suddenly dried up by any external application.

PAIN OF THE STOMACH, &c.

THIS may proceed from various causes; as indigestion; wind; the acrimony of the bile; sharp, acrid, or poisonous substances taken into the stomach, &c. It may likewise proceed from worms; the stoppage of customary evacuations; a translation of gouty matter to the stomach, the bowels, &c.

WOMEN in the decline of life are very liable to pains of the stomach and bowels, especially such as are afflicted with hysteric complaints. It is likewise very common to hypochondriac men of a sedentary and luxurious life. In such persons it often proves so extremely obstinate as to baffle all the powers of medicine.

WHEN the pain of the stomach is most violent after eating, there is reason to suspect that it proceeds from some fault either in the digestion or the food. In this case the patient ought to change his diet, till he finds what kind of food agrees best with his stomach, and should continue chiefly to use it. If a change of diet does not remove the complaint, the patient may take a gentle vomit, and afterwards a dose or two of rhubarb. He ought likewise to take an infusion of camomile flowers, or some other stomachic bitter, either in wine or water. I have often known exercise remove this complaint, especially sailing, or a long journey on horseback, or in a carriage.

WHEN a pain of the stomach proceeds from flatulency, the patient is constantly belching up wind, and feels an uneasy distention of the stomach after meals. This is a most deplorable disease, and is seldom thoroughly cured. In general, the patient ought to avoid all windy diet, and every thing that sours on the stomach, as greens, roots, &c. This rule, however admits of some exceptions. There are many instances of persons very much troubled with wind, who received great benefit from eating parched pease, though that grain is generally supposed to be of a windy nature. These are prepared by steeping or soaking pease in water, and afterwards drying them in a pot or kiln till they be be quite hard. They may be used at pleasure.

THIS complaint may likewise be greatly relieved by labour, especially digging, reaping, mowing, or any kind of active employment by which the bowels are alternately compressed and dilated. The most obstinate case of this kind I ever met with was in a person of a sedentary occupation, whom I advised after he had tried every kind of medicine in vain, to turn gardener; which he did, and has ever since enjoyed good health.

WHEN a pain of the stomach is occasioned by the swallowing of acrid or poisonous substances, they must be discharged by vomit; this may be excited by butter, oils, or other soft things, which sheath and defend the stomach from the acrimony of its contents.

WHEN pain of the stomach proceeds from a translation of gouty matter, warm cordials are necessary, as generorus wines, French brandy, &c. Some have drank a whole bottle of brandy or rum, in this case, in a few hours, without being in the least intoxicated, or even feeling the stomach warmed by it. It is impossible to ascertain the quantities necessary upon these occasions. This must be left to the feelings and discretion of the patient. The safer way however is, not to go too far. When there is an inclination to vomit, it may be promoted by drinking an infusion of camomile flowers, or carduus benedictus.

IF a pain of the stomach proceeds from the stoppage of customary evacuations, bleeding will be necessary, especially in sanguine and very full habits. It will likewise be of use to keep the body gently open by mild purgatives; as rhubarb or senna, &c. When this disease affects women, in the decline of life, after the stoppage of the menses, making an issue in the leg or arm will be of peculiar service.

WHEN the disease is occasioned by worms, they must be destroyed, or expelled by such means as are recommended in the following section.

WHEN the stomach is greatly relaxed and the digestion bad, which often occasion flatulencies, the acid elixir of vitriol will be of singular service. Fifteen or twenty drops of it may be taken in a glass of wine or water twice or thrice a-day.

PERSONS afflicted with flatulency are generally unhappy unless they be taking some purgative medicines; these, though they may give immediate ease, tend to weaken and relax the stomach and bowels, and consequently increase the disorder. Their best method is to mix purgatives and stomachics together. Equal parts of Peruvian bark and rhubarb may be infused in brandy or wine, and taken in such quantity as to keep the body gently open.

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