Plaid

“ When gloaming deepened into night, when the call of the wild drake resounded far beneath them, and the cry of the white owl fell on the ear, when the north star looked down on them with its bright, clear, kindly eye, then, spreading their blankets under the tents, and wrapping their plaids more closely around them, they committed themselves to Heaven’s protection, and sweetest dreamless slumber. ”

“ If heat, swelling, redness, or pain develop in a wound after a day or two, a doctor should be consulted; and not a minute should be lost if the patient has a chill or if red streaks appear extending from the wound in the general direction of the heart. Until the doctor comes the wounded part should be elevated and covered with cold applications wet in alcohol 25%, or in a solution of common salt, a teaspoonful to a pint of water.
Several points should be remembered in dressing wounds. In the first place the mouth, which [274] is full of germs, is not a good place for cut fingers. ”

“ The surgeon gazed, for a moment, on the black veil, as if to ascertain the expression of the features beneath it: its thickness, however, rendered such a result impossible.
‘You are ill,’ he said, gently, ‘although you do not know it. The fever which has enabled you to bear, without feeling it, the fatigue you have evidently undergone, is burning within you now. Put that to your lips,’ he continued, pouring out a glass of water—‘compose yourself for a few moments, and then tell me, as calmly as you can, what the disease of the patient is, and how long he has been ill. ”

“ The upper part of the body is covered with frequent spots and tumours, the redness gradually changes to black, the skin is thickened, and covered with hard asperities like scales; the body wastes, but the face, legs, and feet swell; and when the disease is protracted, the fingers and toes become buried in the swelling, and a slight fever comes on, which finishes the patient’s sufferings. Such is his description of the disease. His treatment consists in bleeding at the commencement, abstinence, then supporting the strength, purging, exercise, sudorifics, and friction. ”

“ Such persons as have frequent pains in the vertex and temples, without fever or loss of color, unless they have some other obvious deposit in the face, or speak in a rough tone, or have pain in the teeth, may be expected to have a hemorrhage from the nose. Those who have bleeding at the nose, although they may appear to be otherwise in good health, will be found to have enlarged spleen, or pain in the head, or flashes of light before their eyes. ”

“ When I touched the glands in the groin, they felt like walnuts under the skin, and it is, as I said, the presence of this obvious symptom which gives the plague its characteristic name of “bubonic,” from the Greek word for groin. After incision, the patient’s temperature often goes down rapidly, but, in any case, the pain from the glands is usually very great; indeed, I think it is the chief cause of such pain as the plague gives.
Next to heart failure, the commonest cause of death is lung complication after the crisis of fever is passed. ”

“ It is remarkable, that the dread of producing a dropsy by bleeding, is confined chiefly to its use in malignant fevers; for the men who urge this objection to it, do not hesitate to draw four or five quarts of blood in the cure of the pleurisy. The habitual association of the lancet with this disease, has often caused me to rejoice when I have heard a patient complain of a pain in his side, in a malignant fever. ”

“ Bleeding is forbidden, or should be used cautiously in that malignant state of fever, in which a weak morbid action, or what Dr. Darwin calls a tendency to inirritability, takes place in the blood-vessels. [346] It is known by a weak and frequent pulse, such as occurs in the typhus fever, and in the plague in warm climates. I have often met with it in the malignant sore throat, and occasionally in the pleurisy and yellow fever. The remedies here should be gentle vomits or purges, and afterwards cordials. Should the pulse be too much excited by them, bleeding may be used to reduce it. ”

“ MEDICINE.——Almost every person knows, when a fever is attended with a violent pain of the side, and a quick hard pulse, that bleeding is necessary. When these symptoms come on, the sooner this operation is performed the better; and the quantity at first must be pretty large, provided the patient is able to bear it. A large quantity of 166blood let at once, in the beginning of a pleurisy, has a much better effect than repeated small bleedings. A man may lose twelve or fourteen ounces of blood as soon as it is certainly known that he is seized with a pleurisy. ”

“ There is sometimes vomiting of black, [283] but more frequently of yellow bile. There are often fetid sweats. The disease usually terminates with syncope, coldness of the extremities, lethargy, spasms, and convulsions. Some of the most fatal varieties of the plague are not marked by any striking symptoms, neither the heat, pulse, nor urine being much affected. Fetid breath, as indicating putrefaction about the heart, is a most mortal symptom. The treatment must commence with venesection, if there be a plethora of blood, or with purging, if the body be loaded with other humours. ”

“ When the colour of the blood is dark, and it is thick in consistence, a larger amount is to be abstracted than when it is thin and of a light colour. He makes the important remark, that bleeding sometimes kindles up a fever. He forbids the bath immediately before the operation, and food or exercise immediately afterwards. When a piece of fat obstructs the flow of blood, he directs that it should be gently pushed aside, but not cut out. (i, 4, 20.)
No author, ancient or modern, has described the modes of performing venesection in all parts of the body more accurately than Albucasis. ”

“ The notion of drawing off the bad blood by bleeding, is very erroneous and absurd; the whole is too intimately mixed, and will ever generate the same again till the disease is removed.
Bleeding is requisite 1st. When a strong robust person, of a full and sanguine complexion, by accident receives a heavy contusion; a broken limb; or wound, whereby the parts become inflamed; a fever like to ensue; and that the pulse becomes hard and full, the veins distended, &c. ”

“ It is no objection to this theory of dropsy, that we sometimes find water in the cavities of the body after death, without any marks of inflammation in the contiguous blood-vessels. We often find pus, both in the living and dead body, under the same circumstances, where we are sure it was not preceded by any of the obvious marks of inflammation. ”

“ When the menstrual or hemorrhodial discharge is expected, he directs us to bleed less profusely than otherwise. Persons of a hard, sanguine, and compact habit of body are said to bear bleeding best. In practising venesection, he directs the physician to pay more attention to the strength of the patient than to the period of the fever. He is particularly earnest in recommending the use of cold drink: he directs it to be given at the acme of the disease, but not at the commencement. He forbids us to administer it freely when there is obstruction or inflammation of an internal viscus ”

“ Those who have been accustomed to bleed at a certain season of the year are apt, if they neglect it, to be seized with a pleurisy. Keeping the body too warm by means of fire, clothes, &c. renders it more liable to this disease. A pleurisy may likewise be occasioned by violent exercise, as running, wrestling, leaping, or by supporting great weight, blows on the breast, &c. A bad conformation of the body renders persons more liable to this disease, as a narrow chest, a straitness of the arteries of the pleura, &c. ”

“ A venereal bubo, or scrofulous enlargement of glands, or enlargement of femoral or inguinal gland due to traumatic or other causes which may be attended with fever should not be mistaken for a plague symptom. A medical man who has, however, carefully observed the facies of a few cases of true plague, and who carefully takes into consideration all other probable conditions which may be mistaken for plague, may not commit a mistake, but its probabilities are to be borne in mind. ”

“ Such was the form which the plague assumed in the 14th century, for the accompanying chest affection which appeared in all the countries whereof we have received any account, cannot, on a comparison with similar and familiar symptoms, be considered as any other than the inflammation of the lungs of modern medicine,26 a disease which at present only appears sporadically, and, owing to a putrid decomposition of the fluids, is probably combined with hemorrhages from the vessels of the lungs. ”

“ When this bleeding is spontaneous it comes from the mucous membranes, especially from the nose, but also from the mouth, bowel and bronchial tubes. Slight bruises are apt to be followed by extravasations of blood into the tissues; the swollen joints (knee especially) of a bleeder are probably due, in the first instance, to the escape of blood into the joint cavity or synovial membrane. It is always from the smallest vessels that the blood escapes, and may do so in such quantities as to cause death in a few hours. ”

“ Organisms may be introduced to such a wound from the shaft or wheel by which he was struck, from the ground on which he lay, from any portion of his clothing that may have come in contact with the wound, or from his own skin. Or, again, the hands of those who render first aid, the water used to bathe the wound, the handkerchief or other extemporised dressing applied to it, may be the means of conveying bacterial infection. Should the wound open on a mucous surface, such as the mouth or nasal cavity, the organisms constantly present in such situations are liable to prove agents of infection. ”

“ Moreover, in both Diseases, when eminently malignant, Blood is sometimes voided by the Mouth, by Urine, or the like [94] . And we may farther add, that in both Death is usually caused by Mortifications in the Viscera. This has constantly been found in the Plague by the Physicians in France: and I am convinced, from Accounts I have by me, of the Dissection of a great many, who had died of the Small-Pox, that it is the same in that Distemper. ”

“ Sometimes the blood persists as a collection of fluid with a newly formed connective-tissue capsule, constituting a hæmatoma or blood cyst, more often met with in the scalp than in other parts.
The impairment of the blood supply of the skin may lead to the formation of blisters, or to necrosis. Death of skin is more liable to occur in bleeders, and when the slough separates the blood-clot is exposed and the reparative changes go on extremely slowly. Suppuration may occur and lead to the formation of an abscess as a result of direct infection from the skin or through the circulation. ”

“ It is not possible that the whole Mass of Blood should be corrupted in so short a Time as that, in which the fatal Symptoms, in some Cases, discover themselves. [Pg 48] Those Patients of the first Class, mentioned in the beginning of this Discourse, particularly the Porters who opened the infected Bales of Goods in the Lazaretto’s of Marseilles, died upon the first Appearance of Infection, as it were by a sudden Stroke; being seized with Rigors, Tremblings, Heart-Sickness, Vomitings, Giddiness and Heaviness of the Head, an universal Languor and Inquietude ”

“ It is necessary to examine what Part may be hurt, by considering the situation of the Wound, and its Symptoms: If the Lungs are pierc'd, a spitting of froathy Vermilion-colour'd Blood ensues, with difficulty of Respiration, and a Cough. If any of the great Vessels are open'd, the wounded Person feels a Weight at the bottom of his Breast, is seiz'd with cold Sweats, being scarce able to fetch his Breath, and Vomits Blood, some Portion whereof issueth out of the Wound. ”

“ Except in very particular cases he disapproves of bleeding. He approves in general of discutient applications; but when the swelling tends to suppuration, he directs us to promote it; and when pus is fairly formed he recommends us to let it out, but cautions the surgeon not to attempt this operation unless he has a practical acquaintance with anatomy, lest he wound any of the veins, arteries, or nerves. ”

“ In fevers of all kinds, and when inflammation attacks any important organ, as the brain, eyes, lungs, stomach, intestines, liver, kidneys, bladder, &c. bleeding is of the greatest use. It diminishes the quantity of blood in the body; and by this means prevents the ill effects of inflammation. ”

“ When the wounded part begins to discharge a whitish, thick matter, and is observed to fill up, the general treatment and dressings to the sore, now mentioned, should be continued; and in the course of the cure, the animal, when free of fever, may be allowed better provision, and may take gentle exercise. If the animal be feeble, from the loss of blood originally, or from the long continuance of a feverish state produced by the inflammation attending the wound, or from weakness arising from confinement, or connected with its constitution naturally ”

“ The next day I was taken back to Leeds in a state of absolute helplessness, and, being got to bed in my own house, had to remain there for nine mortal weeks.
Some of the experiences of that time were curious. Phlebitis had set in, and for a time I was in serious danger from the formation of a clot of blood in one of the arteries. As is pretty generally known, whilst this state of things exists death may occur at any moment from the stoppage of the heart through the clot getting free and passing into the central organ. ”

“ How, under such circumstances, could she possibly buy and use the blisters, caustics, or other means of producing the bleeding wounds? But, granting she had all these at her command, how could the ignorant peasant girl—even though aided by two or three accomplices—produce a result which the physician with all the resources of science cannot effect? For it involved the necessity of causing a bloody discharge from nine or ten points of the body, and of sustaining this for a half-day or even longer under the very eyes of witnesses who prevented any repeated irritation of the bleeding surfaces. ”