Domestic Medicine - Chapters 50-53



CHAPTER L.
OF SURGERY.

TO describe all the operations of surgery, and to point out the different 
diseases in which these operations are necessary, would extend this 
articIe far beyond the limits set to it: we must therefore confine our 
observations to such cases as most generally occur, and in which proper 
assistance is either not asked, or not always to be obtained.

THOUGH an acquaintance with the structure of the human body is 
indispensably necessary to qualify a man for being an expert surgeon; yet 
many things may be done to save the lives of their fellow-men in 
emergencies by those who are not adepts in anatomy. It is amazing with 
what facility the peasants daily perform operations upon brute animals, 
which are not of a less difficult nature than many of those performed on 
the human species; yet they seldom fail of success.

INDEED every man is in some measure a surgeon whether he will or not. He 
feels an inclination to assist his fellow-men in distress, and accidents 
happen every hour which give occasion to exercise this feeling. The 
feelings of the heart, however, when not directed by the judgment, are apt 
to mislead. Thus one, by a rash attempt to save his friend, may sometimes 
destroy him; while another, for fear of doing amiss, stands still and sees 
his bosom-friend expire, without so much as attempting to relieve him, 
even when the means are in his power. As every good man would wish to 
steer a course different from either of these, it would no doubt be 
agreeable to him to know what ought to be done upon such emergencies.


OF BLEEDING.

NO operation of surgery is so frequently necessary as bleeding; it ought 
therefore to be very generally understood. But though practiced by 
Midwives, Gardeners, Blacksmiths, &c. We have reason to believe that very 
few know when it is proper. Even physicians themselves have been so much 
the dupes of theory in this article, as to render it the subject of 
ridicule. It is, however, an operation of great importance, and must, when 
seasonably and properly performed, be of singular service to those in 
distress.

BLEEDING is proper at the beginning of all inflammatory fevers, as 
pleurisies, peripneumonies, &c. It is likewise proper in all topical 
inflammations, as those of the intestines, womb, bladder, stomach, 
kidnies, throat, eyes, &c. as also in the asthma, sciatic pains, coughs, 
head-achs, rheumatisms, the apoplexy, epilepsy, and bloody flux. After 
falls, blows, bruises, or any violent hurt received either externally or 
internally, bleeding is necessary. It is likewise necessary for persons 
who have had the misfortune to be strangled, drowned, suffocated with foul 
air, the fumes of metal, or the like. In a word, whenever the vital 
motions have been suddenly stopt from any cause whatever, except in 
swoonings, occasioned by mere weakness or hysteric affections, it is 
proper to open a vein. But in all disorders proceeding from a relaxation 
of the solids and an impoverished state of the blood, as dropsies, 
cacochymies, &c. bleeding is improper.

BLEEDING for topical inflammations ought always to be performed as near 
the part affected as possible. When this can be done with a lancet, it is 
to be preferred to any other method, but where a vein cannot be found, 
recourse must be had to leeches or cupping.

THE quantity of blood to be let must always be regulated by the strength, 
age, constitution, manner of life, and other circumstances relating to the 
patient. It would be ridiculous to suppose that a child could bear to lose 
as much blood as a grown person, or that a delicate lady should be bled to 
the same extent as a robust man.

FROM whatever part of the body blood is to be let, a bandage must be 
applied betwixt that part and the heart. As it is often necessary, in 
order to raise the vein, to make the bandage pretty tight, it will be 
proper in such cases, as soon as the blood begins to flow, to slacken it a 
little. The bandage ought to be applied at least an inch, or an inch and 
half from the places where the wound is intended to be made.

PERSONS not skilled in anatomy ought never to bleed in a vein that lies 
over an artery or a tendon, if they can avoid it, the former may easily be 
known from its pulsation or beating, and the latter from its feeling hard 
or tight like a whip cord under the finger.

IT was formerly a rule, even among those who had the character of being 
regular practitioners, to bleed their patients in certain diseases till 
they fainted. Surely a more ridiculous rule could not be proposed. One 
person will faint at the very sight of a lancet, While another will lose 
almost the whole blood of his body before he faints. Swooning depends more 
upon the state of the mind than of the body; besides, it may often be 
occasioned or prevented by the manner in which the operation is performed.

CHILDREN are generally bled with leeches. This, though sometimes 
necessary, is a very troublesome and uncertain practice. It is impossible 
to know what quantity of blood is taken away by leeches; besides, the 
bleeding is often very difficult to stop, and the wounds are not easily 
healed. Would those who practise bleeding take a little more pains, and 
accustom themselves to bleed children, they would not find it such a 
difficult operation as they imagine.

CERTAIN hurtful prejudices with regard to bleeding still prevail among the 
country people. They talk, for instance, of head-veins, heart-veins, 
breast-veins, &c. and believe that bleeding in these will certainly cure 
all diseases of the parts from whence they are supposed to come, without 
considering that all the blood vessels arise from the heart, and return to 
it again; for which reason, unless in topical inflammations, it signifies 
very little from what part of the body blood is taken. But this, though a 
foolish prejudice, is not near so hurtful as the vulgar notion that the 
first bleeding will perform wonders. This belief makes them often postpone 
the operation when necessary, in order to reserve it for some more 
important occasion, and when they think themselves in extreme danger they 
fly to it for relief, whether it be proper or not; bleeding at certain 
stated periods or seasons has likewise bad effects.

IT is likewise a common notion that bleeding in the feet draws the humours 
downwards, and consequently cures diseaes of the head and other superior 
parts; but we have already observed that, in all topical affections, the 
blood ought to be drawn as near the part as possible. When it is 
necessary, however, to bleed in the foot or hand, as the veins are small, 
and the bleeding is apt to stop too soon, the part ought to be immersed in 
warm water, and kept there till a sufficient quantity of blood be let.

WE shall not spend time in describlng the manner of performing this 
operation. That will be better learned by example than precept. Twenty 
pages of description would not convey so just an idea of the operation as 
seeing it once performed by an expert hand. Neither is it necessary to 
point out the different parts of the body from whence blood may be let, as 
the arm, foot, forehead, temples, neck, &c. These will readily occur to 
every intelligent person, and the foregoing observations will be 
sufficient for determining which of them is most proper upon any 
particular occasion. In all cases where the intention is only to lessen 
the general mass of blood, the arm is the most commodious part of the body 
in which the operation can be performed.


OF INFLAMMATIONS AND ABSCESSES.

FROM whatever cause an inflammation proceeds, it must terminate either by 
dispersion, suppuration, or gangrene. Though it is impossible to foretel 
with certainty in which of these ways any particular inflammation will 
terminate, yet a probable conjecture may be formed with regard to the 
event, from a knowledge of the patient's age and constitution. 
Inflammations happening in a slight degree upon colds, and without any 
previous indisposition, will most probably be dispersed; those which 
follow close upon a fever, or happen to persons of a gross habit of body, 
will generally suppurate; and those which attack very old people, or 
persons of a dropsical habit, will have a strong tendency to gangrene.

IF the inflammation be slight, and the constitution sound, the dispersion 
ought always to be attempted. This will be best promoted by a slender 
diluting diet, plentiful bleeding, and repeated purges. The part itself 
must be fomented and, if the skin be very tense, it may be embrocated with 
a mixture of three-fourths of sweet oil, and one-fourth of vinegar, and 
afterwards covered with a piece of wax plaster.

IF, notwithstanding these applications, the symptomatic fever increases, 
and the tumour becomes larger, with violent pain and pulsation, it will be 
proper to promote the suppuration. The best application for this purpose 
is a soft poultice, which may be renewed twice a-day. If the suppuration 
proceeds but slowly, a raw onion cut small or bruised may be spread upon 
the poultice. When the abscess is ripe or fit for opening, which may 
easily be known from the thinness of the skin in the most prominent part 
of it, a fluctuation of matter which may be felt under the finger, and, 
generally speaking, an abatement of the pain, it may be opened either with 
a lancet or by means of caustic.

THE last way in which an inflammation terminates, is in a gangrene or 
mortification, the approach of which may be known by the following 
symptoms: The inflammation loses its redness, and becomes duskish or 
livid; the tension of the skin goes off, and it feels flabby; little 
bladders filled with ichor of different colour spread all over it; the 
tumour subsides, and from a duskish complexion becomes black; a quick low 
pulse, with cold clammy sweats, are the immediate forerunners of death.

WHEN these symptoms first appear the part ought to be dressed with London 
treacle, or a cataplasm made of lixivium and bran; should the symptoms 
become worse, the part must be scarified, and afterwards dressed with 
basilicum softened with oil of turpentine. All the dressings must be 
applied warm. With regard to internal medicines, the patient must be 
supported with generous cordials, and the Pervian bark exhibited in as 
large doses as the stomach will bear it. If the mortified parts should 
separate, the wound will become a common ulcer, and must be treated 
accordingly.

THIS article includes the treatment of all those diseases, which, in 
different parts of the country, go by the names of biles, imposthumes, 
whitloes, &c. They are all abscesses in consequence of a previous 
inflammation, which, if possible, ought to be discussed; but when this 
cannot be done, the suppuration should be promoted, and the matter 
discharged by an incision, if necessary; afterwards the sore may be 
dressed with yellow basilicum, or some other digestive ointment.


OF WOUNDS.

NO part of medicine has been more mistaken than the treatment or cure of 
wounds. Mankind in general believe that certain herbs, ointments, and 
plasters are possessed of wonderful healing powers, and imagine that no 
wound can be cured without the application of them. It is however a fact, 
that no external application whatever contributes towards the cure of a 
wound, any other way than by keeping the parts soft, clean, and defending 
them from the external air, which may be as effectually done by dry lint, 
as by the most pompous applications, while it is exempt from many of the 
bad consequences attending them.

THE same observations hold with respect to internal applications. These 
only promote the cure of wounds as far as they tend to prevent a fever, or 
to remove any cause that might obstruct or impede the operations of 
Nature. It is Nature alone that cures wounds; all that Art can do is to 
remove obstacles, and to put the parts in such a condition as is the most 
favourable to Nature's efforts.

WITH this simple view, we shall consider the treatment of wounds, and 
endeavour to point out such steps as ought to be taken to facilitate their 
care.

THE first thing to be done when a person has received a wound, is to 
examine whether any foreign body be lodged in it, as wood, stone, iron, 
lead, glass, dirt, bits of cloth, or the like. These, if possible, ought 
to be extracted, and the wound cleaned, before any dressings be applied. 
When that cannot be effected with safety, on account of the patient's 
weakness, or loss of blood, they must be suffered to remain in the wound, 
and afterwards extracted when he is more able to bear it.

WHEN a wound penetrates into any of the cavities of the body, as the 
breast, the bowels, &c. or where any considerable blood-vessel is cut, a 
skilful surgeon ought immediately to be called, otherwise the patient may 
lose his life. But sometimes the discharge of blood is so great, that if 
it be not stopt, the patient may die even before a surgeon, though at no 
great distance, can arrive. In this case, something must be be done by 
those who are present. If the wound be in any of the limbs, the bleeding 
may generally be stopt by applying a tight ligature or bandage round the 
member a little above the wound. The best method of doing this is to put a 
strong broad garter round the part, but so slack as easily to admit a 
small piece of stick to be put under it, which must be twisted, in the 
same as a countryman does a cart-rope to secure his loading, till the 
bleeding stops. Whenever this is the case, he must take care to twist it 
no longer, as straining it too much might occasion an inflammation of the 
parts, and endanger a gangrene.

IN parts where this bandage cannot be applied, various other methods may 
be tried to stop the bleeding, as the application of styptics, 
astringents, &c. Cloths dipped in a solution of blue vitriol in water, or 
the styptic water of the Dispensatories, may be applied to the wound. When 
these cannot be obtained, strong spirits of wine may be used. Some 
recommend the Agaric of the oak as preferable to any of the other 
styptics; and indeed it deserves considerable encomiums. It is easily 
obtained, and ought to be kept in every family, in case of accidents. A 
piece of it must be laid upon the wound, and covered with a good deal of 
lint, above which a bandage may be applied so tight as to keep it firmly 
on.

DR. TISSOT, in his Advice to the People, gives the following directions 
for gathering, preparing, and applying the agaric. - "Gather in autumn, 
says he, while the fine weather lasts, the agaric of the oak, which is a 
kind of fungus or excresence issuing from the wood of that tree. It 
consists at first of four parts, which present themselves successively: 1. 
The outward rind or skin, which may be thrown away. 2. The part 
immediately under this rind, which is the best of all. This is to be beat 
well with a hammer, till it become soft and very pliable. This is the only 
preparation it requires, and a slice of it of a proper size is to be 
applied directly over the bursting open blood-vessels. It constringes and 
brings them close together, stops the bleeding, and generally falls off at 
the end of two days. 3. The third part adhering to the second may serve to 
stop the bleeding from the smaller vessels; and the fourth and last part 
may be reduced to powder as conducing to the same purpose - Where the 
agaric cannot be had, sponge may be used in its stead. It must be applied 
in the same manner, and has nearly the same effects.

THOUGH spirits, tinctures, and hot balsams may be used, in order to stop 
the bleeding when it is excessive, they are improper at other times. They 
do not promote but retard the cure, and often change a simple wound into 
an ulcer. People imagine, because hot balsams congeal the blood, and seem, 
as it were, to solder up the wound, that they therefore heal it; but this 
is only a deception. They may indeed stop the flowing blood, by searing 
the mouths of the vessels; but, by rendering the parts callous, they 
obstruct the cure.

IN slight wounds, which do not penetrate much deeper than the skin, the 
best application is a bit of the common black sticking plaster. This keeps 
the sides of the wound together, and prevents the air from hurting it, 
which is all that is necessary. When a wound penetrates deep, it is not 
safe to keep its lips quite close: this keeps in the matter, and is apt to 
make the wound fester. In this case the best way is to fill the wound with 
soft lint, commonly called caddis. It however must not be stuffed in too 
hard, otherwise it will do hurt. The caddis may be covered with a cloth 
dipped in oil, or spread with the common wax plaster; See Appendix, Wax 
plaster; and the whole must be kept on by a proper bandage.

WE shall not spend time in describing the different bandages that may be 
proper for wounds in different parts of the body; common sense will 
generally suggest the most commodious method of applying a bandage; 
besides, descriptions of this kind are not easily understood or remembered.

THE first dressing ought to continue on for at least two days; after which 
it may be removed, and fresh lint applied as before. If any part of the 
first dressing sticks so close as not to be removed with ease or safety to 
the patient, it may be allowed to continue, and fresh lint dipped in sweet 
oil laid over it. This will soften it so as to make it come off easily at 
next dressing. Afterwards the wound may be dressed twice a-day in the same 
manner till it be quite healed. Those who are fond of salves or ointments, 
may, after the wound is become very superficial, dress it with the yellow 
basilicum; See Appendix, Yellow basilicum; and if fungus, or what is 
called proud flesh, should rise in the wound, it may be checked, by mixing 
with the ointment a little burnt alum or red precipitate of mercury.

WHEN a wound is greatly inflamed, the most proper application is a 
poultice of bread and milk, softened with a little sweet oil or fresh 
butter. This must be applied instead of a plaster, and should be changed 
twice a-day.

IF the wound be large, and there is reason to fear an inflammation, the 
patient should be kept on a very low diet. He must abstain from flesh, 
strong liquors, and every thing that is of a heating nature. If he be of a 
full habit, and has lost but little blood from the wound, he must be bled: 
and, if the symptoms be urgent, the operation may be repeated. But when 
the patient has been greatly weakened by loss of blood from the wound, it 
will be dangerous to bleed him, even though a fever should ensue. Nature 
should never be too far exhausted. It is always more safe to allow her to 
struggle with the disease in her own way, than to sink the patient's 
strength by excessive evacuations.

WOUNDED persons ought to be kept perfectly quiet and easy. Every thing 
that ruffles the mind, or moves the passions, as love, anger, fear, 
excessive joy, &c. are very hurtful. They ought, above all things, to 
abstain from venery. The body should be kept gently open, either by 
laxative clysters, or by a cool vegetable diet, as roasted apples, stewed 
prunes, boiled spinnage, and such like.


OF BURNS.

IN slight burns which do not break the skin, it is customary to hold the 
part near the fire for a competent time, to rub it with salt, or to lay a 
compress upon it dipped in spirits of wine or brandy. But when the burn 
has penetrated so deep as to blister or break the skin, it must be dressed 
with some of the liniment for burns mentioned in the Appendix, or with the 
emollient and gently drying ointment, commonly called Turner's cerate; See 
Appendix, Turner's cerate. This may be mixed with an equal quantity of 
fresh olive oil, and spread upon a soft rag, and applied to the part 
affected. When this ointment cannot be had, an egg may be beat up with 
about an equal quantity of the sweetest salad oil. This will serve very 
well till a proper ointment can be prepared. When the burning is very 
deep, after the first two or three days, it should be dressed with equal 
parts of yellow basilicum, and Turner's cerate mixed together.

WHEN the burn is violent, or has occasioned a high degree of inflammation, 
and there is reason to fear a gangrene or mortification, the same means 
must be used to prevent it as are recommended in other violent 
inflammations. The patient, in this case, must live low, and drink freely 
of weak diluting liquors. He must likewise be bled, and have his body kept 
open. But if the burnt parts should become livid or black, with other 
symptoms of mortification, it will be necessary to bathe them frequently 
with warm camphorated spirits of wine, tincture of myrrh, or other 
antiseptics, mixed with a decoction of the bark. In this case the bark 
must likewise be taken internally, and the patient's diet must be more 
generous.

AS example teaches better than precept, I shall relate the treatment of 
the most dreadful case of this kind that has occurred in my practice. A 
middle-aged man, of a good constitution, fell into a large vessel full of 
boiling water, and miserably scalded about one half of his body. As his 
cloths were on the burning, in some parts, was very deep before they could 
be got off. For the first two days the scalded parts had been frequently 
anointed with a mixture of lime-water and oil, which is a very proper 
application for recent burnings. On the third day, when I first saw him, 
his fever was high and his body costive, for which he was bled, and had an 
emollient clyster administered; poultices of bread and milk softened with 
fresh butter, were likewise applied to the affected parts, to abate the 
heat and inflammation. His fever still continuing high, he was bled a 
second time, was kept strictly on the cooling regimen, took the saline 
mixture with small doses of nitre, and had an emollient clyster 
administered once a-day. When the inflammation began to abate, the parts 
were dressed with a digestive composed of brown cerate and yellow 
basilicum; where any black spots appeared they were slightly scarified, 
and touched with the tincture of myrrh; and to prevent their spreading, 
the Peruvian bark was administered. By this course, this man was so well 
in three weeks as to be able to attend his business.


OF BRUISES.

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 parts 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 manageing 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 but some 
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.


OF ULCERS.

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 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 fresh 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. Some times 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."

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 Wards 
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.



CHAPTER LI.
OF DISLOCATIONS.

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 if 
the injury be increased by too frequent an exertion of the parts, no 
wonder if they be found weak and diseased ever after.


DISLOCATION OF THE JAW.

THE lower jaw may be luxated by yawning, blows, falls, chewing hard 
substanees, or the like. It is easily known from the patient's being 
unable to shut his mouth, or eat anything, 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.


DISLOCATION OF THE NECK.

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.


DISLOCATION OF THE RIBS.

As the articulation of the ribs with the back-bone 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 
upon 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.


DISLOCATION OF THE SHOULDER.

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 extention is made, he lifts up the 
head of the bone, and with his hand 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 extention, the arm ought aways to 
be a little bent.


DISLOCATION OF THE ELBOW.

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 ncessary 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.


DISLOCATION OF THE THIGH.

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 usally 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 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.



CHAPTER LII.
OF BROKEN BONES, &c.

THERE is, in most country villlages, 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 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. Various pieces of machinery 
have been contrived for counteracting the force of the muscles, and 
retaining the fragments of broken bones; but as descriptions of these 
without drawings would be of little use, I shall refer the reader to a 
cheap and useful performance on the nature and cure of fractures, lately 
published by my ingenious friend Mr. Aitken, surgeon in Edinburgh; wherein 
that gentleman has not only given an account of the machines recommended 
in fractures by former authors, but has likewise added several 
improvements of his own, which are peculiarly useful in compound 
fractures, and in cases where patients with broken bones are obliged to be 
transported from one place to another.

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 laid 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 a great many 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 oxyerate, or a 
mixture of vinegar and water. The bandages should be wet with this at 
every dressing.


OF STRAINS.

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 afffected 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. A great many external 
applications are recommended for strains, some of which do good, and 
others hurt. The following are such as may be used with the greatest 
safety, viz. poultices made of stale beer or vinegar and oatmeal, 
camphorated spirits of wine, Mindererus's spirit, volatile liniment, 
volatile aromatic spirit diluted with a double quantity of water, and the 
common fomentation, with the addition of brandy or spirit of wine.


OF RUPTURES.

CHILDREN and very 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 
possilble, be kept from crying, and from all violent motion, 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 a little 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. I would here beg leave to recommend it to every practitioner, 
when his patient complains of pain in the belly with obstinate 
costiveness, to examine the groins and every place where a rupture may 
happen, in order that it may be immediately reduced. By neglecting this, 
many perish who were not suspected to have had ruptures till after they 
were dead. I have known this to happen where half a dozen of the faculty 
were in attendance.

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.



CHAPTER LIII.
OF CASUALTIES.

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. This 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 superistition may be, we shall not pretend to 
enquire; 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 enquire 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.


OF SUBSTANCES STOPT BETWEEN THE MOUTH AND STOMACH.

THOUGH accidents of this kind are very common, and extremely dangrous, 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. A 
woman in one of the hospitals of this city lately discharged a great 
number of pins, which she had swallowed in the course of her business, 
through an ulcer in her side.

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 not 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 conducting 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 some times 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 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 conducted 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 twisted, as to be moved every way, 
which must in many cases be a considerable advantage.

ANOTHER material employed on these unhappy occasions, 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 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 a 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 
inflammnation, 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 can not, 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.


OF DROWNED PERSONS.

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 attended 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 exhitbiting 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 cloths, 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 windpipe 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 his 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, sufflocation, 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.


OF NOXIOUS VAPOURS.

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 stink 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.


EFFECTS OF EXTREME COLD.

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 appoplexy; 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 be 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 if. 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.


EFFECTS OF EXTREME HEAT.

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.