2530 



THE MODERN SYSTEM 



stance of recovery seldom occurs where the 

 treatment has been delayed beyond the second 

 day : indeed it often destroys in twenty-four 

 hours. Bleeding is the first indication, and if 

 the subject be young, large, and plethoric, six 

 or seven quarts may be safely taken away ; 

 and should the symptoms continue unabated, 

 the same may be repeated in four hours, to 

 the amount of four or five quarts more ; nor 

 should even a third lesser bleeding be omit- 

 ted at tlie same distance of time, if the 

 inflammatory appearances have not become 

 mitigated. The bleeding may be known to 

 have a salutary effect by the pulse becoming 

 softer and fuller, particularly if it shew a dis- 

 position to rise as the blood flows. Here also 

 it is proper that the blood be abstracted 

 quickly, and from a large orifice. 



As soon as the first bleeding is over, pro- 

 ceed to back-rake, to remove any hardened 

 dung that may obstruct the passage, and 

 which if suffered to remain, would infallibly 

 aggravate the complaint, and which indeed, 

 in many instances, is the cause of it. The dis- 

 tressing stranguary that sometimes accom- 

 panies inflammation of the bowels, is also 

 frequently as much produced by the pressure 

 of hardened excrement. 



It is not the dropping away of a few balls 

 of hardened dung, nor the passage of some thin 

 glairy matter, which shews that no obstruc- 

 tion exists ; on the contrary, when these are 

 present, a most obstinate costiveness may yet 

 remain farther up in the passage ; and a flow 

 of thin faeces may escape by a groove, formed 

 by the side of an obstructing portion of dung, 

 as has happened. Unless, therefore, there be 

 an evident free passage to all the faecal matter, 

 and that the excrement be wholly softened, it 

 is always proper to rake ; for it must not be 



lost sight of, that whether as a consequence 

 or a cause, constipation aggravates the dis- 

 ease, and is always present. 



Neither does amendment, seldom, if ever 

 take place, until that be removed. It is 

 always of consequence to bear in mind, that 

 as the state of the bowels is such as not to 

 render it prudent to allow of strong purga- 

 tives being given by the mouth ; so the greater 

 activity is required to empty them mechani- 

 cally, and by the assistance of clysters, which 

 should be thrown up very frequently. The 

 next indication is to raise a brisk external 

 inflammation over the belly, to lessen thereby 

 the internal affection, and in this case, even 

 the cantharides are hardly quick enough in 

 their action ; but a more speedy determination 

 to the skin may be made, by first fomenting 

 the belly with hot water for a quarter of an 

 hour, and then by applying a large mustard 

 poultice, farther liquefied with oil of turpen- 

 tine, or with the liquid blister {see list of 

 medicines), which may be spread on coarse 

 linen, or a horse-cloth ; or what is preferable, 

 the fleshy side of a newly stripped sheep skin 

 may be covered with it, and then applied 

 close to the belly by means of flannel rollers 

 which will retain it in its situation. When 

 this has remained on for three or four hours, 

 if an evident abatement of symptoms have not 

 taken place, proceed to blister in the usual 

 way. It next becomes a consideration as to 

 what remedies may be given by the mouth, 

 which must greatly depend on the degree of 

 costiveness present. In a case where the ob- 

 struction did not appear obstinate, I should 

 recommend that castor and linseed oils be 

 given united, six or eight ounces of each, 

 shaken together, with a little gruel. When 

 the bowels are more closely constringed. 



