Bruises are generally productive of worse consequences than wounds. The danger from them does not appear immediately, by which means it often happens that they are neglected. It is needless to give any definition of a disease so universally known; we shall therefore proceed to point out the method of treating it.
In slight bruises it will be sufficient to bathe the part with warm vinegar, to which a little brandy or rum may occasionally be added, and to keep cloths wet with this mixture constantly applied to it. This is more proper than rubbing it with brandy, spirits of wine, or other ardent spirits, which are commonly used in such cases.
In some parts of the country the peasants apply to a recent bruise a cataplasm of fresh cow-dung. I have often seen this cataplasm applied to violent contusions occasioned by blows, falls, bruises, and such like, and never knew it fail to have a good effect.
When a bruise is very violent, the patient ought immediately to be bled, and put upon a proper regimen. His food should be light and cool, and his drink weak, and of an opening nature; as whey sweetened with honey, decoctions of tamarinds, barley, cream-tartar-whey, and such like. The bruised part must be bathed with vinegar and water, as directed above; and a poultice made by boiling crumb of bread, elder-flowers, and camomile-flowers, in equal quantities of vinegar and water, applied to it. This poultice is peculiarly proper when a wound is joined to the bruise. It may be renewed two or three times a-day.
As the structure of the vessels is totally destroyed by a violent bruise, there often ensues a great loss of substance, which produces an ulcerous sore very difficult to cure. If the bone be affected, the sore will not heal before an exfoliation takes place; that is, before the diseased part of the bone separates, and comes out through the wound. This is often a very slow operation, and may even require several years to be completed. Hence it happens, that these sores are frequently mistaken for the king’s evil, and treated as such, though in fact they proceed solely from the injury which the solid parts received from the blow.
Patients in this situation are pestered with different advices. Every one who sees them proposes a new remedy, till the sore is so much irritated with various and opposite applications, that it is often at length rendered absolutely incurable. The best method of managing such sores is, to take care that the patient’s constitution does not suffer by confinement, or improper medicine, and to apply nothing to them besides simple ointment spread upon soft lint, over which a poultice of bread and milk, with boiled camomile-flowers, or the like, may be put, to nourish the part, and keep it soft and warm. Nature, thus assisted, will generally in time operate a cure, by throwing off the diseased parts of the bone, after which the sore soon heals.
Ulcers may be the consequence of wounds, bruises, or imposthumes improperly treated; they may likewise proceed from an ill state of the humours, or what may be called a bad habit of body.
In the latter case, they ought not to be hastily dried up, otherwise it may prove fatal to the patient. Ulcers happen most commonly in the decline of life; and persons who neglect exercise, and live grossly, are most liable to them. They might often be prevented by retrenching some part of the solid food, or by opening artificial drains, as issues, setons, or the like.
An ulcer may be distinguished from a wound by its discharging a thin watery humour, which is often so acrid as to inflame and corrode the skin; by the hardness and perpendicular situation of its sides or edges, by the time of its duration, &c.
It requires considerable skill to be able to judge whether or not an ulcer ought to be dried up. In general, all ulcers which proceed from a bad habit of body, should be suffered to continue open, at least till the constitution has been so far changed by proper regimen, or the use of medicine, that they seem disposed to heal of their own accord. Ulcers which are the effect of malignant fevers, or other acute diseases, may generally be healed with safety after the health has been restored for some time. The cure ought not however to be attempted too soon, nor at any time without the use of purging medicines and a proper regimen. When wounds or bruises have, by wrong treatment, degenerated into ulcers, if the constitution be good, they may generally be healed with safety. When ulcers either accompany chronical diseases, or come in their stead, they must be cautiously healed. If an ulcer conduces to the patient’s health, from whatever cause it proceeds, it ought not to be healed; but if, on the contrary, it wastes the strength, and consumes the patient by a slow fever, it should be healed as soon as possible.
We would earnestly recommend a strict attention to these particulars, to all who have the misfortune to labour under this disorder, particularly persons in the decline of life; as we have frequently known people throw away their lives by the want of it, while they were extolling and generously rewarding those whom they ought to have looked upon as their executioners.
The most proper regimen for promoting the cure of ulcers, is to avoid all spices, salted and high-seasoned food, all strong liquors, and to lessen the usual quantity of flesh meat. The body ought to be kept gently open by a diet consisting chiefly of cooling laxative vegetables, and by drinking butter-milk, whey sweetened with honey, or the like. The patient ought to be kept cheerful, and should take as much exercise as he can easily bear.
When the bottom and sides of an ulcer seem hard and callous, they may be sprinkled twice a-day with a little red precipitate of mercury, and afterwards dressed with the yellow basilicum ointment. Sometimes it will be necessary to have the edges of the ulcer scarified with the lancet.
Lime-water has frequently been known to have very happy effects in the cure of obstinate ulcers. It may be used in the same manner as directed for the stone and gravel.
My late learned and ingenious friend, Dr. Whytt, strongly recommends the use of the solution of corrosive sublimate of mercury in brandy, for the cure of obstinate ill conditioned ulcers. I have frequently found this medicine, when given according to the Doctor’s directions, prove very successful. The dose is a table-spoonful night and morning; at the same time washing the sore twice or thrice a-day with it. In a letter which I had from the Doctor a little before his death, he informed me, “That he observed washing the sore thrice a-day with the solution of a triple strength was very beneficial[198].”
A fistulous ulcer can seldom be cured without an operation. It must either be laid open so as to have its callous parts destroyed by some corrosive application, or they must be entirely cut away by the knife: but as this operation requires the hand of an expert surgeon, there is no occasion to describe it. Ulcers about the anus are most apt to become fistulous, and are very difficult to cure. Some indeed pretend to have found Ward’s Fistula paste very successful in this complaint. It is not a dangerous medicine, and being easily procured, it may deserve a trial; but as these ulcers generally proceed from an ill habit of body, they will seldom yield to any thing except a long course of regimen, assisted by medicines, which are calculated to correct that particular habit, and to induce an almost total change in the constitution.
When a bone is moved out of its place or articulation, so as to impede its proper functions, it is said to be luxated or dislocated. As this often happens to persons in situations where no medical assistance can be obtained, by which means limbs, and even lives, are frequently lost, we shall endeavour to point out the method of reducing the most common luxations, and those which require immediate assistance. Any person of common sense and resolution, who is present when a dislocation happens, may often be of more service to the patient, than the most expert surgeon can after the swelling and inflammation have come on. When these are present, it is difficult to know the state of the joint, and dangerous to attempt a reduction; and by waiting till they are gone off, the muscles become so relaxed, and the cavity filled up, that the bone can never afterwards be retained in its place.
A recent dislocation may generally be reduced by extension alone, which must always be greater or less according to the strength of the muscles which move the joint, the age, robustness, and other circumstances of the patient. When the bone has been out of its place for any considerable time, and a swelling or inflammation has come on, it will be necessary to bleed the patient, and, after fomenting the part, to apply soft poultices with vinegar to it for some time before the reduction is attempted.
All that is necessary after the reduction, is to apply cloths dipt in vinegar or camphorated spirits of wine to the part, and to keep it perfectly easy. Many bad consequences proceed from the neglect of this rule. A dislocation seldom happens without the tendons and ligaments of the joint being stretched and sometimes torn. When these are kept easy till they recover their strength and tone, all goes on very well; but is the injury be increased by too frequent an exertion of the parts, no wonder if they be found weak and diseased ever after.
The lower jaw may be luxated by yawning, blows, falls, chewing hard substances, or the like. It is easily known from the patient’s being unable to shut his mouth, or to eat any thing, as the teeth of the under jaw do not correspond with those of the upper; besides, the chin either hangs down, or is thrown toward one side, and the patient is neither able to speak distinctly, nor to swallow without considerable difficulty.
The usual method of reducing a dislocated jaw, is to set the patient upon a low stool, so as an assistant may hold the head firm by pressing it against his breast. The operator is then to thrust his two thumbs, being first wrapped up with linen cloths that they may not slip, as far back into the patient’s mouth as he can, while his fingers are applied to the jaw externally. After he has got firm hold of the jaw, he is to press it strongly downwards and backwards, by which means the elapsed heads of the jaw may be easily pushed into their former cavities.
The peasants in some parts of the country have a peculiar way of performing this operation. One of them puts a handkerchief under the patient’s chin, then turning his back to that of the patient, pulls him up by the chin so as to suspend him from the ground. This method often succeeds, but we think it a dangerous one, and therefore recommend the former.
The neck may be dislocated by falls, violent blows, or the like. In this case, if the patient receives no assistance, he soon dies, which makes people imagine the neck was broken; it is, however, for the most part only partially dislocated, and may be reduced by almost any person who has resolution enough to attempt it. A complete dislocation of the neck is instantaneous death.
When the neck is dislocated, the patient is immediately deprived of all sense and motion; his neck swells, his countenance appears bloated; his chin lies upon his breast, and his face is generally turned towards one side.
To reduce this dislocation, the unhappy person should immediately be laid upon his back on the ground, and the operator must place himself behind him so as to be able to lay hold of his head with both hands, while he makes a resistance by placing his knees against the patient’s shoulders. In this posture he must pull the head with considerable force, gently twisting it at the same time, if the face be turned to one side, till he perceives that the joint is replaced, which may be known from the noise which the bones generally make when going in, the patient’s beginning to breathe, and the head continuing in its natural posture.
This is one of those operations which it is more easy to perform than describe. I have known instances of its being happily performed even by women, and often by men of no medical education. After the neck is reduced, the patient ought to be bled, and should be suffered to rest for some days, till the parts recover their proper tone.
As the articulation of the ribs with the backbone is very strong, they are not often dislocated. It does however sometimes happen, which is a sufficient reason for our taking notice of it. When a rib is dislocated either upwards or downwards, in order to replace it, the patient should be laid upon his belly on a table, and the operator must endeavour to push the head of the bone into its proper place. Should this method not succeed, the arm of the disordered side may be suspended over a gate or ladder, and, while the ribs are thus stretched asunder, the heads of such as are out of place may be thrust into their former situation.
Those dislocations wherein the heads of the ribs are forced inwards, are both more dangerous and the most difficult to reduce, as neither the hand nor any instrument can be applied internally to direct the luxated heads of the ribs. Almost the only thing that can be done is, to lay the patient his belly over a cask, or some gibbous body, and to move the fore-part of the rib inward towards the back, sometimes shaking it; by this means the heads of the luxated ribs may slip into their former place.
The humerus or upper bone of the arm may be dislocated in various directions: it happens however most frequently downwards, but very seldom directly upwards. From the nature of its articulation, as well as from its exposure to external injuries, this bone is the most subject to dislocation of any in the body. A dislocation of the humerus may be known by a depression or cavity on the top of the shoulder, and an inability to move the arm. When the dislocation is downward or forward, the arm is elongated, and a ball or lump is perceived under the arm-pit; but when it is backward, there appears a protuberance behind the shoulder, and the arm is thrown forwards toward the breast.
The usual method of reducing dislocations of the shoulder is to seat the patient upon a low stool, and to cause an assistant to hold his body so that it may not give way to the extension, while another lays hold of the arm a little above the elbow, and gradually extends it. The operator then puts a napkin under the patient’s arm, and causes it to be tied behind his own neck: by this, while a sufficient extension is made, he lifts up the head of the bone, and with his hands directs it into its proper place. There are various machines invented for facilitating this operation, but the hand of an expert surgeon is always more safe. In young and delicate patients, I have generally found it a very easy matter to reduce the shoulder, by extending the arm with one hand, and thrusting in the head of the bone with the other. In making the extension, the arm ought always to be a little bent.
The bones of the fore-arm may be dislocated in any direction. When this is the case, a protuberance may be observed on that side of the arm towards which the bone is pushed, from which, and the patient’s inability to bend his arm, a dislocation of this joint may easily be known.
Two assistants are generally necessary for reducing a dislocation of the elbow; one of them must lay hold of the arm above, and the other below the joint, and make a pretty strong extension, while the operator returns the bones into their proper place. Afterwards the arm must be bent, and suspended for some time with a sling about the neck.
Luxations of the wrist and fingers are to be reduced in the same manner as those of the elbow, viz. by making an extension in different directions, and thrusting the head of the bone into its place.
When the thigh-bone is dislocated forward and downward, the knee and foot are turned out, and the leg is longer than the other; but when it is displaced backward, it is usually pushed upward at the same time, by which means the limb is shortened, and the foot is turned inwards.
When the thigh-bone is displaced forward and downward, the patient, in order to have it reduced, must be laid upon his back, and made fast by bandages, or held by assistants, while by others an extension is made by means of slings fixed about the bottom of the thigh a little above the knee. While the extension is made, the operator must push the head of the bone outward, till it gets into the socket. If the dislocation be outward, the patient must be laid upon his face, and, during the extension, the head of the bone must be pushed inward.
Dislocations of the knees, ancles, and toes, are reduced much in the same manner as those of the upper extremities, viz. by making an extension in opposite directions, while the operator replaces the bones. In many cases, however, the extension alone is sufficient, and the bone will slip into its place merely by pulling the limb with sufficient force. It is not hereby meant, that force alone is sufficient for the reduction of dislocations. Skill and address will often succeed better than force. I have known a dislocation of the thigh reduced by one man, after all the force that could be used by six had proved ineffectual.
There is, in most country villages, some person who pretends to the art of reducing fractures. Though in general such persons are very ignorant, yet some of them are very successful; which evidently proves, that a small degree of learning, with a sufficient share of common sense and a mechanical head, will enable a man to be useful in this way. We would, however, advise people never to employ such operators, when an expert and skilful surgeon can be had; but when that is impracticable, they must be employed: we shall therefore recommend the following hints to their consideration:
When a large bone is broken, the patient’s diet ought in all respects to be the same as in an inflammatory fever. He should likewise be kept quiet and cool, and his body open by emollient clysters; or, if these cannot be conveniently administered, by food that is. of an opening quality; as stewed prunes, apples boiled in milk, boiled spinage, and the like. It ought however to be here remarked, that persons who have been accustomed to live high, are not all of a sudden to be reduced to a very low diet. This might have fatal effects. There is often a necessity for indulging even bad habits, in some measure, where the nature of the disease might require a different treatment.
It will generally be necessary to bleed the patient immediately after a fracture, especially if he be young, of a full habit, or has at the same time received any bruise or contusion. This operation should not only be performed soon after the accident happens, but if the patient be very feverish, it may be repeated next day. When several of the ribs are broken, bleeding is peculiarly necessary.
If any of the large bones which support the body are broken, the patient must keep his bed for several weeks. It is by no means necessary, however, that he should lie all that time, as is customary, upon his back. This situation sinks the spirits, galls and frets the patient’s skin, and renders him very uneasy. After the second week he may be gently raised up, and may sit several hours, supported by a bed-chair, or the like, which will greatly relieve him. Great care, however, must be taken in raising him up, and laying him down, that he make no exertions himself, otherwise the action of the muscles may pull the bone out of its place[199].
It is of great importance to keep the patient dry and clean while in this situation. By neglecting this, he is often so galled and excoriated, that he is forced to keep shifting places for ease. I have known a fractured thigh-bone, after it had been kept straight for above a fortnight, displaced by this means, and continue bent for life, in spite of all that could be done.
It has been customary when a bone was broken, to keep the limb for five or six weeks continually upon the stretch. But this is a bad posture. It is both uneasy to the patient, and unfavourable to the cure. The best situation is to keep the limb a little bent. This is the posture into which every animal puts its limbs when it goes to rest, and in which fewest muscles are upon the stretch. It is easily effected, by either laying the patient upon his side, or making the bed so as to favour this position of the limb.
Bone-setters ought carefully to examine whether the bone be not shattered or broken into several pieces. In this case it will sometimes be necessary to have the limb immediately taken off, otherwise a gangrene or mortification may ensue. The horror which attends the very idea of an amputation often occasions its being delayed in such cases till too late. I have known this principle operate so strongly, that a limb, where the bones were shattered into more than twenty pieces, was not amputated before the third day after the accident, when the gangrene had proceeded so far as to render the operation useless.
When a fracture is accompanied with a wound, it must be dressed in all respects as a common wound.
All that art can do towards the cure of a broken bone, is to lay it perfectly straight, and to keep it quite easy. All tight bandages do hurt. They had much better be wanting altogether. A great many of the bad consequences which succeed to fractured bones are owing to tight bandages. This is one of the ways in which the excess of art, or rather the abuse of it, does more mischief than would be occasioned by the want of it. Some of the most sudden cures of broken bones which were ever known, happened where no bandages were applied at all. Some method however must be taken to keep the member steady; but this may be done many ways without bracing it with a tight bandage.
The best method of retention is by two or more splints made of leather or pasteboard. These, if moistened before they be applied, soon assume the shape of the included member, and are sufficient, by the assistance of a very slight bandage, for all the purposes of retention. The bandage which we would recommend is that made with twelve or eighteen tails. It is much easier applied and taken off than rollers, and answers all the purposes of retention equally well. The splints should always be as long as the limb, with holes cut for the ancles when the fracture is in the leg.
In fractures of the ribs, where a bandage cannot be properly used, an adhesive plaster may be applied over the part. The patient in this case ought to keep himself quite easy, avoiding every thing that may occasion sneezing, laughing, coughing, or the like. He ought to keep his body in a straight posture, and should take care that his stomach be constantly distended, by taking frequently some light food, and drinking freely of weak watery liquors.
The most proper external application for a fracture is oxycrate, or a mixture of vinegar and water. The bandages should be wet with this at every dressing.
Strains are often attended with worse consequences than broken bones. The reason is obvious; they are generally neglected. When a bone is broken, the patient is obliged to keep the member easy, because he cannot make use of it; but when a joint is only strained, the person, finding he can still make a shift to move it, is sorry to lose his time for so trifling an ailment. In this way he deceives himself, and converts into an incurable malady what might have been removed by only keeping the part easy for a few days.
Country people generally immerse a strained limb in cold water. This is very proper, provided it be done immediately, and not kept in too long. But the custom of keeping the part immersed in cold water for a long time is certainly dangerous. It relaxes instead of bracing the part, and is more likely to produce a disease than remove one.
Wrapping a garter, or some other bandage, pretty tight about the strained part, is likewise of use. It helps to restore the proper tone of the vessels, and prevents the action of the parts from increasing the disease. It should not however be applied too tight. I have frequently known bleeding near the affected part have a very good effect: but what we would recommend above all is ease. It is more to be depended on than any medicine, and seldom fails to remove the complaint[200].
Children and old people are most liable to this disease. In the former it is generally occasioned by excessive crying, coughing, vomiting, or the like. In the latter, it is commonly the effect of blows or violent exertions of the strength, as leaping, carrying great weights, &c. In both, a relaxed habit, indolence, and an oily or very moist diet, dispose the body to this disease.
A rupture sometimes proves fatal before it is discovered. Whenever sickness, vomiting, and obstinate costiveness give reason to suspect an obstruction of the bowels, all those places where ruptures usually happen ought carefully to be examined. The protrusion of a very small part of the gut will occasion all these symptoms; and, if not returned in due time, will prove mortal.
On the first appearance of a rupture in an infant, it ought to be laid upon its back, with its head very low. While in this posture, if the gut does not return of itself, it may easily be put up by gentle pressure. After it is returned, a piece of sticking-plaster may be applied over the part, and a proper truss or bandage must be constantly worn for a considerable time. The method of making and applying these rupture-bandages for children is pretty well known. The child must, as far as possible, be kept from crying, and from all violent exertions, till the rupture is quite healed.
In adults, when the gut has been forced down with great violence, or happens from any cause to be inflamed, there is often great difficulty in returning it, and sometimes the thing is quite impracticable without an operation; a description of which is foreign to our purpose. As I have been fortunate enough, however, always to succeed in my attempts to return the gut, without having recourse to any other means than what are in the power of every man, I shall briefly mention the method which I generally pursue.
After the patient has been bled, he must be laid upon his back, with his head very low, and his breech raised high with pillows. In this situation flannel cloths wrung out of a decoction of mallows and camomile-flowers, or, if these are not at hand, of warm water, must be applied for a considerable time. A clyster made of this decoction, with a large spoonful of butter and an ounce or two of salt, may be afterwards thrown up. If these should not prove successful, recourse must be had to pressure. If the tumour be very hard, considerable force will be necessary; but it is not force alone which succeeds here. The operator, at the same time that he makes a pressure with the palms of his hand, must with his fingers artfully conduct the gut in by the same aperture through which it came out. The manner of doing this can be much easier conceived than described. Should these endeavours prove ineffectual, clysters of the smoke of tobacco may be tried. These have been often known to succeed where every other method failed.
There is reason to believe that, by persisting in the use of these, and such other means as the circumstances of the case may suggest, most hernias might be reduced without an operation. Cutting for the hernia is a nice and difficult matter. I would therefore advise surgeons to try every method of returning the gut before they have recourse to the knife. I have once and again succeeded by persevering in my endeavours, after eminent surgeons had declared the reduction of the gut impracticable without an operation[201].
An adult, after the gut has been returned, must wear a steel bandage. It is needless to describe this, as it may always be had ready made from the artists. Such bandages are generally uneasy to the wearer for some time, but by custom they become quite easy. No person who has had a rupture after he arrived at man’s estate should ever be without one of these bandages.
Persons who have a rupture ought carefully to avoid all violent exercise, carrying great weights, leaping, running, and the like. They should likewise avoid windy aliment and strong liquors; and should carefully guard against catching cold.
It is certain that life, when to all appearance lost, may often, by due care, be restored. Accidents frequently prove fatal, merely because proper means are not used to counteract their effects, No person ought to be looked upon as killed by any accident, unless where the structure of the heart, brain, or some organ necessary to life, is evidently destroyed. The action of these organs may be so far impaired as even to be for some time imperceptible, when life is by no means gone. In this case, however, if the fluids be suffered to grow cold, it will be impossible to put them again in motion, even though the solids should recover their power of acting. Thus, when the motion of the lungs has been stopt by unwholesome vapour, the action of the heart by a stroke on the breast, or the functions of the brain by a blow on the head, if the person be suffered to grow cold, he will in all probability continue so; but, if the body be kept warm, as soon as the injured part has recovered its power of acting, the fluids will again begin to move, and all the vital functions will be restored.
It is a horrid custom immediately to consign over to death every person who has the misfortune, by a fall, a blow, or the like, to be deprived of the appearance of life. The unhappy person, instead of being carried into a warm house, and laid by the fire, or put to a warm bed, is generally hurried away to church, or a barn, or some other cold damp house, where, after a fruitless attempt has been made to bleed him, perhaps by one who knew nothing of the matter, he is given over for dead, and no further notice taken of him. This conduct seems to be the result of ignorance, supported by an ancient superstitious notion, which forbids the body of any person killed by accident to be laid in an house that is inhabited. What the ground of this superstition may be, we shall not pretend to inquire; but surely the conduct founded upon it is contrary to all the principles of reason, humanity, and common sense.
When a person seems to be suddenly deprived of life, our first business is to inquire into the cause. We ought carefully to observe whether any substance be lodged in the wind-pipe or gullet; and, if that is the case, attempts must be made to remove it. When unwholesome air is the cause, the patient ought immediately to be removed out of it. If the circulation be suddenly stopped, from any cause whatever, except mere weakness, the patient should be bled. If the blood does not flow, he may be immersed in warm water, or rubbed with warm cloths, &c. to promote the circulation. When the cause cannot be suddenly removed, our great aim must be to keep up the vital warmth, by rubbing the patient with hot cloths, or salt, and covering his body with warm sand, ashes, or the like.
I should now proceed to treat more fully of those accidents, which, without immediate assistance, would often prove fatal, and to point out the most likely means for relieving the unhappy sufferers; but as I have been happily anticipated in this part of my subject by the learned and humane Dr. Tissot, I shall content myself with selecting such of his observations as seem to be the most important, and adding such of my own as have occurred in the course of practice.
Though accidents of this kind are very common, and extremely dangerous, yet they are generally the effect of carelessness. Children should be taught to chew their food well, and to put nothing into their mouths which it would be dangerous for them to swallow. But children are not the only persons guilty of this piece of imprudence. I know many adults who put pins, nails, and other sharp-pointed substances in their mouths upon every occasion, and some who even sleep with the former there all night. This conduct is exceedingly injudicious, as a fit of coughing, or twenty other accidents, may force over the substance before the person is aware[202].
When any substance is detained in the gullet, there are two ways of removing it, viz. either by extracting it, or pushing it down. The safest and most certain way is to extract it; but this is pot always the easiest; it may therefore be more eligible sometimes to thrust it down, especially when the obstructing body is of such a nature, that there is no danger from its reception into the stomach. The substances which may be pushed down without danger are, all common nourishing ones, as bread, flesh, fruits, and the like. All indigestible bodies, as cork, wood, bones, pieces of metal, and such like, ought if possible to be extracted, especially if these bodies be sharp pointed, as pins, needles, fish-bones, bits of glass, &c.
When such substances have not passed in too deep, we should endeavour to extract them with our fingers, which method often succeeds. When they are lower, we must make use of nippers, or a small pair of forceps, such as surgeons use. But this attempt to extract rarely succeeds, if the substance be of a flexible nature, and has descended far into the gullet.
If the fingers and nippers fail, or cannot be duly applied, crotchets, a kind of hooks, must be employed. These may be made at once, by bending a piece of pretty strong iron wire at one end. It must be introduced in the flat way; and for the better conducing it, there should likewise be a curve or bending at the end it is held by, to serve as a kind of handle to it; which has this further use, that it may be secured by a string tied to it, a circumstance not to be omitted in any instrument employed on such occasions, to avoid such ill accidents as have sometimes ensued from these instruments slipping out of the operator’s hand. After the crotchet has passed below the substance that obstructs the passage, it is drawn up again, and hooks up the body along with it. The crotchet is also very convenient, when a substance somewhat flexible, as a pin or fish-bone, sticks across the gullet, the hook, in such cases, seizing them about their middle part, crooks and thus disengages them; or, if they are very brittle substances, serves to break them.
When the obstructing bodies are small, and only stop up a part of the passage, and which may either easily elude the hook, or straiten it by their resistance, a kind of rings, made either of wire, wool, or silk, may be used. A piece of fine wire of a proper length may be bent into a circle, about the middle, of about an inch diameter, and the long unbent sides brought parallel, and near each other: these are to be held in the hand, and the circular part or ring introduced into the gullet, in order to be conduced about the obstructing body, and so to extract it. More flexible rings may be made of wool, thread, silk, or small pack-thread, which may be waxed for their greater strength and consistence. One of these is to be tied fast to a handle of iron wire, whale-bone, or any kind of flexible wood, and by this means introduced, in order to surround the obstructing substance, and to draw it out. Several of these rings passed through one another may be used, the more certainly to lay hold of the obstructing body, which may be involved by one, if another should miss it. These rings have one advantage, which is, that when the substance to be extracted is once laid hold of, it may then, by turning the handle, be retained so strongly in the ring thus twitted, as to be moved every way, which must in many cases be a considerable advantage.
Another material employed on these unhappy occassions is the sponge. Its property of swelling considerably on being wet is the principal foundation of its usefulness here. If any substance is stopt in the gullet, but without filling up the whole passage, a bit of sponge may be introduced into that part which is unstopt, and beyond the substance. The sponge soon dilates, and grows larger in this moist situation; and indeed the enlargement of it may be forwarded by making the patient swallow a few drops of water. Afterwards it is to be drawn back by the handle to which it is fastened; and as it is now too large to return through the small cavity by which it was conveyed in, it draws out the obstructing body along with it.
The compressibility of sponge is another foundation of its usefulness in such cases. A pretty large piece of sponge may be compressed or squeezed into a small size, by winding a string of tape closely about it, which may be easily unwound, and withdrawn, after the sponge has been introduced. A bit of sponge may likewise be, compressed by a piece of whale-bone split at one end; but this can hardly be introduced in such a manner as not to hurt the patient.
I have often known pins and other sharp bodies, which had stuck in the throat, brought up by causing the person to swallow a bit of tough meat tied to a thread, and drawing it quickly up again. This is safer than swallowing sponge, and will often answer the purpose equally well.
When all these methods prove unsuccessful, there remains one more, which is, to make the patient vomit: but this can scarcely be of any service, unless when such obstructing bodies are simply engaged in, and not hooked or stuck into the sides of the gullet, as in this case vomiting might sometimes occasion further mischief. If the patient can swallow, vomiting may be excited by taking half a drachm or two scruples of ipecacuanha in powder made into a draught. If he is not able to swallow, an attempt may be made to excite vomiting, by tickling his throat with a feather; and, if that should not succeed, a clyster of tobacco may be administered. It is made by boiling an ounce of tobacco in a sufficient quantity of water: this has often been found to succeed, when other attempts to excite vomiting had failed.
When the obstructing body is of such a nature that it may with safety be pushed downwards, this may be attempted by means of a wax-candle oiled, and a little heated, so as to make it flexible; or a piece of whale-bone, wire, or flexible wood, with a sponge fastened to one end.
Should it be impossible to extract even those bodies which it is dangerous to admit into the stomach, we must then prefer the least of two evils, and rather run the hazard of pushing them down than suffer the patient to perish in a few minutes; and we ought to scruple this resolution the less, as a great many instances have happened, where the swallowing of such hurtful and indigestible substances has been followed by no disorder.
Whenever it is manifest that all endeavours either to extract or push down the substance must prove ineffectual, they should be discontinued; because the inflammation occasioned by persisting in them might be as dangerous as the obstruction itself. Some have died in consequence of the inflammation, even after the body which caused the obstruction had been entirely removed.
While the means recommended above are making use of, the patient should often swallow, or, if he cannot, he should frequently receive by injection through a crooked tube or pipe that may reach down to the gullet, some emollient liquor, as warm milk and water, barley-water, or a decoction of mallows. Injections of this kind not only soften and sooth the irritated parts, but, when thrown in with force, are often more successful in loosening the obstruction than all attempts with instruments.
When, after all our endeavours, we are obliged to leave the obstructing body in the part, the patient must be treated as if he had an inflammatory disease. He should be bled, kept upon a low diet, and have his whole neck surrounded with emollient poultices. The like treatment must also be used, if there be any reason to suspect an inflammation of the passages, though the obstructing body be removed.
A proper degree of agitation has sometimes loosened the inhering body more effectually than instruments. Thus, a blow on the back has often forced up a substance which stuck in the gullet; but this is still more proper and efficacious when the substance gets into the wind-pipe. In this case, vomiting and sneezing are likewise to be excited. Pins, which stuck in the gullet, have been frequently discharged by riding on horseback, or in a carriage.
When any indigestible substance has been forced down into the stomach, the patient should use a very mild and smooth diet, consisting chiefly of fruits and farinaceous substances, as puddings, pottage, and soups. He should avoid all heating and irritating things, as wine, punch, pepper, and such like; and his drink should be milk and water, barley-water, or whey.
When the gullet is so strongly and fully closed, that the patient can receive no food by the mouth, he must be nourished by clysters of soup, jelly, and the like.
When the patient is in danger of being immediately suffocated, and all hope of freeing the passage is vanished, so that death seems at hand, if respiration be not restored; the operation of bronchotomy, or opening of the wind-pipe, must be directly performed. As this operation is neither difficult to an expert surgeon, nor very painful to the patient, and is often the only method which can be taken to preserve life in these emergencies, we thought proper to mention it, though it should only be attempted by persons skilled in surgery.
When a person has remained above a quarter of an hour under water, there can be no considerable hopes of his recovery. But as several circumstances, may happen to have continued life, in such an unfortunate situation, beyond the ordinary term, we should never too soon resign the unhappy object to his fate, but try every method for his relief, as there are many well attested proofs of the recovery of persons to life and health who had been taken out of the water apparently dead, and who remained a considerable time without exhibiting any signs of life.
The first thing to be done, after the body is taken out of the water, is to convey it as soon as possible to some convenient place where the necessary operations for its recovery may be performed. In doing this, care must be taken not to bruise or injure the body by carrying it in any unnatural posture with the head downwards, or the like. If an adult body, it ought to be laid on a bed, or on straw, with the head a little raised, and carried on a cart or on men’s shoulders, and kept in as natural and easy a position as possible. A small body may be carried in the arms.
In attempting to recover persons apparently drowned, the principal intention to be pursued is, to restore the natural warmth, upon which all the vital functions depend; and to excite these functions by the application of stimulants, not only to the skin, but likewise to the lungs, intestines, &c.
Though cold was by no means the cause of the person’s death, yet it will prove an effectual obstacle to his recovery. For this reason, after stripping him of his wet clothes, his body must be strongly rubbed for a considerable time with coarse linen cloths, as warm as they can be made; and, as soon as a well-heated bed can be got ready, he may be laid in it, and the rubbing should be continued. Warm cloths ought likewise to be frequently applied to the stomach and bowels, and hot bricks, or bottles of warm water, to the soles of his feet, and to the palms of his hands.
Strong volatile spirits should be frequently applied to the nose; and the spine of the back and pit of the stomach may be rubbed with warm brandy or spirit of wine. The temples ought always to be chafed with volatile spirits; and stimulating powders, as that of tobacco or marjoram, may be blown up the nostrils.
To renew the breathing, a strong person may blow his own breath into the patient’s mouth with all the force he can, holding his nostrils at the same time. When it can be perceived by the rising of the chest or belly that the lungs are filled with air, the person ought to desist from blowing, and should press the breast and belly so as to expel the air again; and this operation may be repeated for some time, alternately inflating and depressing the lungs so as to imitate natural respiration.
If the lungs cannot be inflated in this manner, it may be attempted by blowing through one of the nostrils, and at the same time keeping the other close. Dr. Monro for this purpose recommends a wooden pipe fitted at one end for filling the nostril, and at the other for being blown into by a person’s mouth, or for receiving the pipe of a pair of bellows, to be employed for the same purpose, if necessary.
When air cannot be forced into the chest by the mouth or nose, it may be necessary to make an opening into the wind-pipe for this purpose. It is needless, however, to spend time in describing this operation, as it should not be attempted unless by persons skilled in surgery.
To stimulate the intestines, the fume of tobacco may be thrown up in form of clyster. There are various pieces of apparatus contrived for this purpose, which may be used when at hand; but where these cannot be obtained, the business may be done by a common tobacco-pipe. The bowl of the pipe must be filled with tobacco well kindled, and, after the small tube has been introduced into the fundament, the smoke may be forced up by blowing through a piece of paper full of holes wrapped round the mouth of the pipe, or by blowing through an empty pipe, the mouth of which is applied close to that of the other. This may also be done in the following manner: A common clyster-pipe with a bag mounted upon it may be introduced into the fundament, and the mouth of the bag may be applied round the small end of a tobacco-pipe, in the bowl of which tobacco is to be kindled, and the smoke blown up as directed above. Should it be found impracticable to throw up the smoke of tobacco, clysters of warm water, with the addition of a little salt and some wine or spirits, may be frequently administered. This may be done by a common clyster-bag and pipe; but, as it ought to be thrown well up, a pretty large syringe will answer the purpose better.
While these things are doing, some of the attendants ought to be preparing a warm bath, into which the person should be put, if the above endeavours prove ineffectual. Where there are no conveniencies for using the warm bath, the body may be covered with warm salt, sand, ashes, grains, or such like. Tissot mentions an instance of a girl who was restored to life, after she had been taken out of the water, swelled, bloated, and to all appearance dead, by laying her naked body upon hot ashes, covering her with others equally hot, putting a bonnet round her head, and a stocking round her neck stuffed with the same, and heaping coverings over all. After she had remained half an hour in this situation, her pulse returned, she recovered speech, and cried out, I freeze, I freeze; a little cherry-brandy was given her, and she remained buried as it were under the ashes for eight hours; afterwards she was taken out, without any other complaint except that of lassitude or weariness, which went off in a few days. The Doctor mentions likewise an instance of a man who was restored to life, after he had remained six hours under water, by the heat of a dunghill.
Till the patient shews some signs of life, and is able to swallow, it would be useless and even dangerous to pour liquors into his mouth. His lips, however, and tongue, may be frequently wet with a feather dipt in warm brandy or other strong spirits; and, as soon as he has recovered the power of swallowing, a little warm wine, or some other cordial, ought every now and then to be administered.
Some recommend a vomit after the patient is a little re-animated; but if he can be made to puke without the sickening draught, it will be more safe: this may generally be done by tickling the throat and fauces with an oiled feather, or some other soft substance, which will not injure the parts. Tissot in this case recommends the oxymel of squills, a table-spoonful of which, diluted with water, may be given every quarter of an hour, till the patient has taken five or six doses. Where that medicine is not at hand, a strong infusion of sage, camomile-flowers, or carduus benedictus, sweetened with honey, or some warm water, with the addition of a little salt, may, he says, supply its place. The Doctor does not intend that any of these things should be given in such quantity as to occasion vomiting. He thinks emetics in this situation are not expedient.
We are by no means to discontinue our assistance as soon as the patients discover some tokens of life, since they sometimes expire after these first appearances of recovering. The warm and stimulating applications are still to be continued, and small quantities of some cordial liquor ought frequently to be administered. Lastly, though the person should be manifestly re-animated, there sometimes remain an oppression, a cough, and feverishness, which effectually constitute a disease. In this case it will be necessary to bleed the patient in the arm, and to cause him to drink plentifully of barley-water, elder-flower-tea, or any other soft pectoral infusions.
Such persons as have the misfortune to be deprived of the appearances of life, by a fall, a blow, suffocation, or the like, must be treated nearly in the same manner as those who have been for some time under water. I once attended a patient who was so stunned by a fall from a horse, that for above six hours he scarcely exhibited any signs of life; yet this man, by being bled, and proper methods taken to keep up the vital warmth, recovered, and in a few days was perfectly well. Dr. Alexander gives an instance to the same purpose, in the Edinburgh Physical and Literary Essays, of a man who was to all appearance killed by a blow on the breast, but recovered upon being immersed for some time in warm water. These, and other instances of a similar nature, which might be adduced, amount to a full proof of this fact, that many of those unhappy persons who lose their lives by falls, blows, and other accidents, might be saved by the use of proper means duly persisted in.
Air may be many ways rendered noxious, or even destructive to animals. This may either happen from its vivifying principle being destroyed, or from subtle exhalations with which it is impregnated. Thus air that has passed through burning fuel is neither capable of supporting fire nor the life of animals. Hence the danger of sleeping in close chambers with charcoal fires. Some indeed suppose the danger here proceeds from the sulphureous oil contained in the charcoal, which is set at liberty and diffused all over the chamber; while others imagine it is owing to the air of the room being charged with phlogiston. Be this as it may, it is a situation carefully to be avoided. Indeed, it is dangerous to sleep in a small apartment with a fire of any kind. I lately saw four persons who had been suffocated by sleeping in an apartment where a small fire of coal had been left burning.
The vapour which exhales from wine, cyder, beer, or other liquors, in the state of fermentation, contains something poisonous, which kills in the same manner as the vapour of coal. Hence there is always danger in going into cellars where a large quantity of these liquors is in a state of fermentation, especially if they have been close shut up for some time. There have been many instances of persons struck dead on entering such places, and of others who have with difficulty escaped.
When subterraneous caves, that have been very long shut, are opened, or when deep wells are cleaned, which have not been emptied for several years, the vapours arising from them produce the same effects as those mentioned above. For this reason, no person ought to venture into a well, pit, cellar, or any place that is damp, and has been long shut up, till the air has been sufficiently purified, by burning gunpowder in it. It is easy to know, as has been observed in a former part of this work, when the air of such places is unwholesome, by letting down a lighted candle, throwing in burning fuel, or the like. If these continue to burn, people may safely venture in; but where they are suddenly extinguished, no one ought to enter till the air has been first purified by fire.
The offensive smell of lamps and of candles, especially when their flames are extinguished, operate like other vapours, though with less violence, and less suddenly. There have however been instances of people killed by the fumes of lamps which had been extinguished in a close chamber, and persons of weak delicate breasts generally find themselves quickly oppressed in apartments illuminated with many candles.
Such as are sensible of their danger in these situations, and retreat seasonably from it, are generally relieved as soon as they get into the open air, or, if they have any remaining uneasiness, a little water and vinegar, or lemonade, drank hot, affords them relief. But when they are so far poisoned, as to have lost their feeling and understanding, the following means must be used for their recovery:
The patient should be exposed to a very pure, fresh, and open air; and volatile salts, or other stimulating substances, held to his nose. He should next be bled in the arm, or if that does not succeed, in the neck. His legs ought to be put into warm water, and well rubbed. As soon as he can swallow, some lemonade, or water and vinegar, with the addition of a little nitre, may be given him.
Nor are sharp clysters by any means to be neglected; these may be made, by adding to the common clyster, syrup of buckthorn and tincture of senna, of each two ounces; or, in their stead, half an ounce of Venice turpentine dissolved in the yolk of an egg. Should these things not be at hand, two or three large spoonfuls of common salt may be put into the clyster. The same means, if necessary, which were recommended in the former part of this chapter, may be used to restore the circulation, warmth, &c.
Mr. Tossach, surgeon at Alloa, relates the case of a man suffocated by the steam of burning coal, whom he recovered by blowing his breath into the patient’s mouth, bleeding him in the arm, and causing him to be well rubbed and tossed about. And Dr. Frewen, of Sussex, mentions the case of a young man who was stupified by the smoke of sea-coal, but was recovered by being plunged into cold water, and afterwards laid in a warm bed.
The practice of plunging persons suffocated by noxious vapours in cold water, would seem to be supported by the common experiment of suffocating dogs in the grotto del cani, and afterwards recovering them, by throwing them into the neighbouring lake.
When cold is extremely severe, and a person is exposed to it for a long time, it proves mortal, in consequence of its stopping the circulation in the extremities, and forcing too great a proportion of blood towards the brain; so that the patient dies of a kind of apoplexy, preceded by great sleepiness. The traveller, in this situation, who finds himself begin to grow drowsy, should redouble his efforts to extricate himself from the imminent danger he is exposed to. This sleep, which he might consider as some alleviation of his sufferings, would, if indulged, prove his last.
Such violent effects of cold are happily not very common in this country; it frequently happens, however, that the hands or feet of travellers are so benumbed or frozen, as to be in danger of a mortification, if proper means are not used to prevent it. The chief danger in this situation arises from the sudden application of heat. It is very common, when the hands or feet are pinched with cold, to hold them to the fire; yet reason and observation shew that this is a most dangerous and imprudent practice.
Every peasant knows, if frozen meat, fruits, or roots of any kind, be brought near the fire, or put into warm water, they will be destroyed, by rottenness, or a kind of mortification; and that the only way to recover them, is to immerse them for some time in very cold water. The same observation holds with regard to animals in this condition.
When the hands or feet are greatly benumbed with cold, they ought either to be immersed in cold water, or rubbed with snow, till they recover their natural warmth and sensibility: after which the person may be removed into an apartment a little warmer, and may drink some cups of tea, or an infusion of elder flowers sweetened with honey. Every person must have observed, when his hands were even but slightly affected with cold, that the best way to warm them was by washing them in cold water, and continuing to rub them well for some time.
When a person has been so long exposed to the cold, that all appearances of life are gone, it will be necessary to rub him all over with snow or cold water; or, what will answer better, if it can be obtained, to immerse him in a bath of the very coldest water. There is the greatest encouragement to persist in the use of these means, as we are assured that persons who had remained in the snow, or had been exposed to the freezing air during five or six successive days, and who had discovered no marks of life for several hours, have nevertheless been revived.
I have always thought, that the whitloes, kibes, chilblains, and other inflammations of the extremities, which are so common among the peasants in the cold season, were chiefly occasioned by their sudden transitions from cold to heat. After they have been exposed to an extreme degree of cold, they immediately apply their hands and feet to the fire, or, if they have occasion, plunge them into warm water, by which means, if a mortification does not happen, an inflammation seldom fails to ensue. Most of the ill consequences from this quarter might be easily avoided, by only observing the precautions mentioned above.
The effects of extreme heat, though not so common in this country, are no less fatal, and much more sudden than those of cold. In hot countries people frequently drop down dead in the streets, exhausted with heat and fatigue. In this case, if any warm cordial can be poured into the mouth it ought to be done. If this cannot be effected, they may be thrown up in form of a clyster. Volatile spirits, and other things of a stimulating nature, may be applied to the skin, which should be well rubbed with coarse-cloths, whipped with nettles, or other stimulating things. Some of the ancient physicians are said to have restored to life persons apparently dead, by beating them with rods.
Strong and healthy persons, who abound with blood, are often seized with sudden fainting fits, after violent exercise, drinking freely of warm or strong liquors, exposure to great heat, intense application to study, or the like.
In such cases the patient should be made to smell to some vinegar. His temples, forehead, and wrists ought at the same time to be bathed with vinegar mixed with an equal quantity of warm water; and two or three spoonfuls of vinegar, with four or five times as much water, may, if he can swallow, be poured into his mouth.
If the fainting proves obstinate, or degenerates into a syncope, that is, an abolition of feeling and understanding, the patient must be bled. After the bleeding, a clyster will be proper, and then he should be kept easy and quiet, only giving him every half hour a cup or two of an infusion of any mild vegetable, with the addition of a little sugar and vinegar.
When swoonings, which arise from this cause, occur frequently in the same person, he should, in order to escape them, confine himself to a light diet, confiding chiefly of bread, fruits, and other vegetables. His drink ought to be water or small beer, and he should deep but moderately, and take much exercise.
But fainting fits proceed much oftner from a defect than an excess of blood. Hence they are very ready to happen after great evacuations of any kind, obstinate watching, want of appetite, or such like. In these an almost directly opposite course to that mentioned above must be pursued.
The patient should be laid in bed, with his head low, and being covered, should have his legs, thighs, arms, and his whole body rubbed strongly with hot flannels. Hungary water, volatile salts, or strong smelling herbs, as rue, mint, or rosemary, may be held to his nose. His mouth may be wet with a little rum or brandy; and, if he can swallow, some hot wine, mixed with sugar and cinnamon, which is an excellent cordial, may be poured into his mouth. A compress of flannel dipt in hot wine or brandy must be applied to the pit of his stomach, and warm bricks, or bottles filled with hot water, laid to the feet.
As soon as the patient is recovered a little, he should take some strong soup or broth, or a little bread or biscuit soaked in hot-spiced wine. To prevent the return of the fits, he ought to take often, but in small quantities, some light yet strengthening nourishment, as panado made with soup instead of water, new laid eggs lightly poached, chocolate, light roast meats, jellies, and such like.
Those fainting fits, which are the effect of bleeding, or of the violent operation of purges, belong to this class. Such as happen after artificial bleeding are seldom dangerous, generally terminating as soon as the patient is laid upon the bed; indeed persons subject to this kind should always be bled lying, in order to prevent it. Should the fainting however continue longer than usual, volatile spirits may be held to the nose, and rubbed on the temples, &c.
When fainting is the effect of too strong or acrid purges or vomits, the patient must be treated in all respects as if he had taken poison. He should be made to drink plentifully of milk, warm water, and oil, barley-water, or suck like; emollient clysters will likewise be proper, and the patient’s strength should afterwards be recruited, by giving him generous cordials, and anodyne medicines.
Faintings are often occasioned by indigestion. This may either proceed from the quantity or quality of the food. When the former of these is the cause, the cure will be best performed by vomiting, which may be promoted by causing the patient to drink a weak infusion of camomile-flowers, carduus benedictus or the like. When the disorder proceeds from the nature of the food, the patient, as in the case of weakness, must be revived by strong smells, &c. after which he should be made to swallow a large quantity of light warm fluid, which may serve to drown, as it were, the offending matter, to soften its acrimony, and either to effect a discharge of it by vomiting, or force it down into the intestines.
Even disagreeable smells will sometimes occasion swoonings, especially in people of weak nerves. When this happens, the patient should be carried into the open air, have stimulating things held to his nose, and those substances which are disagreeable to him ought immediately to be removed. But we have already taken notice of swoonings which arise from nervous disorders, and shall therefore say no more upon that head.
Fainting fits often happen in the progress of diseases. In the beginning of putrid diseases they generally denote an oppression at stomach, or a mass of corrupted humours, and they cease after evacuations either by vomit or stool. When they occur at the beginning of malignant fevers, they indicate great danger. In each of these cases, vinegar used both externally and internally is the best remedy during the paroxysm, and plenty of lemon-juice and water after it. Swoonings which happen in diseases accompanied with great evacuations, must be treated like those which are owing to weakness, and the evacuations ought to be restrained. When they happen towards the end of a violent fit of an intermitting fever, or at that of each exacerbation of a continual fever, the patient must be supported by small draughts of wine and water.
Delicate and hysteric women are very liable to swooning or fainting fits after delivery. These might be often prevented by generous cordials, and the admission of fresh air. When they are occasioned by excessive flooding, it ought by all means to be restrained. They are generally the effect of mere weakness or exhaustion. Dr. Engleman relates the case of a woman “in child-bed, who, after being happily delivered, suddenly fainted, and lay upwards of a quarter of an hour apparently dead. A physician was sent for; her own maid, in the mean while, being out of patience at his delay, attempted to assist her herself, and extending herself upon her mistress, applied her mouth to her’s, blew in as much breath as she possibly could, and in a very short time the exhausted woman awaked as out of a profound sleep; when proper things being given her, she soon recovered.
“The maid being asked how she came to think of this expedient, said she had seen it practised at Altenburgh, by midwives, upon children with the happiest effect.”
We mention this case chiefly that other midwives may be induced to follow so laudable an example. Many children are born without any signs of life, and others expire soon after the birth, who might, without all doubt, by proper care, be restored to life.
From whatever cause fainting fits proceed, fresh air is always of the greatest importance to the patient. By not attending to this circumstance, people often kill their friends while they are endeavouring to save them. Alarmed at the patient’s situation, they call in a crowd of people to his assistance, or perhaps to witness his exit, whose breathing exhausts the air, and increases the danger. There is not the least doubt but this practice, which is very common among the lower sort of people, often proves fatal, especially to the delicate, and such persons as fall into fainting fits from mere exhaustion, or the violence of some disease. No more persons ought ever to be admitted into the room where a patient lies in a swoon than are absolutely necessary for his assistance, and the windows of the apartment should always be opened, at least as far as to admit a stream of fresh air.
Persons subject to frequent swoonings, or fainting fits, should neglect no means to remove the cause of them, as their consequences are always injurious to the constitution. Every fainting fit leaves the person in dejection and weakness; the secretions are thereby suspended, the humours disposed to stagnation, coagulations and obstructions are formed, and, if the motion of the blood be totally intercepted, or very considerably checked, polypuses are sometimes formed in the heart or larger vessels. The only kind of swoonings not to be dreaded are those which sometimes mark the crisis in fevers; yet even these ought, as soon as possible, to be removed.
The effects of intoxication are often fatal. No kind of poison kills more certainly than an over-dose of ardent spirits. Sometimes, by destroying the nervous energy, they put an end to life at once; but in general their effects are more slow, and in many respects similar to those of opium. Other kinds of intoxicating liquors may prove fatal when taken to excess, as well as ardent spirits; but they may generally be discharged by vomiting, which ought always to be excited when the stomach is overcharged with liquor.
More of those unhappy persons, who die intoxicated, lose their lives from an inability to conduct themselves than from the destructive quality of the liquor. Unable to walk, they tumble down, and lie in some awkward posture, which obstructs the circulation or breathing, and often continue in this situation till they die. No drunken person should be left by himself, till his clothes have been loosened, and his body laid in such a posture as is most favourable for continuing the vital motions, discharging the contents of the stomach, &c. The best posture for discharging the contents of the stomach is to lay the person upon his belly; when asleep he may be laid on his side, with his head a little raised, and particular care must be taken that his neck be no way bent, twisted, or have any thing too tight about it.