CHAPTER XVI.

INFLAMMATION OF THE STOMACH AND OTHER VISCERA.

ALL inflammations of the bowels are dangerous, and require the most speedy assistance, as they frequently end in a suppuration, and sometimes in a mortification, which is certain death.

CAUSES.—An inflammation of the stomach may proceed from any of the causes which produce an inflammatory fever; as cold liquor drank while the body is warm, obstructed perspiration, or the sudden striking in of any eruption. It may likewise proceed from the acrimony of the bile, or from acrid and stimulating substances taken into the stomach; as strong vomits or purges, corrosive poisons, and such like. When the gout has been expelled from the extremities, either by cold or improper applications, it often occasions an inflammation of the stomach.

SYMPTOMS.—It is attended with a fixed pain and burning heat in the stomach; great restlessness and anxiety; a small, quick, and hard pulse; vomiting, or at least a nausea and sickness; excessive thirst; coldness of the extremities; difficulty of breathing; cold clammy sweats; and sometimes convulsions and fainting fits. The stomach is swelled, and often feels hard to the touch. One of the most certain signs of this disease is, the sense of pain which the patient feels upon taking any kind of food or drink, especially if it be either too hot or too cold.

When the patient vomits every thing he eats or drinks, is extremely restless, has a hiccup, with an intermitting pulse, and frequent fainting fits, the danger is very great.

REGIMEN.—All acrimonious, heating, and irritating food and drink are carefully to be avoided. The weakness of the patient may deceive the by-standers, and induce them to give him wines, spirits, or other cordials; but these never fail to increase the disease, and often occasion sudden death. The inclination to vomit may likewise impose on the attendants, and make them think a vomit necessary; but that too is almost certain death.

The food must be light, thin, cool, and easy of digestion. It must be given in small quantities, and should neither be quite cold nor too hot. Thin gruel made of barley or oatmeal, light toasted bread dissolved in boiling water, or very weak chicken-broth, are the most proper. The drink should be clear whey, barley-water, water in which toasted bread has been boiled, or decoctions of emollient vegetables, as liquorice and marsh-mallow roots, sarsaparilla, &c.

MEDICINE.—Bleeding in this disease is absolutely necessary, and is almost the only thing that can be depended on. When the disease proves obstinate, it will often be proper to repeat this operation several times, nor must the low state of the pulse deter us from doing so. The pulse, indeed, generally rises upon bleeding, and so long as that is the case the operation is safe.

Frequent fomentations with luke-warm water, or a decoction of emollient vegetables, are likewise beneficial. Flannel cloths dipped in these must be applied to the region of the stomach, and removed as they grow cool. They must neither be applied too warm, nor be suffered to continue till they become quite cold, as either of these extremes would aggravate the disease.

The feet and legs ought likewise to be frequently bathed in luke-warm water, and warm bricks or poultices may be applied to the soles of the feet. The warm bath, if it can be conveniently used, will be of great service.

In this, and all other inflammations of the bowels, an epispastic, or blistering-plaster, applied over the part affected, is one of the best remedies I know. I have often used it, and do not recollect one instance wherein it did not give relief to the patient.

The only internal medicines which we shall venture to recommend in this disease, are mild clysters. These may be made of warm water, or thin water-gruel; and if the patient be costive, a little sweet oil, honey, or manna, may be added. Clysters answer the purpose of internal fomentation, while they keep the body open, and at the same time nourish the patient, who is often, in this disease, unable to retain any food upon his stomach. For these reasons they must not be neglected, as the patient’s life may depend on them.

OF THE COLIC.

Colics are variously denominated according to their causes, as the flatulent, the bilious, the hysteric, the nervous, &c. As each of these requires a particular method of treatment, we shall point out their most general symptoms, and the means to be used for their relief.

The flatulent, or wind-colic, is generally occasioned by an indiscreet use of unripe fruits, meats of hard digestion, windy vegetables, fermenting liquors, and such like. It may likewise proceed from an obstructed perspiration, or catching cold. Delicate people, whose digestive powers are weak, are most liable to this kind of colic.

The flatulent colic may either affect the stomach or intestines. It is attended with a painful stretching of the affected part. The patient feels a rumbling in his bowels, and is generally relieved by a discharge of wind, either upwards or downwards. The pain is seldom confined in any particular part, as the vapour wanders from one division of the bowels to another, till it finds a vent.

When the disease proceeds from windy liquor, green fruits, sour herbs, or the like, the best medicine on the first appearance of the symptoms is a dram of brandy, gin, or any good spirits. The patient should likewise sit with his feet upon a warm hearth-stone, or apply warm bricks to them; and warm cloths may be applied to his stomach and bowels.

This is the only colic wherein ardent spirits, spice, or any thing of a hot nature, may be ventured upon. Nor indeed are they to be used here unless at the very beginning, before any symptoms of inflammation appear. We have reason to believe that the colic occasioned by wind or flatulent food might always be cured by spirits and warms liquors, if they are taken immediately upon perceiving the first uneasiness; but when the pain has continued for a considerable time, and there is reason to fear an inflammation of the bowels has already begun, all hot things are to be avoided as poison.

Several kinds of food, as honey, eggs, &c. occasion colics in some particular constitutions. I have generally found the best method of cure for these was, to drink plentifully of small diluting liquors, as water-gruel, small posset, toast and water, &c.

Colics, which proceed from excess and indigestion, generally cure themselves by occasioning vomiting or purging. These discharges are by no means to be stopped, but promoted by drinking plentifully of warm water or weak posset. When their violence is over, the patient may take a dose of rhubarb, or any other gentle purge, to carry off the dregs of his debauch.

Colics, which are occasioned by wet feet, or catching cold, may generally be removed at the beginning, by bathing the feet and legs in warm water, and drinking such warm diluting liquors as will promote the perspiration, as weak wine-whey, or water gruel, with a small quantity of spirits in it.

Those flatulent colics which prevail so much among country people, might generally be prevented were they careful to change their clothes when they get wet. They ought likewise to take a dram, or to drink some warm liquor after eating any kind of green trash. We do not mean to recommend the practice of dram-drinking, but in this case ardent spirits prove a real medicine, and indeed the best that can be administered. A glass of good peppermint-water will have nearly the same effect as a glass of brandy, and in some cases is rather to be preferred.

The bilious colic is attended with very acute pains about the region of the navel. The patient complains of great thirst, and is generally costive. He vomits a hot, bitter, yellow coloured bile, which being discharged seems to afford some relief, but is quickly followed by the same violent pain as before. As the distemper advances, the propensity to vomit sometimes increases so as to become almost continual, and the proper motion of the intestines is so far perverted, that there are all the symptoms of an impending iliac passion.

If the patient be young and strong, and the pulse full and frequent, it will be proper to bleed, after which clysters may be administered. Clear whey or gruel, sharpened with juice of lemon, or cream of tartar, must be drank freely; small chicken-broth, with a little manna dissolved in it, or a slight decoction of tamarinds, are likewise very proper, or any other thin, acid, opening liquor.

Besides bleeding and plentiful dilution, it will be necessary to foment the belly with cloths dipped in warm water; and if this should not succeed, the patient must be immersed up to the breast in warm water.

In the bilious colic the vomiting is often very difficult to restrain. When this happens, the patient may drink a decoction of toasted bread, or an infusion of garden mint in boiling water. Should these not have the desired effect, the same draught, with a few drops of laudanum in it, may be given and repeated according to the urgency of the symptoms. A small quantity of Venice treacle may be spread in the form of a cataplasm, and applied to the pit of the stomach. Clysters, with a proper quantity of Venice treacle or liquid laudanum in them, may likewise be frequently administered.

The hysteric colic bears a great resemblance to the bilious. It is attended with acute pains about the region of the stomach, vomiting, &c. What the patient vomits in this case is commonly of a greenish colour. There is a great sinking of the spirits, with dejection of mind and difficulty of breathing, which are the characteristic symptoms of this disorder. Sometimes it is accompanied with the jaundice, but this generally goes off of its own accord in a few days.

In this colic, all evacuations, as bleeding, purging, vomiting, &c. do hurt. Every thing that weakens the patient, or sinks the spirits, is to be avoided. If, however, the vomiting should prove violent, lukewarm water, or small posset, may be drank to cleanse the stomach. Afterwards the patient may take fifteen, twenty, or twenty-five, drops of liquid laudanum in a glass of cinnamon-water: this may be repeated every ten or twelve hours till the symptoms abate. The patient may likewise take four or five of the fetid pills every six hours, and drink a cup of penny-royal tea after them. If asafœtida should prove disagreeable, which is sometimes the case, a tea-spoonful of the tincture of castor in a cup of penny-royal tea, or thirty or forty drops of the balsam of Peru dropped upon a bit of loaf-sugar, may be taken in its stead.

INFLAMMATION OF THE KIDNEYS.

SYMPTOMS.—There is a sharp pain about the region of the kidneys, with some degree of fever, and a stupor or dull pain in the thigh of the affected side. The urine is at first clear, and afterwards of a reddish colour; but in the worst kind of the disease it generally continues pale, is passed with difficulty, and commonly in small quantities at a time. The patient feels great uneasiness when he endeavours to walk or sit upright. He lies with more ease on the affected side, and has generally a nausea or vomiting, resembling that which happens in the colic.

This disease, however, may be distinguished from the colic by the pain being seated farther back, and by the difficulty of passing urine, with which it is constantly attended.

REGIMEN.—Every thing of a heating or stimulating nature is to be avoided. The food must be thin and light; as panado, small broths, with mild vegetables, and the like. Emollient and thin liquors must be plentifully drank; as clear whey, or balm-tea sweetened with honey, decoctions of marsh-mallow roots, with barley and liquorice, &c. The patient, notwithstanding the vomiting, must constantly keep sipping small quantities of these or other diluting liquors. Nothing so safely and certainly abates the inflammation, and expels the obstructing cause, as copious dilution. The patient must be kept easy, quiet, and free from cold, as long as any symptoms of inflammation remain.

MEDICINE.—Bleeding is generally necessary, especially at the beginning. Ten or twelve ounces may be let from the arm or foot with a lancet; and if the pain and inflammation continue, the operation may be repeated in twenty-four hours, especially if the patient be of a full habit. Leeches may likewise be applied to the hæmorrhoidal veins, as a discharge from these will greatly relieve the patient.

Cloths dipped in warm water, or bladders filled with it, must be applied as near as possible to the part affected, and renewed as they grow cool. If the bladders be filled with a decoction of mallows and camomile-flowers, to which a little saffron is added, and mixed with about a third part of new milk, it will be still more beneficial.

Emollient clysters ought frequently to be administered; and if these do not open the body, a little salt and honey or manna may be added to them.

The same course is to be followed where gravel or stone is lodged in the kidneys; but when the gravel or stone is separated from the kidney, and lodges in the ureter, it will be proper, besides the fomentations, to rub the small of the back with sweet-oil, and to give gentle diuretics; as juniper-water sweetened with the syrup of marsh-mallows; a tea-spoonful of the sweet spirits of nitre, with a few drops of laudanum, may now and then be put in a cup of the patient’s drink; he ought likewise to take exercise on horseback, or in a carriage, if he be able to bear it.

When the disease is protracted beyond the seventh or eighth day, and the patient complains of a stupor and heaviness of the part, has frequent returns of chilliness, shivering, &c. there is reason to suspect that matter is forming in the kidney, and that an abscess will ensue.

When matter in the urine shows that an ulcer is already formed in the kidney, the patient must be careful to abstain from all acid, sour, and salted provisions, and to live chiefly upon mild mucilaginous herbs and fruits, together with the broth of young animals, made with barley and common pot-herbs, &c. His drink may be whey, and butter-milk that is not sour. The latter is by some reckoned a specific remedy in ulcers of the kidneys. To answer this character, however, it must be drank for a considerable time. Chalybeate waters have likewise been beneficial in this disease.

Those who are liable to frequent returns of inflammation, or obstructions of the kidneys, must abstain from wines, especially such as abound with tartar; and their food ought to be light and easy of digestion. They should use moderate exercise, not lie too hot, nor too much on their back.

INFLAMMATION OF THE BLADDER.

THE inflammation of the bladder proceeds in a great measure from the same causes as that of the kidneys. It is known by an acute pain towards the bottom of the belly, and difficulty of passing urine, with some degree of fever, a constant inclination to go to stool, and a perpetual desire to make water.

This disease must be treated on the same principles as the one immediately preceding. The diet must be light and thin, and the drink of a cooling nature. Bleeding is very proper at the beginning, and in robust constitutions it will often be necessary to repeat it. The lower part of the belly should be fomented with warm water, or a decoction of mild vegetables; and emollient clysters ought frequently to be administered, &c.

The patient should abstain from every thing that is of a hot, acrid, and stimulating quality; and should live entirely upon small broths, gruels, or mild vegetables.

A stoppage of urine may proceed from other causes besides an inflammation of the bladder; as a swelling of the hemorrhoidal veins; hard fæces lodged in the rectum; a stone in the bladder; excrescences in the urinary passages; a palsy of the bladder, hysteric affections, &c. Each of these requires particular treatment, which does not fall under our present consideration. We shall only observe, that in all of them mild and gentle applications are the safest, as strong diuretic medicines, or things of an irritating nature, generally increase the danger.

INFLAMMATION OF THE LIVER.

THE liver is less subject to inflammation than most of the other viscera, as in it the circulation is slower; but when an inflammation does happen, it is with difficulty removed, and often ends in a suppuration or scirrhus.

CAUSES.—Besides the common causes of inflammation, we may here reckon the following, viz. excessive fatness, a scirrhus of the liver itself, violent shocks from strong vomits when the liver was before unsound, an adust, or atrabilious state of the blood, any thing that suddenly cools the liver after it has been gently heated, stones obstructing the course of the bile, drinking strong wine and spirituous liquors, using hot spicy aliment, obstinate hypochondriacal affections, &c.

SYMPTOMS.—This disease is known by a painful tension of the right side under the false ribs, attended with some degree of fever, a sense of weight or fulness of the part, difficulty of breathing, loathing of food, great thirst, with a pale or yellowish colour of the skin and eyes.

The symptoms here are various, according to the degree of inflammation, and likewise according to the particular part of the liver where the inflammation happens. Sometimes the pain is so inconsiderable, that an inflammation is not so much as suspected; but when it happens in the upper or convex part of the liver, the pain is more acute, the pulse quicker, and the patient is often troubled with a dry cough, a hiccup, and a pain extending to the shoulder, with difficulty of lying on the left side, &c.

This disease may be distinguished from the pleurisy by the pain being less violent, seated under the false ribs, the pulse not so hard, and by the difficulty of lying on the left side. It may be distinguished from the hysteric and hypochondriacal disorders by the degree of fever with which it is always attended.

This disease, if properly treated, is seldom mortal. A constant hiccuping, violent fever, and excessive thirst, are bad symptoms. If it ends in a suppuration, and the matter cannot be discharged outwardly, the danger is great. When the scirrhus of the liver ensues, the patient, if he observes a proper regimen, may nevertheless live a number of years tolerably easy; but if he indulge in strong animal food and strong liquors, or take medicines of an acrid or irritating nature, the scirrhus will be converted into a cancer, which must infallibly prove fatal.

REGIMEN.—The same regimen is to be observed in this as in other inflammatory disorders. All hot things are to be carefully avoided; and cool diluting liquors, as whey, barley-water, &c. drank freely. The food must be light and thin, and the body, as well as the mind, kept easy and quiet.

MEDICINE.—Bleeding is proper at the beginning of this disease, and it will often be necessary, even though the pulse should not feel hard, to repeat it. All violent purgatives are to be avoided; the body, however, must be kept gently open. A decoction of tamarinds, with a little honey or manna, will answer this purpose very well. The side affected must be fomented in the manner directed in the foregoing diseases. Mild laxative clysters should be frequently administered, and if the pain should notwithstanding continue violent, a blistering-plaster may be applied over the part affected.

Medicines which promote the secretion of urine have a very good effect here. For this purpose, half a drachm of purified nitre, or a tea-spoonful of the sweet spirits of nitre, may be taken in a cup of the patient’s drink three or four times a-day.

When there is an inclination to sweat, it ought to be promoted, but not by warm sudorifics. The only thing to be used for that purpose is plenty of diluting liquor drank about the warmth of the human blood. Indeed the patient in this case, as well as in all the other topical inflammations, ought to drink nothing that is colder than the blood.

If the stools should be loose, and even streaked with blood, no means must be used to stop them, unless they be so frequent as to weaken the patient. Loose stools often prove critical, and carry off the disease.

If an abscess or imposthume is formed in the liver, all methods should be tried to make it break and discharge itself outwardly, as fomentations, the application of poultices, ripening cataplasms, &c. Sometimes indeed the matter of an abscess comes away in the urine, and sometimes it is discharged by stool; but these are efforts of Nature which no means can promote. When the abscess bursts into the cavity of the abdomen at large, death must ensue; nor will the event be more favourable when the abscess is opened by an incision, unless in cases where the liver adheres to the peritonæum, so as to form a bag for the matter, and prevent it from falling into the cavity of the abdomen; in which case opening the abscess by a sufficiently large incision, will probably save the patient’s life.^*

If the disorder, in spite of all endeavours to the contrary, should end in a scirrhus, the patient must be careful to regulate his diet, &c. in such a manner as not to aggravate the disease. He must not indulge in flesh, fish, strong liquors, or any highly seasoned or salted provisions; but should, for the most part, live on mild vegetables, as fruits and roots, taking gentle exercise, and drinking whey, barley-water, or buttermilk.

* I know a gentleman who had several abscesses of the liver opened, and is now a strong and healthy man, though above eighty years of age.