When the Pain and Fever were gone, we then gave a gentle Vomit in the Evening, and next Day a Dose of Rhubarb; and afterwards so much of the pilulæ saponaceæ cum rheo daily as kept the Body open; or the saline Draughts with five or six Grains of Rhubarb in each, or such a Quantity as answered the same Purpose as the Pills; and from Time to Time repeated the Emetic[93] and Purge.
Most of the icteric Cases we had, which were not complicated with other Disorders, yielded to the above Treatment in about twelve or fourteen Days. Two or three remained obstinate for a longer Time. To one I ordered a Quart of the pectoral Decoction, made with Parsly Roots instead of the Linseed, to be drunk daily along with the Soap Pills; and the Jaundice disappeared in about eight or ten Days. One who had the Disease more obstinate than the rest, and complained for some Time of a Tension and Uneasiness about the Liver, was ordered to have the right Side fomented Morning and Evening, and to rub it for some Time after with the linimentum saponaceum and to drink the Decoction of Sarsaparilla after the Soap Pills; and by continuing this Course for about three Weeks, the Disorder went off[94].
The Hæmorrhage from the Nose commonly stopped soon. Where it was violent, we kept the Patient cool, and applied Cloths dipped in Vinegar and Water to the Nose.—In two Cases, one at Munster, the other at Bremen, the Patients were hot and feverish, and a Vein was opened, and eight or ten Ounces of Blood taken away; and in one Case nothing took Effect till we gave repeated Doses of the tinctura saturnina in a common acid Julep.
FOOTNOTES:
[89] Obstructions and Scirrhi of the Liver have been assigned as the Cause of the Jaundice; but as we have so many Cases of this Kind related where no Jaundice appeared, it is now much doubted, whether such Obstructions, which do not affect the Ducts, are capable of producing this Disorder.
[90] We have numerous Cases in Bonetus, and other physical Observations, where Calculi have been found in the Gall Bladder, and Ducts of People who have died of the Jaundice; and I have frequently found two, three, and sometimes twelve, fifteen, or twenty, such bilious Calculi in these Cavities.
[91] Viscid Mucus or Pituita, or viscid Bile, has been observed frequently to obstruct the Ducts. Dr. Coe says, sometimes icteric Patients discharge very thick Bile, almost as viscid as Bird-Lime. See his Treatise on biliary Concretions, chap. ii. where he has collected a great Number of icteric Cases, in which the Bile has been found quite viscid after Death.
[92] See the Case of a Jaundice in Bonetus’s Sepulchretum Anatomicum, tom. II. p. 326, where the Sides of the common biliary Duct were compressed by an Enlargement of the Glands about the vena portarum; and we sometimes meet with a Jaundice in pregnant Women which goes off after Delivery, and seems to have been caused by the Pressure of the Uterus and indurated Fœces in the Colon. Van Swieten says, he has seen this very frequently, vol. III. sect. 918, p. 95.
[93] Vomits are reckoned amongst the most efficacious Remedies in this Disorder, and I have often seen good Effects follow their Use.—Janet Crags, a Woman thirty Years of Age, was, on the 21st of December 1758 admitted into St. George’s Hospital for a Jaundice of some Months Continuance. Her Eyes and Skin were not of the common icteric Colour, but of a dark livid yellow, for which Reason both she and the Nurses termed her Disorder the Black Jaundice. She at first complained of a Difficulty of Breathing, and a Weight and Oppression about the Region of the Liver, for which she was blooded, took some Doses of Physick, and the Soap Pills with Rhubarb; but these produced no Change in her Complaints. On the 29th she had a Cough, and complained much of Sickness and Difficulty of Breathing, for which she was ordered a Vomit, and afterwards to take the Squill Draught Morning and Evening, which occasioned a Purging and Gripes. On the 5th of January 1759, the Looseness still continuing, I ordered her to leave off the Use of the Squill Draughts, and to take only some Rhubarb in an oily Draught every Night at Bed-Time. On the 8th, tho’ the Purging had increased, I did not chuse to check it, as I suspected it would prove a Crisis to the Disorder, and therefore only ordered her the Cordial Draughts and Wine to support her Strength. The Looseness continued till the 15th, when most of the icteric Symptoms were gone, and by the 30th they entirely disappeared. However, she continued low, and subject to Flatulencies for some Months afterwards, which were at last removed by the continued Use of Cordials, gentle Bitters, a nourishing Diet, and repeated Doses of Rhubarb; and on the 2d of May she was discharged in a firm State of Health.