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[[120]].
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 butter-milk. If he takes any thing stronger, it should be fine mild ale, which is less heating than wines or spirits.
We shall take no notice of inflammations of the other viscera. They must in general be treated upon the same principles as those already mentioned. The chief rule with respect to all of them, is to let blood, to avoid every thing that is strong, or of a heating nature, to apply warm fomentations to the part affected, and to cause the patient to drink a sufficient quantity of warm diluting liquors.
CHAP. XXXI.
OF THE CHOLERA MORBUS, AND OTHER EXCESSIVE DISCHARGES FROM THE STOMACH AND BOWELS.
The cholera morbus is a violent purging and vomiting, attended with gripes, sickness, and a constant desire to go to stool. It comes on suddenly, and is most common in autumn. There is hardly any disease that kills more quickly than this, when proper means are not used in due time for removing it.
CAUSES.——It is occasioned by a redundancy and putrid acrimony of the bile; cold; food that easily turns rancid or sour on the stomach; as butter, bacon, sweetmeats, cucumbers, melons, cherries, and other cold fruits[[121]]. It is sometimes the effect of strong acrid purges or vomits, or of poisonous substances taken into the stomach. It may likewise proceed from violent passions or affections of the mind; as fear, anger, &c.
SYMPTOMS.——It is generally preceded by a cardialgia, or heart-burn, sour belchings, and flatulencies, with pain of the stomach and intestines. To these succeed excessive vomiting, and purging of green, yellow, or blackish-coloured bile, with a distension of the stomach, and violent griping pains. There is likewise a great thirst, with a very quick unequal pulse, and often a fixed acute pain about the region of the navel. As the disease advances, the pulse often sinks low as to become quite imperceptible, the extremities grow cold, or cramped, and are often covered with a clammy sweat, the urine is obstructed, and there is a palpitation of the heart. Violent hiccuping, fainting, and convulsions, are the signs of approaching death.
MEDICINE.——At the beginning of this disease the efforts of Nature to expel the offending cause should be assisted, by promoting the purging and vomiting. For this purpose the patient must drink freely of diluting liquors; as whey, butter-milk, warm water, thin water-gruel, small posset, or, what is perhaps preferable to any of them, very weak chicken broth. This should not only be drank plentifully to promote the vomiting, but a clyster of it given every hour in order to promote the purging.
After these evacuations have been continued for some time, a decoction of toasted oat-bread may be drank to stop the vomiting. The bread should be toasted till it is of a brown colour, and afterwards boiled in spring water. If oat-bread cannot be had, wheat-bread, or oatmeal well toasted, may be used in its stead. If this does not put a stop to the vomiting, two table-spoonfuls of the saline julep, with ten drops of laudanum, may be taken every hour till it ceases.