The store-house of physical practice being a general treatise of the causes and signs of all diseases afflicting human bodies : together with the shortest, plainest and safest way of curing them, by method, medicine and diet : to which is added, for the benefit of young practicers, several choice forms of medicines used by the London physicians / by John Pechey ...

CHAP. LXXI. Of the Bilious Chollick of the Years 1670, 71, 72.

IN all these Years the Blood was much inclined to put off upon the Bowels hot and Cholerick Humours, upon which Account this Chollick was more frequent than is usual: The same Febrile Symptoms preceded this Disease as used to go before the Dysentery, that reigned in those times; and sometimes this Disease followed the Dysentery, when it had a long while afflicted the Patient, and was just about to leave him; but when it did not follow a long Dysentery, it generally took its Rise from a Feaver, which after some Hours was wont to end in this Disease; it chiefly seised Young People of a hot and Cholerick Con∣stitution, especially in the Summer the Pain of the Bowels was extreamly violent, and more intollerable than any other that afflicts poor Mortals; it sometimes binds as it were the Guts, and sometimes being contracted to a Point, it bores like an Auger; the Pain now and then remits, and presently the Fit approaches again, which as soon as the Patient perceives, he looks sadly, and bemoans himself, as if it were actually upon him. At the beginning of this Disease the Pain is not so certainly determined to one Point, as in the Progress of it; nor is the Vomiting so frequent, or does the Belly so obstinately resist Catharticks; but the more the Pain is increased, the more pertinaciously is it fixed in a Point, the Vomiting is more frequent, and the Belly more bound, till at length by the dreadful Force of these Symptoms, a total subversion of the Peristaltick Motion of the Guts, if the Patient be not relieved; and by conse∣quence an Iliack Passion is procured, in which Disease all purging Medicines become presently Emetick, and Glisters that are injected are vomited up with the Excrements.

The Matter that is cast up after this Manner, if it be sincere, and without mixture, is sometimes green, and sometimes Yellow, and sometimes of an unusual Co∣lour.

In order to the Cure, I bleed freely in the Arm, if no Blood has been taken away before, and after two or three Hours I give an Anodyne; the next day I prescribe some gentle Purge, and order that it should be repeated. The next day save one, and sometimes thrice, according as the Relicks of the Humour are more or less.

But we must take notice, that if this Disease proceeds from eating too much Fruit, or from any Meat of hard Digestion, upon which account ill and corrupted Juices are first transmitted to the Blood, and afterwards to the Bow∣els: I say in this Case the Stomach must be washed with large draughts of Posset-drink, which must be vomited up again; which being done, an Anodyne must be given and the next Day a Vein must be opened; and as to other things, you 〈◊〉〈◊〉 proceed according to the Directions above mentioned; but when the Violence of the Pain, and the Vomiting (by reason of which the Guts are as it were inverted) do resist the Operation of the Catharticks, for it is in vain to give a gentle Purge, unless the Patient is easily purged, which must be carefully inquired into; for such a Medicine being not strong enough to make its way through the Intestines, the Patient is more injured thereby; for by its ineffectual Agitation the Vomiting and the pain are increased. A lenitive purging Potion of the Infusion of Tamarinds, of the Leaves of Senna, and Rubarb, in which may be dissolved Manna, and Syrup of Roses, is to be preferred before other Catharticks, for it least exagi∣tates and moves the Humours; but if the Sick cannot re∣tain a Liquid Medicine by reason of an Aversion, or be∣cause of the Vomiting, you must necessarily use Pills; among which the Pill Coch pleases me best, for they pass best through the Body in this, and in most other Cases. But when the Weakness of the Stomach, or the Vomiting is so great, that the Pills cannot be retained, then I first order an Anodyne, and a few hours after a Purge; but there must be so much space betwixt them, that the Ca∣thartick be not quelled by the Narcotick, and so rendred ineffectual; but that it may continue so long in the Sto∣mach

as is necessary for its imparting its purgative Quali∣ty to it, that it may operate when the Vertue of the Nar∣cotick is spent, though the purge, if it could be conve∣niently done, is best given a long while after the Anodyn, for twelve hours after taking it, the patient is difficultly purged.

But because in this, as well as in most other Diseases wherein Narcoticks are indicated, a purge always increa∣ses the pain (at least when it has done working, for while it is in Operation the patient is not so ill) therefore I usu∣ally give an Anodyne as soon as the purge has done work∣ing, which I order to be taken Morning and Evening daily betwixt the purges, that I may the more certainly appease the pain, till the patient has been sufficiently purged.

The purging of the Humours being over, I endeavour to bridle the Fury of the Disease (which now only re∣mains to be done) by giving an Anodyne constantly Mor∣ning and Evening, which must be sometimes repeated oftner; nor could I ever take off violent Pains without a larger Dose than is usual, and that repeated too; for that which is sufficient to vanquish another Disease, will be al∣together insufficient in this Case, the violence of the Dis∣ease subduing the force of the Medicine: And it is indeed safe to repeat Narcoticks, while such a Pain as this con∣tinues violent, but not when it is gone off. Wherefore I repeat the Anodyne according to the degree of the Pain till it ceases, or till it be very much lessened.

Yet there must be such a Space of Time between them, that you may find what may be hoped for from the former Dose, before another be given; but for the most part unless the Pain be very violent, a Paregorick given Mor∣ning and Evening may be sufficient. Liquid Laudanum is the Anodyne I chiefly use, whereof I give Sixteen Drops in some cordial Water; or the dose may be increased ac∣cording to the violence of the Pain. But here I must ad∣monish you, that though I have said Bleeding and pur∣ging must necessarily precede this quieting Method, yet sometimes upon occasion both being omitted, you must begin with Anodynes.

For Instance, when by reason of some preceding Sickness, large Evacuations have been used not long before the Com∣ing

of the Chollick, for many Times they who have reco∣vered of another Disease have fell suddenly into this, by reason of the Weakness of the Bowels; especially if there be a great degree of Heat occasioned by drinking of Wine or some other Spiritous Liquor immoderately; I say in this Case, it is not only unnecessary, but I think it is in∣jurious, to give Catharticks again; for by them new Tu∣mults will be raised. Moreover, The Guts are most com∣monly sufficiently cleansed by Glisters frequently used, be∣fore the Physician is advised with; so that partly for this cause, and partly by reason of the long continuance of the Disease, Narcoticks seem in a manner to be only use∣ful.

But because this pain of it's own Nature is wont to re∣turn more than any other, all Occasions of its Relapse must be prevented, by giving an Anodyne twice a day for some days; but if as often as the Narcotick is intermitted, the pain now and then returns, as it sometimes happens, I do not know any thing that will so certainly perfect the Cure, as riding on Horseback, or in a Coach, with which the Patient must take long Journies; and in the mean while an Anodyne must be given constantly Morning and Evening. But Riding must not be used before the Pati∣ent has been well purged, and then it must be continued for many Days.

If the Patient be young, and of a hot Constitution, I order a cooling and thickning Diet, suppose Pulp of Bar∣ly, Panada, and the like; and every third Day, if the Stomach is craving, a Chick or a Whiteing boiled; and I allow no other Drink than small Beer, or Milk-water, and this is all I order, unless Riding necessary to recover the Health requires more nourishing Food, and more gene∣rous Liquor, whereby the Spirits exhausted by Exercise may be repaired.

But when the Disease, being unskilfully treated, has a long while afflicted the Patient, so that the Bowels become weak and infirm, and he is in a manner quite wasted, I say in this Case we find by experience, that the free use of Epidemick Water, or of Aqua-mirabilis, or any other the Patient likes best, relieves him at this Time beyond Expectation,

Moreover, As in the Cure of the Disease, so when it is over, the thin Diet we have mentioned must be observed for some time; for this Disease being more apt to return than any other, and seating it self upon the principle parts of Concoction, the least error in this kind will presently occasion much Pain: Wherefore in this and all other Dis∣eases of the Bowels, Meats of hard Digestion are carefully to be avoided, and things of easie Digestion must be taken only in such a Quantity as will suffice to sustain Life.