CHAP. LIV. OF FAINTING FITS, AND OTHER CASES WHICH REQUIRE IMMEDIATE ASSISTANCE.
STRONG and healthy persons, who abound with blood, are often seized with sudden fainting fits, after violent excrcise, drinking freely of warm or strong liquors, exposure to great heat, intense application to study, or the like.
IN such cases the patient should be made to smell to some vinegar. His temples, forehead, and wrists ought at the same time to be bathed with vinegar mixed with an equal quantity of warm water; and two or three spoonfuls of vinegar, with four or five times as much water, may, if he can swallow, be poured into his mouth.
IF the fainting proves obstinate, or degenerates into a syncope, that is, an abolition of feeling and understanding, the patient must be bled. After the bleeding, a clyster will be proper, and then he should be kept easy and quiet, only giving him every half hour a cup or two of an infusion of any mild vegetable, with the addition of a little sugar and vinegar.
WHEN swoonings, which arise from this cause, occur frequently in the same person, he should, in order to escape them, confine himself to a light diet, consisting chiefly of bread, fruits, and other vegetables. His drink ought to be water, or small beer, and he should sleep but moderately, and take much exercise.
BUT fainting fits proceed much oftener from a defect, than an excess of blood. Hence they are very ready to happen after great evacuations of any kind, obstinate watching, want of appetite, or such like. In these an almost directly opposite course to that rnentioned. above must be pursued.
THE patient should be laid in bed, with his head low, and being covered, should have his legs, thighs, arms, and his whole body rubbed strongly with hot flannels. Hungary water, volatile salts, or strong smelling herbs, as rue, mint, or rosemary, may be held to his nose. His mouth may be wet with a little rum or brandy; and, if he can swallow, some hot wine, mixed with sugar and cinnamon, which is an excellent cordial, may be poured into his mouth. A compress of flannel dipt in hot wine or brandy must be applied to the pit of his stomach, and warm bricks, or bottles filled with hot water, laid to the feet.
AS soon as the patient is recovered a little, he should take some strong soup or broth, or a little bread or biscuit soaked in hot-spiced wine. To prevent the return or the fits, he ought to take often, but in small quantities, some light yet strengthening nourishment, as panado made with soup instead of water, new laid eggs lightly poached, chocolate, light roast meats, jellies, and such like.
THOSE fainting fits, which are the effect of bleeding, or of the violent operation of purges, belong to this class. Such as happen after artificial bleeding are seldom dangerous, generally terminating as soon as the patient is laid upon the bed; indeed persons subject to this kind should always be bled lying, in order to prevent it. Should the fainting, however, continue longer than usual, volatile spirits may be held to the nose, and rubbed on the temples, &C.
WHEN fainting is the effect of too strong or acrid purges or vomits, the patient must be treated in all respects as if he had taken poison. He should be made made to drink plentifully of milk, warm water, and oil, barley-water, or such like; emollient clysters will likewise be proper, and the patient's strength should afterwards be recruited, by giving him generous cordials, and anodyne medicines.
FAINTINGS are often occasioned by indigestion. This may either proceed from the quantity or quality of the food. When the former of these is the cause, the cure will be best performed by vomiting, which may be promoted by causing the patient to drink a weak infusion of camomile flowers, carduus benedictus, or the like. When the disorder proceeds from the nature of the food, the patient, as in the case of weakness, must be revived by strong smells, &c. after which he should be made to swallow a large quantity of light warm fluid, which may serve to drown, as it were, the offending matter, to soften its acrimony, and either to effect a discharge of it by vomiting, or force it down into the intestines.
EVEN disagreeable smells will sometimes occasion swoonings, especially in people of weak nerves. When this happens, the patient should be carried into the open air, have stimulating things held to his nose, and those substances which are disagreeable to him ought immediately to be removed. But we have already taken notice of swoonings which arise from nervous disorders, and shall therefore say no more upon that head.
FAINTING-FITS often happen in the progress of diseases. In the beginning of putrid diseases, they generally denote an oppression at stomach, or a mass of corrupted humours, and they cease after evacuations either by vomit or stool. When they occur at the beginning of malignant fevers, they indicate great danger. In each of these cases, vinegar used both externally and internally is the best remedy during the paroxysm, and plenty of lemon-juice and water after it. Swoonings which happen in diseases accompanied with great evacuations, must be treated like those which are owing to weakness, and the evacuations ought to be restrained. When they happen towards the end of a violent fit of an intermitting fever, or at that of each exacerbation of a continual fever, the patient must be supported by small draughts of wine and water.
DELICATE and hysteric women are very liable to swooning or fainting fits after delivery. These might be often prevented by generous cordials, and the admission of fresh air. When they are occasioned by excessive flooding, it ought by all means to be restrained. They are generally the effect of mere weakness or exhaustion. Dr. Engleman relates the case of a woman "in childbed, who, after being happily delivered, suddenly fainted, and lay upwards of a quarter of an hour apparently dead. A physician was sent for; her own maid, in the mean while, being out of patience at his delay, attempted to assist her herself, and extending herself upon her mistress, applied her mouth to her's, blew in as much breath as she possibly could, and in a very short time the exhausted woman awaked as out of a profound sleep; when proper things being given her, she soon recovered."
THE maid being asked how she came to think of this expedient, said she had seen it practiced at Altenburgh, by midwives, upon children with the happiest effect."
WE mention this case chiefly that other midwives may be induced to follow so laudable an example. Many children are born without any signs of life, and others expire soon after the birth, who might, without all doubt, by proper care, be restored, to life.
FROM whatever cause fainting fits proceed, fresh air is always of the greatest importance to the patient. By not attending to this circumstance, people often kill their friends while they are endeavouring to save them. Alarmed at the patient's situation, they call in a crowd of people to his assistance, or perhaps to witness his exit, whose breathing exhausts the air, and increases the danger. There is not the least doubt but this practice, which is very common among the lower sort of people, often proves fatal, especially to the delicate, and such persons as fall into fainting fits from mere exhaustion, or the violence of some disease. No more persons ought ever to be admitted into the room where a patient lies in a swoon than are absolutely necessary for his assistance, and the windows of the apartment should always be opened, at least as far as to admit a stream of fresh air.
PERSONS subject to frequent swoonings, or fainting fits, should neglect no means to remove the cause of them, as their consequences are always injurious to the constitution. Every fainting fit leaves the person in dejection and weakness; the secretions are thereby suspended, the humours disposed to stagnation, coagulations and obstructions are formed, and, if this motion of the blood be totally intercepted, or very considerably checked, polypuses are sometimes formed in the heart or larger vessels. The only kind of swoonings not to be dreaded are those which sometimes mark the crisis in fevers; yet even these ought, as soon as possible, to be removed.
THE effects of intoxication are often fatal. No kind of poison kills more certainly than an overdose of ardent spirits. Sometimes by destroying the nervous energy, they put an end to life at once; but in general their effects are more slow, and in many respects similar to those of opium. Other kinds of intoxicating liquors may prove fatal when taken to excess, as well as ardent spirits; but they may generally be discharged by vomiting, which ought always to be excited when the stomach is overcharged with liquor.
MORE of those unhappy persons, who die intoxicated, lose their lives from an inability to conduct themselves, than from the destructive quality of the liquor. Unable to walk, they tumble down, and lie in some awkward posture, which obstructs the circulation or breathing, and often continue in this situation till they die. No drunk person should be left by himself, till his clothes have been loosened, and his body laid in such a posture as is most favourable for continuing the vital motions, discharging the contents of the stomach, &c. The best posture for discharging the contents of the stomach is to lay the person upon his belly; when asleep he may be laid on his side, with his head a little raised, and particular care must be taken that his neck be no way bent, twisted, or, have any thing too tight about it.
THE excessive degree of thirst occasioned by drinking strong liquors, often induces people to quench it by taking what is hurtful. I have known fatal consequences even from drinking freely of milk after a debauch of wine or sour punch; these acid liquors, together with the heat of the stomach, having coagulated the milk in such a manner that it could never be digested. The safest drink after a debauch is water with a toast, tea, infusions of balm, sage, barley-water, and such like. If the person wants to vomit, he may drink a weak infusion of camomile flowers, or lukewarm water and oil; but in this condition vomiting may generally be excited by only tickling the throat with the finger or a feather.
INSTEAD of giving a detail of all the different symptoms of intoxication which indicate danger, and proposing a general plan of treatment for persons in this situation, I shall briefly relate the history of a case, which lately fell under my own observation, wherein most of those symptoms usually reckoned dangerous concurred, and where the treatment was successful.
A YOUNG man, about fifteen years of age, had, for a hire, drank ten glasses of strong brandy. He soon after fell fast asleep, and continued in that situation for near twelve hours, till at length his uneasy manner of breathing, the coldness of the extremities, and other threatening symptoms, alarmed his friends and made them send for me. I found him still sleeping, his countenance ghastly, and his skin covered with a cold clammy sweat. Almost the only signs of life remaining, were, a deep laborious breathing, and a convulsive motion or agitation of his bowels.
I TRIED to rouse him, but in vain, by pinching, shaking, applying volatile spirits, and other stimulating things to his nose, &c. A few ounces of blood were likewise let from his arm, and a mixture of vinegar and water was poured into his mouth; but as he should not swallow, very little of this got into the stomach. None of these things having the least effect, and the danger seeming to increase, I ordered his legs to be put in warm water, and a sharp clyster to be immediately administered. This gave him a stool, and was the first thing that relieved him. It was afterwards repeated with the same happy effect, and seemed to be the cause of his recovery. He then began to shew some signs of life, took drink when it was offered him, and came gradually to his senses. He continued however, for several days weak and feverish, and complained much of a soreness in his bowels, which gradually went off, by means of a slender diet, and cool mucilaginous liquors.
THIS young man would probably have been suffered to die, without any assistance being called, had not a neighbour, a few days before, who had been advised to drink a bottle of spirits to cure him of an ague, expired under very similar circumstances.
OF SUFFOCATION AND STRANGLING.
THESE may sometimes proceed from an infraction of the lungs, produced by viscid clammy humours, or a spasmodic affection of the nerves of that organ.
PERSONS who feed grossly, and abound in rich blood are very liable to suffocating fits from the former of these causes. Such ought, as soon as they are attacked, to be bled, to receive an emollient clyster, and to take frequently a cup of diluting liquor with a little nitre in it. They should likewise receive the steams of hot vinegar into their lungs by breathing.
NERVOUS and asthmatic persons are most subject to spasmodic affections of the lungs. In this case the patient's legs should be immersed in warm water, and the steams of vinegar applied as above. Warm diluting liquors should likewise be drank; to a cup of which a tea-spoonful of the Paregoric elixir may occasionally be added. Burnt paper, feathers, or leather, may be held to the patient's nose, and fresh air should be freely admitted to him.
INFANTS are often suffocated by the carelessness or inattention of their nurses. These accidents are not always the effects of carelessness. I have known an infant over-laid by its mother being seized in the night with an hysteric fit. This ought to serve as a caution against employing hysteric woman as nurses; and should likewise teach such women never to lay an infant in the same bed with themselves, but in a small adjacent one. An infant when in bed should always be laid so that it cannot tumble down with its head under the bed-clothes; and when in a cradle, its face ought never to be covered. A small degree of attention to these two simple rules would save the lives of many infants, and prevent others from being rendered weak and sickly all their days by the injuries done to their lungs.
INSTEAD of laying down a plan for the recovery of infants who are suffocated, or over-laid, as it is termed by their nurses, I shall give the history of a case related by Monfieur Janin, of the Royal College of Surgery at Paris, as it was attended with success, and contains almost every thing that can be done on such occasions.
A NURSE having had the misfortune to over-lay a child, he was called in, and found the infant without any signs of life; no pulsation in the arteries, no respiration, the face livid, the eyes open, dull, and tarnished, the nose full of snivel, the mouth gaping, in short it was almost cold. Whilst some linen cloths and a parcel of ashes were warming, he had the boy unswathed, and laid him in a warm bed, and on the right side. He then was rubbed all over with fine linen, for fear of fretting his tender and delicate skin. As soon as the ashes had received their due degree of heat, Mr. Janin buried him in them, except the face, placed him on the side opposite to that on which he had been at first laid, and covered him with a blanket, He had a bottle of eau de luce in his pocket, which he presented to his nose from time to time; and between whiles some puffs of tobacco were blown up his nostrils; to these succeeded the blowing into his mouth, and squeezing tight his nose. Animal heat began thus to be excited gradually; the pulsations of the temporal artery were soon felt, the breathing became more frequent and free, and the eyes closed and opened alternately. At length the child fetched some cries expressive of his want of the breast, which, being applied to his mouth, he catched at it with avidity, and sucked as if nothing had happened to him. Though the pulsations of the arteries were by this time very well re-established, and it was hot weather, yet Mr. Janin thought it adviseable to leave his little patient three quarters of an hour longer under the ashes. He was afterwards taken out, cleaned, and dressed as usual; to which a gentle sIeep succeeded, and he continued perfectly well,
MR. JANIN mentions likewise an example of a young man who had hanged himself through despair, to whom he administered help as effectually as in the preceding case.
MR. GLOVER, surgeon in Doctors Commons, London, relates the case of a person who was restored to life after twenty-nine minutes hanging, and continued in good health for many years after.
THE principal means used to restore this man to life were, opening the temporal artery and the external jugular; rubbing the back, mouth, and neck, with a quantity of volatile spirits and oil; administering the tobacco clyster by means of lighted pipes, and strong frictions of the legs and arms. This course had been continued for about four hours, when an incision was made into the wind-pipe, and air blown strongly through a canula into the lungs. About twenty minutes after this, the blood at the artery began to run down the face, and a slow pulse was just perceptlible at the wrist. The frictions were continued for some time longer: his pulse became more frequent, and his mouth and nose being irritated with spirit of sal ammoniac, he opened his eyes. Warm cordials were then administered to him, and in two days he was so well as to be able to walk eight miles.
THESE cases are sufficient to shew what may be done, for the recovery of those unhappy persons who strangle themselves in a fit of despair.
OF PERSONS WHO EXPIRE IN CONVULSION FITS.
CONVULSION FITS often constitute the last scene of acute or chronic disorders. When this is the case, there can remain but small hopes of the patient's recovery after expiring in a fit. But when a person, who appears to be in perfect health, is suddenly seized with a convulsion fit, and seems to expire, some attempts ought always to be made to restore him to life. Infants are most liable to convulsions, and are often carried off very suddenly by one or more fits about the time of teething. There are many well-authenticated accounts of infants having been restored to life, after they had to all appearance expired in convulsions; but we shall only relate the following instance mentioned by Dr. Johnson in his pamphlet on the practicability of recovering persons visibly dead.
IN the parish of St.Clemens, at Colchester, a child of six months old, lying upon its mother's lap, having had the breast, was seized with a strong convulsion fit, which lasted so long, and ended with so total a privation of motion in the body, lungs, and pulse, that it was deemed absolutely dead. It was accordingly stripped, laid out, the passing bell ordered to be tolled, and a coffin to be made; but a neigbouring gentlewoman who used to admire the child, hearirig of its sudden death, hastened to the house, and upon examining the child found it not cold, its joints limber, and fancied that a glass she held to its mouth and nose was a little damped with the breath; upon which she took the child in her lap, sat down before the fire, rubbed it, and kept it in gentle agitation. In a quarter of an hour she felt the heart began to beat faintly; she then put a little of the mother's milk into its mouth, continued to rub its palms and soles, found the child began to move, and the milk was swallowed; and in another quarter of an hour she had the satisfaction of restoring to its disconsolate mother the babe quite recovered, eager to lay hold of the breast, and able to suck again. The child throve, had no more fits, is grown up, and at present alive.
THESE means, which are certainly in the power of every person, were sufficient to restore to life an infant to all appearance dead, and who, in all probability, but for the use of these simple endeavours, would have remained so. There are, however, many other things which might be done, in case the above should not succeed; as rubbing the body with strong spirits, covering it with warm ashes of salt, blowing air into the lungs, throwing up warm stimulating clysters, or the smoke of tobacco, into the intestines, and such like.
WHEN children are dead born, or expire soon after the birth, the same means ought to be used for their recovery, as if they had expired in circumstances similar to those mentioned above.
THESE directions may likewise be extended to adults, attention being always paid to the age and other circumstances of the patient.
THE foregoing cases and observations afford sufficent proof of the success which may attend the endeavours of persons totally ignorant of medicine, in assisting those who are suddenly deprived of life by any accident or disease. Many facts of a similar nature might be adduced were it necessary; but these, it is hoped, will be sufficient to call up the attention of the public, and to excite the humane and benevolent to exert their utmost endeavours for the preservation of their fellow men.
The society for the recovery of drowned persons, instituted at Amsterdam in the year 1767, had the satisfaction to find that not fewer than 150 persons, in the space of four years, had been saved by the means pointed out by them, many of whom owed their preservation to peasants and people of no medical knowledge. But the means used with much efficacy in recovering drowned persons, are, with equal success, applicable to a number of cases where the powers of life seem in reality to be only suspended, and to remain capable of renewing all their functions, on being put into motion again. It is shocking to reflect, that for want of this consideration many persons have been committed to the grave, in whom the principles of life might have been revived.
THE cases wherein such endeavours are most likely to be attended with success, are all those called sudden deaths from an invisible cause, as apoplexies, hysterics, faintings, and many other disorders wherein persons in a moment sink down and expire. The various casualties in which they may be tried are, suffocations, from the suphureous damps of mines, coal-pits, &c.; the unwholesome air of long unopened wells or caverns; the noxious vapours arising arising from fermenting liquors; the steams of burning charcoal; sulphureous mineral acids; arsenical effluvia, &c.
THE various accidents of drowning, strangling, and apparent deaths, by blows, falls, hunger, cold, &c. likewise furnish opportunities of trying such endeavours. Those perhaps who to appearance are killed by lightning, or by any violent agitation of the passions, as fear, joy, surprise, and such like, might also be frequently recovered by the use of proper means, as blowing strongly into their lungs, &c.
THE means to be used for the recovery of persons suddenly deprived of life are nearly the same in all cases; they are practicable by every one who happens to be present at the accident, and require no great expence, and less skill. The great aim is to restore the warmth and vital motions. This may in general be attempted by means of heat, frictions, bleeding, blowing air into the lungs, administering clysters and generous cordials. These must be varied according to circumstances. Common sense, and the situation of the patient, will suggest the proper manner of conducting them. Above all we would recommend perseverance. People ought never to despair on account of discouraging circumstances; or to leave off their endeavours as long as there is the least hope of success. Where much good and no hurt can be done, no one ought to grudge his labour.
IT were greatly to be wished, that an institution, similar to that of Amsterdam, was established, upon a more extensive plan, in Great Britain; and that a reward was allowed to every one who should be instrumental in restoring to life a person seemingly dead. Men will do much for fame, but still more for money. Should no profit, however, be annexed to those benevolent offices, the heart-felt pleasure which a good man must enjoy, on reflecting that he has been the happy instrument of saving one of his fellow-creatures from an untimely grave, is itself a sufficient reward.
The Author is happy to observe, that, since the first publication of this work, several societies have been instituted in Britain with the same benevolent intention as that of Amsterdam, and that their endeavours have proved no less successful. He is likewise happy to observe, that premiums have been awarded to those who have been actve in their endeavours to restore to life persons who had been drowned, or suddenly deprived of life by any accident. How much is this superior to the superstitious institution, which allows any man a premium who brings a dead person out of the water, so that he may receive Christian burial; but allows nothing to the person who brings him out alive, or who recovers him after he has been, to all appearance, dead.