§ 441. The Balsams and vulnerary Plants, which have often been so highly celebrated for the Cure of Wounds, are very noxious, when taken inwardly; because the Introduction of them gives or heightens the Fever, which ought to have been abated.
Of Contusions, or Bruises.
§ 442. A Contusion, which is commonly called a Bruise, is the Effect of the forcible Impression or Stroke of a Substance not sharp or cutting, on the Body of a Man, or any Animal; whether such an Impression be violently made on the Man, as when he is struck by a Stick, or by a Stone thrown at him; or whether the Man be involuntarily forced against a Post, a Stone, or any hard Substance by a Fall; or whether, in short, he is squeezed and oppressed betwixt two hard Bodies, as when his Finger is squeezed betwixt the Door and the Door-Post, or the whole Body jammed in betwixt any Carriage and the Wall. These Bruises, however, are still more frequent in the Country than Wounds, and commonly more dangerous too; and indeed the more so, as we cannot judge so exactly, and so soon, of the whole Injury that has been incurred; and because all that is immediately visible of it is often but a small Part of the real Damage attending it: since it frequently happens that no Hurt appears for a few successive Days; nor does it become manifest, until it is too late to admit of an effectual Cure.
§ 443. It is but a few Weeks since a Cooper came to ask my Advice. His Manner of breathing, his Aspect, the Quickness, Smallness, and Irregularity of his Pulse, made me apprehensive at once, that some Matter was formed within his Breast. Nevertheless he still kept up, and went about, working also at some Part of his Trade. He had fallen in removing some Casks or Hogsheads; and the whole Weight of his Body had been violently impressed upon the right Side of his Breast. Notwithstanding this, he was sensible of no Hurt at first; but some Days afterwards he began to feel a dull heavy Pain in that Part, which continued and brought on a Difficulty of Breathing, Weakness, broken Sleep and Loss of Appetite. I ordered him immediately to Stillness and Repose, and I advised him to drink a Ptisan of Barley sweetened with Honey, in a plentiful Quantity. He regularly obeyed only the latter Part of my Directions: yet on meeting him a few Days after, he told me he was better. The very same Week, however, I was informed he had been found dead in his Bed. The Imposthume had undoubtedly broke, and suffocated him.
§ 444. A young Man, run away with by his Horse, was forced with Violence against a Stable-Door, without being sensible of any Damage at the Time. But at the Expiration of twelve Days, he found himself attacked by some such Complaints, as generally occur at the Beginning of a Fever. This Fever was mistaken for a putrid one, and he was very improperly treated, for the Fever it really was, above a Month. In short, it was agreed at a Consultation, that Matter was collected in the Breast. In Consequence of this, he was more properly attended, and at length happily cured by the Operation for an Empyema, after languishing a whole Year. I have published these two Instances, to demonstrate the great Danger of neglecting violent Strokes or Bruises; since the first of these Patients might have escaped Death; and the second a tedious and afflicting Disorder, if they had taken, immediately after each Accident, the necessary Precautions against its Consequences.
§ 445. Whenever any Part is bruised, one of two Things always ensues, and commonly both happen together; especially if the Contusion is pretty considerable: Either the small Blood-vessels of the contused Part are broken, and the Blood they contained is spread about in the adjoining Parts; or else, without such an Effusion of it, these Vessels have lost their Tone, their active Force, and no longer contributing to the Circulation, their Contents stagnate. In each of these Cases, if Nature, either without or with the Assistance of Art, does not remove the Impediment, an Inflammation comes on, attended with an imperfect, unkindly Suppuration, with Putrefaction and a Gangrene; without mentioning the Symptoms that arise from the Contusion of some particular Substance, as a Nerve, a large Vessel, a Bone, &c. Hence we may also conceive the Danger of a Contusion, happening to any inward Part, from which the Blood is either internally effused, or the Circulation wholly obstructed in some vital Organ. This is the Cause of the sudden Death of Persons after a violent Fall; or of those who have received the violent Force of heavy descending Bodies on their Heads; or of some violent Strokes, without any evident external Hurt or Mark.
There have been many Instances of sudden Deaths after one Blow on the Pit of the Stomach, which has occasioned a Rupture of the Spleen.
It is in Consequence of Falls occasioning a general slight Contusion, as well internal as external, that they are sometimes attended with such grievous Consequences, especially in old Men, where Nature, already enfeebled, is less able to redress such Disorders. And thus in Fact has it been, that many such, who had before enjoyed a firm State of Health, have immediately lost it after a Fall (which seemed at first to have affected them little or not at all) and languished soon after to the Moment of their Death, which such Accidents very generally accelerate.
§ 446. Different external and internal Remedies are applicable in Contusions. When the Accident has occurred in a slight Degree, and there has been no great nor general Shock, which might produce an internal Soreness or Contusion, external Applications may be sufficient. They should consist of such Things as are adapted, first, to attenuate and resolve the effused and stagnant Blood, which shews itself so apparently; and which, from its manifest Blackness very soon after the Contusion, becomes successively brown, yellow, and greyish, in Proportions as the Magnitude of the Suffusion or Sealing decreases, till at last it disappears entirely, and the Skin recovers its Colour, without the Blood's having been discharged through the external Surface, as it has been insensibly and gradually dissolved, and been taken in again by the Vessels: And secondly, the Medicines should be such as are qualified to restore the Tone, and to recover the Strength of the affected Vessels.
The best Application is Vinegar, diluted, if very sharp, with twice as much warm Water; in which Mixture Folds of Linnen are to be dipt, within which the contused Parts are to be involved; and these Folds are to be remoistened and re-applied every two Hours on the first Day.