Lectures on the theory and practice of physic (Volume 1).

  • William Stokes
Date:
1845
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Licence: Public Domain Mark

Credit: Lectures on the theory and practice of physic (Volume 1). Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    of lessening the powers of life without removing the original disease. It is much better to leech again and again than to do this. Where there is not much epigastric tenderness, you may apply a cupping- glass over the leech-bites with advantage, as you can get away as much blood as you choose, and the tendency to after-hemorrhage from the leech-bites is diminished by the application of the cupping- glass. In very young subjects, the tendency to obstinate hemorrhage from leech-bites is so^great, that many practitioners are afraid to use leeches, and I believe some children have been sacrificed to this fear. The best mode of managing this is, if the leech-bites cannot be stop- ped by the ordinary means (and in very young children they seldom can), to stop them at once by the application of caustic. Do not lose time in trying to arrest the flow of blood with flour, or lint, or sticking-plaster; wipe the blood off the bite with a piece of soft, dry lint, plunge into it a piece of lunar caustic, scraped to a point, give it a turn or two, and the whole thing is settled ; and you can gene- rally go away with the agreeable consciousness of having prevented all further danger, and without being uneasy lest your patient should bleed to death in your absence. Management of the bowels. — With respect to the management of the bowels in acute gastritis, a few observations will suffice. You will always have to obviate the effects of constipation ; both in the acute and chronic forms of the disease there is always more or less constipation ; in fact the same condition of the bowels is gene- rally observed in both. Now, if yon attempt to relieve this consti- pation in acute gastritis, by administering purgatives, you will most certainly do a vast deal of mischief. Nothing can exceed the irri- tability of the stomach in such cases; the mildest purgatives are instantly rejected, even cold water, or effervescing draughts are often not retained, and a single pill or powder is frecpaently thrown up the moment it is swallowed.* Under such circumstances, it is plain that the administration of purgative medicine is totally out of the question. Even though the stomach should retain the purga- tive, you purchase its operation at too dear a price; for it invariably proves a source of violent exacerbation, kindling fresh inflammation in an organ already too much excited. In this state of things, the best thing you can employ to remove constipation is a purgative enema, repeating it according to the urgency or necessity of the case. Where there is no inflammation in the lower part of the intestinal canal, you may employ injections of a strong and stimulating nature, with the view not merely of opening the bowels, but also of exer- cising a powerful revulsive action. I shall mention here an interest- ing tact, proving that stimulant injections have a decided revulsive effect; and that their influence extends not only to other portions * [I have, in some cases, after venesection and leeching, given calomel with advantage in gastritis: —its action on the duodenum, liver, and large intestines, renders it decidedly revulsive. I prefer it alone, to its union with opium, under these circumstances. I can speak favourably, also, of a laudanum enema in gastritis after san- guineous depletion. —13.]